The new approach

Routine episiotomies are no longer recommended. Still, the procedure is sometimes needed. Your health care provider might recommend an episiotomy if your baby needs to be quickly delivered because:

• Your baby's shoulder is stuck behind your pelvic bone (shoulder dystocia)
• Your baby has an abnormal heart rate pattern during your delivery
• You need an operative vaginal delivery (using forceps or vacuum)

How it works

If you need an episiotomy and you haven't had any type of anesthesia or the anesthesia has worn off, you'll likely receive an injection of a local anesthetic to numb the tissue. You shouldn't feel your health care provider making the incision or repairing the episiotomy, but recovery can be uncomfortable. Your healthcare provider will discuss different techniques for improving your comfort as you heal.

There are two types of episiotomy incisions:

• Midline (median) incision. A midline incision is done vertically. A midline incision is easier to repair, but it has a higher risk of extending into the anal area.
• Mediolateral incision. A mediolateral incision is done at an angle. A mediolateral incision offers the best protection from an extended tear affecting the anal area, but it is often more painful and is more difficult to repair.