If you’re expecting a baby, you might have heard the word episiotomy and felt a little unsure about what it means. It’s natural to feel anxious when it comes to birth interventions, but understanding what an episiotomy is, when it’s suggested, and why can help you feel more confident and informed about your options.
In this post, I’ll gently walk you through everything you need to know — backed by the latest research and guidelines — so you can go into labour feeling empowered and prepared. 💛
What is an episiotomy?
An episiotomy is a small surgical cut made in the perineum — the area between your vagina and anus — during the second stage of labour, just before your baby is born.
The aim is to make more space for your baby’s head or to speed up birth if needed. In the UK, most maternity units use a mediolateral episiotomy, where the cut is made at an angle away from the anus to reduce the risk of severe tearing.
Are episiotomies routine?
No — and that’s an important point.
Decades ago, episiotomies were performed routinely, but research has shown this isn’t necessary and can even cause more harm than good in straightforward births.
Today, in the UK and many other countries, episiotomies are only suggested when there’s a clear medical reason.
How common are they?
Episiotomy rates depend on a few factors:
- Among first-time vaginal births, around 4 in 10 women will have one.
- For assisted births — where forceps or a vacuum (ventouse) are used — episiotomies are much more common and often help reduce the risk of severe tears.
- In straightforward, unassisted births, most women won’t need one.
So, while it’s useful to be informed, there’s also a good chance you won’t need an episiotomy at all.
When might an episiotomy be suggested?
An episiotomy is usually only recommended if:
- Assisted birth is needed — with forceps or vacuum, an episiotomy can make space and lower the risk of deeper perineal tears.
- Baby needs to be born quickly — for example, if there are signs your baby isn’t coping well during labour.
- High risk of severe tearing — in some situations, a carefully placed episiotomy can prevent a more serious tear.
What does the research say?
- Selective, not routine — The latest Cochrane review confirms that restrictive use of episiotomy leads to less trauma and faster recovery compared to routinely performing one in every birth.
- Technique matters — When an episiotomy is needed, making the cut at the right angle (about 60°) significantly lowers the risk of serious injury to the anal muscles.
- Warm compresses help — Studies show that using warm perineal compresses during the pushing stage can reduce the risk of severe tearing and ease discomfort. You can ask your midwife about this option.
Preparing for birth: your options and your voice
There are a few steps you can take to feel confident and informed:
1. Include your preferences in your birth plan
Talk to your midwife or doctor about your thoughts on episiotomy. You might want to say, for example:
“If I need forceps or vacuum assistance, I’d prefer a mediolateral episiotomy cut at the recommended angle.”
2. Ask about perineal support
Things like warm compresses and gentle, hands-on perineal support during pushing have been shown to reduce tearing.
3. Understand the ‘why’
If an episiotomy is suggested during labour, your care team should explain why it’s needed, what the benefits are, and what recovery will look like.
Recovery after an episiotomy
If you do have an episiotomy, you’ll be given stitches, which usually dissolve on their own. Most women recover well, but it’s normal to feel soreness in the first few weeks.
Tips for recovery include:
- Keeping the area clean and dry
- Using pain relief as advised
- Pelvic floor exercises once you’re comfortable
- Speaking to your GP or midwife if you notice increased pain, swelling, or signs of infection
For many women, recovery is smooth — but don’t hesitate to ask for support if you’re uncomfortable or worried.
Final thoughts
An episiotomy can sound daunting, but remember:
- It’s not routine
- It’s usually suggested only when it can make birth safer
- There are ways to reduce your risk and feel more in control
The most important thing is to have open conversations with your midwife or doctor, understand your options, and make decisions together.
Knowledge is empowering — and going into labour informed can make a real difference to how you experience your birth. 🌿
If you are pregnant and looking for support, get in touch.
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