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HealthWiki > A Book for Midwives > Chapter 19: Advanced skills for pregnancy and birth > Episiotomy

An episiotomy means cutting the opening of the vagina to make it larger for the baby to come through. Episiotomies are rarely needed and are done much too often.

Only do an episiotomy if the baby is already in the vagina and must be born quickly because of a medical emergency. An episiotomy may be necessary when:

  • the baby is breech.
  • the baby is about to be born, and there is a gush of blood from the vagina (which may mean the placenta has come off the womb wall). This baby must be born very quickly or she could die.
  • the cord has prolapsed.
  • the mother has had female genital cutting, and heavy scars may prevent the vagina from stretching open for the baby. If you know how, you can cut the scar. If you do not know how to cut this scar, you may need to do an episiotomy.

WARNING!   Cutting an episiotomy has many risks:

  • The cut can become infected.
  • The cut can go through a blood vessel and cause heavy bleeding.
  • The cut can be very painful for the mother after the birth. This can make it harder for her to care for her baby.
  • Even a small cut can continue to tear. In the worst case, it can tear through the rectum (anus).
  • You can accidentally cut the baby.

Episiotomies do not heal more easily than tears. Only do an episiotomy to save the life or health of a baby or mother.

How to do an episiotomy

    MW Ch19 Page 354-1.png
  1. Wash your hands well and put on sterile gloves.

  2. Wait until the vagina is bulging open and you can see the baby's head pushing out.

  3. illustration of the below: 2 fingers in the vagina next to the baby's head.
  4. Put your fingers into the vagina like this. Your fingers will hold the skin of the vagina away from the baby.
  5. MW Ch19 Page 355-2.png

  6. Feel with your thumb to find the rectal sphincter (the round muscle around the anus). Never cut through the rectal sphincter.

  7. MW Ch19 Page 355-3.png
  8. Use a pair of sterile scissors to make a cut in the skin about 2.5 centimeters (1 inch) long. It is best to use scissors that are rounded on the end so you will not poke the mother or cut the baby.

    There are 2 common ways to cut an episiotomy. Use the cut that you have been trained to make.

    A median cut goes straight down from the vagina. This type of cut may heal more easily and with less pain.
    illustration of a median cut.
    A mediolateral cut starts at the bottom center of the vagina and points toward the right or left. These cuts are less likely to tear into the anus.
    illustration of a mediolateral cut.
  9. MW Ch19 Page 355-6.png

  10. Feel the cut with your fingers. Cut it larger only if you have to. It is better to make one cut than several small cuts. Remember, do not cut into the muscle around the anus.

  11. Press on the cut with a sterile cloth to slow the bleeding.
  12. MW Ch19 Page 355-7.png

  13. After the birth, sew the cut tissue together. See more information about sewing tears and episiotomies.

This page was updated:19 Aug 2019