An episiotomy is a surgical incision in the area behind the vagina, above the rectum. It is made during delivery to avoid tearing the vaginal opening or rectum.
Discuss with your physician at your prenatal visits whether you will need an episiotomy. Most women having their first or second baby will have an episiotomy. The more children a woman has had, the less likely it is she will need an episiotomy. It also depends on the size of the baby. Some situations do not require an episiotomy, such as a small baby or a premature baby. Often the decision cannot be made until the time of delivery.
Why Have One?
An episiotomy is done to allow room for the baby to fit through the birth canal and to avoid tearing into the mother's other organs. If a woman has had a few pregnancies and deliveries, she may not need an episiotomy with her later children.
Some factors leading to an episiotomy include:
 | the size of the mother's vaginal opening |
| the size of the baby's head and shoulders |
| the number of babies previously delivered |
| a forceps or vacuum delivery |
Episiotomies vary by degree according to the depth of the incision. There are four degrees that describe incision depth:
| 1 st degree—cuts only the skin |
| 2nd degree—cuts the skin and underlying tissue, called fascia |
| 3rd degree—cuts the skin, underlying tissue and rectal sphincter, the muscle around the anus |
| 4th degree—goes through the three layers described above and the rectal mucosa, which is the lining of the rectum |
Episiotomy Pain
After delivery of your baby, the most painful part of the birth process might be your episiotomy. Don't be afraid to ask for help with this pain. Pain medication, ice, sitz baths and laxatives can help relieve the discomfort.
