# Episiotomy

Source: https://www.pregnancypowerhour.com/birth/episiotomy
Last updated: 2026-07-15

> An episiotomy is a surgical incision made in the perineum—the tissue between the vagina and anus—to enlarge the vaginal opening during childbirth.

An episiotomy, often referred to as a perineal cut, is a surgical procedure performed during the pushing phase of labor to enlarge the vaginal opening. This intervention, once a common practice, is now largely reserved for specific clinical situations, reflecting a significant shift in evidence-based maternity care.

## What it is
An episiotomy involves a healthcare provider using surgical scissors to make an incision in the perineum. This cut is intended to prevent severe tearing or to expedite delivery in certain circumstances. Historically, it was believed that a clean surgical incision would heal better than a natural tear and prevent more extensive damage. However, current research offers a more nuanced understanding of perineal health during birth. After the baby is born, the incision is stitched closed. Understanding this procedure is a key part of making [informed decisions](/birth/birth-plan) about your birth experience.

## What the evidence says
The landscape of episiotomy practice has changed dramatically over the past few decades, guided by robust research. Routine episiotomy is no longer recommended by leading organizations like ACOG (the American College of Obstetricians and Gynecologists) and Cochrane. Evidence suggests that a selective approach, where an episiotomy is only performed when clinically indicated, actually reduces the risk of severe perineal trauma compared to routine use. This is a crucial point: natural tearing often heals more favorably than a surgical cut. This shift in understanding underscores the importance of evidence-based care in supporting your body's natural process. Many parents find that engaging in [childbirth education](/birth/childbirth-education) helps them understand these nuances and prepare for various scenarios.

## When it's recommended
While routine episiotomy is no longer the standard, there are specific, limited situations where an episiotomy might be considered. These include scenarios where there is fetal distress, requiring a very fast delivery, or in cases of shoulder dystocia, where the baby's shoulder gets stuck after the head is born. Other specific clinical scenarios might also warrant this intervention. The decision to perform an episiotomy should always be made in collaboration with your care provider, with a clear understanding of the immediate clinical need. It's about weighing the potential benefits in an urgent situation against the general evidence that natural tearing often heals better.

## Brittany's doula perspective
As a doula, my focus is always on supporting your autonomy and helping you feel calm, clear, and confident in your birth choices. The conversation around episiotomy is a prime example of where informed consent truly matters. Knowing that routine episiotomy is no longer recommended can empower you to discuss this openly with your provider. You get to decide what feels right for your body and your baby. We can explore options for supporting perineal health, such as perineal massage in late pregnancy and the use of warm compresses during the pushing phase, which evidence suggests can reduce the severity of tearing. Having [doula support](/birth/doula-support) can provide an extra layer of advocacy and information during these important conversations, ensuring your preferences are heard and respected. Your provider is your best resource for your specific situation, and a collaborative approach ensures you feel supported every step of the way.