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Episiotomy why you might need one

Your vagina and your perineum (the area between your vaginal opening and your bottom) are very stretchy. During the birth of your baby, they need to stretch to allow your baby to be born.

Sometimes, during the birth, your midwife or obstetrician will need to make a cut in your perineum to make the opening at your vagina bigger. This is called an episiotomy.

The cut will be stitched up by your midwife or obstetrician after the birth.

Episiotomies are not carried out routinely in Ireland. This means that they are only done when needed. They happen in about 1 in 4 vaginal births.

Episiotomies are more common in:

  • first-time births
  • births where instruments such as a forceps or ventouse are needed

They are done if extra help is needed to birth the baby or to prevent the muscles and skin from tearing.

Reasons for an episiotomy

You might need an episiotomy if:

  • your baby’s heart rate is beating too quickly or too slowly (sometimes called “fetal distress”) - this could be a sign that your baby is not getting enough oxygen
  • your obstetrician or midwife need to make the opening at your vagina bigger - this might be needed if they are going to use instruments like forceps or a ventouse to help with the birth
  • you are having a breech birth – this means the baby is coming bottom or feet first
  • your baby is big
  • you have certain medical conditions, such as heart disease, and your doctors have recommended that your labour be as quick as possible
  • you have been pushing for a while and are exhausted
  • it is needed to prevent a third-degree tear

Third-degree tears

A third-degree tear is a tear of the muscles in your perineum that also affects muscles of your anus (bottom).

Doing an episiotomy during certain types of birth (for example, forceps births) can reduce the risk of a third-degree tear.

Page last reviewed: 21 February 2023
Next review due: 21 February 2026