Last updated: 02/17/2009

An episiotomy is a surgical incision, usually made with sterile scissors, in the perineum as the baby's head is being delivered. This procedure may be used if the tissue around the vaginal opening begins to tear or does not seem to be stretching enough...

to allow the baby to be delivered.

In most cases, the physician makes a midline incision along a straight line from the lowest edge of the vaginal opening toward the anus. In other cases, the episiotomy is performed by making a diagonal incision across the midline between the vagina and anus (called a mediolateral incision). This method is used much less often, may be more painful, and may require more healing time than the midline incision. After the baby is delivered through the extended vaginal opening, the incision is closed with stitches. A local anesthetic may be applied or injected to numb the area before it is sewn up (sutured).

Episiotomies are classified according to the depth of the incision:

• A first-degree episiotomy cuts through skin only (vaginal/lierineal).
• A second-degree episiotomy involves skin and muscle and extends midway between the vagina and the anus.
• A third-degree episiotomy cuts through skin, muscle, and the rectal sphincter.

• A fourth-degree episiotomy extends through the rectum and cuts through skin, muscle, the rectal sphincter, and anal wall.