Both episiotomies and perineal lacerations require stitches to repair and ensure the best

healing. Both are similar in recovery time and discomfort during healing.

Episiotomy is a minor incision or surgical cut made during childbirth to widen the opening of the
vagina.

Two types of episiotomy incisions:

1. Midline (median) incision. A midline incision is done vertically. A midline incision is

easier to repair, but it has a higher risk of extending into the anal area.

Advantages: This type of episiotomy is also less painful and is less likely to result in
long-term tenderness or problems with pain during sexual intercourse. There is often
less blood loss with a midline episiotomy as well.

Disadvantages: This type of injury can result in long-term problems, including fecal
incontinence, or the inability to control bowel movements. There is an increased risk for
tears that extend into or through the anal muscles.

2. Mediolateral incision. A mediolateral incision is done at a 45 – degree angle. A

mediolateral incision offers the best protection from an extended tear affecting the anal
area, but it is often more painful and is more difficult to repair.

Advantages: the risk for anal muscle tears is much lower.

Disadvantages: increased blood loss, more severe pain, difficult repair and higher risk
of long-term discomfort, especially during sexual intercourse.
  Episiotomy recovery is uncomfortable, and sometimes the surgical incision is more
extensive than a natural tear and infection is possible also.

 Your healthcare provider may advise an episiotomy in these following situations:

a. The baby does not have enough oxygen (fetal distress)

b. Complicated birth, such as when the baby is positioned bottom or feet first (breech)
or when the baby’s shoulders are trapped (shoulder dystocia)
c. Long pushing stage of labor
d. The mother needs a forceps or vacuum-assisted delivery
e. Large baby
f. Preterm baby
g. Birth is imminent and the perineum hasn’t had time to stretch slowly
h. The baby’s head is too large for the vaginal opening
i. The mother isn’t able to control her pushing.

Note: A vaginal / perineal tear or laceration is a tear in the tissue (skin and muscle) around
your vagina and perineum. It heals quicker and better when it tears naturally, plus it tends to feel
less painful.