Although done much less often an episiotomy may be needed if the baby's head is too big for the mother's vaginal opening, or the baby is in a breech position (feet or buttocks coming first) and there is a problem during delivery.
Just before the baby is born and while the woman is awake and pain-free (local anesthesia or epidural block), an incision is made at the bottom of the vaginal opening to enlarge it for the delivery of the baby's head.
Review Date 4/19/2018
Updated by: John D. Jacobson, MD, Professor of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda Center for Fertility, Loma Linda, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.