page_title: Episiotomy
section_title: Types
hierarchical_section_title: Episiotomy / Types
caption_attribution_description: English: Location of Possible Episiotomy. See a full animation of this medical topic.
context_page_description: Episiotomy, also known as perineotomy, is a surgical incision of the perineum and the posterior vaginal wall generally done by a midwife or obstetrician. Episiotomy is usually performed during second stage of labor to quickly enlarge the opening for the baby to pass through. The incision, which can be done at a 90 degree angle from the vulva towards the anus or at an angle from the posterior end of the vulva, is performed under local anesthetic, and is sutured after delivery.
  Its routine use is no longer recommended. Despite this, it is one of the most common medical procedures performed on women. In the United States, as of 2012, it was performed in 12% of vaginal births. It is still widely practiced in many parts of the world, including Japan, Taiwan, China, and Spain.
context_section_description: There are four main types of episiotomy:
  Medio-lateral: The incision is made downward and outward from the midpoint of the fourchette either to the right or left. It is directed diagonally in a straight line which runs about 2.5 cm (1 in) away from the anus (midpoint between the anus and the ischial tuberosity).
  Median: The incision commences from the centre of the fourchette and extends on the posterior side along the midline for 2.5 cm (1 in).
  Lateral: The incision starts from about 1 cm (0.4 in) away from the centre of the fourchette and extends laterally. Drawbacks include the chance of injury to the Bartholin's duct, therefore some practitioners have strongly discouraged lateral incisions.
  J-shaped: The incision begins in the centre of the fourchette and is directed posteriorly along the midline for about 1.5 centimetres (0.59 in) and then directed downwards and outwards along the 5 or 7 o'clock position to avoid the internal and external anal sphincter. This procedure is also not widely practised.
caption: Illustration of midline and medio-lateral incision sites for possible episiotomy.
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