Don’t perform routine episiotomy apart from when there are clear clinical indications.

Episiotomy was performed to avoid genital prolapse, urinary incontinence and perineal trauma. However recent studies have demonstrated that routine episiotomy involves several side effects like unpredictable extension of the surgical incision towards anus and rectum, narrowing of the vaginal introit, excessive blood loss, edema, pain, infection, diastasis and dyspareunia.
Episiotomy may be indicated in the operative vaginal delivery (vacuum extractor or forceps), when it is necessary to accelerate the fetus expulsion in the presence of fetal distress and invasive maneuvers are needed to treat shoulder dystocia.
In any case median episiotomies must be avoided because they are associated to an increased risk of extension to the rectum.


1. Cochrane Library Jiang H, Qian X, Carroli G, Garner P Selective versus routine use of episiotomy for vaginal birth (Review) 2017.
2. M.A. Muhleaman et al. To cut or not to cut, that is the question: A review of the anatomy, the technique, risks and benefits of an episiotomy. Clin Anat. 2017 Apr;30(3):362-372.
3. ACOG Practice Bulletin. Episiotomy clinical management guidelines for obstetrician-gynecologists. Obstet Gynecol, 2006;107:957–62.
4. WHO recommendations : intrapartum care for a positive childbirth experience 2018.



Attention. Please note that these items are provided only for information and are not intended as a substitute for consultation with a clinician. Patients with any specific questions about the items on this list or their individual situation should consult their clinician.