Episiotomy and suturing: High-probability medical treatments An episiotomy and episiostomy are actually completely different medical treatments performed on the same site at different times. When a baby is born, the perineum (the area between the vagina and anus) thins and lengthens until it reaches the vaginal opening. However, if the perineal expansion is not good, the fetus will not come out, which will cause the fetal heart rate to drop. Alternatively, the fetus comes out before the perineum is fully dilated, which may