Somehow we still believe that what was once a routine standard of care for the delivering woman is still practiced all the time. Episiotomy is an incision made in the tissue between the vagina and the rectum ( perineum ) during the actual delivery of the baby. It was thought, at one time, that it was a preventative measure to eliminate extensive vaginal tearing and that the repair of surgical incision would heal much better than a "natural " tear. It was also thought to eliminate the vaginal and rectal prolapsing that sometimes occurs as women age.
Now we know that this medical practice is not necessary in childbirth. It doesn't prevent problems and may even produce unwanted results. Recovery is protracted. Infection and bleeding risk increases. The incision site may cause pain for months. It may contribute to fecal incontinence after delivery. A tear may not even occur and if it should, it may be much less extensive than episiotomy.
All that being said, your provider will recommend a surgical incision to the perineum if it appears very likely that extensive tearing will occur at the time of delivery. If the baby's position is abnormal, such that delivery will be complicated, episiotomy may be warranted There is no time to wait for the natural easing of perineal tissue, as is the case when a delivery is truly an emergency.
Anesthesia is used in the form of local injection, if you haven't had any obstetrical medical management already. There is no pain felt at the time of the incision. The pain that you may experience post delivery can be managed the same way as a slight tear would be, with topical gels and creams that numb the site.
There are many ways to prepare the perineum for delivery. The internet and books and articles abound in information. The brain aids by allowing for secretion of hormones that encourage the tissue to become more malleable. And you can do perineal massage safely all by yourself for weeks before the baby's due date. Easy to lubricate your thumbs, insert into vagina and push down toward the anus for 30 seconds after your shower or bath. A similar techinque is used extensively by nurses, midwives and physicians when actually preparing you for delivering your baby.
No need to be afraid of episiotomy. It's not your grandma's delivery.