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A local anesthetic is used.

Surgical scissors or a scalpel are used to make a cut extending from the back wall of the
vagina (through the perineal skin and muscles) to the side of the anus (mediolateral) or in a direct line with the anus
(midline). Shortly after delivery, the cut tissues are stitched (sutured) together again. The stitches (sutures) dissolve after
about 10 days.

PHYSIOLOGY OF PREGNANCY

A human pregnancy starts when the male sperm fertilizes the ovum (egg) in a woman's Fallopian tube,
and it lasts, on average, 266 days. Contraception works by inhibiting the release of the ovum from the
ovary (birth control pill, injectible, or subdermal implant), by impeding the release of sperm (vasectomy),
by blocking sperm from entering the vagina or cervix (male or female condom, diaphragm, or cervical
cap), or by blocking the Fallopian tubes (tubal ligation). Once conception takes place, the fertilized egg
travels through the Fallopian tube into the uterus, where it implants about seven days later. The
intrauterine device (IUD) impedes such implantation, and medications like mifepristone (RU486) causes
the implanted embryo to abort.

A developing human is called an embryo between two and eight weeks after conception; thereafter it is
called a fetus until delivery. Development of the major organs begins during the early embryonic period,
and interference with this process may result in birth defects. Women taking harmful substances, or
women with preexisting diseases like diabetes mellitus, are at increased risk for having babies with birth
defects. Because the development of major organs begins during early pregnancy, often before a woman
starts prenatal care or realizes that she is pregnant, preconceptional care is recommended for every
woman of reproductive age.

Although most major organs are present at the end of the embryonic period, the development of their
functions continues well into the fetal period, infancy, and early childhood. Interference with this process
may lead to functional deficits. For example, undernutrition during this period of growth has been
associated with increased risk for coronary heart disease, and maternal alcohol use during pregnancy has
been linked to mental retardation and other birth defects.

Remarkable changes take place in a woman during pregnancy. The heart circulates 40 percent more blood
volume to supply nutrients and oxygen to the growing baby, deeper breaths occur and an increased
amount of harmful substances are cleansed through the kidneys. Digestion slows down for better
absorption or nutrients, which may cause problems such as heartburn and constipation. The baby is
sustained in the uterus by the placenta, which serves as the interface between maternal and fetal
circulations. Hormones prepare the breasts for lactation, and the immune system is altered so that it does
not reject the baby as a foreign body. While most healthy women make these adaptations readily,
pregnancy can jeopardize the health, and sometimes the lives, of women who are less healthy and suffer
increased stress to the system during pregnancy.