Stitches (sutures) are used to close the incision after both the baby and placenta have been delivered. The stitches are absorbed by the body and do not need to be removed.
Although done much less often an episiotomy may be needed if the baby's head is too big for the mother's vaginal opening, or the baby is in a breech position (feet or buttocks coming first) and there is a problem during delivery.
Just before the baby is born and while the woman is awake and pain-free (local anesthesia or epidural block), an incision is made at the bottom of the vaginal opening to enlarge it for the delivery of the baby's head.
The external female genitalia include the labia, the opening to the vaginal canal, and the clitoris. During birth, the vaginal canal expands to let the baby through.