Episiotomy is the process of cutting the entrance of the vagina in order to aid the delivery of the baby, and to minimise the risk of tearing the wall of the vagina as the baby is born. It is used during instrumental delivery (where forceps or suction devices are used to help delivery), where delivery is being slowed because the vaginal tissues do not dilate and the baby's head is large, or where there are signs of foetal distress. Some authorities promote the use of episiotomy in all labours where there is delay during the second stage, particularly during a first delivery, but others feel that any resulting tear may cause less trauma to the genital tract than the episiotomy. The cut is usually made to one side rather than in the midline towards the anus, because of the risk that the cut might extend and breach the muscles that make up the external anal sphincter, producing incontinence. Properly repaired episiotomies should heal without residual discomfort, but sometimes they are a persistent cause of pain on intercourse (called dyspareunia, described in the section on the female genital tract) and may need further treatment.