There is insufficient evidence to support routine episiotomy with instrumental delivery, however, most obstetricians will have a low threshold for performing an episiotomy with forceps delivery.
Feel for stretch or give in the tissues of the posterior forchette. If the tissues feel rigid and a tear appears likely, then an episiotomy should be considered.
In the UK the recommended technique is a mediolateral episiotomy, starting at midline of the vaginal forchette (to avoid the Bartholin’s duct) and usually directed towards the right side. The angle to the vertical axis should be 45–60°.
An episiotomy performed close to the time of delivery will prevent excessive blood loss.