Objective To investigate the influencing factors of vaginal delivery with lateral episiotomy and natural laceration in women with suspected macrosomia. Methods The clinical data of 149 pregnant women with suspected macrosomia delivered in the First Affiliated Hospital of Nanjing Medical University from January 2022 to July 2022 were analyzed retrospectively. According to whether the perineum was cut laterally during vaginal delivery, the perineum was divided into two groups: the lateral resection group and the laceration group. By analyzing the risk factors of vaginal delivery of pregnant women with suspected macrosomia. Results Among 149 pregnant women with suspected macrosomia, 40 (26.85%) were delivered by perineal lateral episiotomy, 149 (73.15%) were delivered by vaginal delivery with natural laceration, including 93 cases of Grade I laceration and 16 cases of Grade II laceration. The proportion of primipara and working years of midwife < 5 years in the lateral resection group was higher than that in the laceration group (P=0.000, P=0.021); The proportion of the second stage of labor < 47 min in the lateral resection group (87.5%) was significantly higher than that in the perineal laceration group (P=0.000). In addition, the proportion of amniotic fluid properties (clear+I degree) in perineal laceration group was significantly higher than that in the lateral resection group (P=0.034), and the rate of postpartum hemorrhage was significantly lower than that in perineal laceration group (P=0.010). The differences were statistically significant. Primipara and working years of midwife < 5 years were independent risk factors for peritectomy of suspected macrosomia (OR > 1, P < 0.05). Conclusion The incidence of vaginal delivery with lateral episiotomy of suspected macrosomia in primipara and midwives with working years < 5 years is higher, the rate of postpartum hemorrhage in the lateral episiotomy group was significantly reduced.