Women in labour

Some women need an episiotomy when they give birth. Here we talk about what it is, when they’re needed and what to expect if you have one.

What is an episiotomy?

An episiotomy is a cut to a woman’s perineum (skin between the vagina and anus) made by a doctor or midwife during childbirth. Episiotomies help to make the vaginal opening wider to allow the baby through more easily. The procedure is only performed when there is a medical reason to do so (NICE, 2014).  

What is the difference between an episiotomy and a perineal tear?

An episiotomy is a cut made by a health professional, while a perineal tear happens on its own during the second stage of labour. When a baby is being born, the perineum needs to stretch a lot and sometimes tears on its own.

How common are tears and episiotomies?

More than 85% of women who have a vaginal birth have some kind of tear or episiotomy (Frolich and Kettle, 2015). In first-time vaginal births, you’re more likely to have worse injuries if the perineum tears on its own than if you get an episiotomy (NHS Choices, 2017).

At least one third of women in the UK and US have perineal tears that need stitches (Frolich and Kettle, 2015). About three in 100 women having a vaginal birth have the more severe perineal tears. Tears are slightly more common with a first vaginal birth than in women who have had a vaginal birth before (RCOG, 2015b).

Can perineal massage reduce my risk of tearing?

Some evidence suggests massaging the perineum in the last weeks of pregnancy might reduce the likelihood of tearing or needing an episiotomy or stitches (Beckmann and Stock 2013). For more information on how to do it, see our article on perineal massage.

What to expect during an episiotomy

  • If you need an episiotomy during childbirth, you will be offered pain relief and will be given stitches afterwards. It’s usually a straightforward procedure.
  • For pain relief, you’ll have local anaesthetic applied to numb the area. If you’ve had an epidural, the dose can be topped up as needed.
  • The cut your doctor or midwife makes will be small and diagonal. It’ll go from the back of the vagina, down and out to one side. 
  • The doctor or midwife will stitch up the cut after your baby is born. They’ll use dissolvable stitches. (NICE, 2014; NHC Choices, 2017)

When might I need an episiotomy?

You might need an episiotomy if:

  • Forceps or ventouse are required to help you give birth to your baby.
  • Your baby is in distress (their heart rate gets much faster or slower) and they need to be born quickly.
  • You have been trying to give birth for several hours and are worn out from pushing. 
  • You're having a breech birth – your baby is not head-first.
  • You have a serious health condition that requires your baby’s birth to be as quick as possible to minimise risks to you. (NICE, 2014; NHS Choices, 2017)

An episiotomy might prevent more severe tears in some births, particularly in those where forceps are used (NHS Choices, 2017).

Recovery from episiotomy

  • Episiotomy cuts are usually stitched up within an hour of your baby's birth.
  • The cut might bleed quite a lot to start with, but this should stop with pressure and stitches.
  • Your stitches should heal within one month of your baby’s birth. (NHS Choices, 2017)

Talk to your midwife or GP about which activities you should avoid during the healing period. Read more in our article on episiotomy recovery.

If you are concerned about how you are healing following a perineal tear or episiotomy, it’s important to talk to a health professional. You can then get treatment if required.

This page was last reviewed in August 2018

Further information

Our support line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 0300 330 0700.

You might find attending one of our Early Days groups helpful as they give you the opportunity to explore different approaches to important parenting issues with a qualified group leader and other new parents in your area.

Make friends with other parents-to-be and new parents in your local area for support and friendship by seeing what NCT activities are happening nearby.

The Royal College of Obstetricians and Gynaecologists (RCOG) has an information hub for perineal tears and episiotomies in childbirth. You can find out more about the types of tears that can occur during childbirth, how to minimise your risk of deeper tearing, and what can be done to help your recovery if you do tear. It also covers what to do if you have any concerns about your recovery, helping you feel better informed when discussing any topics with a healthcare professional.

Beckmann M, Stock O. (2013) Antenatal perineal massage for reducing perineal trauma. Cochrane Database Syst Rev. (4):CD005123. Available from: http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD005123.pub3/abstract;jsessionid=CF32264FB13246A8540B877017B34E8C.f02t04 [Accessed 1st September 2018].

Frolich J, Kettle C. (2015) Perineal care. BMJ Clin Evid. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4356152/[Accessed 16th May 2017].

NHS Choices. (2017) Episiotomy and perineal tears. Available from: http://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/episiotomy.aspx [Accessed 16th May 2017].

NICE. (2014) Intrapartum care for healthy women and babies. Available from:  https://www.nice.org. uk/guidance/cg190  [Accessed 16th May 2017].

RCOG. (2015a) The management of third- and fourth-degree perineal tears. https://www.rcog.org.uk/globalassets/documents/guidelines/gtg-29.pdf [Accessed 16th May 2017].

RCOG. (2015b) A third of fourth degree tear during birth (also known as obstetiric anal sphincter injury – OASI). Available from: https://www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/pregnancy/pi-third--or-fourth-degree-tear-during-birth.pdf [Accessed 16th May 2017].

RCOG. (2016) Patterns of maternity care in English NHS trusts 2013/14. Available from: https://www.rcog.org.uk/globalassets/documents/guidelines/research--audit/maternity-indicators-2013-14_report2.pdf [Accessed 16th May 2017].

 

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