Home Women's Health A Guide on Episiotomy and Perineal Tears During Childbirth!

A Guide on Episiotomy and Perineal Tears During Childbirth!

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Episiotomy and Perineal Tears – sounds scary, right?

Being a woman, you likely have enough knowledge of episiotomies to know that you would want to avoid a snip down there. An episiotomy is an incision that enlarges the vaginal opening so your baby may emerge safely during a vaginal birth. 

Episiotomies were frequently the norm of the day a few years ago under the presumption that they guarded women against spontaneous tears, which were difficult to mend and would cause later issues like urine incontinence. 

Also, doctors were concerned that neonates would experience birth damage due to the head pressing too hard against the perineum during labor.

Let’s understand why episiotomy gets necessary on top of an already painful childbirth process.

What are Episiotomy and Perineal Tears?

Episiotomy is a surgical procedure in which the doctor applies an incision in the perineum, the area between the vaginal opening and the anus, during childbirth. 

Episiotomy and perineal tears widen the birth canal and facilitate the delivery of the baby.

Traditionally, episiotomies were a routine part of childbirth in many countries. Today, doctors and midwives prefer to allow the perineum to stretch and tear naturally during delivery. This approach results in fewer complications and faster healing.

According to Dr. Rabbia Ashraf, a renowned Gynecologist with six years of expertise, the incision is typically repaired with sutures after the baby is born, and the stitches dissolve within a few weeks. 

Women who have had an episiotomy may experience pain, discomfort, and difficulty with activities like sitting, walking, and using the bathroom for several weeks after delivery.

What are Different Episiotomy and Perineal Tears Types?

There are two types of episiotomy:

Midline Episiotomy

The doctor makes a midline incision directly down the middle of the perineum, from the vaginal opening to the anus. 

This type of episiotomy is the most common and easiest to repair, but it can increase the risk of a tear extending through the anal sphincter.

Mediolateral Episiotomy

The doctor applies the incision at an angle to the left or right of the midline. It reduces the risk of a tear extending through the anal sphincter. 

This type of episiotomy is less common and hard to repair, but it may reduce the risk of long-term problems with incontinence and sexual function.

What are the Degrees of Episiotomy?

There are two degrees of episiotomy:

First-degree Episiotomy

It is a small incision made only in the skin of the perineum.

Second-Degree Episiotomy

It is a deep incision that goes through the skin and the perineal muscles. 

Occasionally, third and fourth-degree episiotomies involve extending the incision through the anal sphincter and rectal mucosa. However, these are now rarely performed and reserved for emergencies where it is necessary to speed up the delivery process or if the baby is in distress.

How is an Episiotomy Performed?

An episiotomy enlarges the vaginal opening and reduces the risk of tears or injuries to the baby’s head during delivery.

Here’s how a doctor typically performs an episiotomy:

  1. Before the procedure, the patient is given local anesthesia to numb the area.
  2. The doctor will use a scalpel or scissors to make a small incision in the perineum. The incision may be midline or at an angle, depending on the doctor’s preference and the delivery needs.
  3. The incision may be deep enough to extend into the muscle tissue or more superficial.
  4. Once the incision is made, the baby’s head can be delivered through the enlarged opening.
  5. After the baby is delivered, the doctor will carefully stitch up the incision using dissolvable stitches.

In many cases, doctors can prevent or minimize tears and injuries to the perineum with other techniques, such as perineal massage or positioning changes during delivery. However, in some cases, an episiotomy may still be necessary to protect the safety of the mother and baby during childbirth.

When Does an Episiotomy Get Necessary?

There is some debate among medical professionals about the routine use of episiotomies during childbirth. Some doctors believe to use them only when necessary, while others believe in a routine episiotomy used to prevent perineal tears.

In general, an episiotomy may be necessary if:

  • The mother is carrying twins, and the doctor notices an irregular heartbeat in either the mother or the unborn child.
  • The baby is in distress and needs to get delivered quickly
  • The baby is in an unusual position, such as breech or shoulder first, and the delivery is difficult
  • The mother has a medical condition that makes pushing difficult, such as heart disease or high blood pressure
  • The baby is large, weighing more than 4 kg, and the perineum is not stretching enough to allow for delivery without tearing

Natural Vaginal Tears Vs. Episiotomy: What’s Better?

According to studies, women and babies are typically fine without episiotomies. In reality, the women who did not receive an episiotomy:

  • Recuperated in the same amount of time (or less) and with less discomfort
  • Did not face problems such as fecal and urinary incontinence, infection, and bleeding
  • Less prone to develop tears into third- or fourth-degree lacerations, which are more severe
  • Faced little perineal discomfort and hastened the healing process

Episiotomy Complications!

Gynecology experts at Iqra Medical Complex say, even when performed under appropriate circumstances, an episiotomy can have potential complications, such as:


Pain in the perineal area is a common complication after an episiotomy. It can be severe and can last for several days or even weeks.


Any surgical incision can increase the risk of infection, and an episiotomy is no exception. Infection can cause pain, swelling, and fever, requiring medical treatment.


Episiotomy can cause excessive bleeding, especially if the incision is too deep or the cut is in the wrong direction.

Scar Tissue

The incision made during an episiotomy can result in scar tissue formation, which can cause pain and discomfort during sex and other activities.


Episiotomy can increase the risk of urinary and fecal incontinence if the incision damages the muscles and nerves in the perineal area.


Episiotomy can also increase the risk of pelvic organ prolapse, which occurs when the pelvic organs (such as the bladder or uterus) drop down into the vaginal canal due to weakened muscles and ligaments.

Episiotomy Healing!

Recovering from an episiotomy can be uncomfortable, but there are several things you can do at home to promote healing and relieve pain:

Keep the Area Clean

After using the bathroom, gently wash the area with water and pat it dry with a clean towel.

Use Ice Packs

Applying ice packs to the area for 10-15 minutes can help reduce swelling and pain. Use a clean towel to wrap the ice pack, and avoid placing it directly on the skin.

Take Pain Medication

Over-the-counter pain medication such as acetaminophen or ibuprofen can help relieve pain and discomfort. Always follow the recommended dosage.

Use a Sitz Bath

Soaking in warm water can help promote healing and relieve pain. You can use a sitz bath that fits over your toilet or fill a bathtub with a few inches of warm water.

Practice Pelvic Floor Exercises

Doing pelvic floor exercises, such as Kegels, can help strengthen the muscles in the area and promote healing. Read more about the best exercises for normal delivery

Avoid Strenuous Activity

Avoid lifting heavy objects or any strenuous activity that puts pressure on the vaginal area.

Wear Loose Clothing

Wear loose, breathable clothing to avoid irritating the area.

A Final Thought from Healthwire!

Although it may hurt the first few days when you sit down or change positions, an episiotomy shouldn’t prevent you from moving around or nurturing your baby. However, if the pain doesn’t go away, consult a well-known gynecologist to get yourself checked and treated in case of any complications.

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