Perineal tears and episiotomy

When your baby’s being born your vagina stretches, but sometimes it can’t stretch enough. If this happens, the bit between your vagina and your back passage (your perineum) may tear.

A tear can affect the skin, muscles and sometimes your bowel.

Is my perineum likely to tear during birth?

Most tears are unexpected and it’s hard to predict whether you’re likely to tear or not.

A tear’s more likely to happen if:

• it’s your first vaginal delivery
• your baby’s big
• you need forceps or ventouse delivery
• you’re a long time in the second stage of labour

Talk to your midwife about the chances of having a tear and what that might mean for you.

Degrees of perineal tears

There are 4 degrees of tear, depending on how deep they are and how far they go:

• First-degree tears are small and skin-deep
• Second-degree tears are deeper and affect the muscle of your perineum
• Third-degree tears also involve the muscle that controls your anus (the anal sphincter)
• Fourth-degree tears goes further into the lining of your anus or bowel

Treating first and second-degree tears

First degree tears usually heal naturally. Second degree tears usually need stitches.

About 3 in 10 women will have a first or second-degree tear.

Treating third and fourth-degree tears

If you have a third or fourth-degree tear you’ll be taken through to the operating theatre to make sure you’re completely comfortable and the obstetrician has good light and equipment to repair it properly.

Around 5 in 100 women having a vaginal delivery will have a third or fourth-degree tear. This is a little more likely (6 in 100) for first time pregnancies.

Episiotomy

An episiotomy is a cut in your perineum. This makes the opening of your vagina wider so that your baby can be born more easily. About 1 in every 6 women giving birth will have one.

Your midwife or obstetrician may do an episiotomy to try to prevent a third or fourth-degree tear if:

• you’re likely to tear
• your baby needs to be born quickly or with help

You’ll only have an episiotomy when there’s no other option and you’re likely to tear if you don’t have one.

Before you have the procedure, you’ll have an injection of local anaesthetic into the muscle to numb the area.

You’ll need to have stitches put in after the birth. These will dissolve themselves over the next 2 to 4 weeks.

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Translations and alternative formats of this information are available from Public Health Scotland.

If you need a different language or format, please contact phs.otherformats@phs.scot.

• Ready Steady Baby guide. Available in Arabic, Polish, Simplified Chinese (Mandarin) and Ukrainian
• Ready Steady Baby guide. Available in English (Easy Read)