Vaginal Tearing & Episiotomy – The Facts

Let’s talk about the elephant in the room when it comes to childbirth.

Have you ever had a friend or family member share with you their horror stories of 3rd or even 4th degree tearing.

It is important to be fully informed about how your body works during birth, what to be prepared for and discuss any fears associated with labour and birth. Although, hearing stories like these can promote fear and cause our focus to remain on the possible negatives instead of the beautiful empowering positives within childbirth.

I remember finding out that I was expecting and being so excited!

But soon after, my mind turned to fears of vaginal tearing and how I could possibly prevent that happening.

If like myself, this is a fear you have surrounding your birth, let’s discuss your options for preventative measures and recommendations.

I did not feel comfortable discussing my fear of vaginal tearing with my GP, I asked all kinds of questions but I was too shy to discuss vaginal tearing, the perineum or anus.

I would like this to be a safe place for anyone with these concerns to be able to get the answers they deserve and hopefully feel more confident with the trust that they place in their body and their Birth Plan.

What are the different kinds of vaginal tearing?

  • First degree tear – When only the skin is torn.
  • Second degree tear – When the skin and vaginal muscle is torn.
  • Third degree tear – When the perineal muscles and the muscles surrounding the anal canal tear as well.
  • Fourth degree tear – When the tear goes through the anal sphincter all the way to the anal canal and rectum.

Your Perineum is the skin tissue between your vaginal opening and back passage (the anus).

Overall 3rd or 4th degree tears occur in about three in one hundred women having a vaginal birth. 



A procedure that has been used since the early 20thcentury called an Episiotomy was believed to help prevent more extensive vaginal tearing and thought to heal more effectively than a natural tear.

The procedure involves an incision made in the perineum – the skin tissue between the vaginal opening and anus.

There are two types of episiotomies:

A Midline incision (also known as a Median) is cut vertically; this incision has a higher likelihood of an extended tear into the anal area.

This type of episiotomy is more common as it is easier to repair.

Though easier for health professionals to repair, it does not necessarily mean that it will heal easily or comfortably.

A natural tear is known to heal more effectively.

A Mediolateral incision is cut at an angle, this incision offers more protection from an extended tear involving the anal sphincter or bowel lining, although it is often  much more painful and harder to repair.

With medical advancement and further understanding of the human body, research suggests that routine episiotomies do not prevent tearing and in fact heighten the chances of having a 3rd or 4th degree tear.

Although an episiotomy cut may be easier to suture, a natural tear takes less time to heal and causes less pain.

Once a routine part of childbirth, now an episiotomy is only recommended in certain cases.

Your health care provider may recommend an episiotomy for an instrumental birth or an emergency birth where the baby needs to be born quickly.

Below is a diagram from Mayo Foundation for Medical Education & Research of the two types of episiotomy incisions:




Concerns & complications with episiotomies

There are many concerns associated with episiotomies, a large one is that it can cause excessive blood loss.

Extension of tearing – Episiotomy can in fact increase your chances of having extensive tearing. And can be extremely uncomfortable while healing. The healing process is different for everyone but is often a slow and painful time.

Perineal Infections – After having an episiotomy it is extremely crucial to take care of the area using the utmost hygiene. Unfortunately perineal infections are quite common and only extend the healing process and pain.


Recovery after vaginal tearing or Episiotomy

The Recovery time varies with the type of episiotomy performed.

On average it can take about a month to recover from the incision, for the wound to heal and for the stitches to dissolve.

It is important to follow medical advice throughout this time to allow effective healing and avoid infection.

It is important to also:

  • ·       Soothe and clean the wound.
  • ·       Perform Pelvic Exercises.
  • ·       Avoid pressure on the wound.
  • ·       Use Pain relief as prescribed.

Strategies to prevent an Episiotomy or extended tearing


Warm compress
Using a warm compress to apply pressure to the perineum can work well to avoid tearing and keeps the area moist and eases the tissue to stretch.

Perineal massage
Perineal massage is a strategy many women use to prepare the area for stretching and again hydrates the area keeping it supple and more prepared for birth.

Breathing techniques
The perineum has the ability to stretch and thin as far as it needs to during birth.

A woman who feels empowered, calm and strong can use breathing techniques and trust her body to support her in the most natural way. This is supported by a hormone that the body releases around the perineum area called Relaxin.

By using slow steady breaths and listening to your body’s intuition to push the perineum will stretch gradually the way it is designed to.


My name is Sarah Armstrong I am a Student Doula who has trained with Vicki Hobbs at the Doula Training Academy. 

If you would like to hear about my Doula services please contact me: 


[email protected]

Further information and resources

Royal College of Obstetricians and Royal College of Obstetricians and Gynaecologists U.K 

MAYO Foundation for medical education and research

Preventing a perineal tear­pregnancy-and-baby/episiotomy/#preventing-a-perineal-tear

NCT: Perineal massage­worries-and-discomforts/common-discomforts/perineal-massage

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