When giving birth, the skin and muscle between your vagina and anus can get torn. Or the doctor or midwife may need to make a cut (called an episiotomy) to help your baby out. It's not always possible to avoid a tear or cut. But there are things you and your doctor or midwife can do to reduce the risk.
We've brought together the best research about tears and cuts during childbirth and weighed up the evidence about how to avoid them. You can use our information to talk to your doctor or midwife and decide what is best for you.
When giving birth, the skin and muscle between your vagina and anus can get torn. Or your doctor or midwife may need to make a cut (called an episiotomy) to help your baby out.
The area between your vagina and anus is called the perineum. During childbirth, sometimes the perineum stretches without tearing. But quite often it gets torn during the last stage of birth, usually when the baby's head or shoulders come out.
There are four types of tears:
A first-degree tear means that just the skin of your vagina or labia (the folds of skin around your vagina) is torn
A second-degree tear means that the skin and muscle around your vagina or perineum are torn
A third-degree tear means that the skin and muscle in your perineum and the muscle around your anus are torn
A fourth-degree tear is the same as a third-degree tear, but the area just inside your anus is torn as well.
An episiotomy is a cut in your perineum that your doctor or midwife makes. The cut makes the opening of your vagina bigger so that it's easier for your baby's head to come out. Before making the cut your doctor or midwife will give you an injection (a local anaesthetic) to make the area numb so that the cut doesn't hurt.
Doctors and midwives may make a cut if they want to deliver your baby quickly or if they want to use forceps (a pair of large tongs) to help your baby out. But they will discuss this with you and ask your permission before they do this.
Doctors and midwives use cuts much less now than they did in the past. Most of them now think that both tears and cuts should be avoided whenever possible, because they can slow down your recovery.
Childbirth, tear or cut: why me?
You're more likely to have a cut if:
It's your first baby
Your baby is big
Your baby is coming out bottom first (breech birth) or face up (instead of face down)
You haven't been eating well (your nutrition is poor)
You have unusually weak skin
You are older
Your doctor or midwife prefers to make a cut in your perineum rather than letting it tear
You live in a country or region where cuts are still offered to everyone, such as in eastern Europe.
A local anaesthetic is a painkiller that's used to numb one part of your body. You usually get local anaesthetics as injections.
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