Tears and episiotomy in childbirth: what to expect and how healing works

Worrying about tearing is very common. Here is what the NHS says about tears and episiotomies, and what recovery looks like.

How common are tears?

The NHS says up to 9 in 10 first-time mothers who have a vaginal birth will have a tear, graze or episiotomy. Most of these are minor. The Royal College of Obstetricians and Gynaecologists (RCOG) describes the degrees. First-degree tears are small tears affecting only the skin and usually heal quickly. Second-degree tears affect the muscle of the perineum as well as the skin and generally need stitches. Third- and fourth-degree tears extend into the anal sphincter, the muscle that controls the anus, and are repaired in an operating theatre with an epidural or spinal. RCOG says about 3.5 in 100 women have a tear this deep. The NHS gives the chance of a third or fourth degree tear as about 3 in 100 vaginal births, 4 in 100 ventouse births and 8 to 12 in 100 forceps births. See forceps and ventouse.

What is an episiotomy?

A cut in the area between the vaginal opening and the anus. The NHS says episiotomies are not done routinely in England. They may be considered if your baby is in distress and needs to be born quickly, if forceps or ventouse are needed, or if there is a risk of a tear to the anus. Local anaesthetic numbs the area first, and the cut is usually small and diagonal.

Can perineal massage help?

The NHS says massaging the perineum in the last few weeks of pregnancy can reduce the chances of having an episiotomy during birth. Studies vary in how it is done, usually with 1 or 2 fingers inserted into the vagina, and the greatest benefit was seen in women who did it every day. Ask your midwife to show you.

Stitches and healing

Repairs are usually done within an hour of the birth, with dissolvable stitches, so you don’t need to return to have them removed.
The NHS says stitches should heal within about a month.
Pelvic floor exercises can help healing and reduce pressure on the area. A midwife can show you how.
Pain that goes on beyond 2 to 3 weeks is unusual, so speak to a health professional.

When to get help

Call your midwife or GP if your stitches become more painful, you have smelly discharge, or the skin around the cut or tear is red and swollen. These can be signs of infection. For general recovery, see self-care tips for postpartum mothers.

If you have a third or fourth degree tear, your team should explain follow-up care and who to contact. Ask them if you haven’t been told.

Questions people ask

Will I tear?

It’s common, especially with a first vaginal birth. Your midwife will check and repair any tear.

Does an episiotomy hurt?

The NHS says local anaesthetic numbs the area first.

Can I do anything to reduce my chance of a tear?

The NHS says perineal massage in the last few weeks may reduce the chance of an episiotomy. Ask your midwife.

How long will it hurt?

The NHS says stitches should heal within about a month. Pain beyond 2 to 3 weeks should be checked.