Pregnancy and baby

Episiotomy and perineal tears



Sometimes a woman's perineum may tear as the baby comes out. An episiotomy can help to avoid a tear or speed up delivery.

Recent studies suggest that in first-time vaginal births, it is more common to have severe injuries involving the anal muscle if the perineum tears spontaneously rather than if an episiotomy is cut.

Why you might need an episiotomy

How it's performed

Recovering from an episiotomy

Preventing an episiotomy

The National Institute for Health and Care Excellence (NICE) recommends that an episiotomy should be considered if:

  • there is a clinical need, such as a delivery that needs forceps or ventouse, or a risk of a tear to the anus


Around one in seven deliveries involves an episiotomy.

If you have a tear or an episiotomy, you will probably need stitches to repair it. Dissolving stitches are used, so you won't need to return to hospital to have them removed.

Why you might need an episiotomy

An episiotomy may be recommended if your baby develops a condition known as foetal distress, where the baby's heart rate significantly increases or decreases before birth.

This means the baby may not be getting enough oxygen and has to be delivered quickly to avoid the risk of birth defects or stillbirth

Another reason for carrying out an episiotomy is when it's necessary to widen your vagina so instruments, such as forceps or ventouse suction, can be used to assist with the birth.

This may be necessary if:

  • you are having a breech birth, where the baby is not head-first
  • you have a serious health condition, such as heart disease, and it is recommended that delivery should be as quick as possible to minimise any further health risks 

Research shows that in some births, particularly with forceps deliveries, an episiotomy may prevent third-degree tears, where the tear affects the anal muscle. 

How an episiotomy is performed

An episiotomy is usually a simple procedure. A local anaesthetic is used to numb the area around the vagina so you won't feel any pain. If you've already had an epidural, the dose can be topped up before the cut is made.


Recovering from an episiotomy

Episiotomy cuts are usually repaired within an hour of the baby's birth. The cut (incision) may bleed quite a lot initially, but this should stop with pressure and stitches.

Stitches should heal within one month of the birth. Talk to your midwife or obstetrician about which activities you should avoid during the healing period.

Coping with pain

It's common to feel mild to moderate pain after an episiotomy. Painkillers such as paracetamol can help relieve pain and are safe to use if you're breastfeeding. 

Ibuprofen should not be used if your baby was born premature (before 37 weeks of pregnancy), had a low birth weight, or has a medical condition. 

Aspirin also isn't recommended as it can be passed on to your baby through your breast milk.


Research suggests around 1% of women will feel severe pain that seriously affects their day-to-day activities and quality of life after having an episiotomy.

If this happens, it may be necessary to treat the pain with stronger prescription-only painkillers, such as codeine.

However, prescription-only medication may affect your ability to breastfeed safely. Your GP or midwife will be able to advise you about this.

Placing an ice pack or ice cubes wrapped in a towel on the incision may also help relieve pain. Avoid placing ice directly on to your skin as this could cause damage.

Using a doughnut-shaped cushion or squeezing your buttocks together while you're sitting may also help relieve the pressure and pain at the site of your cut.

Exposing the stitches to fresh air can encourage the healing process. Taking off your underwear and lying on a towel on your bed for around 10 minutes once or twice a day may help.

It's unusual for postoperative pain to last longer than two to three weeks. If the pain persists, you should speak to a doctor, health visitor, or another health professional.

Going to the toilet



You may find squatting over the toilet, rather than sitting on it, reduces the stinging sensation when passing urine.

When you're passing a stool, you may find it useful to place a clean pad at the site of the cut and press gently as you poo. This can help relieve pressure on the cut.


If you find passing stools particularly painful, taking laxatives may help. This type of medication is usually used to treat constipation and makes stools softer and easier to pass.

For more information, read about treating constipation.

Pain during sex


In the weeks after giving birth, many women feel sore as well as tired, whether they've had an episiotomy or not. Don't rush into it. If sex hurts, it won't be pleasurable.


Studies have found around 9 out of 10 women who had an episiotomy reported resuming sex after the procedure was very painful, but pain improves over time.

If penetration is painful, say so. It's not pleasant to have sex if it causes pain. If you pretend everything is all right when it isn't, you may start to see sex as a nuisance rather than a pleasure, which won't help you or your partner. 


Get tips on talking about sex.






You can also talk to your GP or health visitor, or go to a contraception clinic at any time.

Find sexual health services near you.


Look out for any signs that the cut or surrounding tissue has become infected, such as red, swollen skin, discharge of pus or liquid from the cut, or persistent pain.

Tell your GP, midwife or health visitor as soon as you can about any possible signs of infection so they can make sure you get any treatment you need. 


Strengthening the muscles around the vagina and anus by doing pelvic floor exercises can help promote healing, and will reduce the pressure on the incision and surrounding tissue.

Pelvic floor exercises involve squeezing the muscles around your vagina and anus as though to stop yourself from going to the loo or passing wind (farting).

Your midwife can show you how to perform the exercises correctly. You can also read pelvic floor exercises for women (PDF, 68kb) for advice.

Scar tissue



Preventing a perineal tear





Research suggests massaging the perineum in the last few weeks of pregnancy can reduce the chances of having an episiotomy during birth.

A review of four trials showed massaging the perineum from 35 weeks of pregnancy reduced the likelihood of tears, needing an episiotomy and pain in women who had not given birth vaginally before. 

The type and frequency of massage varied across the trials. Most involved inserting one or two fingers into the vagina and applying downward or sweeping pressure towards the perineum.

The benefit was more marked among those women who carried out perineal sweeping twice a week.

Page last reviewed: 14/07/2016

Next review due: 30/04/2017


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Assisted delivery

Learn about the instruments that may be used to help you deliver your baby, including forceps and a ventouse

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