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An episiotomy is a surgical incision in the perineum, used to enlarge the vaginal opening during vaginal childbirth. (See diagram below)

Picture this: a woman giving birth must lay down on her back, which reduces the size of the opening of the birth canal, and then undergo an episiotomy to make the opening bigger!

Where's the logic in that?

In many hospitals episiotomies were and are still routinely performed. In the USA, over 30% of women giving birth are reported to undergo this procedure1,2 and in other countries the statistics may be higher.

However, evidence-based research shows that, in general, the outcomes are not benefitting women as intended.

Giving Birth Facts

Did you know that the episiotomy rate for water births is zero?4,5

According to the Coalition for Improving Maternity Services, rates of episiotomies should be 20% or less, with a goal of 5%.3

It is your responsibility to find out policies and actual rates of episiotomies by your caregiver/s and state your preferences clearly in your birth plan.

If you wish to avoid this surgery, you need to state this clearly and have a plan to avoid it. If necessary, you may need to find an alternative caregiver or an alternative birth venue which will allow you the type of birth experience you wish for.

Click here for Tips to Avoid Episiotomy and Tearing.

Two Types of Incision

Episiotomy The medio-lateral incision, which slants away from the rectum is the most commonly used incision as it reduces tearing into the anus.

The median incision which is directly back towards the rectum causes less blood loss, heals well and is easier to repair but has a greater risk of tearing through to the anus.

When May Episiotomy Be Required?

  1. To avoid second or third degree tearing when the perineum has not had time to stretch slowly and birth is imminent.

  2. The baby's head is too large for the vaginal opening and there is a risk of a serious tear.

  3. To hasten birth when the baby is in distress.

  4. When instruments are required to assist a baby's birth.

  5. Certain variations or complications are present e.g. certain cases of breech, shoulder dystocia.

Potential Risks and Disadvantages of Episiotomy

  • Tears of the anal sphincter muscles are more common and may lead to flatulence or anal incontinence.
  • Pain and discomfort post-partum
  • Prolonged period of healing after birth
  • Pain during sexual intercourse
  • Risk of infection
  • Bruising
  • Swelling
  • Bleeding
  • Painful scar
  • Future incontinence

Pros and Cons of Natural Tearing

Advantages of Tearing Naturally

  • Less painful - the skin of the perineum is designed to stretch during birth. Few women actually feel when they tear
  • Less chance of needing stitches - many tears are superficial and do not need to be stitched
  • A tear usually heals more quickly
  • Post-partum discomfort is less than after a surgical cut

Disadvantages of Natural Tearing

  • The birth process is slower. This is usually a good thing as it allows the perineum to stretch naturally. However in a case of a baby in distress, this could be a disadvantage.
  • Ragged tears are not always easy to repair
  • There is a chance that a tear could go right to the anus, causing more serious damage.

Care of Episiotomy and Tears

  1. Apply a perineal cold pack to the area to reduce bruising and swelling.

  2. Take frequent sitz baths and place coarse salt in the water to help disinfect and dry out the wound.

  3. Use a squirt bottle to spray water over the wound when you urinate.

  4. Use double ply toilet paper to pat the area dry gently.

  5. Use a lubricant when you resume sexual intercourse. Remind your partner to be gentle!

Related Pages

Tips to Avoid Episiotomy and Tearing

Perineal Massage

Kegel Exercises for the Pelvic Floor

The Amazing Female Pelvis

Use of a Birth Ball in Labor


1. Popovic JR. 1999 National Hospital Discharge Survey: Annual summary with detailed diagnosis and procedure data. Vital Health Stat 13 2001; (151):i-v, 1-206.

2. Martin JA, Hamilton BE, Ventura SJ, et al. Births: Final data for 2000. Natl Vital Stat Rep 2002; 50(5):1-101.

3. CIMS, Mother-Friendly Childbirth Initiative,, retrieved 07/09/2010

4. Burn, E., Greenish, K. (1993). Water Birth. Pooling information. Nursing Times 89 (8): 47-9.

5. Garland, D., Jones, K. (1997, June). Ibid.


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