Giving birth is one of the most life-changing experiences a woman can have. While it’s a natural process, sometimes medical support is necessary to ensure the safety of both mother and baby. One of these interventions is an episiotomy – a small surgical cut made during delivery.
Understanding what an episiotomy is, why it might be done, and how it affects recovery can help women feel more prepared before birth and better supported afterwards.
This article provides an overview of the basics and offers guidance on healing and self-care.
An episiotomy is a surgical incision made in the perineum – the area between the vagina and anus – during childbirth to enlarge the vaginal opening.
It was once a routine part of vaginal deliveries, but today it’s performed much less often, as research shows that natural tears usually heal more smoothly.
While both involve the perineum being opened to allow the baby to pass, there are some important differences between an episiotomy and a vaginal tear after childbirth.
An episiotomy is a surgical incision deliberately made by a doctor or midwife. Because it’s controlled, it should be given at an angle (mediolateral) to direct trauma away from the anus. The benefit is that it allows immediate space if the baby needs to be delivered quickly, especially in emergencies or assisted births. However, because it is a surgical incision, it can sometimes extend deeper, and recovery may be more uncomfortable.
A natural tear happens spontaneously as the tissues stretch during birth. Tears are often smaller and more superficial – many are just first- or second-degree, affecting only the skin or muscle close to the vaginal opening. These lighter tears tend to heal more quickly and with less long-term discomfort. In fact, research shows that natural tears usually lead to fewer complications than intentional surgical incisions.
That said, severe tears can also occur naturally, and in some cases, an episiotomy is performed specifically to prevent an uncontrolled, more damaging tear. Every birth is unique, and the approach varies depending on the situation, the baby’s condition, and the mother’s well-being.
There are certain situations where an episiotomy can make birth safer for mother and baby, such as:
The decision is made in the moment by the doctor or midwife, always with the aim of protecting the health of both mother and child.
If an episiotomy is needed, pain relief is usually given either through a local anaesthetic or an existing epidural.
There are two main types of episiotomy:
After birth, the incision is stitched with dissolvable sutures. Episiotomies are also classified in degrees (from first to fourth), depending on how deep the cut or tear extends, which influences the healing process.
An episiotomy can sometimes be beneficial, for example, by speeding up delivery in urgent situations or helping to prevent a more severe, uncontrolled tear. At the same time, it carries certain risks. Many women experience pain and discomfort during the healing process, and there is also a risk of infection, scar tissue formation, or lingering tenderness in the affected area.
Some women may notice discomfort during sex or weakness in the pelvic floor muscles. Interestingly, research has shown that natural tears often heal more smoothly than surgical incisions, which is one of the main reasons episiotomies are no longer performed routinely.
The good news is that there are gentle ways to prepare the body that may reduce the likelihood of needing an episiotomy. Techniques such as perineal massage in the weeks before labour, the use of warm compresses, and guided, controlled pushing during birth can all help the perineum stretch more naturally.
Beyond physical preparation, the most important step is open communication with your healthcare provider. Talking honestly about your wishes and understanding how they approach episiotomy can give you confidence. In modern maternity care, the procedure is generally reserved only for situations where it is truly necessary.
Postpartum Recovery: What to Expect
Healing after an episiotomy usually takes a few weeks, although everyone’s experience is different. Here’s what recovery often looks like:
Contact your healthcare provider if you notice:
Regular postpartum check-ups are crucial for ensuring long-term well-being. And remember – you don’t have to struggle in silence; your care team is there to support you.
An episiotomy may sound intimidating, but in most cases, it’s only performed when truly necessary to protect both mother and baby. With the right care and a little patience, healing usually goes smoothly, and most women regain their comfort, confidence, and intimacy in time.
Every birth is unique, and so is every recovery. Don’t hesitate to ask questions, share your worries, or seek extra support if you need it – you deserve to feel informed and cared for throughout the process.
At London Women’s Centre, our specialists are here to guide you with compassion and expertise, making sure you feel safe and supported every step of the way.