Episiotomy Explained: Here's Everything You Need To Know

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Pregnancy & Parenting

Episiotomy Explained: Here’s Everything You Need To Know

For aspiring mums and mums to be, episiotomy is a term they hear a lot in passing and wonder what it is, will I have it and if it’s necessary. In addition to this, people often get confused between tearing and episiotomy and call tearing episiotomy.


While tearing happens naturally, an episiotomy is done by the doctor and is a surgical incision in the perineum (the tissue between the anus and the vaginal opening). The doctor, instead of waiting for the perineum to tear naturally or for complications to arise, will make an incision in the perineum. This surgical routine or process is called an episiotomy.


Is Episiotomy Necessary

According to the World Health Organization (WHO), a routine or liberal episiotomy is not recommended for women undergoing spontaneous vaginal birth and the role of episiotomy in obstetric emergencies remains to be established. This is because routine episiotomy isn’t evidence-based.

However, there are situations in which episiotomy is necessary and can be highly beneficial such as:

  • A natural tear going upwards: this can cause damage to the urethra and in this case, an episiotomy might be performed as a preventive measure and to give the baby more room. Episiotomies are performed on the lower part of the vagina (perineum) and will discourage the upward tear.
  • Fetal distress: When the baby is low in the birth canal and requires assisted birth. Usually, this requires vacuum or forceps which means the doctors need more space and thus an episiotomy.
  • Unique perineum anatomy: When a natural tear begins and a woman has small perineum, an episiotomy might be performed to angle the tear in a way that it doesn’t extend to the anal sphincter.
  • Any time assisted birth is necessary, this is because of the way the tools are used.


Natural Tears Vs Episiotomy

After reading all of this, you might be wondering where to lean on in terms of natural childbirth and in the event that your baby needs more space.


First, let’s look into Natural Tears

Natural tears can be 1st degree, 2nd degree, 3rd degree, or 4th-degree tear depending on how far they go and how they affect the perineum.

First-degree tears are superficial, only affect the skin, and might need a few stitches.

Second-degree tears affect the skin and the muscle and require a few stitches.

A third-degree tear involves skin, muscle, perineum tissues and requires stitches while a fourth-degree tear is similar to the third-degree tear but also involves the anal sphincter.

In both cases, there are risks involved such as:

  • Bleeding
  • Infection during healing
  • Damage to the nerve and tissues
  • The need for stitches and for an episiotomy, risks can also include a need for stitches more deeper than natural tears, prolonged healing and painful intercourse due to scar tissues.


Overall, natural tears heal faster and have fewer risks than episiotomy which is only recommended in the aforementioned instances. Episiotomies are only recommended in case the baby needs assistance or in case a natural tear happens upwards towards the urethra.

Episiotomies increase the risk of long term pelvic floor, vaginal damage, and anal sphincter damage, especially when done routinely. Therefore, natural tears are recommended.


This article is for information purpose only and should not be considered as Medical or Obstetric Advice. Consult an Obstetrician before making any obstetric decision.


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