Childbirth, tear or cut - What is it?

When giving birth, the skin and muscle between your vagina and back passage can get torn. Or the doctor or midwife may need to make a cut (called episiotomy) to help your baby out.

The area between your vagina and back passage is called the perineum. During childbirth, sometimes the perineum stretches without tearing. But quite often it gets torn during the last stage of birth, usually when the baby's head or shoulders come out.

There are four types of tear:[1]

A first-degree tear means that just the skin of your vagina or labia (the folds of skin around your vagina) is torn.
A second-degree tear means that the skin and muscle around your vagina or perineum are torn.
A third-degree tear means that the skin and muscle in your perineum and the muscle around your back passage are torn.
A fourth-degree tear is the same as a third-degree tear, but the area just inside your back passage is torn as well.

Your perineum is that area between your vagina and your anus. An episiotomy is a cut in your perineum that your doctor or midwife makes. The cut makes the opening of your vagina bigger, so that it's easier for your baby's head to come out. Before making the cut your doctor or midwife will give you an injection (a local anaesthetic) to make the area numb so that the cut doesn't hurt.

Doctors and midwives may make a cut if they want to deliver your baby quickly or if they want to use forceps (a pair of large tongs) to help your baby out.[1] But they will discuss this with you and ask your permission before they do this.

Doctors and midwives use cuts much less now than they did in the past. Most of them now think that both tears and cuts should be avoided whenever possible, because they can slow down your recovery.[2]

Other reasons why you may have a tear or cut are:[2] [3] [4] [5]

It's your first baby
Your baby is big
Your baby is coming out bottom first (breech birth) or face up (instead of face down)
You haven't been eating well
You have unusually weak skin
You are older
Your doctor or midwife prefers to make a cut in your perineum rather than letting it tear
You live in a country or region where cuts are still offered to everyone, such as in eastern Europe.

References

Royal College of Obstetricians and Gynaecologists. Methods and materials used in perineal repair: Guideline No. 23. June 2004. Available at http://www.rcog.org.uk/resources/Public/pdf/perineal_repair.pdf (accessed 27 September 2006).
Eason E, Feldman P. Much ado about a little cut: is episiotomy worthwhile? Obstetrics and Gynaecology. 2000; 95: 616-618.
Sultan AH, Kamm MA, Bartram CI, et al. Perineal damage at delivery. Contemporary Review of Obstetrics and Gynaecology. 1994; 6: 18-24.
Renfrew MJ, Hannah W, Albers L, et al. Practices that minimize trauma to the genital tract in childbirth: a systematic review of the literature. Birth. 1998; 25: 143-160.
Johanson RB, Menon BKV. Vacuum extraction versus forceps for assisted vaginal delivery (Cochrane review). In: The Cochrane Library, Issue 1, 2006. Wiley, Chichester UK.

Glossary

local anaesthetic: A local anaesthetic is a painkiller that's used to numb one part of your body. You usually get local anaesthetics as injections.

This information does not replace medical advice. If you are concerned you might have a medical problem please ask your Boots pharmacy team in your local Boots store, or see your doctor.