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When you give birth, the skin and muscle between your vagina and anal opening can get torn. Or the doctor or midwife may need to make a cut (called an episiotomy) to help your baby come out.

The area between your vagina and anal opening is called the perineum.

During childbirth, sometimes the perineum stretches without tearing.

But quite often, the perineum gets torn during the last stage of birth, usually when the baby's head or shoulders come out.

There are four types of tears, depending on where the tear is and how deep it is: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 anal opening are torn.
• A fourth-degree tear is the same as a third-degree tear, but the area just inside your anal opening is torn as well.

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 a shot (a local anesthetic) 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 come 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

You're more likely to have a cut if:^{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.

This information is for educational use only, and is not a substitute for prompt professional medical advice. Readers should always consult a physician or other professional for advice and treatment. ©BMJ Publishing Group Limited 2008. All rights reserved.