What You Need to Know About Episiotomy – Will You Need One Again?

Ah, the infamous episiotomy—a word that can make even the most confident of pregnant women wince. If you had one in a previous birth, you might be wondering:

1. Will I need another one?
2. Can I do anything to avoid it this time?
   Let’s break it down.

What is an Episiotomy?

An episiotomy is a small surgical cut made in the perineum (the area between your vagina and anus) during childbirth. The idea is that it can help speed things up if needed, particularly in cases where the baby needs to be born quickly or if your perineum isn’t stretching as well as needed. Unlike a natural tear, an episiotomy is a deliberate cut made by your midwife or doctor.

How Common is an Episiotomy?

Episiotomy rates vary widely depending on the hospital and country. In the UK, rates have been reported to range from 26% to 67% across different hospitals. The likelihood of having an episiotomy is higher if you are a first-time mumor if you need an instrumental delivery (forceps or ventouse).

What Are the Chances of Having One Again?

If you had an episiotomy in your first birth, you might be wondering if it’s inevitable the second time around. The good news is that most women don’t need another one!

According to research, around 17.5% of women who had an episiotomy in their first birth required another one in their second birth, compared to just 3.1% of women who didn’t have one previously. So while your chances are slightly higher if you’ve had one before, the majority of women will not need another episiotomy.

Can You Avoid an Episiotomy in This Pregnancy?

Yes! While there’s no magic guarantee, there are definitely things you can do to reduce your chances of needing one:

1. Perineal Massage

• Studies suggest that perineal massage in the final weeks of pregnancy can reduce the likelihood of an episiotomy.
• Massaging from 34 weeks onwards, ideally 3-4 times per week, can help improve elasticity, making the perineum more likely to stretch naturally.
• If reaching is tricky, a partner can help, or you can try a massage tool like Perimom.
• Using a high-quality, natural perineal massage oil (like The Honest Midwife Perineal Massage Oil) can nourish the skin and support flexibility.

2. Positioning During Birth

• Lying on your back puts extra pressure on your perineum, increasing the likelihood of needing an episiotomy.
• Side-lying or being on all fours can reduce the need for an episiotomy and tearing.
• Water births may also help by softening the perineum and reducing tension.

3. Slow and Controlled Pushing

• When your baby’s head is crowning, resist the urge to push full-force.
• Your midwife will likely tell you to pant—think of blowing out lots of birthday candles one by one.
• This gives your perineum time to stretch gradually rather than tear.

4. Warm Compress

• A warm compress on the perineum during birth has been shown to reduce tearing and episiotomies.
• It can also be surprisingly soothing and comforting.

5. Hypnobirthing & Relaxation Techniques

• Staying as relaxed as possible can help your perineum soften and stretch more easily.
• If you feel tense or scared, your muscles naturally tighten, which can make tearing or needing an episiotomy more likely.
• Hypnobirthing techniques can help keep you calm—if you haven’t already, you might want to check out our hypnobirthing course!

Final Thoughts

While an episiotomy can sometimes be necessary, it’s definitely not an automatic repeat if you had one before. The majority of women who had an episiotomy in their first birth will not need one again! By preparing your perineum with massage, choosing the right birthing position, and staying as relaxed as possible, you’ll be giving yourself the best chance of avoiding another cut.

And if you do end up needing one again? You’ll know exactly what to expect—and how to heal well afterward.