Cuts and tears and repairs? Oh my! 

I’m just going to come out an say it: your vagina might get injured during birth. 

Did you just cross your legs protectively? Because I just did.

Of all the things pregnant women tell me they are afraid of, tearing when pushing during birth is the number one fear.

Getting an episiotomy is the second biggest concern.

It’s no wonder!  A cut or tear in the vagina would make the toughest woman cringe.

As a doula and a childbirth educator my job is to simultaneously inform women of what they can expect during birth and to put their minds at ease about what is possible.

Let’s talk about episiotomies first.

An episiotomy, if you did not already know, is a procedure performed during a vaginal birth where a small cut is made in the perineum. It is performed for the purposes of re-directing tears that could create complications, when the opening of the vagina is not stretching open to accommodate the baby’s head or to provide extra space for an Obstetrician to perform an assisted delivery, usually with a vacuum extractor.

We know that within the last five years the episiotomy rate in the Hamilton, Halton, Niagara and Brant region is 15%. That means 2 women out of every 20 will get a cut. (1)

If we can take comfort in anything, we can take comfort in the fact that it happens so rarely in our area.  I can confirm that in a decade of attending births in Hamilton and area I have only seen a handful of clients receive an episiotomy. I have only ever seen them performed when there is a clear medical indication.

The other thing that is a comfort to many women is knowing that when an episiotomy is performed, Lidocaine is used as a local numbing agent so that women do not experience any pain from the cut.

A syringe of Lidocaine is always used unless the baby’s head is on the perineum stretching the skin. In this case the skin is stretched so taught the nerves reach their maximum capacity for sensation and mothers can usually only feel the intense burning sensation of crowning.

This good news – if the famous “ring of fire” can be called good news – extends to spontaneous tearing. This means that if you experience tearing while pushing during birth, you will not feel any painful sensation in addition to the burning sensation of the stretched skin.

Approximately 50% of women will tear during the vaginal birth of their baby.  Take heart!  You also have a 50% chance that you WON’T tear while birthing your baby. (2) Women who tear enough to require stitches will get lots of Lidocaine to numb their vaginal tissue.

The doctors and midwives I have observed in Hamilton, Halton, Niagara and Brant are not interested in causing you any additional unnecessary pain. They will do their best to help you be as comfortable as possible.

If you require a repair, having a doula by your side is a huge help. She will be able to hold your hand and focus you. She can help you breathe calmly and will distract you while your repair is being performed. After birth a postpartum doula will help you around your home and with baby care so that you can recover and heal from birth.

You’ll will be back to normal in no time.



(1) Born Ontario, Provincial Overview of Perinatal Health in 2011–2012, Ottawa, October 2008,

(2) Public Health Agency of Canada. Canadian Perinatal Health Report, 2008 Edition.
Ottawa, 2008,