Severe tears & pelvic floor injury
When an Episiotomy Goes Wrong: The Cut, the Repair and the Consent
The short answer
An episiotomy is a cut to the perineum to make more room for the baby. It can be the right call, for example in an instrument birth or when a baby needs to be born quickly. But three things can go wrong. The consent: you weren't asked, or were told rather than asked. The cut: made at the wrong angle, so it extended into a severe tear. The repair: leaving you with pain, deformity or bowel problems. An episiotomy done without your consent can be a legal wrong in itself. A poorly performed or repaired one can be medical negligence. Both may give rise to a claim.
"They just cut me."
You were pushing. You were exhausted, scared, maybe flat on your back with your legs in stirrups. Someone said something about "a little cut". Or no one said anything at all, and you only found out afterwards.
Maybe you said no, and it happened anyway.
Now you have a scar, maybe pain, maybe a tear that went much further than the cut. And a feeling that's hard to name: that something was done to you, not with you.
What you're feeling makes sense. Your body, and decisions about it, were yours.
You're not alone. Around 30 women from the Riverina told the NSW Birth Trauma inquiry about invasive procedures performed without their consent.
What an episiotomy is, and when it's used
Episiotomy
A surgical cut through the skin and muscle of the perineum, the area between the vagina and anus, made during birth.
In plain terms: a deliberate cut, made to widen the opening, which then has to be stitched like a tear.
Episiotomies aren't done routinely any more. They're mainly considered when:
- forceps or vacuum are being used, particularly forceps
- the baby needs to be born quickly because of distress
- a severe tear seems likely without one
If an instrument birth was involved, my articles on birth trauma after forceps or vacuum delivery and birth injuries and medical devices may help.
Consent: what you were entitled to
In Australia, doctors and midwives must tell you about the material risks of a procedure: the risks a reasonable person in your position would want to know. That principle comes from the High Court's decision in Rogers v Whitaker. And beyond risks, you must actually agree to the procedure.
Consent in labour
Labour can move fast, and there may be little time. But you should still, wherever possible, be told what's proposed and why, and asked. Ideally the conversation starts in pregnancy, so you're not hearing about it for the first time while pushing.
In plain terms: "We need to do a cut to help your baby out. Is that okay?" is a very different thing from silence and a pair of scissors.
An obstetrician writing in O&G Magazine in 2024 made the case that informed consent in the birth space depends on antenatal education, clear communication and good documentation, especially when decisions are time-critical.
Consent was one of the biggest themes of the NSW Parliament's 2024 Birth Trauma report. In its response, the NSW Government committed to strengthening consent processes in maternity care. It also committed to reviewing birthing intervention policies to align them with NSW Health's consent manual.
I've written more about consent and forceps in "Why didn't anyone tell me forceps could do this?".
The cut: why the angle matters
This is something many women never hear about. The direction of an episiotomy matters a great deal.
- A midline cut, straight down towards the back passage, can more easily extend into the anal sphincter, causing a third or fourth degree tear.
- A mediolateral cut, angled out to the side, is designed to direct any extension away from the sphincter.
The Royal Hospital for Women's perineal trauma guideline recommends a right mediolateral episiotomy over a midline one. Australia's national standard on severe tears also addresses reducing the risk of severe tears during labour and birth, including when an episiotomy is used.
If your episiotomy extended into a severe tear, that's a question worth asking about. See "I can't control wind after birth" and severe perineal tears.
If this is landing for you, and you're realising you were never really asked, I'd be glad to hear your story. There's no obligation.
The repair, and the healing
An episiotomy has to be repaired carefully, layer by layer, with good lighting and pain relief. The Royal Hospital for Women's guideline lists episiotomy among the factors linked to needing a second repair, for infection, wound breakdown, significant pain or disfigurement.
Problems after a poor repair can include:
- a wound that opens or becomes infected
- a misshapen or asymmetric perineum
- tight, painful scar tissue
- pain when sitting, or painful sex
- bowel symptoms, if a sphincter extension was missed
Signs your episiotomy went wrong
- You weren't asked, or you said no and it was done anyway
- You later learned the cut extended into a third or fourth degree tear
- You have wind or bowel leakage, or urgency
- The wound broke down or became infected
- You still have pain months later
- Your perineum looks or feels very different, uneven or tight
- Sex is painful
Your legal options
If you didn't consent.
Doing a procedure on someone without their consent can be a legal wrong in its own right, separate from negligence. That's true even if the procedure was skilfully done. Whether a claim is worth pursuing depends on the circumstances, including what was said, whether it was a genuine emergency, and what harm followed.
If the cut or repair was poorly done.
If the episiotomy was cut at the wrong angle, unnecessary, or poorly repaired, and you've been left injured, that may be medical negligence. Independent experts review the records to decide whether the care fell below the expected standard, and whether it caused your injury.
Other options.
You can ask the hospital for an explanation, raise a complaint with the Health Care Complaints Commission, or notify Ahpra about an individual practitioner.
For what compensation can cover, see what a pelvic floor injury claim can cover. If you felt your concerns were brushed aside afterwards, see when being dismissed by a doctor becomes a legal issue.
Frequently asked questions
Can a doctor do an episiotomy without consent?
You should be told what's proposed and asked, wherever possible, even in labour. A procedure done without consent can be a legal wrong in itself. In a true emergency the conversation may be brief, but you should still be told.
Can an episiotomy cause a fourth degree tear?
Yes. An episiotomy can extend into a severe tear. The angle matters: cuts angled away from the back passage (mediolateral) are recommended over midline cuts to reduce this risk.
Can I sue for a bad episiotomy?
Possibly, if it was done without consent, was unnecessary, was cut or repaired poorly, or led to an injury that was missed. Independent expert review of your records is needed.
Is there a time limit?
Yes. Time limits often run from when you knew, or ought to have known, about the injury and its cause. Please get advice early.
A closing thought
Being cut without being asked is a deeply personal violation, even when it happens in a hospital and is described as routine.
So here's a question to sit with: if you'd been given the choice in that moment, what would you have wanted to say?
Keep reading: Maternal birth injuries: what we must talk about · Birth trauma and obstetric negligence
This article is general information only. It is not medical or legal advice, and it doesn't replace advice from your own doctor, midwife or physiotherapist. Reading it does not create a lawyer–client relationship. If you are in crisis, please call Lifeline on 13 11 14 or 000 in an emergency.
