Perineal tears during childbirth

One of the most common questions asked by expectant mothers is about vaginal tearing during childbirth and what can be done to avoid it. Most women experience some type of tearing during labour, particularly with the birth of their first baby. To ease any fears and expel the misconceptions, below are some answers to the most common questions  patients have about tearing during childbirth.

Why do Perineal tears happen?

Vaginal tears, also called perineal tears, are lacerations in the perineum – the area between the vagina and anus. They occur during childbirth when the vagina and perineum are unable to stretch adequately to accommodate the size of a baby being born, resulting in a tear.

Are tears common?

Yes, incredibly common – they happen in most deliveries. The good news is that after your first vaginal birth, the tissue around your vagina becomes more flexible and the chance of tearing in subsequent deliveries is reduced.

What are the types of tears and what do they mean?

There are four degrees of tears. The level of degree correlates to the extent of the tear and the area involved.

• First degree: These are superficial tears involving the skin of the perineum and/or the vaginal tissue and usually require minimal stitches or heal by themselves.
• Second degree: These are tears to the skin and muscle layer of the perineum and require some stitches. This type of tear tends to heal in a few weeks.
• Third degree: These are tears that extend through the perineal muscles and into the sphincter muscles (internal and/or external) around the anus. For tears classified as third degree and upwards, your obstetrician will likely recommend that they are repaired in an operating theatre
• Fourth degree: These are tears that extend to the lining of the anus or rectum. Few women experience this.
• Episiotomy: These are cuts that are made to the entrance of the vagina by your obstetrician or health care provider, to enlarge the vaginal opening and accommodate the size of a baby being born. They are usually considered a second-degree tear. Your obstetrician will inform you if they think this is the best point of action, although is not routine in most vaginal deliveries.

If you experience a first- or second-degree tear, you can expect some mild discomfort, such as when you cough or sit down during the first week following childbirth. Third- and fourth-degree tears may be more painful during your recovery and take longer to heal. You may experience some difficulty passing urine or opening your bowels initially, but early management of these problems will likely lead to a return of normal function after a few weeks

What if you need stitches or surgery?

If you have a mild tear and stitches are required, your obstetrician will act upon it as soon as your baby is born. Local anesthetic will be given so no pain is felt. The stitches usually do not need to be removed as they will dissolve or fall out by themselves.

However, third degree and fourth degree tears require greater surgical intervention. Your care team will inform you if this is the best course of action and guide you through the process and recovery. You will usually be prescribed a course of antibiotics to reduce the risk of infection, take laxatives and be provided with a stronger pain relief option. Very rarely but sometimes, this can be a traumatic experience for the mother, and they may choose a caesarean delivery for their next baby.

If your stitches become painful or malodorous, or if you have any other concerns following stitches or surgery, contact your obstetrician or health care provider as this may be a sign of infection.

What can I do to treat my tear and reduce the pain?

To reduce discomfort, try to:

• Lie on your side as much as possible
• Go to the bathroom when you need to – do not fight it. Shower daily and change pads regularly to avoid infection
• Avoid any pressure on your muscles, like heavy lifting
• Begin pelvic floor exercises in the first week after delivery to strengthen your muscles – a physiotherapist can guide you in your exercises.
• Drink at least two litres of water a day and continue your laxative as needed to assist with bowel motions
• Take pain medication as instructed by your obstetrician or health care provider
• Avoid sex until you feel comfortable
• Ensure you follow-up with your obstetrician or health-care provider at your 6-week postnatal check to ensure your tear is healing appropriately

What can I do to reduce risk of tearing?

Whilst we can’t always avoid tearing, there are definitely ways to reduce the risk.

• Massaging your perineum during the last few weeks of your pregnancy
• Having your midwife or obstetrician apply a warm compress to the perineum during labour while you are pushing
• Pick a labour position that puts less pressure on the perineum, like lying on your side, kneeling, standing or being on all fours when you give birth

Try pushing in a slow and controlled way to avoid a rapid delivery. Your obstetrician or midwife may also take a “hands-on” approach to delivering your baby to help prevent tearing at this important time.

At the end of day, please remember tearing cannot always be avoided and do not be overwhelmed by the stories you hear. Your care team will do their best to ensure the tear is as mild as possible and support you in your recovery.