“Will I tear when I give birth?”
This is a common question and concern for first-time moms. Vaginal tears, or perineal tears, can’t always be avoided—but as with all things pregnancy, knowledge is power.
Read on to learn about perineal internal tearing during childbirth and how to prevent it.
Understanding perineal tears
Vaginal tears that happen as a result of labor and birth are also known as perineal tears.
The perineum is the area between the vaginal opening and the anus—and it plays a starring role during childbirth. “The perineum is made up of skin, connective tissues, and muscles, and it provides anchorage and support for the pelvic floor,” explains Dr. Nicole Calloway Rankins, a board-certified ob/gyn.
During childbirth, the perineum relaxes and slowly stretches to allow the baby’s head to pass through the vagina. Stretching during crowning can actually increase the length of the perineum by 50% vertically and 170% horizontally (wow!).
In some cases, the baby passes through the vagina without causing any tears or lacerations to the perineum. However, it’s estimated that the majority of women will experience tearing during vaginal birth.1 Most of these are spontaneous tears, not episiotomies.
A matter of degree
Perineal tears are classified by degree, based on their severity and how much tissue is torn.
1st degree perineal tears
1st degree tears are the most minor, meaning only the superficial part of the vagina is torn. They may require one or two stitches, if any. As Dr. Rankins describes it: “A 1st degree tear is similar to if you fell and scraped your skin, except it’s on the inside of your vagina.”
2nd degree perineal tears
2nd degree tears involve both skin and perineal muscle. These types of tears will need more stitches and a slightly longer recovery time.
The majority of vaginal tears will be 1st or 2nd degree tears, and they should heal without any problems. “You may have mild pain, swelling, and discomfort afterward, but the recovery is typically very straightforward,” Dr. Rankins says. At-home treatments like cold therapy, a numbing pain relief spray, or a sitz bath should bring some soothing relief.
Mom Katelynn experienced a second degree tear: “My recovery was smooth. I continued to take it easy and really not overdo it physically. I eased my way back into activity, which I think helped a lot.” A small subset of first-time moms will have more severe perineal tears.
3rd degree perineal tearsA 3rd degree tear means the tear has extended through the skin and into the muscles that surround the anus, known as the anal sphincter complex.
4th degree perineal tears
4th degree tears are both the most severe and the least common. This means your vagina is torn, the muscles between your vagina and anus are torn, and your anus or rectal areas are torn as well.
3rd and 4th degree tears require more involved repair, and your recovery time will be longer. This level of tearing can sometimes lead to some long-term complications, such as loss of bowel control and pelvic floor disorders.
Kelsey, a mom of two, experienced a third degree tear with her first child, which she describes as: “difficult to recover from. It took 4-6 months to fully feel better.”
But rest assured: After 3rd and 4th degree tears are repaired and given time to heal, 60% to 80% of women report having no long-term complications. “Even if you have a more severe tear, it’s most likely that it will heal without any problems,” says Dr. Rankins. “Be sure to keep up with all of your postpartum visits to ensure you are on the road to a healthy recovery.”
The degrees of perineal tears described above are spontaneous, meaning they happen on their own during labor and birth. Occasionally a healthcare provider may need to make a cut in the perineum area during childbirth. This procedure is called an episiotomy. If you haven’t already had an epidural or other pain medication, your provider may inject a local anesthetic to numb the perineal area first.
“An episiotomy makes the opening of the vagina a bit wider, allowing the baby to come through more easily,” Dr. Rankins explains. “It can also help speed up delivery if the baby needs to be born quickly.”
If you have an episiotomy, your healthcare provider will repair the cut with stitches after you deliver. The stitches will dissolve into your body as the incision heals. You should keep the area clean and dry, and follow any care instructions from your healthcare provider.
Preventing perineal tears
There is no way to guarantee you won’t tear during a vaginal birth. But there are some techniques that can help reduce the risk of tearing during childbirth.
The first is perineal massage, which involves massaging the tissues of your perineum. This increases blood flow to the perineum, which can help the tissues stretch more easily during childbirth. Perineal massage can be done any time after week 34 of your pregnancy, as well as during the second stage of labor while you’re pushing.
Other methods include applying warm compresses to the perineum during pushing, as well as changing your position while pushing. “There is a reduced risk of tearing if you are on your side or in a semi-recumbent position during birth—so not flat on your back, but sitting upright with your back angled at about 45 degrees or so,” attests Dr. Rankins.
Talk with your healthcare provider about different labor positions, so you find one that’s comfortable and works during your birth.
Preparing for birth
You can’t predict whether you will tear. But our hope is that becoming informed helps ease any fears you may have about this aspect of labor.
By understanding the different degrees of perineal tears, and tips and tricks to help reduce your risk of tearing, you’re one step closer to preparing for labor—and becoming “mama”!
1ACOG (2018) Prevention and management of obstetric lacerations at vaginal delivery. Practice Bulletin 198
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