This is one of the most asked questions we get on social media: how can I prevent tearing during birth? Maybe you've heard horror stories about women who sustained severe tears. Maybe you're concerned about healing. We've got answers! Let's dive into all things perineal tearing.
What is perineal tearing?
Perineal tearing refers to a tear or laceration that occurs in the area between the vagina and the anus (known as the perineum) during childbirth. This can happen when the baby's head stretches the perineum during delivery, causing the tissues to tear.
Perineal tearing is common during vaginal delivery, and studies suggest that up to 90% of women experience some degree of tearing during their first vaginal delivery. The severity of the tear can range from a small superficial tear to a more severe tear that extends into the anal sphincter.
What are the four degrees of tearing?
First-degree tear: A first-degree tear is the least severe type of perineal tear. It is a small, superficial tear that involves only the skin. This type of tear may not require stitches and typically heals within a couple of weeks.
Second-degree tear: A second-degree tear is a deeper tear that involves the skin and the muscle beneath it. This type of tear may require stitches to help the area heal. Second-degree tears may cause moderate to severe pain and discomfort, and women may need pain relief medication or sitz baths to help manage the pain. Recovery time for a second-degree tear can take up to six weeks.
The vast majority of tears (up to 95%) are first and second-degree tears. Here are the two less common degrees of tears:
Third-degree tear: A third-degree tear is a severe tear that extends into the anal sphincter muscle. This type of tear requires surgical repair and can take up to twelve weeks to heal fully. Women with a third-degree tear may experience pain, discomfort, and difficulty with bowel movements. They may need pain relief medication and stool softeners to help manage the pain and prevent constipation.
Fourth-degree tear: A fourth-degree tear is the most severe type of perineal tear. It extends through the anal sphincter muscle and into the rectal lining. This type of tear requires immediate surgical repair and can take up to twelve weeks to heal. Women with a fourth-degree tear may experience significant pain and difficulty with bowel movements. They may need pain relief medication, stool softeners, and a special diet to help manage the pain and prevent constipation.
What causes perineal tearing?
Perineal tearing is most commonly caused by the stretching of the perineal tissues during childbirth. Other factors that can increase the risk of perineal tearing include:
Giving birth for the first time
Having a large baby
Having a prolonged second stage of labor
Using forceps or a vacuum extractor during delivery
Having an episiotomy (a surgical cut made to enlarge the vaginal opening during delivery)
How can perineal tearing be prevented?
While perineal tearing cannot always be prevented, there are some things that women can do to reduce their risk of tearing during childbirth:
Perineal massage: This involves gently stretching and massaging the perineum in the weeks leading up to delivery, which can help to increase its elasticity and reduce the risk of tearing.
Warm compresses: Applying warm compresses to the perineum during delivery can help to relax the tissues and reduce the risk of tearing.
Controlled pushing: Taking breaks between contractions and using controlled, slow pushing can help to reduce the force of the baby's head on the perineum and reduce the risk of tearing.
Avoiding episiotomy: While episiotomy used to be a common procedure during delivery, it is now generally only done when necessary, as it can increase the risk of tearing and other complications.
We teach about how to push slowly and with control in our Birth Class for Couples. Click here to learn more!
How is perineal tearing treated?
If a woman experiences perineal tearing during childbirth, the tear will typically be repaired using stitches. The stitches will dissolve on their own over time, and the area will usually heal within a few weeks.
In some cases, more severe tears may require additional treatment, such as:
Pain relief medication: Pain relievers such as ibuprofen or acetaminophen can help to manage the pain associated with perineal tearing.
Sitz baths: Sitting in a warm bath a few times a day can help to reduce pain and promote healing. We like this one on Amazon!
Pelvic floor exercises: Strengthening the pelvic floor muscles with help from a pelvic floor PT can help to promote healing and reduce the risk of long-term complications such as incontinence.
Take a deep breath!
Perineal tearing is a common occurrence during vaginal delivery, but there are steps that women can take to reduce their risk of tearing. If tearing does occur, it can be treated with stitches and other forms of supportive care. Most women go on to have a full recovery!