Menu
One of the less pleasant aspects of labour is tearing. Vaginal tears, also known as perineal tears, can occur during childbirth when the tissue between the vaginal opening and the anus stretches or tears.
This is a common occurrence, and the severity of tears can vary. Factors such as the size of the baby, the speed of delivery, and the use of interventions like forceps can contribute to the likelihood of tears.
According to the NHS, approximately 90% of first-time mothers undergoing a vagina birth experience a tear, graze, or episiotomy in some form. In this article, we will discuss why vagina tears happen, how to avoid it and Tips to help recover if it does occur.
Several types of tears can occur during childbirth, categorized by their severity.
First-Degree Tears: are the mildest form of tears during childbirth. These small injuries involve only the outermost layer of skin around the vagina and perineal area.
Given their limited depth, first-degree tears typically don’t require stitches for closure. Although they are the least severe, proper care is essential to ensure optimal healing and comfort.
A Second-Degree Tear: represents a more common and slightly more extensive form of tearing during childbirth. These tears reach beyond the outer layer of skin, extending deeper into the underlying muscles of the vagina and perineum.
Given their increased depth, second-degree tears typically require stitches to facilitate proper healing and prevent complications. While more involved than first-degree tears, second-degree tears maintain a moderate level of injury.
A Third-Degree Tear: is a more extensive type of tearing during childbirth, involving a significant injury that extends from the vagina to the anus.
This tear affects both the skin and muscles in the perineal area and includes damage to the anal sphincter muscles, which play a crucial role in bowel control. Given the complexity and depth of this tear, stitches are necessary for proper healing.
A Fourth-Degree Tear: represents the most severe and uncommon type of tearing during childbirth. This tear extends through all the deeper layers of the vagina and muscles surrounding the anal sphincter and goes as far as the rectum.
Repairing a fourth-degree tear involves a meticulous closure of multiple layers of vaginal and anal tissues and muscles. Due to its depth and complexity, this type of tear requires specialized attention from healthcare providers to ensure thorough healing.
During childbirth, your baby naturally stretches your vagina and the area between your vagina and anus (perineum), leading to vaginal tearing.
While your body tissues are naturally designed to stretch and accommodate your baby’s passage, certain factors can contribute to tearing during this process. These factors include
The rapid passage of your baby refers to how quickly your baby moves through the birth canal during delivery. When this process is overly swift, it can contribute to tearing. The birth canal is designed to stretch gradually as your baby moves through it.
However, if the speed of this movement is too fast, the tissues may not have sufficient time to stretch and comfortably accommodate your baby’s size. As a result, the increased force and speed can strain the perineal and vaginal tissues, potentially leading to tears.
If your baby is larger than average during birth, it can add extra pressure to the birth canal. This increased strain on the birthing passage raises the risk of tearing.
A larger baby may require more stretching of the perineal and vaginal tissues to make its way through.
When forceps or vacuum extraction are used during childbirth, they may increase the pressure on the perineal and vaginal tissues, potentially leading to tearing.
These tools are employed to guide your baby through the birth canal, and while they can be beneficial, the additional force involved may impact the resilience of the tissues.
For first-time mothers, giving birth for the first time involves the initial stretching of the perineal tissues. Since these tissues haven’t experienced the stretching associated with childbirth before, as a first-time, you may be more susceptible to tearing.
The body undergoes a unique adjustment during the first childbirth, and the perineum, in particular, may need time to adapt to the stretching required for the baby’s passage through the birth canal.
How your baby is positioned matters a lot during childbirth. The best position for a vaginal birth is with the baby’s head down and chin tucked into their chest. This makes it easier for the baby to navigate through the birth canal.
However, if the baby is facing up, has a tilted head, an extended neck, or a hand by their face (all of which are normal and common positions), it makes the passage through the birth canal a bit trickier.
This increased complexity raises the chances of tearing during birth because it requires a larger space and might involve awkward angles.
Your perineal tissue may become swollen when you’ve been in labour or actively pushing for an extended period. This swelling can impact the tissue’s flexibility, limiting its ability to stretch effectively during birthing.
As a result, the risk of tearing during birth increases. The prolonged pressure and swelling can make the perineal area less pliable, potentially making it more susceptible to tears when the baby is passing through the birth canal.
An episiotomy is a procedure during childbirth where doctors make a deliberate cut in the perineum to widen the vaginal opening. This is usually done in emergencies where a quick delivery is necessary. The goal is to prevent extensive tearing during birth.
While it’s intended to be a controlled cut to help with the delivery, it’s important to know that it’s still an incision, and the cut area will need time to heal after giving birth.
If you have experienced a third or fourth-degree perineal tear in previous childbirth, it can impact the flexibility and resilience of the perineal tissues.
These types of tears involve deeper layers and can result in lasting changes to the tissue structure.
The scarring from a previous tear may reduce the natural elasticity of the perineum, potentially increasing the risk of tearing in subsequent births.
Pregnancy at or beyond the age of 35 can increase the likelihood of tearing during childbirth. Ageing changes tissue elasticity, with a reduction in collagen levels, impacting the strength and resilience of the perineal tissues.
The natural ability of these tissues to stretch during childbirth may be compromised, potentially elevating the risk of tearing.
Recovering from a vaginal birth, especially if tears are involved, can be painful, with the level of discomfort depending on the severity of the tears. Even after the intense process of delivering your baby, your body needs time to heal.
The initial weeks may pose challenges, such as bathroom discomfort. The following tips can help you ease your discomfort:
Infection: When tearing occurs during childbirth, it can serve as a potential entry point for bacteria, increasing the risk of infections.
The exposed tissues may be more susceptible to harmful microorganisms, and if not managed properly, this can result in various infections.
Stool Incontinence: Stool incontinence, or the inability to control bowel movements, can be a potential complication arising from tearing during childbirth.
Severe tears, especially those involving the anal sphincter, may impact the muscle’s function, leading to difficulties in controlling bowel movements.
This condition can significantly affect a person’s quality of life and daily activities. Contact your healthcare provider if you experience stool incontinence.
Gas Incontinence: Gas incontinence, or the inability to control the release of gas, can be a potential complication resulting from tearing during childbirth.
Severe tears, particularly those involving the anal sphincter, may affect the muscle’s ability to maintain control over gas passage. Contact your healthcare provider if you experience stool incontinence.
Avoidance of Sexual Activity Due to Pain: Sexual inactivity due to pain can be a significant consequence of tearing during childbirth, particularly if there is discomfort or pain in the perineal area.
The fear of pain or lingering discomfort may lead to a temporary avoidance of sexual activity.
Pain and Sorenesses: Pain and soreness are common experiences following tearing during childbirth. The extent of pain and soreness can vary based on the severity of the tear.
Effective postpartum care involves addressing and managing this discomfort through pain relief measures, recommended exercises, and proper healing support.
While it’s not always possible to prevent tearing during childbirth, some strategies may reduce the risk or severity of tears, such as:
Perineal massage involves gently stretching and massaging the perineum, the area between the vaginal opening and anus.
This practice, when done in the weeks before childbirth, helps to reduce tension and increase elasticity, potentially lowering the risk of tearing during delivery.
During the pushing stage of labour, utilizing warm compresses on the perineum can be beneficial. This practice aims to enhance tissue elasticity, potentially reducing the risk of tearing.
The warmth helps relax the perineal muscles, making them more pliable and accommodating during childbirth. Healthcare providers often use this technique to comfort and support the perineal area.
Adhere to the advice from your healthcare provider regarding controlled pushing during delivery.
This guidance is intended to minimize the risk of extensive tearing, ensuring a more controlled and careful approach to childbirth.
During childbirth, trying different birthing positions like hands and knees or side-lying can be beneficial. These positions have the potential to minimize pressure on the perineum—the area between the vagina and anus.
Different positions can impact pressure distribution during delivery, potentially lowering the risk of extensive tearing.
A water birth involves giving birth in a birthing pool or tub filled with warm water. The buoyancy of the water provides support and may reduce pressure on the perineum—the area between the vagina and anus.
This can create a more comfortable and less stressful environment during childbirth. The warm water helps to relax the perineal muscles, potentially lowering the risk of tearing.
Pelvic floor exercises involve contracting and relaxing the muscles that make up the pelvic floor. When done during pregnancy, these exercises specifically target the muscles supporting the perineum—the area between the vaginal opening and the anus.
Strengthening these muscles can enhance tone and flexibility, potentially reducing the risk of tearing during childbirth.
Perineal massage involves gently stretching and massaging the perineum, the area between the vaginal opening and anus.
This practice, when done in the weeks before childbirth, helps to reduce tension and increase elasticity, potentially lowering the risk of tearing during delivery.
During the pushing stage of labour, utilizing warm compresses on the perineum can be beneficial. This practice aims to enhance tissue elasticity, potentially reducing the risk of tearing.
The warmth helps relax the perineal muscles, making them more pliable and accommodating during childbirth. Healthcare providers often use this technique to comfort and support the perineal area.
Adhere to the advice from your healthcare provider regarding controlled pushing during delivery.
This guidance is intended to minimize the risk of extensive tearing, ensuring a more controlled and careful approach to childbirth.
During childbirth, trying different birthing positions like hands and knees or side-lying can be beneficial. These positions have the potential to minimize pressure on the perineum—the area between the vagina and anus.
Different positions can impact pressure distribution during delivery, potentially lowering the risk of extensive tearing.
A water birth involves giving birth in a birthing pool or tub filled with warm water. The buoyancy of the water provides support and may reduce pressure on the perineum—the area between the vagina and anus.
This can create a more comfortable and less stressful environment during childbirth. The warm water helps to relax the perineal muscles, potentially lowering the risk of tearing.
Pelvic floor exercises involve contracting and relaxing the muscles that make up the pelvic floor.
When done during pregnancy, these exercises specifically target the muscles supporting the perineum—the area between the vaginal opening and the anus.
Strengthening these muscles can enhance tone and flexibility, potentially reducing the risk of tearing during childbirth.
The most common tear during childbirth is a second-degree tear, affecting both the outer skin layer around the vaginal and some perineal muscles.
This type is more frequent, requiring stitches for healing. Only a few people experience third- or fourth-degree tears, which are less common but involve more extensive damage, reaching the anal sphincter muscles and rectum in the case of fourth-degree tears.
Regardless of the tear type, proper medical care is essential for recovery.
The healing time for a vaginal tear can vary based on the severity of the tear. Generally, first and second-degree tears may take a few weeks to heal.
Third-degree tears, involving more extensive damage, may require several weeks, and fourth-degree tears, being the most severe, may take longer to heal.
In many cases, having a previous vaginal tear doesn’t necessarily prevent you from having a vaginal birth in the future. However, discussing your situation with your healthcare provider is essential.
They can assess the severity of the previous tear, its healing, and other factors to provide personalized guidance.
The decision between tearing naturally and having an episiotomy (a deliberate cut) during delivery is typically based on individual circumstances. Generally, healthcare providers prefer to allow natural tearing when possible, as it is believed that tears may heal more easily than incisions.
However, there are instances where episiotomies are performed, such as in emergencies or to facilitate a quicker delivery. The choice depends on various factors, and healthcare providers will consider what is best for the mother and baby in each situation.
Experiencing tearing during your first childbirth doesn’t guarantee that you’ll tear in future deliveries. Individuals often tend to experience less tearing with each subsequent childbirth.
Studies suggest that the likelihood of having another severe tear (third- or fourth-degree) is typically less than 3%. It’s advisable to communicate your concerns about tearing with your healthcare provider during your pregnancy care to address any specific considerations or preventive measures.
A perineal tear occurs naturally when the tissues around the vaginal opening stretch or tear during childbirth. On the other hand, an episiotomy is a deliberate surgical cut made by a healthcare provider to widen the vaginal opening during childbirth.
While both involve the perineum, a perineal tear is a spontaneous event, and an episiotomy is an intentional incision made by a healthcare professional.
The most common tear during childbirth is a second-degree tear, affecting both the outer skin layer around the vaginal and some perineal muscles.
This type is more frequent, requiring stitches for healing. Only a few people experience third- or fourth-degree tears, which are less common but involve more extensive damage, reaching the anal sphincter muscles and rectum in the case of fourth-degree tears.
Regardless of the tear type, proper medical care is essential for recovery.
The healing time for a vaginal tear can vary based on the severity of the tear. Generally, first and second-degree tears may take a few weeks to heal.
Third-degree tears, involving more extensive damage, may require several weeks, and fourth-degree tears, being the most severe, may take longer to heal.
In many cases, having a previous vaginal tear doesn’t necessarily prevent you from having a vaginal birth in the future. However, discussing your situation with your healthcare provider is essential.
They can assess the severity of the previous tear, its healing, and other factors to provide personalized guidance.
The decision between tearing naturally and having an episiotomy (a deliberate cut) during delivery is typically based on individual circumstances.
Generally, healthcare providers prefer to allow natural tearing when possible, as it is believed that tears may heal more easily than incisions. However, there are instances where episiotomies are performed, such as in emergencies or to facilitate a quicker delivery.
The choice depends on various factors, and healthcare providers will consider what is best for the mother and baby in each situation.
Experiencing tearing during your first childbirth doesn’t guarantee that you’ll tear in future deliveries.
Individuals often tend to experience less tearing with each subsequent childbirth. Studies suggest that the likelihood of having another severe tear (third- or fourth-degree) is typically less than 3%.
It’s advisable to communicate your concerns about tearing with your healthcare provider during your pregnancy care to address any specific considerations or preventive measures.
A perineal tear occurs naturally when the tissues around the vaginal opening stretch or tear during childbirth.
On the other hand, an episiotomy is a deliberate surgical cut made by a healthcare provider to widen the vaginal opening during childbirth.
While both involve the perineum, a perineal tear is a spontaneous event, and an episiotomy is an intentional incision made by a healthcare professional.
1. Cleveland Clinic. Vaginal Tears During Birth.
2. Eason, E., Labrecque, M., Marcoux, S. and Mondor, M., 2002. Anal incontinence after childbirth. Cmaj, 166(3), pp.326-330.
3. Gommesen, D., Nohr, E.A., Drue, H.C., Qvist, N. and Rasch, V., 2019. Obstetric perineal tears: risk factors, wound infection and dehiscence: a prospective cohort study. Archives of gynecology and obstetrics, 300, pp.67-77.
4. Hornemann, A., Kamischke, A., Luedders, D.W., Beyer, D.A., Diedrich, K. and Bohlmann, M.K., 2010. Advanced age is a risk factor for higher grade perineal lacerations during delivery in nulliparous women. Archives of gynecology and obstetrics, 281, pp.59-64.
5. Jansson, M.H., Franzén, K., Hiyoshi, A., Tegerstedt, G., Dahlgren, H. and Nilsson, K., 2020. Risk factors for perineal and vaginal tears in primiparous women–the prospective POPRACT-cohort study. BMC pregnancy and childbirth, 20(1), pp.1-14.
6. McGee, K., The Body in Birth-Seven Ways to Prevent Tearing During Childbirth (A Series).
7. NHS. Episiotomy and Perineal tears
8. Simic, M., Cnattingius, S., Petersson, G., Sandström, A. and Stephansson, O., 2017. Duration of second stage of labor and instrumental delivery as risk factors for severe perineal lacerations: population-based study. BMC pregnancy and childbirth, 17(1), pp.1-8.
© Mindsmaking 2024
