When I talk to my clients about their concerns during pregnancy, the fear of tearing comes up often. They've heard the horror stories about this and want to know how to avoid this as much as possible. I'd be lying if I said there isn't a chance of tearing while giving birth, but I'd also be lying if I said that there's a chance you won't. Let's start out by learning what tearing is.
A vaginal or Perineal tear is a tear around the vagina and perineum (that lovely space between vagina and butt hole) When you're in the process of giving birth, the skin in that area begins to thin out. This happens so that your baby's head and body can pass through, but it sometimes leads to tearing. Around 80% of women will have some form of tearing during delivery and the tearing can vary in degrees. (There are four degrees of tearing)
The first degree tear is the least severe. This is a small injury that involves just the first layer of skin around the vagina and perineum. These tears are so small that they hardly cause any discomfort. Women who've given birth barely know that they have them. Stitches for this tear are usually not needed. You can still expect some discomfort during recovery, especially while doing things like sitting up, sneezing, coughing and pretty much anything that causes pressure "down there".
The second degree tear is the most common tear. It's slightly bigger than the first degree and tear. This tear extends deeper through the skin into the underlying muscles of the vagina and perineum, this tear does require stitches. There will be some discomfort while healing just like the first degree tear. Healing will take a few weeks and the stitches will dissolve on their own.
The third degree tear extends from the vagina to the anus. This tear involves injury to the skin and muscles of the perineum as well as the anal sphincter muscles. These are the muscles that control how you poop. You'll need stitches for this tear. Recover can take anywhere from four to six weeks. You could also have some discomfort for a bit during sex and while having a bowel movement.
The fourth degree tear is the least common. This tear extends from the vagina through your rectum. This is the most severe injury and may require surgery to place the stitches. This tear can cause chronic perineal pain, stool incontinence, pain during sex, and insomnia. Please follow up with your practitioner if you're experiencing any discomforts.
So who's most likely to tear?
Women who are pregnant with their first child
If the baby is face up instead of face down while giving birth
If forceps or a vacuum is used while giving birth
If the baby weighs more than 8 pounds
Being of Asian ethnicity
If you've had an epidural
I bet you're wondering, is there a way to prevent tearing? Well there's no way to tell if you will tear or not. However, there are things you can do to reduce the chances. Find a birthing position that puts less pressure on the perineum. I know that the number one position to give birth in is lying on your back and bearing down. But this puts a lot of pressure on the perineum. Try a position like squatting, lying on your side or positions that allow you to lean more forward.
Try to lead the pushing phase. When someone is telling you when to push and how long to push, while counting, this is putting extra pressure on the perineum, which can cause tearing. But, if you are leading this phase, and pushing when you feel the need to, this puts less pressure on the perineum reducing the chances of tearing.
What is an episiotomy? Back in the day doctors would do a routine cut between the vagina and perineum. This was done in hopes of creating more space for the baby to pass through the vagina easily. It was found that this procedure could actually cause more damage to the area and make recovery last longer. This is done vary rarely now.
If I do tear, how do I cope with the discomfort at home?
Use a cold compress or ice pack on the area
Sitz baths are useful as well. Soaking for a few minutes in warm water is helpful. Some women even use different herbs and salts to help.
Witch hazel pads bring relief
Ibuprofen can help as well.
Take stool softeners to help reduce discomfort during bowel movements
Always be sure to follow up with your practitioner if you're having any prolonged pain and discomfort.
As always sending you peace, love, and light.
Tiffany Underwood
Certified Birth and Postpartum Doula
Childbirth Educator
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