Perineal Tearing | Types of Tears | Prevention | Conclusion
Vaginal tearing during childbirth can occur in up to 9 out of 10 first-time mothers during vaginal birth. Also referred to as perineal tears, the majority are mild and heal quickly, however, others can be more severe, require stitches, and a few months to heal.
Although there is no sure way to avoid vaginal tearing, research and feedback suggest that certain steps can be taken to prepare the female body for labor and significantly reduce the risk of perineal lacerations.
Read on to learn what steps you can take before labor to prepare the vaginal and perineal muscles and how to prevent tearing during birth.
What Is Vaginal Tearing & What Does it Feel Like
Vaginal tearing during birth is described as a split or tear in the skin and/or muscles inside the vagina, on the vulva, or the perineum, which is the area between the vagina and the anus. These tears typically occur as the skin and muscles are stretched to their maximum when the baby enters the vagina.
Expectant mothers often describe the feeling as a burning sensation as the skin and muscles stretch around the baby’s head, while others report losing sensation and feeling nothing at all due to the immense contraction of the muscles.
If it becomes clear that the vaginal skin and perineal muscles will not stretch any further, your healthcare provider or midwife may decide to perform an episiotomy to help with the birthing process.
Different Types of Vaginal Tears
Gynecologists and obstetricians categorize vaginal tears, or perineal lacerations during birth into four types – with a first-degree vaginal tear being the mildest and a fourth-degree vaginal tear being the most severe.
Although painful, a first-degree vaginal tear is considered minor, in that it only ruptures the skin of the vaginal wall and not the muscles. A second-degree tear is usually more painful because it splits the skin and muscles of the perineum and often extends into the vagina.
Both types are known to heal quickly, however, can be managed with pain medication, and only the second-degree tears require stitches.
Third-degree vaginal tears, on the other hand, extend from the vagina to the sphincter muscles, while fourth-degree tears continue into the rectal lining. Both types are considered severe, require stitches, can cause pain during bathroom visits and temporary incontinence, and take up to three months to heal.
Statistically, 90% of first-time mothers are known to experience minor perineal lacerations during delivery, such as first or second-degree tears, however, the percentage during subsequent births is significantly lower.
And while 60% of first-time mothers experience third or fourth-degree tears, it is known to occur in only 2% of women who have already given birth.
How to Prevent Tearing During Birth
To prevent tearing during birth, female health experts first and foremost recommend preparing your vaginal and perineal muscles for labor a few weeks in advance. Once in labor, your birthing position, along with when and how you push are also important factors to consider when preventing vaginal tearing.
Perineal Massage from 36 Weeks
One of the most effective ways to reduce severe vaginal tearing and prevent minor tearing during childbirth is to prepare the vaginal and perineal muscles to over-stretch in advance.
In fact, research has shown that women who routinely massage the perineum (the area between the vagina and the anus) from 36 weeks onward are 24% more likely to experience no tears during childbirth, particularly first-time mothers.
A perineal massage involves using the fingers and thumbs to massage the area between the vagina and the anus. To ensure you are performing the massage correctly, ask your healthcare practitioner or obstetrician for guidelines and always use lubrication.
Given the ever-expanding pregnancy belly during the last trimester, it can admittedly be challenging for many expectant mothers to reach the perineum, however, certain positions can make it easier.
These include:
- Standing with an elevated foot on the side of a bed, stool, or bathtub, it can be easier to reach the perineum around the belly or under the raised leg
- Sitting on your bed with the legs open and relaxed, it can be easier to approach the perineum by reaching the arms under the legs
- Half Kneeling is similar to standing with an elevated foot, but one knee remains on the floor and the other bends to a right angle to allow easier access to the perineum around the belly or under the raised leg
If it is proving uncomfortable or too difficult to reach the perineum during the third trimester, female health experts recommend using a vaginal dilator or pelvic wand, like these from Intimate Rose, to help with perineal massage.
Both are made from medical-grade, body-safe silicone that feels smooth and comfortable in the body and will not harm your baby.
Although vaginal dilators and pelvic wands are recommended for at-home use, it is recommended that you first receive guidance from your healthcare practitioner, pelvic floor physical therapist, or obstetrician to understand the correct way to use them for perineum massage.
When & How to Push
When it comes to the pushing stage, in the second phase of labor, preparing yourself to push your baby out in a more controlled way can significantly reduce the risk of vaginal tearing.
Using deep, conscious, and rhythmic breathing, for example, can help to push the baby out slowly and gently, thereby giving the perineum muscles and tissues more time to adequately stretch for a smoother delivery.
Speak with your doula, midwife, or healthcare practitioner about your intentions and birthing plan to ensure they encourage you to push with more control when the time comes.
Warming the Perineum
Research has shown that a warm compress on any part of the body helps blood vessels in that area to open and increase blood flow. This increased blood flow improves the elasticity and flexibility of tissues, allowing muscles to stretch more than they normally would.
During the second stage of labor, placing a warm compress on the perineum has been proven to increase blood flow to that area, thereby helping the muscles and skin tissues to stretch more easily.
Delivery Position
Delivering your baby in particular positions will also help to reduce and prevent vaginal tearing by exuding less pressure on your perineum. For example, upright positions like squatting, leaning forward, or laying on your side - as opposed to lying flat on your back – are known to significantly reduce the risk of perineal tears or lacerations.
To decide which position will suit you best when the time comes, practice some different upright positions with your midwife, birthing partner, or doula in advance.
Perineal Massage
Don’t be embarrassed to discuss receiving a perineal massage from your healthcare practitioner or birthing partner during the second stage of labor. Some gentle downward pressure on the skin and muscles of the inner vagina during this stage of labor can encourage the tissues to relax and stretch just that little bit extra, thereby preventing any form of tearing.
Conclusion
Even though there is no guaranteed way of preventing tearing during birth, regular perineum massages from week 36 onward are known to substantially reduce the risk of vaginal tears. Agreeing on a birthing plan that includes particular delivery positions and perineal care during labor is also incredibly helpful.
Should you decide to use a vaginal dilator or pelvic wand for pre-labor perineal massage, seek guidance from your healthcare practitioner or physical therapist first, to ensure you’re using them correctly and getting the most effective results.
References
Healthline – What to Expect During a Vaginal Delivery - https://www.healthline.com/health/pregnancy/intrapartum-care-vaginal-delivery#labor-and-delivery
What To Expect – Vaginal & Perineal Tears During Childbirth - https://www.whattoexpect.com/first-year/perineal-tears/
American College of Obstetricians and Gynecologists – New Guidance to Prevent Vaginal Tearing During Delivery - https://www.medpagetoday.com/obgyn/pregnancy/58745
National Library of Medicine - A Review and Comparison of Common Maternal Positions During the Second Stage of Labor - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6839002/
My Expert Midwife - Warm perineal compress in labor - protecting your perineum - https://myexpertmidwife.com/blogs/my-expert-midwife/warm-perineal-compress-in-labour-protecting-your-perineum
Cochrane Library - Perineal techniques during the second stage of labor for reducing perineal trauma - https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006672.pub3/full