More than 50% of women who give birth via vaginal delivery, as well as those who experience long labor before a C-section, sustain vaginal or perineal tears. Some tears are mild and heal quickly while others require more care and attention.
To understand more about the different types of vaginal tears during childbirth, how they can be prevented, and how you can ease discomfort during recovery, read on.
What Is a Vaginal Tear?
A vaginal tear is described as a split in the skin and/or muscles of the area located between the vagina and the anus. Because this area is medically referred to as the perineum, vaginal tears are also known as perineal lacerations.
Are There Different Types of Vaginal Tears?
Yes. Gynecologists and obstetricians categorize vaginal tears that happen during labor and childbirth into four categories - with one being the mildest and four being the most severe.
First Degree Tear
A first-degree vaginal tear, although sore, is typically considered a minor injury because it only splits the skin of the vaginal wall, not the muscles. Stitches are rarely required, the tear usually heals quickly and complications are rare.
Second Degree Tear
A second-degree tear ruptures the skin and muscle of the perineum and sometimes the tear extends into the vagina. These types of tears are quite painful and normally require stitches, however, patients are usually prescribed medication to manage the pain, the stitches dissolve on their own within a few weeks, and long-term problems are rare.
Third Degree Tear
A third-degree vaginal tear typically extends from the vagina to the sphincter muscle. Although they might occasionally require surgery, the majority of third-degree tears are repaired with stitches in the delivery room and heal within two to three months.
Additional symptoms can include temporary fecal and bladder incontinence or pain during sex, but if symptoms continue after three months, it’s best to speak with a doctor.
Fourth Degree Tear
A fourth-degree vaginal tear, although very rare, splits through the anal sphincter muscle and continues into the lining of the rectum. Surgery is necessary to stitch this type of laceration and complete recovery can take up to three months.
Additional symptoms can include temporary fecal and bladder incontinence or pain during sex, and once again, if symptoms continue after three months, it’s best to speak with your doctor.
Statistics show that 90% of women who give birth for the first time experience minor perineal lacerations during delivery, such as a first or second-degree tear. Whereas third or fourth-degree tears are known to occur in 60% of first-time deliveries but in only 2% of women who have previously given birth vaginally.
Why Do Vaginal Tears Happen During Childbirth?
Although women’s bodies are naturally designed for childbirth, and many amazing physical changes happen to help deliver the baby, several factors during labor can increase the risk of vaginal tearing.
If for some reason, the vaginal walls have not adequately thinned and stretched, for example, the birth canal is smaller and the baby’s exit can result in a vaginal tear or perineal laceration.
Obstetricians and midwives generally attribute the following factors to vaginal tears or perineal lacerations:
It’s your first-time giving birth. Over 90% of women giving birth for the first time incur vaginal tears because the perineal tissue is not as flexible as women who have given birth before.
It all happens very quickly. When labor happens fast, the vaginal walls don’t have adequate time to thin and stretch, thus resulting in tears as the baby is pushed out.
The baby is a big one. According to statistics, babies weighing more than eight pounds are more likely to cause a perineal laceration.
The baby is facing up. When coming through the birth canal, babies that are facing up usually need to tuck their head and neck beneath the pubic bone, which tends to put more pressure on the bottom of the vagina and increases the risk of vaginal tearing.
When forceps or vacuum are required. If your baby is tired, in distress, in a difficult position, or their heart rate is dropping, your midwife or obstetrician might decide to give you some help in the form of forceps or vacuums to guide the baby out. While these practices are perfectly safe, they are known to contribute to vaginal tearing.
You’ve had an episiotomy. Performed by an obstetrician or midwife, an episiotomy is a deliberate incision between the vagina and the anus to open the vagina and speed up delivery. Although rarely performed these days, episiotomies are sometimes necessary and can unfortunately lead to fourth-degree perineal tears.
How Are Vaginal Tears During Childbirth Repaired?
Tears that measure longer than an inch, like second, third, and fourth-degree lacerations, typically require stitches, whereas a first-degree tear normally heals on its own without any repairing. Depending on the severity of the tear, stitches are either administered straight away in the delivery room or later under anaesthetic in surgery.
Obstetricians also prescribe pain medication, and sometimes antibiotics to prevent infections, that are safe to take while breastfeeding. Tips for healing and recovery after a vaginal tear are also usually provided by your doctor.
Tips For Recovering from Vaginal Tears During Childbirth
As previously mentioned, some vaginal tears will heal quickly within two to three weeks and others need more care and attention. If you had stitches they will dissolve on their own, but the majority of women can expect the site of the tear to be sore for a few months.
That said, there are some helpful tips for postpartum perineal care that will not only help your tear to heal more quickly, but also keep you comfortable and infections at bay. The following are the most highly recommended tips from obstetricians and midwives.
How To Ease the Pain of Vaginal Tears
To manage pain associated with vaginal tears during delivery, avoid any strenuous activities for at least a few weeks and often longer, and make yourself comfortable when sitting by using a donut cushion.
Try to sleep on your side with a soft cushion between your knees for support and don’t sit or stand for too long to prevent extra strain on the perineum.
In addition to pain medication and antibiotics that are safe while breastfeeding, obstetricians will often recommend an over-the-counter anaesthetic ointment or spray to numb the area for the first few days. Don’t be nervous about using these, they will ease your pain.
Throughout the day, alternate with cold & heat therapy to soothe the perineal area. Ice packs will prevent swelling and warm compresses, or a warm sitz bath for up to 20 minutes, are recommended to relax torn tissues and increase blood flow to the area for faster healing.
How To Heal a Vaginal Tear Faster
Do your best not to touch the wound or stitches during recovery. It can be a strange sensation to have a wound in the perineum, however, if you keep touching it to check on how it’s healing, you could spread bacteria from your hands to the wound site, cause an infection, and prolong your healing process.
After delivery, change your sanitary pads every four to six hours over the following weeks. In addition, expose the perineum to the air for a few minutes between each sanitary pad change to help with healing.
When peeing while sitting, the direction of outflowing urine can sting your perineal wound, however, many women have reported that squatting while urinating significantly reduces the stinging sensation.
Instead of wiping with toilet paper after urinating, which could be painful and irritate your stitches, use a spray bottle to squirt warm water on the area and wash away any lingering urine.
When drying after a shower or sitz bath, gently pat the area dry with non-scented sanitary pads or gauze pads that have been approved by your doctor.
Bowel Movements & Urinating Tips After Vaginal Tear
To help with bowel movements, consider your postpartum diet. Hydrate with at least one or two liters of water per day and eat plenty of fruit and vegetables as well as fiber and whole grains.
In the case that your bowels do not move within a few days of childbirth, speak with your doctor about an over-the-counter laxative or stool softener to help you on your way.
Instead of using toilet paper after a bowel movement, use medicated pads or baby wipes to gently clean the area from front to back.
Rebuilding Strength & Confidence After Vaginal Tear
Following a vaginal tear during childbirth, kegel exercises are highly recommended as soon as you feel able. A kegel is an intentional squeeze, lift and hold of the pelvic floor muscles, usually done in repetitive intervals, and practicing them regularly will not only help you to heal quicker they will also help to rebuild your confidence.
After you have fully healed and are no longer experiencing pain (often after the three-six month mark) many female health experts advise adding kegel weights, for up to 15 minutes per day, for the perfect amount of resistance training to rebuild torn tissues and prevent future bladder leakages.
Although they can be bought in individual sizes, for best results, experts recommend purchasing Kegel weights in a set of ascending weights and sizes so you can gradually re-strengthen the muscles and track your progress. Here at Intimate Rose, we’ve taken great care to produce the most comfortable and smoothest medical-grade silicone kegel weights on the market in a set of six ascending sizes and weights.
How To Prevent Vaginal Tears During Childbirth
While there is no guarantee that vaginal tears will not occur during childbirth, certain practices in the last trimester of pregnancy, as well as during labor, are believed to soften the perineal tissues and encourage the vaginal walls to gradually stretch for a smoother delivery. These include:
- Regularly massaging the perineum (the area between the vagina and anus) with a non-synthetic oil during the last trimester.
- Laying a warm compress on the perineum between contractions during labor, as well as massaging the area, can help to avoid vaginal tears.
- Using breathing exercises during labor helps to keep expectant moms’ minds and bodies relaxed. This allows the vaginal skin the time it needs to thin and stretch, meaning less pressure on the perineum as the baby emerges through the birth canal.
- Some birth experts advise that giving birth in an upright position, or on all fours, can minimize the likelihood of vaginal tears during delivery. However, the same experts note that these positions might not be comfortable for every woman, and encourage all expectant mothers to work with their midwife to find the most comfortable delivery position.
While vaginal tears or perineal lacerations during childbirth are common for the majority of first-time mothers, the good news is they are significantly less prevalent for women who have previously given birth.
Although uncomfortable for a few weeks, or months, depending on the severity of the tear, healing can be accelerated by following the above-mentioned care tips and advice.
Should you experience a high fever after a vaginal tear, extreme pain that does not subside with pain medication, a red or inflamed wound, or an unpleasant vaginal odor, contact your doctor about treatment for a possible infection.
What To Expect – Vaginal & Perineal Tears During Childbirth - https://www.whattoexpect.com/first-year/perineal-tears/
Mayo Clinic - Vaginal Tears In Childbirth - https://www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/multimedia/vaginal-tears/sls-20077129?s=1
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/
Mayo Clinic – Post Partum Care – What To Expect After a Vaginal Birth - https://www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/in-depth/postpartum-care/art-20047233
What To Expect - Post Partum Bowel Movements - https://www.whattoexpect.com/first-year/postpartum-health-and-care/postpartum-bowel-movements/
National Library of Medicine – Antenatal Perineal Massage for Reducing Perineal Trauma - https://pubmed.ncbi.nlm.nih.gov/23633325/