Vaginal Tearing During Childbirth: What You Need to Know

There are some unsavory parts of childbirth, and one of them is an almost-certain consequence of first-time vaginal deliveries: tearing. "It's important to normalize the notion of vaginal tearing and not to fear it, because it happens so often," says Katie Page, a certified nurse-midwife in Forest, Virginia. Get the facts about vaginal tears, so you know what to expect down there before and after birth.

What is Vaginal Tearing?

A vaginal tear is a laceration to the perineum (the area between the vagina and rectum) that can occur when the baby is delivered vaginally. The tears are spontaneous, meaning a doctor didn't make a­ cut. They can occur when the pregnant person actively pushes or sometimes as a result of involuntary uterine contractions delivering the baby. "During birth, the vagina has to stretch enough to allow a baby, whose head is the size of a cantaloupe, to come through it," says Sherry Ross, M.D., an OB-GYN and women's health expert at Providence Saint John's Health Center in Santa Monica, California. "Hopefully, the vagina will stretch just enough without tearing, but often a tear does happen."

The Odds of Vaginal Tearing

Many of the studies done on vaginal tearing have been performed outside of the U.S., but according to a 2020 study in BMC Pregnancy and Childbirth, about 70% of pregnant people experience some kind of vaginal tearing during birth. First-time parents are more likely to experience tearing than those who have already delivered a baby.

Other factors also contribute to your likelihood of lacerations, such as being overweight or having a fast birth, since the tissue has less time to adapt and stretch as the baby comes down. The position of the baby can be another factor—for example, babies facing up put extra pressure on the bottom of the vagina. Having a vacuum- or forceps-assisted delivery or an especially long labor that results in severe vaginal swelling increases your chance of tearing as well.

The good news? "Typically, after your first vaginal birth, your tissue is more flexible so tearing becomes less likely," Dr. Ross says.

Vaginal Tear Symptoms and Treatment

There are four degrees of vaginal tears; all can be painful, but some require several stitches after birth. Severe tears can affect your anal sphincter, too. Follow your doctor's advice for how to heal vaginal tears after delivery.

If you experience a first- or second-degree tear, you can expect some discomfort—especially when you're sitting straight up—for a week or so. Having a bowel movement or doing anything that causes an increase of downward pressure, like coughing or sneezing, will hurt as well. By week two, the tear should be pretty well healed and the stitches will have dissolved, "but the nerves and full strength of the muscles can take several more weeks to heal," says Page. (Sex at six weeks will likely be uncomfortable, too, depending on the location of the vaginal tear and the quality of the stitching.)

Healing for third- and fourth-degree lacerations takes longer, with two to three weeks of initial pain. And discomfort during sex, or while having a bowel movement, may last for several months. Stool softeners and a diet of fiber-rich foods can help with the latter, says Page, as can cold compresses and herbal sitz baths. Stitches after birth are necessary with these types of lacerations.

Since severe tears into the vagina or rectum can cause pelvic floor dysfunction and prolapse, urinary problems, bowel movement difficulties, and discomfort during intercourse, it's important to share all of your symptoms with your doctor, because treatment is available.

Decreasing the Severity of Vaginal Tearing

To decrease the severity of vaginal tearing, try to get into a labor position that puts less pressure on your perineum and vaginal floor, like upright squatting or side-lying, Page says. Hands-and-knees and other more forward-leaning positions can reduce perineal tears, too.

It also helps if you lead the pushing phase of labor. "When Mom takes the lead, she does just enough for her to feel her baby move, which allows the vagina to stretch slowly, reducing the likelihood of tearing," says Page. On the flip side, when you're directed to push as hard as you can while someone counts, there's a lot of additional pressure on your perineum, which can increase chances of tearing.

In addition, you may reduce your odds of vaginal tears by applying a warm compress to the perineum during the pushing phase of labor, says Dr. Ross.

Finally, four to six weeks before your due date, (and providing you can reach!) you can practice a 10- to 15-minute perineal massage daily. "Frequently massaging the base of the vagina with oil or a water-based lubricant is thought to soften the tissue, making it more supple and improving its flexibility," says Page. (Always consult your doctor before beginning the practice, especially if you have a history of herpes, as practicing perineal massage with an active herpes outbreak increases the risk of the virus spreading throughout the genital tract.)

Should I Ask for an Episiotomy?

Doctors used to advise that pregnant people get episiotomies in hopes it would reduce perineal tearing and allowed for a more controlled environment that could heal properly. Now, however, an episiotomy—an incision made in the perineum to widen the vaginal opening to allow more room for the baby to pass through—is sometimes necessary, but is no longer routine during a vaginal delivery, says Dr. Ross. What's more, an episiotomy may actually worsen the damage and the healing process. Most doctors advise against an episiotomy unless there's a medical need for one.