Scared of getting a tear down there? Why perineal tearing happens—and what you can do about it.
Let's face it: There are some, well, unsavory parts of childbirth we don't love to talk about. And one of them is an almost-certain consequence of first-time vaginal deliveries: tearing.
Are you cringing yet? We're guessing yes! Still, "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 down-there tears, so you know what to expect.
What exactly is a vaginal tear?
A vaginal tear is a spontaneous (meaning a doctor didn't make a cut) laceration to the perineum (the area between the vagina and rectum) that occurs when the baby is pushed out. "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."
What are the odds of tearing?
Unfortunately, fairly high: First-time moms have a 95 percent chance of experiencing some form of tearing during delivery, since the tissue down there is less flexible. But other factors 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 baby comes down; the position of the baby (those facing up, for example, put extra pressure on the bottom of the vagina) is another factor. 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.
What types of vaginal tears are there?
There are four degrees of tears; all can be painful, but some require several stitches and can affect your anal sphincter, too. (Try not doing an involuntary Kegel while reading that!) Luckily, the most common lacerations are not the most severe.
- First-degree tear: "The tear is just into the lining of the vagina," says Page. "While this does not involve muscle, sometimes it does require a little suturing."
- Second-degree tear: The most frequent laceration, this tear involves the vaginal lining and deeper (submucosal) tissues of the vagina and requires more stitches.
- Third-degree tear: This laceration goes into the deeper layers of the vagina and the muscles that make up the anal sphincter, says Dr. Ross. "Your doctor will need to sew each layer separately, with special attention to closing the muscle layer supporting the sphincter."
- Fourth-degree tear: This deep tear encompasses all of the above and extends right through to the rectal lining. "This is a very delicate and thorough repair that involves closing multiple layers," says Dr. Ross. "Thankfully, this is the least common tear experienced. Generally, third- and fourth-degree tears are more common when baby's shoulder gets stuck or when a vacuum or forceps are used."
What's the recovery like?
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, too. 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 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 BM, 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.) 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, no matter how embarrassing they may seem.
How can I avoid—or decrease the severity of—vaginal tearing?
During delivery, try to get into a 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 tearing 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, 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?
No! An episiotomy—an incision made in the perineum to widen the vaginal opening—is sometimes necessary, but is no longer routine during a vaginal delivery, says Dr. Ross, and may actually worsen the damage and the healing process.