Perineal Tears: Your Guide to Understanding, Preventing, & Healing

Perineal tears seem to be what everyone’s worst birthing nightmares are made of. I am here to tell you that although unwanted, they are not as terrible as they sound. Typically, one will not feel the initial tear because of what is happening the moment the tear occurs. With your baby’s moving down and out, there is so much going on in your vagina that a tear will likely not be what you are noticing. 

The 4 Degrees of Tearing

Tears are pretty common. About 90% of all people who give birth will have at least some type of perineal laceration. There are four different degrees of tearing that a care provider will use as a grade when defining a laceration. They are as such:

First-Degree Tears

First-degree tears are the least severe of the types of tears and only involve the first layer of skin around the vagina and perineal tissue. These lacerations do not typically require suturing and can commonly heal independently with rest and icing.

Second-Degree Tears

Second-degree tears are the next most severe and the most common. This type of laceration is slightly bigger and extends deeper into the skin and muscles of the vagina and perineum. This type of tear requires sutures.

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Third-Degree Tears

The third-degree tear is one that extends from the vagina to the anal sphincter, so when you hear someone say, “I tore end to end,” this is usually what they are talking about. This type of laceration will involve the skin and muscles of your vagina, perineum, and anal sphincter and must be sutured by a surgeon.

Fourth-Degree Tears

Lastly is a fourth-degree tear. This type of tear is the least common and most extensive, it extends from the vagina into the rectum, and in many cases, the repair for this type of suturing is done in the operating room. Though these last two types of tears sound terrifying, the good news is that they only happen about 5% of the time.

How to Prevent Tearing

Sometimes, it is possible to prevent tearing. The most common ways I see prevention of tearing occurring are avoiding an upright or wholly laid back position for pushing, avoiding an epidural or lessening your epidural for pushing, having a warm compress on your perineum during pushing, once crowning, slowing your pushing down and panting your baby out, and asking for counter pressure on your baby’s head during pushing to slow their exit. These are not guaranteed methods for avoiding tearing completely, but they will likely lessen the degree to which you tear.

Who Has a Higher Risk for Tearing?

Some aspects can put you at a higher risk for tearing. Some of these include it being your first delivery, the baby being “sunny-side up” for delivery, the use of surgical equipment for birth including vacuum and forceps birth, a baby more than 8lbs, a prolonged pushing stage of labor, Asian ethnicity, epidural anesthesia, and a solid pelvic floor from dancing, gymnastics, or heavy lifting.

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How to Treat Tears

Tears can be treated at home, even for the most extensive of tears. This treatment looks like a lot of rest, especially if you have one of the greater degrees of tearing or a first degree you chose not to have sutured. To clean yourself after you use the restroom, use a peri-bottle rather than toilet paper; if you must use toilet paper, pat rather than wipe. Swelling is a common complaint, so using ice packs can relieve stress. Avoid constipation by taking a stool softener and extra Magnesium and Fiber. Witch Hazel on pads or in an herbal sitz bath can help heal the trauma to your tissues. You can use over-the-counter painkillers as well as a numbing spray like Dermaplast to help with pain relief. And remember, rest, rest, rest.

When to Contact Your Doctor

If you notice an uptick of your bleeding, a foul odor with your discharge, a fever, or pain that is not going away, it is a good idea to contact your care provider. Infections can happen, and getting them looked at and taken care of quickly will lessen discomfort and harm.

Though tearing is not a fun experience, it is a good reminder for you to rest and heal. Take the laceration’s reminders seriously for the best possible healing during postpartum and the least amount of complications after tearing. Seeing a pelvic floor specialist is an excellent idea once you are healed and at least six weeks postpartum. These doctors can help strengthen your pelvic floor and provide guidance for any complications you may be encountering after a tear.

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