Vaginal Tearing in Birth
“It happens.” Claudia’s co-worker stated matter of factly. “In FACT!” she continued, “My sister’s friend had to have surgery after HER delivery because the tear was SO unimaginable.” McKayla finished, and stuffed a fork full of salad mixture into her mouth. Claudia was just weeks away from her estimated due date, and was finding herself suddenly eager to learn all.the.things. “There’s just SO much information out there.” Claudia sighed. She had heard of vaginal tearing during birth, and didn’t quite understand the magnitude in which it could occur. Her labor doulas had educated that for many birthers some level of vaginal tearing is common during a vaginal birth. But WHY? And HOW could she be an exception to this common occurrence.
Why We Tear
The body is made to give birth, so why does our body tear during birth? The perineum is the space between the vagina and the anus. This space is where tearing is most affected. As the baby’s head descends from the birth canal and into the world, vaginas are opened at 10cm. This 10 centimeters of space can be trying for the perineum if the perineum has not been given tender loving care throughout the pregnancy to promote elasticity.
First Degree. A first degree tear is a small tear involving the first layer of tissue in the perineum. Sutures may be given, which dissolve in the days/weeks postpartum.
Second degree. A second degree tear is the most common form of tears and involves a deeper tear into the tissues of the perineum and the vagina. Sutures are given to help allow the body to heal in the postpartum period.
Third degree. A third degree tear includes layers of the muscle tissue and skin of the perineum. Which has also caused impact to the sphincter muscles. Which were used to bear down during childbirth and control bowel movements. Depending on the severity of the tear, sutures or surgery will be utilized to aid in the postpartum recovery.
Fourth degree. Fourth degree tears are the most intensive form of tear. These tears are the least common, however severely impact post-birth recovery. In a fourth degree tearing, the skin, muscle tissue, perineum and the retum are all involved. Surgical repair is the most utilized repair method.
Preventative Measures Against Vaginal Tearing
There’s no definite concrete way to prevent a vaginal tearing. Sometimes the baby’s head is bigger than the natural size of the vagiana, and sometimes the vagina isn’t as stretchable as needed for the baby to pass through. With that said, there are ways to prep the perineum for birth and passing of a baby to decrease the instance of this occurrence:
- Prepare to push. During the second stage of labor, the pushing stage, aim for more controlled and less expulsive pushing. Pushing the baby out gently and slowly can allow your tissue time to stretch and give way for the baby. Your health care provider will offer guidance.
- Keep your perineum warm. Placing a warm cloth on the perineum during the second stage of labor might help.
- Perineal massage. During the second stage of labor, your health care provider might place two fingers of a lubricated gloved hand just inside your vagina and move them from side to side, exerting mild, downward pressure. Your health care provider might also recommend perineal massage at home at the end of your third trimester, before the start of labor. You can do this yourself or with the help of your partner.
- Deliver in an upright, non-flat position. There are a number of delivery positions that might reduce the risk of a vaginal tear during childbirth. Rather than lying down flat during delivery, deliver in an upright position. Your health care provider will help you find a comfortable and safe delivery position.
(credit: Mayo Clinic)
Additionally, if the idea of a vaginal tear is frightening, an alternative to allowing the perineum to tear naturally is to have an episiotomy. An episiotomy is a procedure conducted by a medical provider that widens the vagina opening with the use of tools in the form of scissors to make an incision in the perineum. This provides more space for the passing of the baby.
Talk with your provider and doula for ways to help soothe the perineum, prepare the perineum, and prevent the perineum from tearing long before presented with the possibility.
Recovering from a Vaginal Tear
What happens if you have a vaginal tear and are looking for some recovery? The length and methods for recovering from a vaginal tear can be dependent on some factors such as: degree of tear, physical capability, and lifestyle. Soothing and comforting the perineum in recovery from a vaginal tear can consist of:
- Stool softeners to aid in the ability to have a bowel movement comfortably
- Peri-bottle. This little squirt bottle is designed for perineum discomforts. By filling with warm water and using before and/or after going to the restroom, to clean the area, or to add relief to the perineum. You can fill it with warm water and natural healing herbs for a holistic healing experience.
- Pat to dry after using the restroom, don’t wipe. This is to prevent more tearing or irritation to the very sensitive area.
When to call your provider
It goes without saying that once you have chosen your provider to care over you and the baby for your prenatal, birth, and postpartum care, they work for you. Therefore communication is important throughout your relationship. Reaching out to your provider when the healing process is not progressing as explained by them. Reach out when there are questions regarding what’s normal and what’s outside of the scope of normal. Some red flags to look for in recovery from a vaginal tear:
- Fever. This is your body fighting off an infection
- Foul odor or discharge. Reminiscences from birth (retained placenta, unnoticed internal trauma, foreign objects, etc) can impact recovery and be an indication of a larger issue
- Pain or stitches that do not gradually cease as recovery continues. The healing process will take 4-6 weeks for stitches to dissolve or discomforts from the site to feel “normal” again. If this is NOT the case, contact your provider immediately.
Claudia was terrified of the thought of vaginal tearing during the birth of her baby. She weighed the idea of electing to have a cesarean birth. Her body had been through so much in her 38 years of life already. As she looked through ways to prepare her temple for the ultimate sacrifice, she prayed that the next two weeks would allow her body to prepare for the birth of her wishes and desires.