Vaginal Birth Tears
There are several types of tears that could occur during vaginal birth. It’s important to note that tears cannot be completely avoided, as a baby’s position may play a huge role in whether or not you tear, or a birth emergency may require a pushing intervention to support vaginal delivery which can increase the risk of tearing.
The different types of tears you can potentially have could include:
Perineal Tears
Labial Lacerations
Cervical Lacerations
Vaginal Wall or Internal Tears
Clitoral Tears
Urethral Tears
Perineal Tears
These are tears in the tissue and muscles located between the vaginal opening and anus. There are 4 different degrees of a tear and each has their own healing and rehab timeline!
First Degree and Second Degree Tears are the most common, occurring to ~94% of people who have a tear.
First Degree
First Degree is a tear into the superficial skin of the perineum. No muscle involvement. This kind of tear may or may not need to be repaired at all for some! If a repair is needed it’s done at the bedside. The healing timeline for these is around a week, maybe less for some.
Second Degree
Second degree is a tear into the skin and the perineal muscle. The repair is done for these at the bedside. The healing timeline for these tears is between 1-3 weeks depending on how deep the tear was into the muscle.
Third and Fourth Degree
Third and Fourth-degree tears are not commonly seen! These occur in ~6% tears.
Third-degree is when the tear involves the skin, perineal muscles, and part of the anal sphincter. The repair is done at the bedside sometimes but can require transfer to an OR for a better repair of the tissues. This recovery timeline can take at least a month but may be longer depending on other factors.
The fourth degree is a tear through the skin, muscle, and anal sphincter going into the rectal mucosa. This repair is usually done in the OR because of the number of layers involved and the lighting and tools available are better in an OR. The healing timeline for these can take several months to fully heal and rehab is important!
We think everyone should see a pelvic floor PT after any birth but ESPECIALLY for those who had a 3rd and 4th-degree tear.
Labial Tears
Labial Tears are tears into the labial tissue. These are the tissue folds that are around the vaginal opening. They begin at the clitoral hood and extend down towards the perineum. They can be one-sided tears or can be bilateral (on both sides). There are usually repaired at the bedside.
Cervix Lacerations
Cervical lacerations are tears on the cervix, these are usually found when there is a ton of bleeding after the baby is born. The cervix is very vascular so when injured it can cause a lot of bleeding. These are usually caused by pushing before the cervix is completely gone or dilated. These can be repaired at the bedside but depending on the extent may require going to the OR
Vaginal Wall or Internal Tears
Tears along the vaginal wall inside of the vaginal opening. These are sometimes called sulcus tears are well. These can be caused by the way the baby is positioned by a hand or elbow, or from an instrument-assisted delivery.
Clitoral Tears/Urethral Tears
These are tears that extend upward. They can happen together or just one or the other. These can be painful while they are healing because the clitoris has a lot of nerve endings and the urethra tears can be irritated more when peeing.
Sometimes they will place a Foley catheter for the first few-24 hours postpartum to aid in healing.
Abrasions
Sometimes when you have a tear, they are not true tears but more abrasions. I compare abrasions to when you fall and scrap your knee. The scrap bleeds but doesn’t require stitches or medical attention usually. The most common abrasions I have seen are labial and urethra.
Ways to try to prevent tearing!
Perineal stretching/massage prenatally starting around 34/36 weeks has been proven to decrease the occurrence of tearing. It’s more effective at reducing the more severe 3rd and 4th-degree tears.
Warm compresses during pushing or giving birth in the water. The warmth helps aid in allowing the muscles and skin to stretch easier
Pushing technique – the way you push can have an effect on tearing because prolonged pushing has higher rates of tears. We want to be effective but not so fast the tissues have no time to stretch on their own!
When crowning, push slowly to allow tissues to stretch and ease babies head out! Using panting, puff breathing or breathing like your blowing out a candle can be effective!
Know that if you tear it is not your fault! Sometimes it happens even if you do all the things above!
Learn more in our childbirth education classes. We offer our childbirth education courses in person/virtually via zoom, and online with our self-paced courses.