It is estimated that 53 to 79% of women will experience a perineal vaginal laceration during childbirth. In most cases, these injuries are classified as first- or second-degree lacerations. Most women if not all, want to know if there are ways they can prevent vaginal tearing during childbirth.
Tearing during delivery is a very common concern, and it’s completely understandable. It is very important to take care of your vagina and pelvic floor.
It is important to understand that there are different kinds of tears during birth. In most cases, tears occur on the perineum, the skin, and the muscle between the vaginal opening and the anus.
It is common for tears to occur in the vagina and extend into the perineal body or between the vagina and the anus. It is also possible to experience tears elsewhere. Some tears are directed toward the labia, the clitoris, or the urethra, but these aren’t as common.
Common Cause of Vaginal Tearing During Childbirth
Having your first baby, or having your doctor use forceps or a vacuum to deliver your baby, will put you at higher risk for a severe tear, like a 3rd or 4th-degree tear. First-time moms, big babies, and women whose doctors use instruments during delivery are at risk of experiencing severe tears, but it’s not guaranteed.
Types of Vaginal Tears
Most women experience first-degree tears within their vaginal tissue. It’s also common for them to experience second-degree tears within their perineal muscles.
A third- and fourth-degree tear is more involved and affects the anal sphincter muscle to a certain degree. During a 4th-degree tear, there’s no distinction between the rectum and the vagina, so there’s going to be a lot of repair work involved and things have to be put back together like they were before pregnancy. Knowing exactly where the tear was and where the stitches were placed is crucial.
1. The most common tears are those of the first- degree.
There are usually no stitches needed for a first-degree tear because it is shallow and just below the skin. Most first-degree tears don’t need to be repaired,
2. The second-degree Tear
There is a tear on the skin which extends a bit into the perineum and some vaginal muscle. As far as subsequent births are concerned, these tears generally heal well and do not really pose an increased risk of more severe tearing.
3. A Third-degree Tear
This means that there has been extensive damage to the skin and muscles of the perineum, all the way up the anus and almost into the anal sphincter, which controls bowel movements.
4. Fourth-degree Tears
If you incur a third or fourth tear, stitches will be required and rehab is typically required afterward. It is not uncommon for women who have suffered a third or fourth-degree tear to wonder what another birth will be like. With a third or fourth-degree tear, you are at risk of tearing again at birth, but the risk is low enough to make vaginal delivery still an excellent option.
Caesarian Section
There is also the option of a C-section if you have had a fourth-degree tear and are planning to give birth in a hospital. You should know, however, that even though a C-section is planned, it is still a major abdominal surgery that can still cause pelvic floor issues, incontinence, pain, and other complications.
Episiotomy
Another consideration when considering vaginal birth after a third- or fourth-degree tear is episiotomies. Occasionally, a care provider will perform an episiotomy before tearing to minimize a more severe tear, but there’s a link between episiotomies and more severe tears, for this reason. episiotomies aren’t performed unless there are medical indications, such as a distressed baby during delivery.
RELATED: 8 Pregnancy Fears: How to Overcome Them
Tips to Prevent Vaginal Tearing During Childbirth
Almost all women want to know if there’s anything they can do to reduce the risk of tearing. This may include perineal massages or using oils to help stretch and massage the perineal muscles prior to birth. It all boils down to how elastic your skin is and how quickly the baby’s head is delivered.
One thing to note; is that aside from being extremely stretchy, the vagina is also extremely flexible, able to accommodate the baby, and heals very well.
There are a few things moms can do to prevent severe perineal tears.
1. A Pelvic Floor Specialist
Consult a pelvic floor therapist to assess the health of your pelvic floor after the third or fourth tear and to determine a specialized care plan. Physical therapy for the pelvic floor involves specialized exercises. This will help relax and lengthen the pelvic floor, thus improving the perineum.
All the organs in the uterus, including the bladder, require the pelvic floor to stay in place. Additionally, it must be able to relax enough to allow pee or poop to pass through as well as a baby during birth.
2. Get Professional Help
If you’re experiencing bladder or bowel incontinence pain during sex or while exercising. No matter if you’ve suffered from a significant tear or not. As a result of significant perineum tears, women’s pelvic floors usually tighten in order to protect themselves, which results in abdominal muscles developing.
3. Movement
Beneficial movements for labor and birth;
- Kneeling on all four
- Walking
- Side-Lying
- Stair Climbing
- Squatting
All of these movements will benefit you immensely, even if you’re not pregnant. Deep squats are a great way to start your pregnancy.
4. Diaphragmatic Breathing
As you exhale, you’ll want to draw your abdominal muscles up and lift your pelvic floor as you draw in your abdominal muscles and release your pelvic floor. This is called diaphragmatic breathing.
During childbirth, diaphragmatic breathing is essential for preventing further tears.
5. Learn About Birth
Having a strong understanding of what will ensure a better birth will make you more confident and prepared.
During labor, you will feel more comfortable, and no physical or emotional trauma will occur. Preparing for birth often requires women to overcome fear; fear affects the body directly when it controls the mind. When a woman is in labor, fear causes tension and pain. Ideally, you should be relaxed to avoid tears.
It is also imperative to learn how to position your baby in the womb optimally. It’s generally helpful to have the baby facing the mom’s back or toward her hips in order to prepare for a smooth labor.
To do this during pregnancy
- Consider using a birth ball instead of a chair
- Do not lay on your back for long periods of time
- Sleep in a position that helps the baby position facing the back
6. Exercise Regularly
Do some pregnancy-safe exercises. Move with the baby during labor to help it rotate and move as freely as possible into the birth canal. As a result, their head will be in the right position when it’s time to push.
7. Learn the Birthing Positions to Avoid Tearing
Lying on your back means you’ll have to push much harder for the baby to come out and more pressure will be placed on the perineum. There are two good positions to deliver; the sideline and on all fours.
If you have experienced a more severe tear on the perineum, squatting is another position that you should avoid.
8. Listen To Your Body
It’s important to realize that your baby wants to be born and that your body naturally pushes you to deliver.
In order to push effectively, you must listen to and respond to your body’s natural urges. In most situations, this is an effective and gentle birthing method. This will allow your body’s perineum tissues to stretch slowly around your baby’s head, preventing severe tears.
Epidurals can make this difficult since you might not feel compelled to push. While monitoring your contractions, your doctor or midwife will determine when to push. Don’t hesitate to take a deep breath when you need it.
9. Perineum Massage
Massages for the perineum, also called vaginal massages, can be performed by yourself or by your partner. While pregnant and during labor, this will help stretch the vaginal area which may prevent vaginal tearing during childbirth.
10. Warm Compress
You can reduce the risk of severe tears during labor by applying a warm compress, such as a warm washcloth, to the perineum
11. Controlling Your Pushing
As your baby crowns, it is imperative that you control your pushing and breathing as you deliver your baby because controlling the final delivery will help prevent tears.
A midwife or OBGYN can help you through this by reminding you to breathe slowly and to do small pushes. Additionally, they can support your perineum.
After A Perineal and Vaginal Tear
In addition to surgical repair, third- and fourth-degree lacerations require very careful post-operative care.
Make sure you are comfortable while these repairs are being made. Depending on your provider, more local numbing medication or even an increase in the dose of your epidural may be necessary if you are not comfortable. As a result, you’ll be more at ease.
Postpartum Care
- Sitting on ice packs
- Use your Perry bottle.
- Tylenol or pain medication prescribed by your doctor
- Avoid lifting heavy things
Final Thought
In vaginal delivery, there is an implied risk of tearing muscles and tissues around the urethra, vagina, and rectum. When a woman tears, the degree of tearing can range from first to fourth degree.
An important consideration is not the length of a tear, but how deep it goes or how many layers it affects, and a first-degree tear only affects the vaginal area.
The recovery process from severe tears may take a couple of weeks, but these kinds of tears are very rare. One thing to keep in mind is that when the doctor stitches things up, the stitches don’t need to be removed. Instead, they dissolve on their own. Your doctor may check you at the woman’s postpartum visit to ensure everything is healing nicely.
There is less chance of a large tear from the perineal muscles if the head passes through them slowly.
With an epidural, you can sometimes control your pushing and help the baby’s head come out more slowly. In the absence of an epidural, you just have a strong urge to push, and if you push too hard, your baby’s head might come flying out. There is a risk of tears for a woman in this situation.
Another conclusion people draw is that if their first baby caused a tear, especially a significant tear, their second, third, and fourth babies are likely to cause a severe tear, but that isn’t necessarily true. You are at risk of having a severe tear if you are expecting your first child.
There is no guarantee that it will happen again.
