Tuesday, September 21, 2021
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Everything You Need to Know About Perineal Tears

This article has been REVIEWED by a physician

We use review ONLY where an article contains information that could be considered from a medical standpoint. The review ensures factual correctness from a medical standpoint only and in no way suggests that the article content is endorsed by the Reviewer or is the Reviewers own viewpoint.

 

Incidents of tearing or birth-related injuries are particularly common among women giving birth for the first time. Some studies have shown that as many as 9-10 first time mothers will have some sort of tear during the birthing experience. Throughout your pregnancy, you may have even had some well-meaning friends or family members share their birthing ‘horror stories’ with you. But by equipping yourself with the knowledge to understand what a perineal tear involves is you will ensure that you have the best information for your situation. Everybody is different, so just because someone else tore while birthing, doesn’t necessarily mean you will. But just in case, here is some information you might find useful.

 What is a perineal tear?

A ‘perineal tear’ is the medical term for an injury acquired during birth to the area between your vagina and your anus.

Injuries such as grazes and tears can also occur in other areas of the vagina during the birthing. While these injuries vary in extent and are quite common, most are fairly minor and mothers recover quickly.

Why do perineal tears and other birth injuries happen?

As you deliver your baby, your muscles need to stretch to accommodate the baby’s head and body. A tear may occur for several reasons, but the following are the most common causes:

  • Assisted birth through the use of forceps or ventouse
  • Delivering a baby that is heavier than 4kg (9lbs)
  • Position of the baby (breech, occipito-posterior, or baby’s shoulder gets stuck)
  • Labour is too fast

How bad will the tear be?

The extent of damage can vary from mother to mother, but as discussed previously, most tears are minor and recovery is quick. When it comes to medical lingo, there are different ways tears are described that relate to the area of injury and how extensive it is.

1. First Degree tear – these tears are minor, and while they can be sore they do not usually cause any long-term problems for the mother. These tears are usually small and only affect the skin.

2. Second Degree tear – These tears affect both the skin and muscle of the perineum and usually require stitches. Although this degree of tear doesn’t usually have long-term effects, the wound site can be very sore.

3. Third Degree tear – a third-degree tear affects the muscles that control the anus.

4. Fourth Degree tear – a fourth-degree tear also affects the lining of the anus and/or rectum.

5. Rectal buttonhole – although quite rare, this injury involves a hole between the back passage and the anal sphincter. While the anus does not tear, this hole means that wind and feces could exit the body via the vagina.

Need more information about the type of tear you’ve experienced? The royal college of obstetricians and gynecologists has some great information for you here.

How can I stop myself from tearing?

While it is impossible to 100% guarantee no tearing during labour, there are things you can do that may reduce your likelihood of experiencing a tear or other birthing injury.

  1. Reducing anxiety – some physicians suspect that the reason fewer mothers tear during home births, is because they are in an environment that is more relaxing to them. You may like to consider how you can make your birthing environment more relaxing.[l1]  Discuss options with your birthing team and midwives to get help deciding what option you might prefer.
  2. Massage – in the final weeks of your pregnancy, massaging the perineum may help to prepare the muscle for birthing, and reduce your likelihood of tearing. Here’s a guide to help you learn how to safely massage.
  3. Birthing position – Depending on the position you give birth in, you may be more or less likely to tear. Discuss this with your doctor or midwife and get some assistance finding the position you’re most comfortable (and least likely to tear in).
  4. Trust your doctor or your midwife – they will help to guide your baby out, and direct you regarding when and how to push. It’s important to listen to your doctor or midwife as best you can, as they can see what’s going on with the baby and your body. They will do their best to ensure both you and the baby avoid any injury. The doctor or midwife will help you pace yourself and allow your muscles and perineum time to stretch and accommodate the delivery of your baby. They may also gently use a warm compress to try and reduce the degree of tearing as the baby is delivered. If you have concerns about how your delivery team will manage tears, don’t be afraid to ask questions in the appointments leading up to the birth.

What happens if I do tear?

Immediately following delivering your baby, the doctor and midwife will check you over. They’ll look at your blood pressure, take your temperature, and assess your downstairs area for any damage. This could include a rectal examination, where a member of the medical staff attending you may use their finger to feel inside your rectum for any tears or bleeding.

Your team should explain what examinations or treatments they’re going to provide you with. There may be some discomfort with the examination, depending on the level of injury you have sustained. You might be offered some pain relief in the form of gas and air, be offered local anaesthetic or your epidural could be topped up.

If stitches or further surgery is needed, this will be done as soon after birth as possible, to minimize your bleeding. If your tear is minor, stitches will usually be done without moving you. If the tear is more severe, you may require surgery and will be moved to an operating theatre as soon as possible.

Usually, you will still get to have a cuddle with your baby while you are being examined, unless it is not medically possible at that time.  Skin-to-skin contact with your baby is often encouraged, but if you’re not able to do so (if you need surgery for example), the medical team will usually offer this to your birthing partner. If you’d like to experience skin-to-skin with your baby, write it into your birthing plan – but know that sometimes things don’t always go to plan. For the safety of you and your baby, getting you fixed up may take precedent.

Support for your recovery

Mental recovery

Sometimes, your birth experience may not go to plan. Tearing, or having other traumatic aspects to your labour can have an effect on you more than just physically. You or your partner may feel distressed by what happened, which could lead to fear of childbirth in future pregnancies. PTSD after birth is not something to be ashamed of. Reach out and get the help you need.

Speak with your OBGYN or maternal healthcare nurse about services to support mothers recovering from traumatic births.

Peer support can also be helpful, so you may like to consider joining a Facebook group or other online support group. Hearing from people who’ve shared similar experiences and know what you’re going through is invaluable.

Physical recovery

Depending on your tear, your recovery may vary. Your doctor will advise on what your specific recovery journey will look like. You can expect there to be some discomfort, so if needed, speak to your doctor about appropriate pain relief.

Hygiene is vital to avoid infections. Keep the area clean, using only water, and shower at least once a day. Change sanitary pads regularly and wash your hands before and after toileting.

If you have a more severe tear, some things such as going to the toilet may be more challenging and painful than you’ve previously experienced. But it is important to keep your fluids up and go to the toilet regularly, to avoid constipation. Some pain medication can have a constipating effect, so be sure to discuss this with your OBGYN if you’re having difficulty opening your bowels. Click here for more ways to manage your recovery.

Final thoughts

Giving birth can be a challenging experience, especially if you have a tear. Most tears are minor and able to be easily treated. If you do have a more severe injury during childbirth, remember that you don’t have to put up with struggles in your recovery process. Help is available, so be sure to discuss any difficulty you may be having with your doctor. You’ve undergone a life-changing experience, bringing a baby into this world, getting some help is nothing to be ashamed of. 


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about the reviewer

Dr Lisa Joels

MB ChB, MD, FRCOG, FHEA

OBSTETRICIAN & GYNAECOLOGIST

Dr Joels has 34 years’ experience in obstetrics and gynaecology including 19 years as a Consultant working in Swansea (2001-11) and subsequently at the Royal Devon & Exeter NHS Foundations Trust in the UK (2011-20). These are both University teaching hospitals, each having more than 4,000 deliveries a year and providing tertiary obstetric and neonatal services as well as gynaecological services to their local population.



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