Birth tears - Perineal trauma
Most women, up to nine in ten (90%), tear to some extent during childbirth.
What are the types of tears during childbirth?
Most tears occur in the perineum, the area between the vaginal opening and the anus (back passage). They may be:
- first degree tears – small, skin-deep tears which usually heal naturally.
- second degree tears – deeper tears affecting the muscle of the perineum as well as the skin. These usually require stitches.
For some women, up to 3 in 100 (3%), the tear may be more extensive. Find out more here
What is the difference between an episiotomy and a tear?
An episiotomy is a cut made by a doctor or midwife through the vaginal wall and perineum to make more space to deliver the baby. A tear happens as the baby stretches the vagina and perineal tissue during birth.
Could anything have been done to prevent it?
You could consider perineal massage during pregnancy in order to reduce the possibility/severity of a perineal tear. Please click here for more information.
Other devices are now available but there is no current offcial recommendation on their use. However you plan to purchase any follow carefully the manufacturer's instruction and use with caution.
What happens after birth?
Soon after the birth of your baby, your midwife or obstetrician will examine of your perineum and anus (back passage) with adequate painrelief to assess if repair is required. If a trauma is confirmed, you will be provided with information about its extent, repair and follow-up care. Your midwife and obstetrician will then suture (stitch) the tear in your delivery room or an operating theatre if the trauma is extended.
What can I do to help with the discomfort?
It is normal to have some discomfort as the area heals. Here are some tips to help coping with uncomfortable sensations:
- ensure you take adequate analgesia on a regular basis. Paracetamol 1g can be used 4 times in 24hrs. You coud also take anti-inflammatories providing there is no contra-indication for you.
- lavender/chamomile short baths may promote healing as well as Arnica tablets.
- cool pads or gel pads can offer some pain relief.
- when resuming sexual intercourse use lubricating gels. It is recommended to wait at least 6 weeks following repair for resumption of sexual intercourse. On that matter your body is the one to listen to!
What can I do to speed up healing of the tear?
- your stitches should dissolve in 2 to 6 weeks – you may find parts of them on your sanitary pad.
- keep the area clean: shower at least once a day (a short bath occasionally is okay too), a separate hand towel to dry the perineum should be used and change your sanitary pads regularly (every 2 to 3 hours).
- wash your hands both before and after you go to the toilet and wipe yourself from to back. This will reduce the risk of infection.
- drink at least 1.5 to 2 litres of water every day and eat a healthy balanced diet with increased fibre (fruit, vegetables, cereals, wholemeal (brown) bread and pasta). This will ensure that your bowels open regularly and prevent you from becoming constipated.
- start pelvic floor exercises as soon as you can after birth. This will increase the circulation of blood to the area and aid the healing process as well as improving bladder/bowel control.
- avoid wearing tight clothing and try to ‘air’ the area whenever possible.
Signs of infection – what to look out for
The following can all be signs of an infection. If you start to experience any, let your midwife or GP know so that appropriate treatment can be given:
- any offensive smelling discharge.
- increasing pain in the area – you will have some discomfort as the area heals, but this should diminish. If it is worsening, get the wound checked.
- increase in bleeding, particularly when not associated with an increase of activity.
- any gaping of the wound.
What are the long-term effects of a tear?
Most women make a good recovery. During the first month some women may experience all of the following:
- pain or soreness in the perineum
- apprehension about having sex.
- questions about future pregnancy and birth.
Your midwife and GP will inspect your perineum as appropriate for healing, signs of infection and to exclude haematoma.
I am experiencing pain and problems with my bowels, what should i do?
If you find you are suffering from perineal pain or bowel problems please discuss this with your community midwife. If they have discharged you from their care please make an appointment to see your GP.