Perineal tears are common in vaginal deliveries. 85% of women will sustain perineal trauma after childbirth, and at least 70% of these will require suturing. Problems can extend into the long term, such as dyspareunia, urinary and fecal incontinence, pelvic organ prolapse, psychosocial problems, and postnatal depression. There are four different types of vaginal tears. There is First Degree, Second Degree, Third Degree, Fourth Degree tears.
First Degree Perineal Tears –
In obstetrics and gynecology, the term ‘perineum’ typically refers to the region between the vaginal opening and the anus. During childbirth, the vagina and perineum are quite flexible and able to stretch to allow the baby to be born. First degree tears require little to no interventions. Think of it as a small paper cut. Sometimes it may require a stitch, sometimes it won’t its typically to the discretion of the doctor. Of course, if you are bleeding a little bit more than normal from the tear, the doctor will likely put a stitch in.
Second Degree Perineal Tears –
Second degree tears are classified as tears which affect both the skin and the muscles of the perineum and vagina. They do not heal naturally - as opposed to first degree tears - instead they have to be treated with stitches following diagnosis. Healing time for second degree tears is good; they heal within the weeks following the birth. Tearing causing some discomfort but the discomfort coupled with second degree tears is not extensive.
Third Degree Perineal Tears –
A third-degree laceration is a tear in the vaginal tissue, perineal skin, and perineal muscles that extends into the anal sphincter (the muscle that surrounds your anus). It likely will require several stitches, but an exact amount depends on the nature of the tear. Recovery and mobility would not be of any concern with proper care and treatment.
Fourth Degree Perineal Tear –
A fourth degree tear involves vaginal tissue, perineal skin and muscles, and extends from the vaginal opening through the anal sphincter. Yes, a tear right through from the vagina to the anus. It sounds scary, uncomfortable and definitely worthy of our anxieties. As a surgical technologist, I have been the assistant in a surgical case where a mom had a fourth degree tear and believe me it’s not pretty. This tear is not a simple – 1-2-3 all done, this would take place in the operating room under twilight anesthesia. Twilight anesthesia is an anesthetic technique where a mild dose of general anesthesia is applied to induce anxiolysis (anxiety relief), hypnosis, and anterograde amnesia (inability to form new memories). The patient is not unconscious, but sedated. Mobility and recovery is a concern for many doctors and moms.
OBSTETRICIANS & GYNECOLOGISTS recommend physical therapy to help with recovery.
You Can Reduce Your Risk Of Tearing
· One way to reduce your fear of tearing, is to make choices about your birth to help reduce the risk of tearing.
· Transfer care to a midwife or provider that will support your birth choices.
· Hire a doula to help with different labor & birth positions to decrease the risk of tearing or possible perineal trauma.
· Maintain good nutrition and stay well hydrated during pregnancy, to help your skin and tissue be its healthiest.
· Use warm compresses during pushing and crowning, to help support the tissue stretching.
· Strengthen your pelvic floor muscles during pregnancy, in preparation for labour and birth. (perineal massage, kegels, prenatal yoga).
· Breathe baby out, rather than use forceful directed pushing; push only when your body feels the urge.
· Choose birthing positions that avoid extra pressure on the pelvic floor and perineum.