On the list of slightly nerve-wracking and unglamorous things about giving birth, vaginal tearing is right up there. Given those chances, it’s important to understand what to expect and how to heal — as always, knowledge is power.
What are vaginal tears and why do they occur?
Vaginal tears are exactly what they sound like: a tear in the tissue and muscle around your vagina and perineum. Vaginal tears are also called perineal lacerations or tears because they can impact the perineal area, the space between the vaginal opening and the anus.
Typically, your body prepares for birth by thinning out the skin of the vagina so it can stretch more easily around baby’s head. Sometimes, however, circumstances arise that lead to vaginal tearing. These include:
• A large baby and/or a baby with a big head
• The vagina isn’t able to stretch enough, regardless of baby size
• A very fast delivery, which doesn’t give the vagina time to thin out and stretch
• Using forceps or a vacuum during delivery
• Baby is in the “sunny side up” (face up) position
• More likely during your first delivery
Understanding vaginal tears
Vaginal tears are categorized into four grades: First, second, third, and fourth-degree tears.
• First-degree tears are the least severe and involve only the perineal skin, which is the skin between the vaginal opening and the rectum. First-degree tears may feel sore and cause mild pain or stinging when peeing. They may require stitches or may heal on their own, which usually takes a few weeks.
• Second-degree tears involve the skin and muscle of the perineum and may extend into the vagina. Second-degree tears cause similar discomfort to first-degree tears, but usually do require stitches, which can be done in the same room where you gave birth. They also typically heal within a few weeks.
• Third-degree tears extend into the anal sphincter, the muscle that surrounds the anus. Third-degree tears are more serious and sometimes need to be repaired with anesthesia in an operating room. Third-degree tears feel painful and sore and also cause pain or stinging when peeing. They take longer to heal, and because they impact the muscles that control bowel movements, can lead to complications like fecal incontinence and painful intercourse.
• Fourth-degree tears are the most severe (but the least common). They extend through the anal sphincter and into the mucous membrane that lines the rectum. Fourth-degree tears usually require repair with anesthesia in an operating room and sometimes more specialized repair. Fourth-degree tears are painful and sore, with pain or stinging when peeing, and can also cause complications such as fecal incontinence and painful intercourse. They take significantly longer than a few weeks to heal.
What about episiotomies?
An episiotomy is a medical procedure in which the perineum is cut to avoid vaginal tearing. Traditionally, medical staff believed that episiotomies would help prevent further damage and tearing, but recent research suggests this might not be true. As a result, episiotomies are no longer recommended on a routine basis.
Episiotomies may still be medically necessary, however, if baby’s shoulder is stuck behind your pelvic bone, there are concerns with baby’s heart rate, or you need an assisted vaginal delivery.
How to avoid vaginal tearing
While not all vaginal tearing can be prevented, there are steps you can take to make it less likely. Tips include:
• Ask your doctor not to perform an episiotomy unless medically necessary
• Perform perineal massage in the weeks before delivery
• Use a lubricant in the vaginal canal during delivery
• Apply warm, moist heat to the perineum while pushing
• Massage the perineum while pushing
• Try different pushing positions that put less pressure on your perineum like squatting or side-lying
• Push baby out genty, allowing your healthcare provider to guide your pushing
Caring for your vaginal tear
If your vaginal tear requires stitches, your healthcare provider will use dissolvable stitches that go away on their own within six weeks. You do not usually need to make a special visit to the doctor to have the stitches removed or receive additional care unless it was a third- or fourth-degree tear that involved additional repair.
At home, ice packs can help with pain and swelling in the first few days following birth. Warmth can help too; starting 24 hours after birth, you can soak your perineal area in warm water either in a warm, shallow bath or using a sitz bath, a shallow pan placed on the toilet. Over-the-counter medication and anesthetic sprays can also be useful for pain. And lying on your side can take pressure off the perineal area while you heal (and can be a great breastfeeding position as well!).
If you are recovering from a vaginal tear, use a peri (squirt) bottle to dilute your urine when you pee. Drink lots of water and try to eat high-fiber foods like fruits and vegetables to avoid constipation, and stool softeners if needed. After you use the bathroom, pat the area dry instead of rubbing.
Finally, call your doctor if you notice signs of infection, like fever, chills, swelling, redness, pain that doesn’t get better, or foul-smelling or excessive discharge from the site of the tear. New or worsening pain can also be a sign that something is wrong, as can urinary or bowel incontinence.
Vaginal tearing is a very common, normal part of childbirth. Do what you can to prepare, but also accept that it often happens no matter what. With a little TLC, the vast majority of tears heal quickly and completely.
For more information on vaginal tearing, healing, and more, check out our Childbirth 101 course.
About our Expert
Ashley Derderian Sousa is a board-certified lactation consultant and registered nurse with nearly ten years of experience in labor, delivery, and postpartum units. Through approachable methods and open and honest philosophy, she believes each journey to becoming a parent is a personal one that should be met with self-compassion. She is currently completing a Masters of Health Education.