- Vaginal tears are a common complication of delivery, however some tears are more severe than others.
- Common risk factors include having an assisted delivery and having a large baby.
- Perineum massage may help prevent vaginal tearing.
Vaginal tears typically occur when your baby’s head passes through your vaginal canal and the skin can’t stretch enough to accommodate your baby. As a result, the skin tears. While tears are a fairly common occurrence during delivery, some are larger than others.
Doctors usually classify vaginal tears as first-degree through fourth-degree.
- First-degree tears: These are the smallest tears, involving skin around the vaginal opening or perineal skin. These don’t always require stitches to repair and may heal on their own.
- Second-degree tears: These tears involve the perineal muscles. These muscles are between the vagina and anus.
- Third-degree tears: Third-degree tears involve the area from the perineal muscles to the muscles around the anus. These can require surgical intervention to repair and can take months to heal.
- Fourth-degree tears: Fourth-degree tears are the most severe of all tears. These tears involve the perineal muscles, the anal sphincter, and the tissue around the rectum. These tears often require surgical repair.
While third- and fourth-degree tears can occur, they are rare.
Vaginal tears occur when a baby’s head or shoulders are too large to pass through the vaginal opening. Sometimes assisted delivery — using forceps or a vacuum — contributes to a vaginal tear because the device increases the forces on the skin, causing it to tear more easily.
Some women are more likely than others to experience a vaginal tear. Risk factors include:
- assisted birth during delivery, such as forceps or vacuum use
- baby’s shoulder is stuck behind your pubic bone
- being of Asian descent
- induced labor
- first baby
- large baby
- older mothers
- prolonged second stage of labor
If your doctor knows you’re at risk for a vaginal tear, they may recommend perineal massage in the weeks leading up to your baby’s birth. Perineal massage can help to stretch the tissues between the vagina and anus to ideally allow the tissue to relax and let your baby pass through more easily. Your doctor or midwife may recommend starting it at about 34 weeks into your pregnancy.
The technique involves stretching the tissues of your vagina, much as you will when your baby passes through. However, you shouldn’t use this technique if you have a vaginal infection or vaginal herpes.
Vaginal tearing can take time to heal — sometimes months for more severe tears. During this time, you can experience discomfort and difficulty having a bowel movement. Infection is also possible due to exposing the tissue to bacteria.
Long-term complications associated with vaginal tears include painful intercourse and fecal incontinence. You can experience painful intercourse due to the sewing of the tear, which can leave the skin feeling tighter than usual. Because tears involve the muscles of the pelvic floor, which are involved in urinating and passing stool, women may experience incontinence. While incontinence resolves in some women over time, some have long-term complications. Your doctor may refer you to a urologist to help treat the incontinence.
If your doctor anticipates your vagina may tear during the delivery, they may choose to do what is called an episiotomy. This is an incision made into the vagina and sometimes the muscle layers. This allows your baby’s head to pass through without tearing. However, some doctors and midwives do not prefer to perform episiotomies as they can sometimes increase the risks for more significant tearing. Episiotomies also don’t improve post-labor symptoms, such as reducing incontinence.
Whether you had an episiotomy or experienced a tear during childbirth, your doctor may choose to stitch the affected area. Doctors don’t usually stitch small tears. Times when your doctor might stitch a tear include:
- the tear doesn’t appear to stop bleeding
- the tear is longer in size and likely not to heal on its own
- the tear is uneven and may not heal correctly without stitching
The stitches will typically dissolve in time. Your doctor will use an anesthetic to numb the affected area if you did not receive an epidural or other pain relief method during delivery.
Your doctor will typically schedule a follow-up appointment after delivery. These are usually about six weeks after giving birth, but may be sooner if you had an especially difficult delivery. At this time, your doctor will inspect the tear to ensure that it’s healing properly. If you notice infection symptoms or pain that gets worse, call your doctor.
While vaginal tears will heal, they can bring complications after giving birth. Having an excellent support system of friends and family at home can help you recover as well as possible. Sleeping when your baby sleeps and accepting help from loved ones for meals, caring for your little one, and taking time for yourself whenever possible can aid your healing.