You probably did a ton of preparation for your pregnancy, labor, and delivery. Then there’s the stuff they didn’t tell you, like what happens after birth.
On top of engorged breasts, night sweats, and sleepless nights, you may be contending with a vaginal tear and stitches. Regardless of whether you expected a second degree tear, it can be painful and inconvenient, especially when caring for a newborn.
Here’s more about why tears happen, how common they are, and what you can expect in the healing process if you have a second degree one.
The skin around the vagina is delicate and stretchy to help accommodate your baby’s head during delivery. Tears happen when either your baby’s head is too big or your skin doesn’t stretch enough for some reason.
A second degree tear is a tear in the skin and muscle of the perineum, which is the area between the vagina and anus. Some second degree tears may even go deep into the vagina. As a result, this type of tear requires stitching immediately after birth to heal properly.
Again, tears happen when the skin is unable to stretch enough (or quickly enough) around your baby’s head during delivery. Sometimes tears are the result of a fast delivery or the use of instruments like forceps. Whatever the case, the skin and other tissues may tear under the stress.
After birthing your baby, tears are pretty common. Up to 90 percent of people experience tearing to some extent during delivery. Furthermore, some sources explain that second degree tears are the most common among those who experience tearing.
As you’ve probably gathered, you can experience varying degrees of tearing during childbirth.
- First degree tears: only involve the first layer of skin between the vaginal canal and rectum, an area known as the perineum
- Second degree tears: go a bit deeper than the surface and involve both the skin and muscle of the perineum
- Third degree tears: further extend to the sphincter muscle, which surrounds the anus; may need more than simple stitching, be repaired under anesthesia, and take longer to heal
- Fourth degree tears: go beyond the sphincter muscle and into the mucous membrane that lines the rectum; usually repaired under anesthesia, may take more than a few weeks to heal, and could lead to complications like fecal incontinence
If you experience a second degree tear, it’ll likely be repaired right after you deliver your baby and placenta. You’ll remain in the same room where you’ve given birth, and your doctor may give you a local anesthetic to help numb the area. So much will be going on — you may not even notice!
After the anesthetic takes effect, your doctor will begin stitching the area. Exactly how many stitches you’ll receive depends on the length of your tear. With second degree tears, the stitching must go through both the skin and muscle.
While you may be uncomfortable initially, second degree tears don’t usually cause long-term issues. Instead, the stitches will typically dissolve on their own within 6 weeks. That’s right — you won’t need to return to your doctor to have the stitches removed, so you can take that off of your to-do list.
It’s completely normal to have pain or soreness in and around the stitches, especially when you’re sitting or walking. Fortunately, many people report feeling less discomfort within just 2 weeks of delivery.
Of course, you’ll need to follow your doctor’s guidelines regarding how to care for your stitches to ensure they’ll heal properly. You may receive specific instructions depending on your particular tear, its location, and any other issues you may be experiencing.
When you can have sex again is something you’ll want your doctor to clarify. Doctors typically recommend waiting 4 to 6 weeks to have sexual intercourse after a delivery without complications. With tearing, you may need to wait a bit longer, until you completely heal.
You should also steer clear of putting yourself in a wide-legged squat or similar position. Sitting crossed-legged or taking stairs two at a time may likewise strain your stitches.
Besides following your doctor’s orders, follow your feelings. In other words: You do you. Your tear may heal quickly, or it may take some time to feel normal again.
You might consider applying an ice pack to the affected area for pain relief. That said, don’t apply ice directly to your perineum. Instead, wrap the ice pack in a light towel, and apply it for 10-to-20-minute increments for a total cooling session of 1 to 2 hours.
Icing is particularly helpful the first day or two after delivery.
Other home healing tips:
- Use a peri bottle. Your hospital may even give you this postpartum essential as a parting gift before you return home. You fill the bottle with lukewarm water and point the stream at your perineum as you urinate to eliminate stinging.
- Change your pads often. This will help keep the area clean and dry and ward off bacteria.
- Use cooling pads. Consider layering your pads with Tucks medicated cooling pads or similar ones containing witch hazel. While traditionally used to help treat hemorrhoids, they may help relieve burning and itching around your stitches.
- Try showering daily. Timing showers and bathing after bowel movements gives you an opportunity to wash away anything you missed that might infect your stitches.
- Drink plenty of water. Aim for six to eight glasses each day to help keep your bowel movements regular and soft. If you’re worried about pooping with your stitches, that’s completely understandable. Still, it’s necessary to avoid constipation, which could be a whole lot more painful.
- Eat a varied diet. Be sure to opt for foods that are rich in fiber, such as fresh fruits and vegetables, over cereal, whole grain breads, and pastas.
- Kegels, Kegels, Kegels. When you feel ready (as soon as 2 to 3 days after delivery), be sure to do regular Kegel exercises to strengthen your pelvic floor muscles.
Otherwise, be sure to rest as much as you can. This is hard to do with a newborn, but it’s important for the healing process. When you do get a few minutes to lie down, try elevating your hips using a pillow.
Infection is uncommon with second degree tears. Still, it’s a good idea to familiarize yourself with signs of infection so you can contact your doctor promptly if you think something’s up.
Signs of infection include:
- pain that gets worse over time
- bad-smelling discharge from the stitches or vaginal area
- swelling, tenderness, or warmth around your stitches
- feeling tired, unwell, or weak
In general, you should be feeling less pain as time goes on — unless there’s an infection. Don’t hesitate to contact your doctor if you have concerns about how your stitches are healing or feel something isn’t quite right.
Tears during delivery are common, so you may not always be able to prevent them from recurring in future pregnancies. A lot of it has to do with factors that are outside of your control, like the size of your baby’s head or their presentation in the birth canal.
That said, first-time pregnancy is a risk factor for tearing, so you may not be as likely to tear in subsequent pregnancies.
What else might help?
- Controlled pushing. In the second stage of labor (the pushing stage), speak with your doctor or midwife about pushing slowly and gently. While difficult, taking your time will give your vaginal tissues some added time to stretch and accommodate your baby’s head and body.
- Warmth. Keeping the perineum warm may also help those tissues stretch. Try applying a warm washcloth to your perineum as you get closer to the pushing stage.
- Massage. You can start perineal massage late in your third trimester to prepare the vaginal tissues for stretching. Either you or your partner can insert two lubricated fingers into the vagina and move them side to side using some gentle pressure toward the rectum. Your doctor or midwife may also perform a massage (with gloves) during the pushing stage. Consider asking about this during your prenatal visits.
- Upright delivery. Lying flat on your back during pushing may put you at an increased risk of tearing due to the angle. Birthing your baby while squatting or standing may be safe options to discuss with your doctor or midwife.
Experiencing a second degree tear after delivery can be upsetting and uncomfortable. Fortunately, in most cases you should start to feel better within a few weeks.
If you have signs of infection or pain with sexual intercourse, exercise, or even normal activity, contact your healthcare provider. Remember: Your healing timeline is individual to you, so if something seems to cause pain or discomfort, ease up and give yourself a bit more time.