A perineal tear is a laceration to the area between the vagina and the rectum. It is a common yet unpleasant side effect of giving birth.

When I get to this point in my prenatal classes I get some worried looks! Of course, it is possible to deliver a baby vaginally with no tears, however, women giving birth for the first time have an increased risk for tears. The risk for tearing increases more with fast deliveries assisted vaginal deliveries (such as a vacuum or forceps) and babies being pushed out in a face-up position as it is a wider diameter of the head coming first.

Average pushing time varies, but it is normal for a first-time mom to push for 1-2 hours. Pushing can be kind of a one step forward, 2 steps backward kind of thing until you get the baby to a certain point where they can’t sneak away anymore and they have no option but to come out! As exhausting as pushing can be, it allows for gradual stretching of the perineum.

When it is close to delivery your doctor or midwife will start applying support to the perineum often with a warm moist cloth. This pressure will help to reduce the risk of tears.

As the babies’ head is crowning your health care providers are going to ask you to slow down the pushing. So instead of the big strong pushes you are used to doing we are going to ask for smaller grunt like pushes, just kind of ease the baby out! This can really help to reduce the risk of tearing.

Different types

There are 4 degrees of perineal tears. 1st to 4th degrees. 1st being the smallest to 4th being the most significant.

Your doctor or midwife will repair the tear using local anesthetic and a dissolvable suture. They do not do individual stitches but rather a continuous stitch of whatever is required. The perineal area heals very quickly and moms will notice flecks of sutures falling out within a couple of days! However, it will take 4-6 weeks for full healing and recovery of the area.

First degree:

    • Minimal
    • Very superficial, vaginal lining only no muscle involvement
    • May or may not require suturing

Second degree:

    • Most common
    • Involve vaginal lining and extends deeper into vaginal tissue
    • Requires stitches

Third degree:

    • Involves deep layers of vagina and muscles around the anal sphincter

Forth degree:

    • Least common (thankfully!)
    • All of the above plus more…tear from the vagina straight down to the muscles surrounding the rectum
    • Rectal muscle involvement may lead to the need for pelvic floor therapy postpartum

If your doctor or midwife notices the weakening of the perineum and feels like there is a good chance for a significant tear, they may opt to cut the perineum (episiotomy). They can angle this cut off to the side to protect you from a worse tear that could extend into the anus.

No matter the size of the tear, you can feel significant discomfort for a week. The pain may last longer with the larger more extensive tears. Some moms opt to sit on pillows if they find sitting difficult. Taking stool softeners to avoid the need to strain during a bowel movement is also a good idea because for a new mom with (or without!) a tear this can be scary!! Drinking lots of water can also help to keep the stool soft. Ice packs work well for perineal discomfort as well as using a peri bottle to keep the area clean after using the washroom. Tylenol, Advil, and Naproxen can be taken regularly postpartum to help deal with the pain and for those moms who are breastfeeding these medications are all safe.

If you are struggling postpartum please reach out to the Mama Coach in your area, we offer a postpartum support package! You got this mama!

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