Everything you need to know about a perineal tear
For most women when they think about childbirth they perhaps think about the potential pain that they might experience during the delivery of their baby.
There is, in fact, another side that women don’t always consider.
Perineal tears, unfortunately, are a reality to a lot of women who have a natural birth.
It’s not uncommon to experience a tear to some degree especially if you have experienced the ring of fire during your labor.
Let’s have a look at what a perineal tear is.
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What is a perineal tear?
A perineal tear is when you get a tear between the vagina and the anus area.
As your baby’s head begins to crown it causes your vagina to stretch to allow your baby to pass through.
Unfortunately, this area is not made of stretchy material so if the delivery of your baby is not handled just right it could cause a tear in your perineum.
This type of tearing occurs when the baby’s head causes too much pressure on the vagina.
It is unlike an episiotomy which a doctor would do to allow for more access for the baby.
Perineal tears are more commonly found in first-time moms.
Some women are fortunate enough that they are not affected by any type of vaginal tear at all.
A perineal tear is not only decided by the size of the baby you deliver but it is also affected by things like the position of your baby when they come out.
The best way to deliver your baby is to have them head downwards with the back of their head facing the front of your stomach.
This is the most recommended position by doctors and midwives.
Unfortunately, we only have so much control over which way around our baby is going to lie.
If your baby is breech then you have a much higher chance of tearing if you have a natural birth.
If a breech baby is picked up early enough there are in fact little things that you can do to help get your baby into the correct positioning.
If you have not heard of spinning babies then you should definitely check them out.
They have some really great techniques in getting your baby turned into a better position before you go into labor.
What happens next if you do get a perineal tear?
If you do end up with a perineal tear, don’t be too hard on yourself because it is a situation that you cannot fully control.
When I gave birth to my daughter, she was in the best possible position but I still tore regardless.
Because she came out with her hand pressed against her cheek.
Things like this are outside of your control so you must always look on the bright side.
Once it has been established that you do in fact have a perineal tear then depending on the severity of it you will likely need stitches.
I know this seems absolutely awful especially as you have just finished pushing out a whole baby from down there but it really is for the best.
You don’t want to be left with any loose hanging bits. You certainly don’t want to have to come back to the hospital days or weeks later having to have stitches done because you couldn’t face it the first time around.
If you need stitches its best to get it over and done with.
I will just say this though. For a few very very fortunate women out there they may get a perineal tear but it can be so small that it can actually heal on its own without having to get stitches done.
- Ring of fire during birth: Did you know you can avoid it?
- 3 Stages of labor you really need to know about
This leads me on to the next point which is, are there different degrees of tears?
The answer to that is yes.
First degree perineal tear
This is the least severe of all the perineal tears.
A first degree tear usually requires little to no stitches at all.
If you are going to tear this is the one you want to have. It will cause you the least discomfort postpartum and you may be able to get away without having any stitches at all.
I had a first degree tear in one of my pregnancies and I remember the midwife discussing if I would need stitches or not.
I was praying so hard that I wouldn’t need them. In the long run they decided it would best I had them now rather than finding out later that I did need them and have to return to the hospital.
Second degree perineal tear
Second degree tears are more common. Whilst they are similar to first degree perineal tears, the tear not only includes the perineal skin but it also includes some of the perineal muscle.
Whilst first degree tears are only perhaps 2 or 3 stitches second degree tears will usually require a few more stitches as well as a longer recovery time.
Third degree perineal tear
Third degree tears as you would expect are more severe than the second.
These types of tears begin to go further into the layers of the vagina. They affect the perineal muscles that make up the anal sphincter.
The anal sphincter is a group of muscles that make the opening of the anus hole tight.
A doctor would have to stitch each of the layers back individually.
This is a little more work and therefore the recovery time will also be a little longer.
Fourth degree perineal tear
This is the most severe type of tear that you will find.
A fourth degree tear means that not only has the anal sphincter been affected but it has also gone as far as the rectal lining.
In this type of case, you would experience several weeks of pain followed by months of discomfort as each layer would have to be individually stitched.
I’m sure you will be pleased to know that this type of tear is fairly uncommon unless your baby has come out in a very strange position.
How long does it take for a perineal tear to heal?
A lot depends on the severity of the initial tear.
Generally speaking, the stitches should dissolve in a couple of weeks (thank God we no longer have to go back to the hospital to have these taken out!).
Even though the stitches are dissolveable, you will still experience some discomfort after the stitches are out which could last anywhere from a few weeks to a few months.
Unfortunately, the discomfort will be heightened during sex or whilst having a bowel movement.
How can you avoid a perineal tear?
Make sure you take it very slowly when you are giving birth. Don’t be in a rush to use all your energy to push the baby out.
This will do nothing for you but cause tearing.
Try a perineal massage to keep the area soft.
Having a water birth can also help a great deal as they tend to keep the vaginal area soft and supple therefore preventing any harsh tearing.
Listen to your body. Only you can feel what is happening so look out for the signs that your body is ready to deliver the baby rather than just focusing on pushing alone.
Is there anything you can do to ease the discomfort of a perineal tear?
Yes, there is.
Sitting is always going to be uncomfortable for the first couple of weeks whether you tore or not.
1. Getting a donut ring is a great way to ease that discomfort as you can still sit down without actually sitting on your stitches in that painful area.
It’s a good idea to get one of these before you even deliver your baby as you won’t have time to get one after coming out of the hospital.
They are great to use even if you don’t tear because that entire area will be very sensitive anyway. You can thank me later!
2. You can also try witch hazel pads like this one. They are reusable and you can use them frozen (they will still remain flexible) or warmed in hot water.
These are great for reducing swelling and calming any itchy areas. You can purchase some here.
3. Postpartum Sitz sprays are also a great thing to try whilst you are heavily inflamed.
You can simply spay the area without having to touch it. If you prefer a little “me” time on your own in the bath then perhaps a sitz bath might be more your style.
4. Stay away from straining as much as possible as you could split your stitches.
Final thoughts on perineal tearing
Don’t go into childbirth worrying about these things too much. Whilst its good to always be informed, you should not let fear put a downer on your childbirth experience.
Go in with a positive mindset and even if you do happen to get a perineal tear its not the end of the world.
In a few months time, it will all have been forgotten about.
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