Causes and treatment of vaginal tears in childbirth

Childbirth tears can occur inside the vagina or other parts of the vulva, including the labia during the delivery process. It is also common for your perineum, which is the area between your vaginal opening and back passage (anus), to tear to some extent during childbirth.

Most first-time mothers who have a vaginal birth will experience some sort of tear, graze or episiotomy. It is slightly less common for mothers who have had a vaginal birth before. For most women, these tears are minor and heal very quickly.

It’s important to normalize the notion of childbirth tears and not to fear it, because it happens so often. Get the facts about down-there tears, so you know what to expect regarding your vagina before and after birth.

Why Do Childbirth Tears Occur?

During birth, the vagina has to stretch enough to allow a baby, whose head is the size of a cantaloupe, to come through it. Hopefully, the vagina will stretch just enough without tearing, but often a tear does happen. The tears are spontaneous, meaning a doctor didn’t make a­ cut. Some of the reasons for the tear can be:

• baby being overweight
• having a fast birth, since the tissue has less time to adapt and stretch
• the position of the baby
• having a vacuum- or forceps-assisted delivery
• an especially long labour that results in severe vaginal swelling

Types Of Childbirth Tears That Occur During Delivery

1st Degree Tear

First-degree tears are the least severe, involving only the perineal skin — the skin between the vaginal opening and the rectum and the tissue directly beneath the skin. You might experience some mild pain or stinging sensation during urination. These tears may or may not require stitches and typically heal within a few weeks.

2nd Degree Tear

Second-degree tears involve the skin and muscle of the perineum and might extend deep into the vagina. Second-degree tears typically require stitches and heal within a few weeks.

3rd Degree Tear

Third-degree tears extend into the muscle that surrounds the anus (anal sphincter). These tears sometimes require repair with anaesthesia in an operating room — rather than the delivery room — and might take longer than a few weeks to heal.

Complications such as stool leakage (faecal incontinence) and painful intercourse are possible. If these problems occur, talk to your health care provider.

4th Degree Tear

Fourth-degree vaginal tears are the most severe. They extend through the anal sphincter and into the mucous membrane that lines the rectum (rectal mucosa). Fourth-degree tears usually require repair with anaesthesia in an operating room — rather than the delivery room — and sometimes require more specialized repair. Healing also might take longer than a few weeks.

Complications such as faecal incontinence and painful intercourse are possible. If these problems occur, talk to your health care provider.

How To Ease Discomfort After A Vaginal Tear

After the birth of your baby, your healthcare professional will carefully examine your vagina, perineum and rectum to see if you have a tear, and if so, what type. They will then advise you if you need stitches.

If you have sustained a third- or fourth- degree tear, you will be transferred to the operating theatre where your muscles will be repaired. You will be given an epidural or spinal anaesthesia so that you have good pain relief.

Your health care provider will evaluate your recovery at your postpartum checkup, typically six weeks after delivery. If you’ve had a third-degree or fourth-degree vaginal tear, you might need to see your doctor more often to ensure early detection of any problems. Tell your health care provider if you’re experiencing severe, persistent or increasing pain, which could be a sign of infection. If you experience complications from a vaginal tear, you might be referred to a urogynecologist, colorectal surgeon or other specialist.

To ease discomfort while you’re recovering:

• Sit on a pillow or padded ring.
• Cool the wound with an ice pack, or place a chilled witch hazel pad between a sanitary napkin and the wound.
• Use a squeeze bottle to pour warm water on your perineum as you’re passing urine.
• Sit in a warm bath just deep enough to cover your buttocks and hips (sitz bath) for five minutes. Use cold water if you find it more soothing.
• Take an over-the-counter pain reliever. Ask your health care provider about a numbing spray or cream, if needed.
• Talk to your health care provider about using a stool softener or laxative to prevent constipation.

Decreasing the Severity of Vaginal Tearing

To decrease the severity of vaginal tearing, try to get into a labour position that puts less pressure on your perineum and vaginal floor, like upright squatting or side-lying, Page says. Hands-and-knees and other more forward-leaning positions can reduce perineal tears, too.

It also helps if you lead the pushing phase of labour. This means you’re doing just enough pushing to feel your baby move. Doing this allows the vagina to stretch slowly, reducing the likelihood of tearing. On the flip side, when you’re directed to push as hard as you can while someone counts; there’s a lot of additional pressure on your perineum, which can increase chances of tearing.

In addition, you may reduce your odds of tearing by applying a warm compress to the perineum during the pushing phase of labour.

Finally, four to six weeks before your due date, practice a 10- to 15-minute perineal massage daily. Frequently massaging the base of the vagina with oil or a water-based lubricant is thought to soften the tissue, making it more supple and improving its flexibility.

Always consult your doctor before beginning the practice, especially if you have a history of herpes, as practising perineal massage with an active herpes outbreak increases the risk of the virus spreading throughout the genital tract.

This article was first published on AfricaParent.com