Perineal tear during Childbirth – What you should know

What is perineal tear?

A perineal tear is a laceration to the area between the vagina and rectum that can occur with vaginal delivery. The tears can occur spontaneously. Most of the perineal tears are minor, but severe tearing and complications can also occur. If you are planning to have a baby in the very near future, it can be helpful to know the different types of tears that can occur, how to prevent bad tearing, and how to help healing.

The odds of perineal tearing

Unfortunately, the odds of getting a perineal tear are fairly high: First-time moms have a 95 percent chance of experiencing some form of tearing during delivery, since the perineum is less flexible.

Other factors contributing to the tearing may include being overweight, rapid labour and delivery, since the tissue has less time to adapt and stretch as the baby comes down. The position of the baby can be another factor—for example, babies facing up put extra pressure on the back wall of the vagina. Having an instrumental delivery or an especially prolonged labour resulting in severe vaginal swelling increases your chance of tearing as well.

“Typically, after your first vaginal birth, your tissue is more flexible so tearing becomes less likely,” 

Degrees of perineal tearing

Up to 80% percent of women will experience some amount of vaginal tearing at the time of delivery. Most of them will be mild tearing of the skin around the vagina or urethra. Mild tearing (1^st or 2^nd degree) can cause some initial pain, but a tear usually heals within 4-6 weeks and doesn’t normally cause any long-term side effects.

More severe tears (3^rd degree) that go from the vagina to the muscle around the rectum occur in 3% of deliveries; and tears that extend from vagina to through the rectum (4^th degree) occur in less than 1% of vaginal deliveries. These tears requiring stitching.

Healing for the third- and fourth-degree lacerations takes longer, with two to three weeks of initial pain. You may experience painful intercourse or discomfort while having a bowel movement, may last for several months. Laxatives and a fibre-rich diet can help with the discomfort while opening the bowels, as can cold compresses.

Since severe tears into the vagina extending to rectum can cause Pelvic floor issues, prolapse, urinary problems, bowel movement difficulties, and discomfort during intercourse, it’s important to share your symptoms with your obstetrician or midwife, no matter how embarrassing they may seem.

How do I prevent perineal tearing?

Some Tips:

• Try upright squatting or lying sideways puts less pressure on your perineum and vaginal floor.
• Delivering on all fours and other more forward-leaning positions can reduce the incidence of perineal tears too.
• Applying a warm compress to the perineum during the pushing phase of labour.
• Practice a 10- to 15-minute perineal massage daily in the last 4 weeks of pregnancy. (Except if you have had a herpes infection in the past- perineal massage may flare up Herpes).
• Ask your obstetrician or midwife to avoid performing an episiotomy unless medically necessary. Episiotomy is no longer routine during a vaginal delivery,

We are experts in the management of Pregnancy and Childbirth.

Please contact Rockingham Women’s Health Centre on 0895918943 to book an appointment or www.rockinghamwomenshealth.com.au