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Perineal tears: What you need to know


Ahh perineal tears. Just the thought is enough to make you cross your legs! 

Outside of childbirth, the perineum isn’t a body part that is discussed much, so if you are reading this thinking peri-whaat? You are not alone. For context, the perineum is the area of skin between the vagina and the anus. During childbirth, the skin and muscles around your vagina stretch to allow your baby to be born (how clever and incredible!). Sometimes the perineum gets torn in the process and this is known as a perineal tear.

While daunting to think about, some degree of perineal tearing is common during childbirth. According to the Royal College of Obstetricians and Gynaecologists, up to 90 per cent of first-time mothers who birth vaginally sustain some degree of tear. As a midwife, I can reassure you that just as your body knows how to stretch to accommodate your bub, it is also capable of healing should it tear. For the vast majority of mums, tears heal within two to six weeks. Fortunately, despite how commonly tears occur only a small portion of people (approximately 3 per cent) will sustain a severe tear. For these mums, recovery time is longer and is therefore supported by a team of health professionals. This can include a surgeon, specialist physiotherapist, general practitioner, dietitian, psychologist and in some cases a sexologist.

Is it possible to prevent tearing? 

While there is no definitive reason why some people tear during childbirth and others do not, research has identified factors that appear to increase the risk of sustaining a tear. These include: 

  • Giving birth for the first time

  • The use of vacuum or forceps

  • Babies birth weight >4kg 

  • Induction of labour

  • Epidural anesthesia 

  • Asian ethnicity 

  • Baby in the posterior position at birth (their back facing mum’s back)

We also know that maintaining good pelvic floor health during pregnancy can improve outcomes relating to perineal trauma. It is recommended that you do pelvic floor exercises every day and it’s a great idea to have your pelvic floor assessed by a specialist physio to ensure you are contracting and relaxing your muscles effectively. 

Research also suggests that practising perineal massage from 34 weeks may reduce the risk of sustaining a tear requiring stitches and episiotomies in people giving birth for the first time. Other evidence-based strategies for minimising the risk of severe perineal trauma include:

  • Adopting a side-lying or all-fours position for the birth of your babies head (you can read more about birth positions here

  • Applying a warm compress to the perineum during the pushing stage, which can be done by your midwife. 

  • Aiming for a slow controlled birth of the head by breathing or pushing gently as your baby crowns.

If I tear, what happens next? 

It is crucial that perineal tears are properly identified so that they can be treated. Following a vaginal birth your midwife or doctor will gently examine your vulva, vaginal wall and anus. I know what you are thinking – But I just pushed a baby out…ouch! – This process is tender but thankfully short-lived. Know that if a tear is identified, you will be offered appropriate pain relief before stitches are commenced. It can also really help to breathe on the gas and air during the assessment to help you relax.

The degree of tear

Perineal tears are graded from one to four, depending on which areas of skin and muscle are affected. Once the midwife or doctor has established the degree of tear, they will discuss with you a plan for repair and healing. 

First and second degree tears impact only the skin and/or a small amount of muscle. The term ‘first degree tear’ can also be used to describe a tear or graze to the labia. These tears may need stitches but can usually be repaired by a midwife or doctor in the birth suite. 

Third and fourth degree tears are more complex as they impact the muscles controlling the anus and therefore require surgical repair in an operating theatre. If you are planning to breastfeed, skin to skin contact and your bub’s first feed can still be prioritised prior to you being taken to theatre. If the stitches need to be done straight away, your baby can do skin to skin with your support person and you will be reunited shortly after the procedure.

Episiotomy

An episiotomy is a cut that is made to the perineum during childbirth. Episiotomies are usually only used to speed up the birth of a baby if bub is in distress. In some cases, making a cut can prevent a severe tear from occurring, however this is mostly when instruments (forceps and vacuum) are being used to help with the birth. During an unassisted vaginal birth, it is rare that an episiotomy will prevent a tear from occurring and therefore it is not routinely recommended, but rather on a case by case basis.

What can I do to recover? 

Just as every birth is unique, so too is the recovery process. Please try not to compare yourself to other mums – getting back into activewear and heading out is not an indication of a seamless recovery, I promise. 

Stitches generally take one to three weeks to dissolve. During this time:

  • Aim to rest as much as possible and limit long periods of standing or sitting (permission to stay in bed granted!). Ice packs can prevent swelling while regular pain relief such as paracetamol or ibuprofen can help keep you comfy.

  • Keeping the area clean and dry will significantly help the healing process. 

  • Rinse the area in warm water at least once a day, change your pad regularly and expose the stitches to fresh air each day (try lying on a towel after you shower).

  • Ensure you are well hydrated to avoid stinging when you urinate and eat a high fibre diet to avoid constipation. 

It is completely normal to worry that things down there will never feel right again but know that your body is incredibly resilient and in time, things will settle down. It is okay to begin gentle pelvic floor exercises and a trip to the women’s health physio at around six weeks post-birth is highly recommended. 

When to seek help

If at any point, your stitches are so tender that it is difficult to sit or walk, you notice the area is red, inflamed, hot to touch or oozing, have your midwife or doctor examine the wound. Occasionally perineal tears become infected after birth however good hygiene and plenty of rest will help prevent this from happening. 

So mama, while the thought of any tear is understandably not ideal, I hope this information gives you confidence in your AMAZING body. You are capable of healing and if a severe tear should occur, with the help of your care team and time, recovery is absolutely possible.

Read next: Recovering from a vaginal birth



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Expert author: Beth Ryan

Beth Ryan is a registered midwife with a Masters degree in Public Health. You can find out more about her by following her on instagram here.

Royal College of Obstetricians and Gynaecologists (2022) Perineal tears during childbirth

Homer, C. & Wilson, A. (2018) Perineal tears: A literature review

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