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Tears and episiotomy

What are perineal tears?

  • Most women, up to 9 in 10 (90%), tear to some extent during childbirth. Most tears occur in the perineum, the area between the vaginal opening and the anus (back passage). They may be:
  • first degree tears – small, skin-deep tears which often heal naturally
  • second degree tears – deeper tears affecting the muscle of the perineum as well as the skin. These usually require stitches.
    For some women with a tear, about 5 in 100 (5%), the tear may be more extensive. This may be:
  • a third-degree tear extending downwards from the vaginal wall and perineum to the anal sphincter, the muscle that controls the anus.
  • a fourth-degree tear extending to the anal canal as well as the rectum (further into the anus)

What causes maternal injuries from childbirth?
These injuries happen when the perineum does not have time to stretch during labor. The baby’s head or shoulders tear the perineum during birth. The tears are more likely to happen if:

  • The baby is very large
  • The mother is giving birth for the first time
  • The doctor or midwife helps pull the baby out with a device that holds onto the baby’s head. This might be done if the baby gets partly stuck in the birth canal.

In the past, doctors and midwives sometimes cut the perineum to make the opening of the vagina larger. This is called an “episiotomy.” It was done to prevent maternal injuries during childbirth. But doctors and midwives now know that an episiotomy can make a woman MORE likely to have a tear near the perineum. However, with a forceps delivery, an episiotomy is usually necessary and may prevent more serious tears.

How are maternal injuries from childbirth treated?

Minor skin tears often need no treatment and heal on their own. If you have a tear that goes deeper, your doctor or midwife will use stitches to repair the tear. These stitches dissolve over time and do not need to be taken out.

What can I do to feel better while my injury heals?

Some people feel better if they:

  • Take “sitz” baths – This is a shallow, warm bath that helps clean and heal the vaginal area. Take them twice a day for 30 minutes each. A handful of cooking salt or sodium bicarbonate (baking soda) in the bath may help.
  • Take medicines to relieve pain, such as paracetamol (sample brand name: Panadol®) or ibuprofen (sample brand names: Advil®, Nurofen®).
  • If you had stitches for a serious tear, your doctor or midwife might recommend foods or medicines to keep your bowel movements soft. This makes you less likely to strain to push out a bowel movement, which might reopen the tear.
  • You should not have sex until the tears heal. Sex can be painful and might reopen the tear.

Can maternal injuries from childbirth be prevented?

Sometimes. You are less likely to have a vaginal injury during childbirth if you control your pushing when you give birth. This helps the perineum to stretch slowly, making it less likely to tear. The use of warm compresses on the perineum whilst you are pushing can reduce the risk of tearing. There are also some things you can do during pregnancy that may reduce the chance of you having a tear. These include:

  • Perineal massage both before and during labour has been shown to reduce the chance of tearing, especially severe tears.
  • Epi No. This is an inflatable silicone balloon that is used in the weeks leading up to delivery to gradually stretch the perineum. It can also be used after delivery to aid in pelvic floor exercises. The concept seems reasonable, but there have been no good studies to show that it is effective.