Vaginal Tears and Episiotomies
What we know:
Tearing during a vaginal labour is probably one of the top fears many women have before giving birth. You might be surprised to learn that 9 in 10 women will experience some kind tear, graze or episiotomy when giving birth. Midwives and doctors are used to dealing with tears and most are minor and heal quickly.
What is a tear?
A tear happens spontaneously when your baby stretches your vagina and perineum during the birth. Your perineum is the area between your vagina and back passage (anus). The type of tear a woman experiences will be graded in severity from first to fourth degree. A first degree tear, or graze, affects just the skin and can occur around the labia, clitoris or inside the vagina. It won’t usually require any stitches and heals quickly without treatment.
A second degree tear affects the muscle of the perineum and the skin and usually requires stitches under local anaesthetic. This is usually done in the same room where you had your baby. It can be very sore in the days and weeks after the birth but is unlikely to cause any long-term problems.
We will cover third and fourth degree tears in a separate article but these are when the tear is deeper and may extend to the muscles controlling the anus, the sphincter. They can occur in approximately 6% of first time births and 2% of second time. They usually require surgery in an operating theatre and will take longer to recover from than other tears.
What is an episiotomy?
An episiotomy is a cut made by your midwife or healthcare professional to help make more room for your baby to come out. It can only be done with your consent and will be stitched up in the same room after your baby is born. In some instances the cut may extend and also tear.
An episiotomy is often carried out during an assisted or instrumental birth. This is when forceps or ventouse may be needed to help bring your baby out. It may also be done if your baby needs to be born quickly or if there is a risk of a perineal tear.
How do I care for my tear or episiotomy?
It is normal to feel pain or discomfort for 2-3 weeks after the birth, especially when walking or sitting. Give yourself time to heal and don’t do anything strenuous or unnecessary. It’s another great reason to ask family and friends to help so you can focus on recovering and being with your baby. Follow these tips when caring for your tear:
• Keep the area clean and only use water to wash
• Change your sanitary pad regularly, at least every four hours
• Shower or bath every day
• Wash your hands before and after going to the toilet
• Drink plenty of water and eat a balanced diet as this will help avoid constipation
• Ask a health professional to check your stitches if you have any concerns
• Pouring water over yourself while urinating can help neutralise the acid and reduce any stinging.
Can I do anything to prevent a tear?
It is impossible to predict who will tear or need an episiotomy during labour. Some factors which may increase the risk are:
• First vaginal birth
• The baby is over 4kg
• The baby’s shoulder becomes stuck
• Assistance is needed in the final stage to bring the baby’s head out
• You can a long second stage of labour (the pushing stage).
Some midwives recommend trying perineal massage in the weeks before your due date. This can help stretch and loosen the perineal muscles. There are some positions during labour which could help reduce the risk of tearing such as all-fours or kneeling and your midwife will help you have a slow and controlled birth. They may also support your perineum as your baby is born - this is called ‘hands on birth’ and can reduce the severity of a tear. This can be done in any position, but not during a water birth.
Final thoughts:
Remember that most women will experience some kind of tear of graze during labour, especially if it is their first baby. It will be very sore but should heal quickly and without complications. If you are worried about tearing speak to your midwife who can discuss the risks and methods for preventing a serious tear.
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