Vaginal tearing & labour: understanding, prevention & care.

Pregnancy is a miraculous experience in so many ways, but a daunting one in many more, especially for those who are experiencing it for the first time. Pregnancy, and particularly labour, can bring about a heap of questions, concerns and anxiousness about what's to come. One topic that often arises is vaginal tearing during labour: "Will I tear? What happens if I tear?" 

Here are some of your most FAQs about vaginal tearing, answered with the help of our resident experts, Dr. Nicole Stamatopoulos, a Sydney-based General Obsterician and Gynaeocologist, and Beth Ryan, Registered Midwife and founder of PowerBirth childbirth education. 

WHAT IS VAGINAL TEARING?

Vaginal tearing, often also referred to as perineal tearing, refers to the small or sometimes larger lacerations that can occur in the vaginal area during childbirth. These tears typically happen when the baby's head stretches the vaginal opening beyond its usual capacity.

Vaginal tears are classified into different degrees, ranging from first-degree (minor) to fourth-degree (severe) tears, depending on the extent of the tear.

WHAT ARE THE DIFFERENT TYPES OR DEGREES OF VAGINAL TEARS?

Vaginal tearing during labour is classified into different degrees or stages, ranging from first-degree to fourth-degree tears. Here's an explanation of each stage (this doesn't mean you'll experience each stage - you may experience one, or none!):

FIRST-DEGREE TEAR 

Open and honest communication with your healthcare provider is vital. Discuss your concerns, preferences, and any previous birth experiences to ensure collaborative decision-making throughout the labour process. 

SECOND DEGREE TEAR 

More extensive than a first-degree tear, and "the most common type of tear, involving the muscle and the skin", according to Dr. Stamatopoulos. It involves a tear in the perineal muscles in addition to the perineal skin and vaginal mucosa. This type of tear usually requires stitches to promote proper healing and reduce the risk of complications. Your Dr/OBGYN or midwife will advise what's best. 

THIRD DEGREE TEAR 

A third-degree tear is a deeper tear that extends further into the perineal muscles, including the anal sphincter complex. This type of tear requires careful repair with stitches to ensure proper healing and restore muscle integrity.. 

FOURTH-DEGREE TEAR 

The most severe type of tear that extends through the perineal muscles, anal sphincter complex and rectal lining. This tear requires immediate medical attention and repair to minimize potential complications and aid in the healing process.

Please note that these classifications are used for healthcare providers to assess the extent of the tear and help them determine the appropriate treatment and care required. These classifications may vary depending on the medical guidelines and terminology used by different practitioners. The above classifications serve as a guideline only, for the purpose of informing.

HOW COMMON IS IT TO TEAR DURING LABOUR?

Tearing during labour is actually way more common than you probably think. According to the Royal College of Obstetricians & Gynaecologists, up to 9 in every 10 first time mothers* who have a vaginal birth will experience some sort of tear, graze or episiotomy. "It's more common to tear when having your first baby", says Dr. Stamatopoulos. "It's slightly less common for those who have had a vaginal birth before", she adds.

The likelihood of tearing can be influenced by various factors, like the size of the baby, the duration of labour, your age, the use of forceps or vacuum extraction during birth, and whether it's your first vaginal birth or not.

*statistic directly from rcog.org.uk 

HOW WILL I KNOW IF I'VE TORN DURING LABOUR?

"After the birth of the placenta, your midwife will check for tearing using a torch and a piece of clean gauze. This requires them to gently part the labia and look at the skin and muscle to identify if any tear has occurred and if it requires stitches," says Registered Midwife, Beth Ryan. "But most women don't know they have torn until we have checked them after birth." She adds, "The stretching sensation as bubs head is born can feel incredibly intense whether you tear or not, and many women are surprised to learn they have only had a small tear."

You heard it here first, Moxettes. Your Midwife has got your back (and your bits, too).

WHAT HAPPENS IF I TEAR DURING LABOUR?

First up, don't stress. Believe it or not, our bodies are built for this kinda thing. "Most of the time, allowing the body to stretch and tear organically is preferred as this has been shown to be less painful and heal better than an episiotomy, but occasionally if there is concern for bubs heart rate during the birth, an episiotomy will be offered to speed up the delivery," explains Beth.

Your Midwife or OBGYN will determine the severity of your tear and the required treatment. Recovery time will vary; mild tears may heal on their own, but more severe tears may require medical intervention, such as stitches or surgical repair.

If you experience excessive bleeding, persistent pain, or any signs of infection  post-tear or postpartum (beyond your regular postpartum bleed), seek medical attention ASAP.

HOW LONG DOES A VAGINAL TEAR TAKE TO HEAL?

"It takes approximately six (6) weeks for tears to heal completely", says Dr. Stamatopoulos. "If you've had stitches, this timeframe allows for them to dissolve and for the tissue to heal - though you may feel like the healing is complete after a few weeks."

HOW DO YOU PREVENT VAGINAL/PERINEAL TEARING DURING LABOUR?

While it may not be possible to completely eliminate the risk of vaginal tearing, there are measures that can help reduce the likelihood of severe tears. Here are some strategies to consider and chat to your health practitioner about:

WARM COMPRESS

"We use a warm compresses during the pushing stage of labour on the perineum to assist with the stretching of the perineum, to help stop tearing," says Dr. Stamatopoulos. 

PERINEAL MASSAGE

Regular perineal massage during pregnancy may help increase the flexibility and stretchiness of the perineal tissues, potentially reducing the risk of tearing.

LABOUR POSITIONS & TECHNIQUES

Certain positions and techniques during labor, such as upright positions, changing positions frequently may facilitate a smoother birth and minimize the chances of tearing. Though often when you're in the throes of labour, often all you want is to feel most comfortable - do whatever you feel works best for you and your body, Moxette.

HEALTHCARE PROVIDER SUPPORT & INTERVENTIONS

Working closely with your healthcare provider is crucial. They can provide guidance, support, and interventions such as perineal support, controlled pushing (your Doctor or Midwife will guide you), and episiotomy when necessary. "Sometimes we may perform an episiotomy to hopefully help prevent tearing to the bottom", explains Dr. Stamatopoulos, "but unfortunately it is not a guarantee."

EFFECTIVE COMMUNICATION & INFORMED DECISION-MAKING 

Open and honest communication with your healthcare provider is vital. Discuss your concerns, preferences, and any previous birth experiences to ensure collaborative decision-making throughout the labour process. 

CAN YOU SCAR FROM VAGINAL TEARING?

Scarring is possible after any vaginal trauma, including childbirth. The skin may be raised, thicker or a different colour, just like a scar on any other part of your body. Talk to your Doctor if you're worried.

HOW LONG AFTER GIVING BIRTH VAGINALLY, OR AFTER A VAGINAL TEAR, CAN YOU HAVE SEX?

The general reco vaginal intercourse is six weeks to allow things to heal, but if you've had a surgical repair down-there after a particularly testy vaginal birth, chat to your Doctor or health practitioner first. OR, if you're just not up (or down) for any kind of intimate play just yet, that's ok, too. Talk to your Doctor, your partner, possibly a pelvic physio if your pelvic floor has taken a bit of a hit. The message here is take your time, and don't be afraid to seek the support you need - however that looks for you.

POST-TEAR CARE

USE A COLD COMPRESS

"We recommend cooling therapy to assist with pain relief and swelling of the perineum after giving birth," says Dr. Stamatopoulos. 

PAIN RELIEF MEDICATION

"Basic medications such as paracetamol can work wonders for discomfort," says Beth. Talk to your Doctor or medical practitioner about what medication is best suited to you, and ensure whatever you take for pain relief 'safe' to take while breast/chest feeding.

KEEP THE AREA CLEAN & DRY

Beth's advice is to "Rinse the area with warm, clean water twice a day, avoid putting really hot or soapy water directly onto the wound; pat dry and ensure you're changing your pad regularly."

WIPE FRONT TO BACK

Take care when going to the toilet, as things will feel sensitive down there. Pat dry when possible, and wipe front to back when you need (you should do this anyway, to avoid unwanted bacteria entering your vagina).

WEAR LIGHT, BREATHABLE FIBRES 

Like cotton undies. Avoid tight-fitting clothing or anything that may rub or irritate the skin.  

Vaginal tearing during labor is a common occurrence, but understanding it and what to expect can help to alleviate some anxieties associated with it. Chat to your Doctor, Midwife or healthcare provider about any concerns you may have and what to expect in the lead up to labour. Remember, each labour and birth experience is unique, and yours will be, too - seeking guidance from medical professionals will help ensure that you get the best care and support suited to your needs.

IMPORTANT PSA: The information posted here and on @MoxieHQ Instagram, TikTok and Facebook channels is intended to inform only, and does not nor should it constitute or replace a personalised medical diagnosis or treatment plan from a medical professional. If you're ever concerned about anything relating to your own intimate health, please make an appointment to see your Doctor or health practitioner.