Perineum Tearing During Labor and Delivery

Congratulations, you’re expecting! As you prepare to meet your little one, it is important to prepare yourself for the labor and delivery process. If you are new to this “momming” thing, you’ll want to acquaint yourself with delivery, as there can be some unexpected surprises that occur right in the midst of wonderful chaos. Read on to find out about perineum tearing and what it might mean for you.

Perineum Tearing: Is Everyone Experiencing It?

A vaginal or perineum tear is one that occurs when your baby is pushed out. These tears happen spontaneously, meaning that it is difficult to predict when they will occur, or to what degree they will affect your perineum, the delicate area of skin between your anus and your vagina.

During childbirth, your vagina has the enormous task of stretching to accommodate your baby’s head, which can sometimes be as large as a cantaloupe. While it is possible for the tissue of the perineum to stretch enough to accommodate a crowning head, most times it will tear during labor. Rest assured, you’ll likely have too many things going on to notice that you have torn tissue until after delivery; your level of discomfort will indicate the level of damage that has been sustained. Remarkably, most perineum tearing heals on its own, but it will need rest, care and attention to heal properly.

What Are the Odds of Tearing?

The odds of tearing for first-time moms is relatively high; almost 95% of mothers are not physically prepared to accommodate stretching, so a perineum tear is inevitable. Other factors play a role in tearing, such as being overweight, bearing down excessively when pushing and the position of the baby. Vacuum and forceps-assisted deliveries can cause tearing as well, as it places extra pressure on the pelvic floor, causing it to swell to capacity. The good news is, this tissue heals relatively quickly, and with subsequent children, the tissue in that area of your body tends to be more flexible, so tearing is less common.

Will I Need Stitches?

Depending on the severity of your perineum tear, you may need stitches in order for it to heal adequately. There are generally four types of tears:

1. First- and second-degree tears

First- and second-degree tears are uncomfortable when sitting up straight, or when you have a bowel movement, for the first week or two after delivery. Coughing and sneezing can also be uncomfortable; while the stitches dissolve within a week, it will take time for nerve and muscle tissue to repair itself around this area. Most physicians recommend no strenuous activity or sexual intercourse for at least six weeks following a vaginal birth.

2. Third- and fourth-degree tears

These tears run deeper into tissue, causing additional complications if not taken care of properly. Discomfort during intercourse or difficulty with bowel movements may last several months; it’s important to give yourself time to heal, as jumping into a regular activity schedule too soon can result in pelvic floor dysfunction, incontinence or even prolapse, a painful and potentially life-threatening condition. If you are experiencing symptoms of pain and discomfort after childbirth and perineum tearing, it is important to be candid with your doctor and explain symptoms in detail. The more information your doctor has, the more effectively your condition can be treated, giving you proper methods and time for healing.

How Can I Decrease the Likelihood of Tearing?

Believe it or not, there are some things you can do to decrease the likelihood of tearing during childbirth. Taking the lead on pushing while contractions are still relatively mild gives your body some extra time to stretch out and prepare for delivery. Gently bear down when you feel contractions coming, and you’ll be preparing your pelvic floor for what is to come.

About four to six weeks before your due date, perform a 10 to 15 minute massage of the perineal area daily with water or a moisturizing lubricant to soften and stimulate the area.

Getting into certain positions also decreases your risk of tearing during labor. Primal squatting positions, hands and knees positions, and lying on your side are all labor positions that reduce pressure on the pelvic floor, making it easier for baby to show himself. Talk to your doctor about some options that might be right for you.

What about Episiotomy?

Episiotomy is not actively practiced in medical circles anymore; this involves cutting into the perineum and anal tissue, making labor and delivery easier. Episiotomies, although they are clean cuts, do not heal well, and often result in scar tissue that is painful and unsightly as the body attempts to heal the trauma caused by the incision. Still, an episiotomy might be required if mother and baby are going into distress, or if other conditions develop where it would be necessary to get baby out quickly.

You Are Not Alone

Soon, you’ll join the thousands of mamas who have been here, done that…and most of us have gone through a perineum tear. If you have questions or concerns about what is coming for you in the delivery room, talk to your obstetrician/gynecologist, who will have ideas for not only easier labor, but faster and more efficient healing afterward. Best of luck to you as you begin your journey of motherhood!