Vaginal tearing, while unpleasant, is an almost inevitable side effect of vaginal births, particularly for those stepping into motherhood for the first time. As Katie Page, a registered nurse-midwife from Forest, Virginia, points out, “It’s important to view vaginal tearing as a common occurrence, not a terrifying prospect.” So, what you should know about vaginal tearing during labor is of paramount importance. Familiarizing yourself with what to anticipate in the genitalia during and post-delivery by learning more about vaginal tears is a wise step.
Vaginal Tearing: What Is It?
The perineum (the area between the vagina and the rectum) can be lacerated during vaginal delivery, resulting in a vaginal tear. The tears aren’t the result of a surgical incision. They may happen from the expecting mother actively pushing, or they may be the result of the baby being delivered by involuntary contractions of the uterus. Sherry Ross, M.D., an OB-GYN and women’s health expert at Providence Saint John’s Health Center in Santa Monica, California, says, “During birth, the vagina has to get big enough for a baby with a head the size of a watermelon to fit through it. It’s hoped that the vagina can extend without tearing, but it usually does tear.
Prevalence of Vaginal Tearing
While most research on vaginal tears has been conducted in other countries, a study published in BMC Pregnancy and Childbirth in 2020 found that over 70% of pregnant women experience vaginal tearing of some kind during birth. Tearing is more common in first-time mothers than mothers who have given birth.
If you’re overweight or have a quick birth, the tissue has less time to adjust and expand as the baby comes down, increasing the risk of lacerations. Another potential contributor is the baby’s position, which might increase pressure on the vaginal floor in some situations (such as when the baby is positioned head-up). Vaginal tearing is also more likely after protracted labor, the use of a vacuum or forceps, or extreme vaginal edema.
What’s the good news? Dr. Ross adds that once a woman has given birth vaginally, her tissues are more pliable, and the risk of tearing decreases.
What to Do When You Have a Vaginal Tear
All four types of vaginal tears are painful, but the more severe ones sometimes need stitches after giving delivery. Extreme crying might also weaken your anal sphincter. In order to mend vaginal rips after giving birth, you should do as your doctor suggests.
For about a week after experiencing a first or second-degree tear, you may feel some discomfort, especially while sitting up straight. Any activity that increases downward pressure, such as passing gas or sneezing, will also be painful. By the end of two weeks, the tear should be mostly healed, and the stitches should be gone, “but it can take several more weeks for the nerves and muscles to get back to full strength,” says Page. The vaginal tear’s location and the quality of the stitches may make sexual activity at six weeks difficult.
Third and fourth-degree lacerations take longer to heal, with the first agony lasting anywhere from two weeks to three weeks. And sexual or intestinal discomfort may persist for weeks or months. Page recommends trying out some sitz baths, cold compresses, and a fiber-rich diet for the latter. These forms of lacerations require stitches after birth.
There is treatment for the symptoms you are experiencing, which may include pelvic floor dysfunction and prolapse, urinary problems, bowel movement difficulties, and discomfort during intercourse if you have had a major tear into the vagina or rectum.
Vaginal Tearing Is Less Severe Now
If you want to reduce the degree of vaginal tearing, Page recommends finding a labor position (such as upright squatting or side-lying) that puts less strain on your perineum and vaginal floor. Perineal tears can be prevented in a variety of hands-and-knees and forward-leaning positions.
If you take charge throughout the pushing stage of labor, that helps, too. Page explains that when the mother is in charge, she does just enough to feel the baby move, which helps the vagina stretch slowly and prevents ripping. On the other hand, your perineum is put under a lot of stress when you’re told to push as hard as you can as someone counts.
As an added precaution against vaginal rips, Dr. Ross recommends using a warm compress on the perineum during the pushing stage of labor.
Finally, from four to six weeks before your due date (if you can reach it!), you can begin a daily 10- to 15-minute perineal massage. Page suggests massaging oil or water-based lubricant into the vaginal base regularly to make the tissue more elastic and improve its suppleness. Perineal massage raises the chance of herpes spreading throughout the vaginal tract; if you have a history of herpes, you should always visit a doctor before beginning the practice.
Do I Need to Request an Episiotomy?
In the past, doctors recommended episiotomies for pregnant women in the hopes that doing so would lessen the amount of perineal tearing and provide a more hospitable environment in which the wounds could heal. Dr. Ross notes that while an episiotomy (an incision made in the perineum to expand the vaginal opening) may still be performed in some cases, it is no longer considered standard procedure for vaginal delivery. Moreover, an episiotomy may prolong both the injury and the recovery processes. Unless absolutely necessary, an episiotomy is generally not recommended by doctors.