If you’re having a baby, you’ve probably heard the word “tear” and shuddered at the thought that this might happen to you. Yet be rest assured that they’re not only easy to recover from, but quite common—tears that require stitches occur in approximately one third of vaginal deliveries in the United States.
“When you have a baby, particularly for the first time, nothing that large has ever had to stretch the vagina quite so much,” according to Dr. Alyssa Dweck, a board-certified OB-GYN and co-author of V is for Vagina.
Read on to find out where and why these tears occur, and what you can do to avoid them.
Where You Might Tear
Tears usually occur around the perineum, the area between the vaginal opening and the anus and are classified by severity:
• First-degree tears are superficial and may not even require stitches
• Second-degree tears are more extensive and involve the muscles
• Third-degree tears involve the anal sphincter, which allows the body to involuntarily control the leakage of stool
• A fourth-degree tear, which goes into and through the rectum, is the most severe tear and takes longer to recover from
Sometimes tears happen around the urethra or through the clitoris, in which case, your provider may make a surgical cut in the perineum, also known as an episiotomy, to avoid this from happening.
Why You Might Tear
The likelihood that you will tear often times depends on the size of your baby, the size of your pelvis, and the baby’s position. Having a vacuum or forceps-assisted delivery can also increase your chances and having an episiotomy not only increases your chances, but it can extend an existing tear into the rectum. Although the medical community cautions providers from using these interventions except when medically necessary, it’s a good idea to find out from your provider how often she performs this type of delivery and under what circumstances.
The position you give birth in is also important. Lying flat on your back with your legs pulled back or in stirrups puts too much pressure on the perineum. “If you stretch fabric really tightly, and then you put a force behind it, it would more likely tear than if there’s a little bit more give,” according to Catherine Ruhl, Director of Women’s Health Programs at the Association of Women’s Health, Obstetric, and Neonatal Nurses, and a practicing nurse-midwife. Upright positions like standing, squatting or even sitting up in bed are best.
The way you push can also help. Holding your breath during contractions and then pushing as hard as you can, is actually associated with a higher rate of tearing, studies show.
According to Ruhl, even if you’re dilated 10 centimeters, you don’t have to push right away. “Laboring down,” or resting and allowing your contractions to bring the baby farther down the birth canal before pushing can prevent tears. “It’s important for the woman to be in charge and to wait for her to find a real urge to push and then to let her push as she wants,” she says. “This is especially important when a woman has an epidural as the decreased sensation may block her natural urge to push.”
Studies also show that perineal massage during pregnancy, particularly if it’s your first time giving birth, can help.
How to Recover
“The vagina and the vulva are very forgiving places,” according to Dweck who says that because the blood supply is so rich, tears heal quickly. If you need stitches, your provider will most likely use dissolvable ones and using ice packs for the first 24 hours after giving birth can prevent swelling. You’ll also be given a peri bottle with warm water which cleanses your perineum and eases any discomfort when you urinate. Sitting in a sitz bath, a small shallow tub filled with water, draws out excess fluid and relaxes the muscles and using witch hazel pads can help with the swelling. Motrin, Tylenol, or a prescription pain reliever can also help.
Your provider will give you the go ahead to resume normal activity including exercise and sex at your 6 week check-up. Some women who have third and fourth degree tears sometimes experience residual pain or have tissue underneath the skin that doesn’t heal properly. If you’re still having pain after just a few weeks, make an appointment to see your doc.
Julie Revelant is a freelance writer specializing in parenting, health, and women’s issues, a certified Spinning® instructor, and a mom. Learn more about Julie at revelantwriting.com
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