On a recent episode of the Healthful Woman podcast, “Tears, Lacerations, and Episiotomies,” Dr. Nathan Dox sat down with Dr. Sadia Mobeen to discuss tears during childbirth. Different types of tears or lacerations can happen and, depending on the severity of the tear, different recovery time is needed.
Tearing during childbirth is normal and we encourage you to ask your doctor about what type of tear you had if it happens. Here is some information to prepare you for the possible lacerations you can expect during childbirth.
About 53-79% of first-time mothers will tear during childbirth, even if it is small. Dr. Mobeen says that she “[usually tells] first-time moms that this baby’s going to make the way for the other babies.” Lacerations on the labia and vagina are either manmade or happen accidentally as the baby is pushed out. Manmade lacerations are called episiotomies, but these are only done in about 5-10% of births if there are difficulties during labor.
The most common types of tears are first-degree and only impact the superficial layer (the skin and mucosa) or second-degree tears that affect the deeper layer of the muscle. If the tear involves the rectal sphincter (the ring of muscle on the anus) externally or internally, this is called OASIS (obstetric anal sphincter injuries). There are also three levels of third-degree lacerations and a fourth-degree classification, depending on how much of the sphincter is involved. These types of tears are rare, “less than 10% and probably, you know, maybe even less than 5% of all births” according to Dr. Fox.
Dr. Mobeen describes a few common techniques she uses to prevent cuts and tearing. A perineal massage, or a massage between the anus and vulva, can help the muscle stretch. Placing warm heat on the perineum in-between contractions can also help the muscle relax so that the mother has an easier time delivering her baby. The perineum is also protected by the doctor as the mother is pushing and delivering the head.
First and second-degree tears can be stitched after the mother is finished with her delivery. A local anesthetic will be injected into the area since the epidural will likely have worn off to some degree. Dr. Mobeen explains that she starts by repairing the bleeding cuts and then moves on to the superficial tears so that the entire area is repaired.
These stitches will dissolve on their own in about 2-3 weeks and during that time, it is important to keep the area clean. These tears will be fully healed in about 6 weeks, after which time women can resume sexual intercourse and the use of tampons.
Third and fourth-degree tears will be repaired similarly to first or second-degree tears but recovery may be a bit more intensive. Dr. Mobeen recommends using a stool softener for six weeks so that the sphincter and perineum area is not strained. Women will also be given antibiotics to prevent possible infections. If you have foul-swelling discharge, let your doctor know right away.
If you are planning a pregnancy or are counting down the days until delivery, we encourage you to schedule a consultation with our maternal fetal medicine experts. We will be happy to answer any questions you might have to prepare you for the exciting delivery of your child.
Maternal Fetal Medicine blogs are intended for educational purposes only and do not replace certified professional care. Medical conditions vary and change frequently. Please ask your doctor any questions you may have regarding your condition to receive a proper diagnosis or risk analysis. Thank you!