Vaginal Tears During Childbirth

What is a vaginal tear?

A vaginal tear happens during childbirth. Also called a perineal laceration, this is a tear in the tissue (skin and muscle) around your vagina and perineum. The perineum is the space between your vaginal opening and your anus (butthole).

During a vaginal delivery, the skin of your vagina prepares for childbirth by thinning out. This part of your body is meant to stretch and allow your baby’s head and body to pass through without trauma. But it’s very common for your vagina to tear. Up to 90% of women who give birth will have some tearing during a vaginal delivery.

Treatment for vaginal tears depends on the severity of the tear. There are several at-home treatments you can to do reduce your discomfort.

What are the four types of perineal lacerations?

There are four different grades of vaginal tears. The severity of the tear determines the grade.

• First-degree tear: The least severe of tears, this small injury involves just the first layer of skin around your vagina and perineal area. It usually doesn’t require stitches.
• Second-degree tear: This second level of tearing is the most common. The tear is slightly bigger, extending deeper through your skin into the underlying muscles of your vagina and perineum. This tear requires stitches.
• Third-degree tear: A third-degree tear extends from your vagina to your anus. This type of tear involves injury to the skin and muscles of your perineal area, as well as damage to your anal sphincter muscles. These muscles control how you poop. You need stitches with a third-degree tear.
• Fourth-degree tear: This is the least common type of tear during childbirth. Extending from your vagina, through your perineal area and anal sphincter muscles and into your rectum, this injury is the most severe type. Your provider may need to take you to an operating room (rather than the delivery room) for stitches.

What is the most common type of tear during childbirth?

A second-degree tear is the most common. It involves the first layer of your perineal skin and some of your perineal muscle. Only about 5% of women have third- or fourth-degree tears.

What causes a vaginal tear during childbirth?

A vaginal tear during childbirth happens because your baby stretches your vagina and perineum during birth. This is normal and common. Some factors, like your vagina’s ability to stretch, are beyond your control. Factors like your baby’s size or situations that arise during delivery may put you at higher risk for vaginal tearing.

Who is more likely to tear during childbirth?

Some factors increase your chances of tearing. These include:

• It’s your first delivery.
• Your baby was face up instead of face down during delivery.
• Use of forceps or a vacuum during delivery.
• A large baby (more than 8 pounds).
• Prolonged second stage of labor (pushing stage).
• Being of Asian ethnicity.
• You had an epidural.

Talk to your pregnancy care provider to determine if you have any risk factors for vaginal tearing.

What are the potential complications of vaginal tears?

Vaginal tears can be uncomfortable and painful, but most small vaginal tears heal within two weeks. It’s common to feel discomfort for a month or two if your tear was larger. Third- and fourth-degree tears come with more complications due to the severity of the injury.

Some of the most common complications of vaginal tears include:

• Infection.
• Bleeding.
• Painful intercourse (once you’re permitted to have intercourse).
• Fecal incontinence (leaking poop).
• Ongoing pain and soreness.

If you experience any of these complications, let your provider know at your postpartum appointment. They can let you know if what you’re experiencing is normal.

Can you feel yourself tear during birth?

Everyone’s birth experience is different, so there isn’t a clear answer. If you had an epidural or other pain relievers during delivery, you’ll likely have no clue if or how much you tore until your provider tells you. However, even if you deliver with no pain medication, you may not feel a vaginal tear.

How are vaginal tears treated or repaired?

Treatment of a vaginal tear depends on the severity of the injury. In a first-degree tear, you probably won’t need stitches. In a second-, third- or fourth-degree tear, you’ll receive stitches to repair the tear. Any stitches will dissolve on their own within six weeks. Providers treat most tears right in the delivery room. However, larger tears may require transfer to an operating room where the lighting is better and the surgeon has access to different equipment. This is especially the case if there’s a lot of bleeding.

In some of the most severe cases, your healthcare provider may need to repair the injury to your anal sphincter. This treatment also uses dissolvable stitches.

How do I care for a vaginal tear at home?

You may feel some discomfort in the weeks after delivery while your tear heals. There are a few things you can do to help ease this discomfort. These tips work with each type of tear:

• Use a peri-bottle (a squirt bottle) to wash yourself clean after using the bathroom. Lukewarm water feels the best.
• Gently pat yourself dry with toilet paper instead of wiping.
• Apply ice packs or wear special sanitary pads that contain a cold pack inside. These pads are often available in the hospital or at your local drugstore.
• Avoid constipation by drinking plenty of water and using a stool softener.
• Take a sitz bath. Fill your bathtub with a few inches of warm water and sit in it for a few minutes.
• Sit on a donut pillow. If you had a third- or fourth-degree tear, it may be helpful to get a donut-shaped pillow from the drugstore. Sitting on that relieves pressure from your bottom.
• Avoid exercises or uncomfortable movements that aggravate your perineal area. This could include squats or walking down steps.
• Take an over-the-counter pain medication. Your provider may provide stronger pain medication if your tear is severe.
• Use a pain-relieving numbing spray like Dermoplast®.
• Line your sanitary pads with witch hazel pads like Tucks®.

Make sure you check with your healthcare provider before taking any pain relief medications. What medicines you can and can’t have may change if you’re breastfeeding.

How long does it take a vaginal tear to heal?

Most women feel relief from any pain caused by a vaginal tear in about two weeks. If your tear was larger, it may take longer. Your stitches dissolve on their own and you don’t need any additional treatment for the tear. Keep an eye out for any signs of an infection while your tear heals. These can include:

• A foul-smelling discharge.
• A fever.
• Pain that doesn’t go away even with medication.

Some women experience pain with sex after having a tear. If you feel any pain or discomfort with sex, talk to your provider. There are treatments to help with this.

Can you prevent vaginal tears?

Most vaginal tears are unavoidable. But there are some things you can do to try to prevent tearing:

• Perform a perineal massage. Perineal massage is a technique that may help your perineum stretch more easily. You can do this after about 34 weeks of pregnancy and during labor.
• Keep your perineum warm during labor. Your provider may have a warm cloth to place on your perineum.
• Sit upright or lie on your side during delivery (as opposed to lying flat).

Remember, these methods may help reduce tears, but most studies show only a small reduction in the amount of tears. It’s best if you talk to your pregnancy care provider about these and other methods to prevent tearing.

Can you give birth without tearing?

Yes, it’s possible to give birth without tearing. But most women tear at least a little.

Is it better to tear or be cut during labor?

An episiotomy is a procedure where your healthcare provider makes a cut from the edge of your vaginal opening outwards. This widens your vaginal opening in a controlled way, but it doesn’t always keep you from tearing. Healthcare providers don’t recommend routine episiotomies and prefer that you tear naturally. The latest research suggests it’s better to let your perineum tear naturally.

Can I have a vaginal delivery if I had a vaginal tear previously?

Yes. You can still plan for a vaginal delivery if you’ve torn in a previous delivery. Even in studies of women with severe tears, there’s no clear evidence that says you should avoid a vaginal delivery in the future. The exception to this may be if you have bowel control issues or distress from a previous vaginal tear. If you’re unsure about a future vaginal birth, talk to your pregnancy care provider.

Will I tear again the next time I give birth?

Not necessarily. Tearing the first time you give birth doesn’t mean you’ll tear in subsequent deliveries. In fact, most women find they tear less with each delivery. In most studies, the chance of having another third- or fourth-degree tear is less than 3%. It’s always best to discuss your concerns about tearing with your pregnancy care provider.

When should I contact my healthcare provider?

You should contact your pregnancy care provider when:

• Your stitches become painful or smell.
• You develop a fever.
• Your pain or soreness becomes worse, even with pain medication.
• You lose control over your bowels.
• It hurts to pee.
• Sex is painful.