Vaginal Tears During Childbirth

Overview

What is a vaginal tear?

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

During a typical vaginal delivery, the skin of your vagina prepares for childbirth by thinning out. This part of your body is meant to stretch and allow the baby’s head and body to pass through without trauma. However, there are several reasons why a vaginal tear might happen. These reasons can include:

  • A large baby.
  • A very quick delivery (the skin hasn’t had time to stretch and thin).
  • Use of forceps during delivery.

How serious are vaginal tears?

There are several different grades of vaginal tears. These grades are determined by the severity of the tear.

  • First-degree tear: The least severe of tears, this small injury involves the first layer of tissue around the vagina and perineal area.
  • Second-degree tear: This second level of this injury is actually the most commonly seen tear during childbirth. The tear is slightly bigger here, extending deeper through the skin into the muscular tissue of the vagina and perineum.
  • Third-degree tear: A third-degree tear extends from your vagina to your anus. This type of tear involves injury to the skin and muscular tissue of the perineal area, as well as damage to the anal sphincter muscles. These muscles control your bowel movements.
  • Fourth-degree tear: This is the least common type of tear during childbirth. Extending from the vagina, through the perineal area and anal sphincter muscles and into the rectum, this injury is the most severe type of tear.

Symptoms and Causes

What causes a vaginal tear during childbirth?

A vaginal tear during childbirth can happen for a variety of reasons. A few factors that could cause a tear can include:

  • If it’s your first delivery.
  • The position of the baby (face-up deliveries).
  • Use of forceps or a vacuum during delivery.
  • A large baby (more than 8 pounds).
  • If you’ve had an episiotomy.
  • If you are of Asian ethnicity.

Management and Treatment

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 may not need any stitches. In a second-, third- and fourth-degree tear, you will receive stitches to repair the injury. Any stitches will dissolve on their own within six weeks. In some of the most severe cases, your healthcare provider may need to repair the injury to the anal sphincter. This will also be done with dissolvable stitches. 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.
  • Gently pat yourself dry with toilet paper instead of wiping.
  • Avoid constipation by drinking plenty of water and using a stool softener.

Your healthcare provider may also give you cooling pads to wear with your sanitary pad post-delivery. These can help relieve discomfort from your tear. 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 are 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 required stitches, they will dissolve within six weeks. You will not need to go back to your healthcare provider’s office to have your stitches removed or receive 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 after your tear, talk to your healthcare provider.

Prevention

Can an episiotomy prevent me from tearing?

An episiotomy is a procedure where the healthcare provider makes a cut from the edge of your vaginal opening outwards. This is meant to widen the opening in a controlled way.

Though an episiotomy widens the vaginal opening, it doesn’t always keep you from tearing. An episiotomy is often listed as one of the risks for a more severe tear (third- or fourth-degree). Talk to your healthcare provider about the pros and cons of this procedure.

Outlook / Prognosis

Can I have a vaginal delivery in a second pregnancy if I had a vaginal tear previously?

In most cases, experiencing a tear during one delivery doesn’t mean you will tear again during a future delivery. Most small tears heal well and will not prevent you from having future vaginal deliveries. If you have had a third- or fourth-degree tear in the past, you can be at risk for a tear during vaginal childbirth in the future. The risk is usually low enough that you can still have a vaginal delivery if you would like to. In some cases, your healthcare provider may suggest a Cesarean section (C-section) delivery to prevent a tear.

Last reviewed by a Cleveland Clinic medical professional on 02/20/2020.

References

  • Woolner A, Ayansina D, Bhattacharya S. . PLoS One. 2019; 14(4): e0215180. Accessed 2/26/2020. The impact of third- or fourth-degree perineal tears on the second pregnancy: A cohort study of 182,445 Scottish women (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6459505/)
  • The American College of Obstetricians and Gynecologists. . Accessed 2/26/2020. Assisted Vaginal Delivery (https://www.acog.org/Patients/FAQs/Assisted-Vaginal-Delivery?IsMobileSet=false)
  • American Pregnancy Association. . Accessed 2/26/2020. Episiotomy (https://americanpregnancy.org/labor-and-birth/episiotomy/)
  • Leeman L, Spearman M, Rogers R. . American Family Physician. Oct 2003; 68(8): 1585-1590. Accessed 2/26/2020. Repair of Obstetric Perineal Lacerations (https://www.aafp.org/afp/2003/1015/p1585.html)
  • National Health Service. . Accessed 2/26/2020. Episiotomy and perineal tears (https://www.nhs.uk/conditions/pregnancy-and-baby/episiotomy/)
  • Smith L, Price N, Burns E. . BMC Pregnancy and Childbirth. 2013; 13:59. Accessed 2/26/2020.Incidence of and risk factors for perineal trauma: a prospective observational study (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3599825/)

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