Expert Tips for How to Prevent Tearing During Birth
There’s no sugarcoating the fact that labor is painful, and undoubtedly one of the most unpleasant aspects of a vaginal birth is tearing during labor. Unfortunately, it’s a common occurrence—according to the American College of Obstetricians and Gynecologists (ACOG), between 53 and 79 percent of vaginal births result in some degree of tearing, either in the vagina or perineum (the skin between the vagina and anus). So why do some people tear and others don’t, and what steps can you take to hopefully avoid it? Keep reading to learn from experts why it happens and how to prevent tearing during birth—and what to expect if you do end up tearing.
Perineal and vaginal tears can happen as baby is coming through the birth canal, says Rebekah Mustaleski, CPM, a certified professional midwife and compression director at Motif Medical. “While our tissues are made to stretch and make space for baby, there are a few variables that can contribute to tearing during delivery,” she adds. These include:
First time giving birth: If it’s your first time giving birth, you might be more likely to tear, says Sherry Ross, MD, an ob-gyn and women’s health expert. “If it’s your first baby, you have a 95 percent chance of having some form of tearing.”
Baby’s position: The most optimal position for a vaginal birth is “head down,” in which baby’s head comes before their body during birth. Ideally baby’s head should be “flexed with their chin tucked into their chest,” Mustaleski says. If baby’s facing up, or if their head is tilted, their neck is extended or if they have a hand by their face—all of which are normal and common positions—it increases the diameter needed to pass through the birth canal, thereby upping the risk of tearing during birth.
Baby’s size: Similarly, larger babies will need more space during birth. If baby is bigger than average, the risk of vaginal tears during birth increases.
Birthing positions: According to Mustaleski, some birthing positions pull the perineal skin a little tighter, which reduces the flexibility it has to stretch around baby’s head. “If you feel the skin between your thumb and your forefinger, you’ll notice you can wiggle it around a bit. But if you stretch your fingers apart, that skin has a lot less flexibility,” she says. “In the same way, the skin on your perineum is affected by the position of your legs.” (More on this below.)
Swollen perineal tissue: Like birthing positions, if you’ve been in labor or pushing for a while, you might have some swelling in the perineal tissue, which limits its ability to stretch and increases the risk of tearing during birth, both experts says.
A speedy delivery: While you might think a speedy delivery would lead to less tearing, Mustaleski says it’s actually the opposite: “Sometimes babies are born very quickly, and the [perineal] skin doesn’t have the chance to stretch like it should. If you only push once or twice for your baby to be born, you’re more likely to tear.”
Forceps or vacuum-assisted delivery: In scenarios where delivery needs to be expedited or you’re unable to push any longer, your OB may use a vacuum extractor or forceps to help get baby out. While usually medically necessary, it often increases the risk of tearing.
Episiotomy: This occurs when a cut is made in the perineum to widen the vaginal opening during birth and helps in unforeseen situations where baby needs to be delivered quickly. It’s usually done to help avoid extensive vaginal tears during birth, but it’s still an incision that will need to heal.
The severity of the perineal or vaginal tears will depend on your individual experience. “I always make a visual analogy comparing baby’s head to the size of a cantaloupe,” Ross says. “The vagina must stretch enough to allow baby’s head to come through it…ultimately, it’s how well the vagina stretches during the pushing phase that determines the degree of tearing.”
Perineal and vaginal tearing during birth is measured on a scale of first, second, third and fourth degree tears, with first being the least severe and fourth being the most. However, “there are some superficial tears that do not fall into the first degree category and are left to heal on their own,” Ross says. Below, Mustaleski and Ross break down each degree:
First degree tears: These occur in 15 percent of deliveries. They “only involve the lining or mucosa of the vagina and may appear as a small abrasion,” Ross says. Because it’s a more superficial tear and usually only affects the top layer of skin, they don’t always require sutures, as long as the edges of the tear line up well, Mustaleski adds. These can occur in the perineum, vaginal canals or on the labia during birth.
Second degree tears: These occur in 65 percent of deliveries and are most common, Ross says. These tears involve deeper layers of the vagina and may also involve some of the pelvic floor muscles. Second degree tears are usually sutured to hold the layer and muscle together as they heal. These usually affect the perineum or vaginal canal (and most often both).
Third degree tears: Occuring in about 15 percent of deliveries, these involve all the deeper layers of the vagina and run down the perineum and often into the anal sphincter. “Repairing a third degree involves sewing each layer separately, with special attention to closing the muscle layer supporting the anal sphincter,” Ross explains.
Fourth degree tears: This is the most severe type of tearing and is also the rarest, only occurring in about 5 percent of deliveries. A fourth degree tear typically goes through “all the deeper layers of the vagina, muscles surrounding the anal sphincter and extends right through to the rectum,” Ross says. Repair of fourth-degree tears involves thorough closure of multiple vaginal and anal layers and muscles. Mustaleski adds that third and fourth degree tears are usually more likely during a vacuum-assisted or forceps delivery.
Unfortunately, there’s no surefire way to prevent tearing during delivery—after all, the childbirth process is hard to predict and may unfold in ways you didn’t plan for. The good news is that there are some things you can do during pregnancy and labor to improve your odds.
What to do during pregnancy to prevent tears
Steps to help avoid tearing during birth should start in pregnancy. “Your skin needs adequate hydration and certain nutrients to maintain the elasticity and flexibility needed during birth,” says Mustalesk. “Make sure you’re consuming adequate amounts of water, Vitamin A, Vitamin C, Vitamin E and collagen.”
Another good exercise to prevent tearing during birth is perineal massage. This technique gently stretches the vaginal opening, making it more elastic and better able to fit around baby’s head at birth. Both experts cite perineal massage as a possible preventative measure, as it can help soften the vaginal tissue and improve its flexibility. Plus, some studies have also found that regular perineal massage during the final few weeks of pregnancy can reduce your risk for tearing during birth.
What to do during a vaginal birth to prevent tearing
While there’s only so much you can control during childbirth, both Mustaleski and Ross recommend controlling your pushes during labor. This lets the vagina stretch slowly and can help reduce the likelihood of tearing, Ross says. It’s also important to be mindful of your perineum (even when all you really want is just to get baby out). “When you start to feel that ring of fire, put your hand on your perineum to give yourself support where you feel you need it the most,” Mustaleski says. “This can help bring your mind back into the moment and give you the ability to ease your baby out while your perineum stretches.” Ross also recommends applying a warm compress to the perineum during the pushing phase of labor.
You’ll also want to pay attention to your birthing position. If possible, Mustaleski recommends avoiding being on your back or having your knees pulled out and up by your ears. “This makes your pelvic outlet smaller and tightens the perineal tissues, which means you have to push harder to get your baby out and you’re more likely to tear,” she explains. For quicker deliveries, Mustaleski suggests side-lying positions or giving birth on your hands and knees. “In general, keeping your knees closer together than your ankles gives more flexibility to the perineal skin and also opens the pelvic outlet, so you won’t have to push as hard, either.”
There’s no sugarcoating the fact that recovery from a vaginal birth can be painful—and your level of pain will depend on how severe your tears are. The hard part of pushing baby out may be over, but it’ll take time for your body to get back up to speed. It may be difficult to use the bathroom during those first couple of weeks, and it will likely sting as you do. Both experts recommend the following at-home treatments to help with recovery and reduce swelling (regardless of how severe the tear is).
- Daily sitz baths with warm water
- Ibuprofen and stool softeners
- Peri bottle rinses with warm water
- Padsicles (Mustaleski says you can buy pre-made ones or make your own by squirting an organic cotton pad with witch hazel and clear aloe vera gel, and then placing it in the freezer.)
Arguably the most important aspect of postpartum recovery is rest. “Some people think that if they got sutures they don’t have to worry about taking it easy,” Mustaleski says. “But even with sutures, if you’re up and moving around, you can pull on that skin and make more work for your body to heal.”
Recovering from severe tears during birth
Wondering if you’ll need to stay longer at the hospital if you tore during birth? While every provider has their own protocols for postpartum care, usually, regardless of severity, tears don’t require a longer hospital stay after birth. Of course, your recovery time will be impacted by the severity of your tears. According to Ross, severe tears into the vagina and rectum can cause issues like pelvic floor dysfunction, prolapse, urinary incontinence, fecal incontinence, sexual dysfunction and pain with intercourse—but prioritizing your recovery and seeing a pelvic floor therapist after birth can help improve outcomes. “A pelvic floor PT is going to help you reconnect your mind and body and regain functional use of your pelvic floor muscles,” Mustaleski says. She recommends scheduling your first appointment around six weeks postpartum.
Ultimately, when it comes to tearing during birth, both the severity and recovery will depend largely on your individual childbirth experience. But take heart in knowing that your body will heal and be almost back to normal in due time. “The vagina is very resilient and will be close to ‘good as new’ within six to 10 weeks,” Ross says. “Until then, keep the vagina and perineum clean, use simple treatment options and sit down slowly so as not to disrupt the healing process.”
Please note: The Bump and the materials and information it contains are not intended to, and do not constitute, medical or other health advice or diagnosis and should not be used as such. You should always consult with a qualified physician or health professional about your specific circumstances.
Rebekah Mustaleski, CPM-TN, IBCLC, is a certified professional midwife specializing in evidence-based maternity care. She co-founded Roots & Wings Midwifery in Knoxville, Tennessee. Mustaleski received her bachelor’s degree in psychology from Centre College and worked as a doula and birth photographer prior to establishing Roots & Wings.
Sherry Ross, MD, is an ob-gyn, women’s sexual health expert and author of She-ology: The Definitive Guide to Women’s Intimate Health. Period. and She-ology, The She-quel. She earned her medical degree from New York Medical College.
American College of Obstetricians and Gynecologists, Ob-Gyns Can Prevent and Manage Obstetric Lacerations During Vaginal Delivery, Says New ACOG Practice Bulletin, June 2016
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