Wisdom Wednesday: Laceration

Did I tear? 

The most common question women ask their doctors and midwives soon after giving birth is whether or not they have a vaginal tear, or laceration. And being afraid of tearing during vaginal childbirth is a very common concern for many women.

The bad news is that most women tear during childbirth--about 90% of first time mothers and about 70% of women who have given birth vaginally in the past.

The good news is that most women don’t actually notice a tear happening. During the final phase of pushing in which the baby is crowning, or maximally stretching the vaginal tissue, women may notice an intense burning sensation, even if they have an epidural. This “ring of fire” is actually the skin stretching, not the sensation of tearing.

The other piece of positivity is that most tears heal without complications and produce only mild discomfort during the healing process.

The perineum is the space between the vagina and anus and is the most common location of vaginal tears. There are four types of perineal tears, with the most minor being a first degree tear, which only involves the skin or vaginal mucosa, and the most severe being a fourth degree tear, involving skin, mucosa, muscle, the anal sphincter, and the rectal mucosa. First degree and second degree tears are the most common and general produce no long term complications. Third or fourth degree tears are rare (only about 1% of deliveries) and may produce more complications.

Preventing Tearing

Although there’s not solid and consistent research about preventing tears, the following practices may help:

  • Eat a nutrient dense diet during pregnancy to promote skin & muscle health.
  • Labor in water.
  • Consider delivering on your side, on all fours, or kneeling, which put the least amount of pressure on the pelvic floor and allow for adequate stretching of the perineum.
  • Allow the pushing stage of labor to happen slowly so that the skin and muscle can adequately stretch.
  • Ask your provider to apply warm compresses.
  • Avoid episiotomy unless absolutely medically necessary.

Healing from Tears

As previously mentioned, most tears sustained from childbirth heal without complications and don’t produce long term sequelae. The following tips can ease your healing process:

  • Use a squirt bottle to cleanse the area after using the bathroom rather than wiping.
  • Padsicles: pads with an herbal solution, witch hazel, or just plain water frozen on them may help to relieve swelling and discomfort.
  • Avoid sitting or standing for long periods of time. Try to stay horizontal for the first few days.
  • Take a warm herbal bath. Your postpartum doula can assist you with preparing the bath and deciding whether or not you'd like your new baby to join you for a relaxing soak.
  • Talk to your provider about postpartum physical therapy.

As always, if you notice anything that seems out of the range of normal, such as foul-smelling discharge or significant pain or bleeding, be sure to notify your provider.