It is not uncommon to tear during a vaginal birth. Dr David Richmond (Royal College of Obstetrics and Gynecology President) states that around ‘90% of women tear during childbirth’. In most cases the tear occurs between your vagina and anus. This area is called your perineum.
Degree of tears:
First: 1st degree tears are the smallest of the tears and generally require a few or no stitches. A tear that only affects the tissue around the opening of the vagina or the skin of the perineum is classed as 1st degree tears and generally will heal naturally with little or no discomfort.
Second: 2nd degree tears are slightly deeper and affect the muscles of the perineum as well as the skin. This degree of tear will require some stitches and may cause some discomfort.
Roughly 4% of vaginal deliveries result in a more serious tear. These tears can increase the risk of anal incontinence and can be painful for many months. If you have a 3rd or 4th degree tear your medical professional will be able to advise you on the best cause of action to heal the tear and return to full health.
Third: A 3rd degree tear will extend to the muscle around the anus whilst also affecting the perineum and vaginal wall.
Fourth: A 4th degree tear is the most serious tear and will reach the anus and the tissue underneath it.
How common are third- or fourth-degree tears?
3rd and 4th degree tears occur in roughy 3 in 100 women who have a vaginal birth. This number rises to 6 in 100 for women who are having their first vagina birth. However, this number drops to 2 in 100 when a woman has previously had a vaginal birth.
What increases the risk of a 3rd or 4th degree tear?
It is difficult to predict if you will tear during birth as many happen unexpectedly. However the risk is increased if:
• this is your first vaginal birth
• you have an assisted delivery (particularly forceps)
• the second stage of labour is longer than expected
• you are given an episiotomy
• you have a larger baby (over 4kg)
• you had a 3rd of 4th degree tear in a previous vaginal birth
What is an episiotomy?
An episiotomy is where a doctor or midwife cuts the perineum (area between the vagina and anus) during birth to allow the baby to come out easier by widening the opening of the vagina.
The National Institute for Health and Care Excellence (NICE) recommends that an episiotomy only takes places ‘if your baby is in distress and needs to be born quicker or there is a clinical need.’
When an episiotomy is performed the area around the vagina will be numbed so that you do not feel any pain. Once the baby has been delivered the cut is usually repaired with stitches that dissolve naturally.
If you are concerned about your perineal tear or tearing during birth we recommend speaking to your medical professional who will be able to advise you further. If you do have a perineal tear we also recommend asking what activities you should avoid whilst your tear heals.