Vaginal Tears

Perinatal tears (or vaginal tears) are one of the many physical hardships women often suffer during childbirth. The perineum is the small area of tissue that separates the vagina and the rectum. Perinatal tears occur when the skin and tissue in this area are torn and lacerated from overstretching during vaginal childbirth.

Perinatal or vaginal tears are extremely common because of the tremendous pressure and strain involved in pushing the baby’s head through the very small birth canal. Over 90% of first-time mothers will suffer some degree of perinatal tearing during a vaginal delivery because their perineal tissue is less flexible.

Perineal tears are classified into 4 different degrees of severity. The degrees of perinatal tearing range from very mild lacerations of the outer lining to extremely deep cuts that can impact the anal muscles and tissue.

Perinatal tears classified as first-degree are the least serious. A first-degree perinatal tear is a superficial injury in which only the outer lining is lacerated. No underlying tissue or muscles are damaged and in most cases, no stitches are required. First-degree tears will be painful for the first week or so but generally heal quickly.

Second-degree perinatal tears are more serious, and they occur when the tear goes beyond just the outer lining and into the submucosal tissue below.

Second-degree is the most common type of vaginal tearing. Second-degree perinatal tears require stitching and take about twice as long to heal compared to first-degree tears.

A perinatal tear is classified as third-degree when the tear goes even deeper into the layers of tissue around the vagina and into the muscles around the anal sphincter. Third-degree tears are fairly serious injuries and often require surgical repair as each layer of tissue must be stitched separately. The recovery from these types of tears can be very long and painful.

Fourth-degree perinatal tears are the worst type and they occur when the tearing and laceration goes so deep that it cuts into the lining of the rectum. Fourth-degree tears are rare and require major surgery to repair all the various layers of damaged tissue. Even after surgical repair, fourth-degree tears can have permanent consequences such as pelvic floor dysfunction and problems with urination.

Vaginal tears are often an unavoidable consequence of vaginal childbirth. Pushing the baby’s head out of the very narrow birth canal requires a great deal of stretching and expanding. During labor hormones in the mother’s body will help the skin around the vagina to thin out allowing it to stretch easier. In some cases, however, the skin is unable to stretch enough, and the pressure of the baby’s head pushing its way out tears through the tissue.

Perinatal tearing is very common in almost all vaginal deliveries, but there are certain factors that make perinatal tears more likely to happen. These include:

• First-Birth: perinatal tears are extremely commonplace in mothers giving birth for the first time. Around 90% of first-time mothers will suffer some degree of perinatal tearing in a vaginal delivery.
• Big Baby: if your baby is overly large (a condition known as fetal macrosomia) perinatal tearing is more likely.
• Rapid Labor: if you have very fast labor before giving birth your skin and tissue may not have enough time to thin and stretch, making perinatal tearing more likely.
• Face-Up Presentation: if your baby presents in the face-up position for delivery (also known as “sunny side up”) a tear will be more likely because the head and neck will need to extend head and neck under the pelvic bone which creates greater pressure and increases the chance of tearing.
• Stuck Shoulder: if your baby’s shoulder gets stuck on your pelvic bone (a complication called shoulder dystocia) doctors may have to use lateral traction to dislodge the shoulder which increases the risk for more severe 3rd or 4th-degree tears.