Even if you are proceeding without any complications throughout your pregnancy, during the last few weeks of your third trimester it’s natural for you to develop apprehensive thoughts about the process of delivery. The most you fear about when you are ready for a vaginal delivery is the torment of unpremeditated laceration of the vagina. Did you know that 95% of the first time moms experience some type of tearing during delivery?
How Does Tearing Happen During Delivery?
It is obvious that during vaginal delivery your vagina has to stretch enough for the baby to come through it. When the perineal skin (perineum is the area between vagina and anus) is not stretched sufficiently, tearing takes place.
What Are The Factors That Increase The Possibilities Of Tear?
Although a small vaginal tearing is very common during delivery, there are factors which increase the possibilities of tearing and the intensity of perineal tearing during delivery like:
The size of your baby: Larger the baby, more the chances of the perineal tear. If the mother is diabetic the chances of the big-sized bay also increase
Shoulder dystocia: This will happen when the delivery becomes complicated as the shoulder gets stuck inside after the head of the baby comes out
The prolonged second stage of labour: During the second stage of labour, you start to push your baby down the vagina. When this stage becomes longer than expected the chances of tearing increases. Want to know more about the stages of labour? Click here
If it is your first vaginal birth: This is the most common cause that increases the risk of tearing. The tissues in vaginal opening remain tensed and tight and won’t dilate enough during first delivery (unlike in second or third delivery) increasing the risk of tearing
Abnormal position of your baby: If your child is in the breech position during delivery or takes the posterior positioning, it increases the risk of vaginal injury
Assisted vaginal delivery: Forceps or vacuum-assisted vaginal delivery are associated with increased vaginal tearing. Comparatively, vacuum-assisted vaginal delivery causes less tearing than forceps-assisted delivery because vacuum extractor does not require wide passage to operate. Forceps assisted deliveries often causes 3rd or 4th-degree vaginal tearing. The chances of assisted delivery increase during induced labour. Read more on assisted delivery here
An earlier episiotomy: If you have had an earlier delivery wherein you were given an episiotomy, chances are that you will likely have a tear again. Also, if your vagina and anus are not apart as average woman, you may get tears during delivery
What Are The Types Of Vaginal Tears?
There are four degrees of tearing distinguished based on the effect and size of the tearing. Apparently all these tearing cause pain irrespective of degree but the extension of tearing is vital because of more the degree of tear, more the degree of pain and chances of developing of other issues.
First-degree tear: In this type of tear, only the skin is torn. Everything beneath it remains intact. Muscle tearing is not involved so in the majority of cases there will be no need of suturing
Second-degree tear: This is deeper than the first-degree tear. Both skin and muscle below will get the tear. It is very common and can be repaired with dissolve-able stitches
Third-degree tear: This is a much deeper tear in which skin, muscle and a part of the external anal sphincter (a band of muscle that helps to hold stool in. Additional stitches are put to bring this sphincter back together which cause more pain. Stool softeners are prescribed if a woman has third-degree tear to keep away constipation
Fourth-degree tear: This is the deepest tear of all. Here, the tear extends completely into the rectum. This will create a direct passage from the vagina to the rectum and the repairing is often done in an operating room. This can be very painful as additional layers of sutures are put to separate the vagina from the rectum. Healing will take quite some time. Constipation should be strictly avoided
Another type of tear that often found is periurethral tears which occur around the urethra (the opening through which urine comes out). These are found to be comparatively small tears which heal on its own. Very rarely needed sutures.
How Can I Prevent Vaginal Tearing During Delivery?
If you follow the following steps you can reduce the chances of vaginal tearing or, at least, decrease the severity.
Select perfect birth positions: In the course of delivery try to select a less stressful position which puts less pressure on your vaginal and perineal area. The best position is in which you are most comfortable. Forward leaning positions and lying one your side (preferably left) are found to reduce pregnancy tears but lying down with legs up or semi-reclining position or any back lying position are found to increase the chances of tearing as they add up the pressure to your vagina. Read more on labour positions here
Prepare to push: Avoid unneeded pushing. Major pregnancy tearing can be avoided by postponing the deliberate pushing until the cervix is fully dilated. You will feel an uncontrollable urge to push when the head of the baby is rotated into the birth position which is the right time. Stop pushing when the head of the baby comes out. Go for breathing out rather than pushing out unnecessarily after this
Keep your perineum warm: Keeping a warm cloth on your perineal area during the pushing phase of labour will help to increase the blood flow towards that area and relieving the muscles
Perineal massage: Preparing the perineum for delivery will reduce the risk of tearing. Before 4-6 weeks prior to your due date practising perennial massage for ten to fifteen minutes daily with oil or water-based lubricants will improve the elasticity of the vaginal tissues. Find more information on perineal massages here
Labour in water: Although it is not yet a common practice, labour in warm water is found to minimize the tearing during delivery because during water birth you can float into a natural relaxed position and will do the only necessary pushing for the birth of the head of the baby (birth crowning)
How To Take Care Of A Vaginal Tear After Birth?
It is important to take care of perineal hygiene to evade infection and promote healing. The below pointers should be kept in mind:
Don’t touch the area frequently to analyze if it is curing because that will increase the curing period
Gently spray warm water over the area during and after urinating
Pat dry with a soft cotton cloth which is sterilized
Make sure yourself not catching constipation. Drink plenty of water and include dietary fibre in your diet. You can also take some laxatives in the supervision of your doctor to eradicate constipation
How Can I Reduce The Pain Of Perineal Tear?
Don’t stand or sit for a long time
Try a cold pack with crushed ice to ease the swelling and pain
Sitz bath is another way to reduce the pain of perineal tear. (please go through our article about sitz bath)
Use a doughnut-shaped pillow to sit. This will help to reduce the pain while you sitting down
Anaesthetic sprays or ointment will help you to ease out the pain temporarily
Don’t use tight underwear. It may rub the affected area and increase the irritation and slow down the repairing process. Select underwear that let your perineum to breath