A tear is one of the types of birth injuries mothers can suffer from during labour.
In the 1970s, it used to be standard practice during birth for women to undergo an episiotomy just before delivery as it was considered that this produced a better result than allowing women to tear naturally. Fortunately, medical thinking has advanced in the last decade or so and episiotomies are no longer routinely performed unless there is a clinical need such as an instrumental delivery. However, it is still quite common for many women to tear during delivery.
While minor tears are common during childbirth and heal quite fast, some vaginal tears can be more severe and take longer to recover. Read our guide below to childbirth tears and what you can do to prevent them.
Perineal tear causes
There is no categorical way to know who is going to tear and who isn't but there are some recognised risk factors such as:
- A baby who weighs over 4kg
- A long second stage in labour
- A occipitoposterior position
- Shoulder dystocia
- A midline episiotomy
- Forceps delivery.
If a tear is left untreated, it may lead to persistent perineal pain and faecal incontinence. A tear during childbirth can cause the mother to suffer a serious bowel and sphincter issue if treated incorrectly. As well as the physical affect, a childbirth tear can also have a psychological impact on the well-being of the postpartum woman too.
If you have suffered a more severe childbirth tear that was caused by a medical personnel’s negligence, or if it was misdiagnosed or treated, you may be entitled to make a claim for compensation where negligence can be proved.
Types of tears
Childbirth tears can vary widely in size and severity. The size and effect of tears a mother can get from childbirth are described in ‘degrees’.
1st degree tear
A first degree tear is when the skin of the perineum and the back of the vagina is torn. First degree tears are often the smallest in size, so they don’t need stitching and will heal naturally.
2nd degree tear
A second degree tear in birth is when the skin, the back of the vagina, and the muscles of the perineum are torn. These are midline tears and require stitches.
3rd degree tear
A 3rd degree tear during childbirth involves the skin, back of the vagina, muscles of the perineum being torn, and extends through to the anal sphincter. Third degree tears in labour need to be stitched closed.
4th degree tear
A fourth degree perineal tear is the same as a third degree tear. However, these extend into the rectum. This type of tear requires stitches.
This is a tear at the top of the vagina. These are often quite small and only need a few stitches.
Preventing and managing tears during childbirth
The Royal College of Obstetricians and Gynaecologists (RGOC) has set out guidelines for the management of third and fourth degree perineal tears.
Every tear should be adequately assessed post-delivery to ascertain the severity of the tear, particularly to ascertain if the tear involves the anal sphincter.
For a third or fourth degree tear, it is recommended that they should be repaired in theatre with either regional or general anaesthetic. This allows the anal sphincter to relax so that the torn ends can be retracted and brought together without tension.
A third or fourth degree tear should always be repaired by an appropriately trained obstetrician. Inexperienced attempts at anal sphincter repair may contribute to maternal morbidity, especially subsequent anal incontinence.
Following a third or fourth degree repair, it is recommended that women are given broad spectrum antibiotics for five to seven days as well as a laxative. After about six to 12 weeks, women should be offered physiotherapy and they should be reviewed by an experienced obstetrician and gynaecologist.
The provision of antibiotics is important as the development of infection will pose a high risk of anal incontinence and fistula formation if the repair breaks down.
If a perineal tear is correctly assessed and competently repaired, then the prognosis is good with 60-68% of women asymptomatic within 12 months. The most common remaining symptoms for women are incontinence of flatus or faecal urgency.
It is important that previous obstetric history is taken into account when a woman finds herself pregnant again. It is possible that a previous sphincter injury may mean that there is a risk of developing anal incontinence or worsening symptoms. If a woman is symptomatic at the time of a subsequent pregnancy it may even be appropriate to consider a caesarean section to avoid such an outcome.
The person who is assisting you in labour can help to prevent a tear during childbirth when the baby’s head becomes visible. They can guide you through labour and instruct when you should stop pushing so the baby can emerge slowly and gently, without tearing the skin and muscles of the perineum.
If you’re experiencing pain or other symptoms after a tear, you should seek medical advice. Your healthcare provider will be able to advise on the severity of your tear and what you should do and avoid to make sure it heals properly.