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How to Prevent Vaginal Tearing During Childbirth

How to Prevent Vaginal Tearing During Childbirth

It’s common for perineal tears to happen during labor and delivery, especially if you’re a first-time mother. How do you prevent vaginal tearing during the birth of your baby?

What is vaginal tearing during childbirth?

Vaginal tears are lacerations on the skin and muscles around the opening of the vagina. It’s also called “perineal tear” because it commonly happens in the space between the vaginal opening and rectum (perineum). However, it can also occur inside the vagina, the vulva, or the labia.

Each mother experiences vaginal lacerations differently. Some only have a small wound that heals quickly, while others suffer from deep tears.

What is an episiotomy?

According to reports, up to 90 percent of first-time mothers experience vaginal tears or episiotomy. Unlike vaginal tears, which are natural wounds, an episiotomy is a surgical cut that the surgeon makes to widen the vaginal opening and assist in childbirth.

Traditionally, doctors believed that an episiotomy can prevent the complications of vaginal tearing during birth. After all, a laceration is often “rugged” whereas an episiotomy wound is “cleaner.” For this reason, many medical experts thought that a surgical wound heals faster than a tear.

However, studies show that’s not always the case. Hence, doctors no longer do “routine” episiotomies; rather, it is only recommended in situations when the baby needs to be delivered immediately.

When do doctors recommend episiotomy?

Doctors may recommend an episiotomy for the following situations:

Shoulder dystocia. This happens when your baby’s shoulder is “stuck” behind the mother’s pelvic bone.

Assisted vaginal delivery. This is when the doctor thinks that the mother needs to deliver her baby with the help of equipment like vacuum and forceps.

The baby is not doing well. The doctor may also perform an episiotomy if they find out that the baby’s vitals are not normal and need to deliver the baby vaginally as soon as possible. A common example is an irregular heartbeat. This is only applicable if the baby’s head is almost coming out of the vagina. The second stage of labor begins with full cervical dilation and ends with the delivery or birth of the baby.

how to prevent vaginal tearing during birth

What are the degrees of a vaginal tear?

Seeing that doctors only perform episiotomies when absolutely needed, it’s important to be familiar with the kinds of vaginal lacerations that pregnant women can experience. The severity of the laceration generally depends on the effects of the vaginal tear:

First-degree laceration. This is just a superficial injury, often occurring in the first layer of the skin. First-degree tears usually happen on the inside of the vagina, labia, or perineum.

Second-degree laceration. Second-degree tears are the most common tears. If the first degree only affects the top layer of the skin, this injury extends a little deeper into the muscular tissues of the perineum.

Third-degree laceration. Like the second-degree laceration, a third-degree tear affects the muscular tissues. However, the injury might be deeper and longer, often from the vaginal opening to the anal sphincter, the structure that helps control your bowel movements.

Fourth-degree laceration. While this injury is the least common, it’s also the most severe. From the vaginal opening, the laceration could reach the anal sphincter and extend to the rectum.

What are the risk factors for vaginal tears?

To prevent vaginal tearing during birth,you must learn about the risk factors. Generally, you are at risk of sustaining a vaginal tear or laceration if:

  • You have a baby that weighs more than 4kg
  • Your baby’s shoulders get “stuck”
  • There’s a need for you to have an assisted delivery (with forceps or a vacuum)
  • You’ve had a long second stage of labor (the second stage is the time when you need to push the baby out)
  • You already had tears or lacerations in your previous childbirths

How do you manage or treat vaginal tearing?

Please note that in most cases, a first or second-degree tear is a very common and normal part of a healthy labor and delivery. Often, they will result in bleeding and soreness, but for the most part, they don’t cause long-term or serious complications.

First-degree tears normally do not need suturing, while second-degree lacerations might need a few stitches. In case you sustain third or fourth-degree perineal tears, you’ll need more stitches. You don’t need to worry about the pain, as your doctor will give adequate anesthesia during the procedure.

To reduce the negative effects of vaginal tears, you will most likely be offered with the following:

  • Antibiotics to reduce the risk of infection, depending on the extent or severity of the laceration
  • Pain relievers to help with the soreness
  • Laxatives to ease bowel movement

How can I prevent vaginal tearing during childbirth?

To prevent vaginal tearing during the birth of your baby, the doctor will offer their guidance on the following measures:

Proper Pushing

When pushing the baby out, try to bear down in a gentle and controlled manner. Usually, this means you need to push slowly but with force. This gives your perineal muscles time to stretch, thus avoiding lacerations.

Warm Compress

To prevent vaginal tearing during the birth of your baby, you could apply a warm compress to the perineum to help “relax” and “loosen” the muscles.

Assuming Other Birthing Positions

Finally, to prevent vaginal tearing during birth, the doctor may advise against giving birth while lying down flat. Positions like lying down on your side or while you’re on your knees may help reduce the risk of perineal lacerations.

Key takeaways

How do you prevent vaginal tearing during birth? First, vaginal tearing is difficult to predict, but there are ways to decrease one’s risk of severe injury. These measures center around “protecting the perineum” and can include choosing a better birthing position, relaxing pelvic floor muscles, applying a warm compress, and pushing the baby out properly. Do not be afraid to talk to your doctor about vaginal tearing.

Learn more about Giving Birth here.

Hello Health Group does not provide medical advice, diagnosis or treatment.

Sources

Episiotomy: When it’s needed, when it’s not
https://www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/in-depth/episiotomy/art-20047282
Accessed October 19, 2020

Can vaginal tears during childbirth be prevented?
https://www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/expert-answers/preventing-vaginal-tearing-during-childbirth/faq-20416226
Accessed October 19, 2020

Vaginal Laceration
https://www.winchesterhospital.org/health-library/article?id=101287
Accessed October 19, 2020

Perineal tears during childbirth
https://www.rcog.org.uk/en/patients/tears/tears-childbirth/
Accessed October 19, 2020

Vaginal Tears During Childbirth
https://my.clevelandclinic.org/health/diseases/21212-vaginal-tears-during-childbirth
Accessed October 19, 2020

VAGINAL LACERATION REPAIR
https://www.stgeorgesurgical.com/procedure/vaginal-laceration-repair/
Accessed October 19, 2020

Picture of the author
Medically reviewed by Dr. Mary Rani Cadiz M.D.
Written by Lorraine Bunag, R.N.
Updated Nov 19, 2020