“I felt the tear right away,” says Toronto mom Christine Feldman* about the moment her now five-month-old son, Ben, came into the world. Feldman experienced a third-degree tear, which is considered fairly serious because it extends into the anal sphincter. “It took an hour and 15 minutes for them to stitch me up,” she says. And, while she’s healing well, she’s still working with a physiotherapist to strengthen her muscles again.
“About 90 percent of first-time moms experience some form of tearing,” says Alix Bacon, president of the Midwives Association of BC. Luckily, the majority of tears are first degree (only affecting the perineal skin) or second degree (injuring the skin and perineal muscles). They can be uncomfortable, sure, but aren’t likely to do permanent damage. A third-degree tear, like Feldman’s, involves a laceration into the muscles of the anal sphincter, while a fourth-degree tear extends beyond the sphincter into the rectal lining as well. Both third- and fourth-degree tears can cause permanent damage, incontinence issues (which Feldman experienced for the first few months postpartum), pelvic floor dysfunction, discomfort during sex and pain that can last for months.
How to prevent perineal tearing Unfortunately, many factors that increase the risk for tearing are out of your control. “If it’s the first baby, a big baby or if you require an operative vaginal delivery [meaning], you’re at an increased risk of tearing,” says George Carson, chair of the Society of Obstetricians and Gynaecologists of Canada. Having oxytocin to induce labour is not a risk factor itself, but it’s often administered in cases where there are other risk factors, and it creates a faster and more intense labour, says Bacon.
But, there are things that can be done to help the tissues stretch enough to make room for the baby. Doing daily perineal massage for four to six weeks leading up to delivery can help to prep the area. “Some evidence shows that it will prevent tears while other research says it will make any tears that do occur less severe,” says Bacon. “Either way, I’d say it’s worth it.”
Perineal massage, also known as perineal stretching, typically requires some help from your partner, since it’s hard to reach around your belly. To start, you get in a semi-reclined position with your knees bent and legs apart as your partner (with clean hands and trimmed fingernails) inserts their fingers or thumbs into your vagina with a water-based lubricant, olive oil or coconut oil, and pulls their fingers apart, stretching to the sides and down, away from the pelvic bone, until you feel a mild stinging sensation. Your partner should hold this initially for 30 seconds, working up to two minutes, then rest a moment and repeat for up to 10 minutes.
If you prefer to do your stretching solo, a device like the Epi-No Delphine Plus can help. “I also like that it can be used post-baby to practise your Kegels and regain pelvic floor strength,” says Bacon.
During delivery, birthing positions that put less pressure on the pelvic floor and perineum, like standing, perching on your hands and knees or lying on one side are preferable. Warm heat on the perineum prior to pushing, from sitting in a bath or using a damp cloth on the area, can also help tissues stretch more effectively, says Bacon.
In the end, though, a slow, controlled delivery is the best bet for reducing tearing. Unfortunately, Feldman’s baby had to make a speedy exit. “Ben’s heart rate began to decelerate and, all of a sudden, they wanted him out fast,” she says.
“The tissues have to stretch a lot to make enough room to let the baby out,” says Carson. That won’t happen quickly or very well under pressure. “That’s why the really important issue is the gentle delivery of the baby who will then hopefully create for himself as much room as he needs,” he says.
How to help a tear heal So what happens if, despite all your best efforts, you experience tearing? After all, some situations like Feldman’s are unavoidable. Doctors stitch up any lacerations that require it (which is likely for second-degree tears and definitely needed for third- and fourth-degree ones). Stitches will take seven to 10 days to dissolve, but the area may require six to eight weeks to heal completely.
To keep the site free of infection while you mend, use a squirt bottle of warm water after peeing to clean the area. Twice-daily sitz baths with warm water (and a pinch of Epsom salt, as well as a few drops of soothing witch hazel and/or lavender oil, if desired, according to Bacon) are also cleansing as well as soothing. Keep stitches dry by patting gently with toilet paper or using a hairdryer on the low setting after a bath or using the bathroom.
Women with serious tears should avoid standing or walking for long periods of time during the healing period, but still remain active. “Do only what’s comfortable—don’t push yourself,” says Carson. And sit with knees together, preferably on one hip to keep pressure off the perineum.
The good news is: “There is enormously good blood supply to the area around the perineum and vagina,” says Carson, “so all of these lacerations tend to heal very well once repaired.”
*Name has been changed