5 things to know about vaginal tears

After baby pushes its way into the world, you could be feeling a bit worse for the wear down there…

Jacintha Johnson, 36, had one of those drama-free childbirth stories every woman going into labour prays for. Induced at 40 weeks, Johnson opted for an epidural and dilated in pain-free bliss for 10 hours. When she was ready to deliver, her gynae took her off the drugs and she out popped her beautiful baby boy, Alex, after some pushing.

“I’d heard so many horror stories of emergency Caesareans or babies being in distress, so I was grateful that everything went smoothly,” Johnson says. “The only thing was that I had to push for almost two hours and needed a little snip in my perineum to help with the delivery, as my muscles were rather tight, according to my doctor.” 

Things got a bit more real down there several hours after the birth. “I had to pee for the first time since giving birth ― when I touched the area around my vagina, it felt like a train wreck!” says Johnson. “I had never given vaginal tears that much thought before and honestly didn’t know what to expect, so it really came as a surprise.”

Birthing your baby is an incredible you’ve-got-to-be-there-to-fully-get-it kind of experience. At the same time, a fully-formed human being is coming out of your body. So, it shouldn’t come as a surprise that your vagina will stretch, thanks to the pressure of your baby’s head pushing through it. This makes the area around it (also known as the perineum) more susceptible to lacerations.

Some 99 per cent of women will get a vaginal tear of some kind during a natural birth. However, most are minor tears and a normal part of the birthing process, so they heal quite fast.

The more severe tears may be the result of an episiotomy ― when your doctor makes a cut between your vagina and the perineum to help move things along.

While it may be impossible to avoid vaginal tearing completely, you have ways to reduce the trauma, as well be more prepared for the aftermath. Wise up to five facts about vaginal tearing...

#1 Some women are more at risk to tearing than others  

According to SmartParents expert ob-gyn Dr Christopher Chong, the perineum ― the diamond-shaped area below the pelvic diaphragm that’s between the legs ― is generally shorter in Asians compared with Caucasians. This increases an Asian women’s likelihood to tear.

You are also more at risk of tearing if you have a small or tight vagina (or perineum area), if you’re birthing a big baby ― 4 kg or heavier ― and if bubba comes out butt first instead of head first.

Expect tears if you have an assisted delivery with forceps or a vacuum, and if it’s your first childbirth. “The more one delivers, the more lax the vagina and perineum, hence the tears will be fewer. Sometimes, in good hands, there’ll be no tears at all!” Dr Chong notes.

#2 There are different degrees of tears

It’s uncommon for you to actually feel yourself tearing, due to the intensity of the pressure that baby puts on the area. Also, everything is pretty much a blur once your labour is in full swing. You’re also probably too preoccupied with labour pains to feel anything else.

Perineum tears can be classified into four types. The most common are first and second degree tears. “These only involve the tearing of the skin and vaginal muscles,” points out Dr Chong. The lacerations are pretty minor and usually only require a few stiches.

Third degree tears, which are less common, involve the perineal muscles and the muscle layer surrounding the anal canal, while fourth-degree tears go through the anus. These will require a lot more stitching up.

The more severe tears may be the result of an episiotomy ― when your doctor makes a cut between your vagina and the perineum to help move things along. While many argue that having an episiotomy can do more harm than help, Dr Chong says tears can still be severe even if you don’t have an episiotomy. He also offers other benefits to the procedure. “An episiotomy gives a less jagged wound, making it easier to repair. It can also reduce anal tears as you can choose to make a cut away from the anus,” he points out. “If a cut is not made, that area will usually end up tearing by itself, in addition to all the other existing tears.”

Have questions on how to minimise perineal tears as well as post-tear care? Read on!