What You Need To Know About First and Second Degree Perineal Tear

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At just the mention of a pelvic examination, my thighs started to twitch, thanks to the memory of my first ever pelvic examination, almost ten years ago. Never mind the fact that I was just listening to a recount of a birth story, I was reliving my own.

When new mom, Toro, got to the part where the doctor said he needed to suture her lady bits, which had been torn while she gave birth, my thighs were firmly closed.  There was no way an imaginary doctor was going to gain access.

Toro is a first-time mom, whose labour had been a whole 18 hours long. It was a dramatic delivery when she finally had her baby, she had heaved a sigh of relief and thought about sleeping, until the doctor came to inform her that he needed to suture her.

And not just in one place but two places.

“But you people said the delivery was smooth, how come I have a tear?” Toro asked, wondering exactly what was going on.

The doctor who had attended her birth, replied, “Yes, the delivery was smooth but we have to be sure that you are no longer bleeding, and you really need to be stitched up.”

At the mention of bleeding, Toro obliged. The local anaesthesia was administered to deaden the nerves down there, but apparently it didn’t work on Toro, as she screamed throughout the suturing. That must have been horrible honestly, imagine feeling yourself being stitched together, and in such a sensitive place at that. Anyways, Toro has been stitched back together and she is healing properly, and the reason for the tear in the first place, her baby, is facing its business; feeding, pooing and sleeping (although, not long enough).

Usually, it is after the third stage of labour, which is when the placenta is expelled, that a new mom will be examined for tearing.

Tear, or perineal tear, as it is medically called, is quite common, especially amongst primigravidas. And for many pregnant women, whether first time or not, the possibility of vaginal and perineal tears frequently tops the list of their concerns.

In obstetrics and gyneacology, the term ‘perineum’ typically refers to the region between the vaginal opening and the anus. During childbirth, the vagina and perineum are quite flexible, and able to stretch to allow the baby to be born. Sometimes, the baby’s positioning or size, the mother’s positioning during birth, the mother’s anatomy, the speed of birth, or intervention can cause a perineal tear.

 

Depending on the severity of the tear, it can be classified as a first, second, third or fourth degree tear; the first degree tear is the least severe. It involves just the skin of the vaginal opening and perineum. They might also affect the outermost layer of the vagina itself, but don’t involve any muscles.

A second degree tear, on the other hand, involves the same area, in addition to some muscle tissue.

 

Stitches

Unfortunately, there is often a need for stitches whenever perineal tears come up, except, of course, where it is very minor tearing that would heal on its own.

However, for second degree tears, stitches are required for optimal healing. There have to be stitches holding the skin and muscle tissue, to make sure everything heals properly. Stitching also prevents excess scar tissue.

Typically, it will be dissolvable stitches, which will gradually come out as you heal, and you won’t need an additional appointment to have the stitches removed.

You can reduce the risk or severity of tearing

Even though it seems as though tearing is prevalent during childbirth, there are actually things you can do to prevent it, or at least, reduce the severity of the tearing.

Of course, you should talk over these things with your doctor or midwife before, so you have their full support while you are in labour.

Some of the steps you can take to reduce the risk of tearing include: decline an episiotomy that isn’t medically necessary (in rare instances, it is medically necessary). Episiotomy, also known as perineotomy, is a surgical incision of the perineum and the posterior vaginal wall, generally done by a midwife or obstetrician during second stage of labour, to quickly enlarge the opening for the baby to pass through.

Give birth in a position that doesn’t create extra pressure on your pelvic floor and perineum (e.g. assisted squat, upright positions, on all fours, etc.)  For this one, you really need to talk to your doctor, because the favoured position in the hospital is to have you on your back. Talk to your doctor and see if your request for a different position can be accommodated.

Strengthen your pelvic floor muscles with exercise during pregnancy.

Use a warm compress to help blood flow, and provide perineal support during pushing.

Breathe baby out rather than push as hard as you can, when your body feels the urge. I personally didn’t feel the impact of the breathing technique of coping with labour, but it can do the trick for you.

 

Healing

Most women who have first degree tears find they heal very quickly. Good hygiene and general postnatal perineal care will typically be enough to ensure healing, with little discomfort or pain.

Second degree tears heal within a few weeks. There can be pain and discomfort, but not more than what most women feel in the immediate postnatal period.

Resting, and giving your body time to heal, are often all you need to cope with a second degree tear. The best advice is to take a few weeks after childbirth to rest and heal.

Your body has done such a wonderful job by giving birth, it deserves some pampering.

Show yourself some love, Mama.

 

 

Join the conversation with any of our TTC and Pregnancy Groups here

 

Photo credits:

1. http://www.femette.com/

2. http://4.bp.blogspot.com/

3. https://images.contentful.com/

4. https://babycenter-a.akamaihd.net/

 

 

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