How do tears occur?
Superficial tears or deeper lacerations can occur at the genital opening when the baby's head and shoulders are delivered. You can view a film that will help you to understand the various types of tears here.
Midwives and doctors are trained in the suturing of tears during their education and postgraduate training. The professional standards for treatment are defined by the guidelines of each individual hospital.
Are there different types of tears?
When you give birth, tears to the tissue around the vagina and perineum can occur. Such lacerations and how they have been sutured will be entered in your medical journal by your midwife or obstetrician.
Midwives and doctors classify tears into different degrees. Tiny lacerations can occur around the labia or inside the vagina. Tears to the labia can be either superficial abrasions or actual tearing of the labia.
The area between the vagina and the anus is called the perineum.
Tears of the perineum occur in the area between the vagina and down towards the anus. Tears to the perineum are divided into four categories:
- 1st degree: superficial tearing of the skin or the vaginal area
- 2nd degree: tearing of the superficial muscles surrounding the vagina
- Episiotomy: involves the same muscles as a 2nd degree tear
- 3rd degree: partial or total rupture of the anal sphincter
- 4th degree: rupture of the rectal mucosa
To view free, visual information describing the various categories, you can watch GynZone's Facts about tears and lacerations.
What is the risk of a tear occuring during birth?
For a mother giving birth for the first time the risk of superficial or deeper lacerations in the area around the vagina and perineum is approx. 80 %.
The most frequent types of tears which occur are superficial. Severe lacerations occur less frequently.
By using a Danish registry with more than 25.000 deliveries in one hospital during 2005-2009, we recorded the following ratio:
- Tearing of the labia: approx. 30 %
- 1st degree tears: approx. 25 %
- 2nd degree tears: approx. 30 %
- Episiotomy: approx. 10 %
- 3rd degree laceration (partial or complete anal tear): approx. 6 %
- 4th degree laceration: less than 0.5 %
Your individual risk of sustaining a perineal tear will depend on the type of delivery, the size of your baby, previous tears and various other factors.
Multipara (women who have previously given birth)
The risk of a tear occurring if you are pregnant with your second or third child is less than 50 %. The tears tend to be less severe than those which occur to first time mothers.
- Tearing of the labia: approx. 20 %
- 1st degree tears: approx. 25 %
- 2nd degree tears: approx. 15 %
- Episiotomy: approx. 5 %
- 3rd degree laceration (partial tear or complete anal rupture): less than 2 %
- 4th degree laceration: less than 0.2 %
The midwife or obstetrician will evaluate which treatment is most suitable for your situation. In some situations, where the tears are only very superficial, suturing may not be necessary.
How long will it take to heal after childbirth?
During the course of a pregnancy your body is primed to heal quickly. Your immune system is more efficient than usual and therefore wounds will heal within a few weeks after childbirth.
Tears of the labia and/or vagina heal in the course of a few days and rarely present problems apart from a stinging sensation, especially when you urinate.
The most common cause of discomfort is from painful scar tissue during the first few days after giving birth. You may also experience swelling and tenderness and it is therefore a good idea to take it easy and rest regularly.
Ice packs may provide pain relief and help to reduce the swelling.
From results obtained from Danish research studies on suturing, we know that approx. 2 % of women may need to be resutured after giving birth because they have not healed optimally.
Very few women experience long term problems such as painful scar tissue or problems with incontinence. You can contact your doctor if you experience these problems. You can also be referred to a specialised physiotherapist or a gynaecologist.
When is an episiotomy necessary?
The midwife or doctor may decide that it is necessary to make a wider opening for the babys head during the birth.
One reason to make an episiotomy is if your baby is lacking oxygen and the delivery must progress quickly. An episiotomy can also be made in cases where the perineum is too rigid.
An episiotomy is rarely performed in most hospitals today as several scientific studies have shown that it can lead to more severe lacerations of the anal sphincter.
We also know from our own research on suturing that women who have had an episiotomy suffer more pain during healing than those who have experienced spontaneous tears.
Does raspberry leaves help me to avoid an episiotomy?
Raspberry leaf tea is very popular among midwives in different European countries. As early as the sixth century, the raspberry leaf plant was used medicinally. The raspberry is native to many parts of Europe and Northern America.
It is believed that raspberry leaf, if taken regularly through pregnancy and labour can shorten and easen the labour and reduce the incidence of episiotomy caused by faster birth.
It is commonly assumed that women who take raspberry leaf throughout labour will have an improved second and third stage of labour. Consequently there is supposed to be a reduced risk of bleeding after birth.
Two Australian midwives, Myra Parsons and Michele Simpson did in 1999 a randomised controlled trial to substantiate the findings. Parsons reports that this study demonstrated the safety of raspberry leaf tablets taken from 32 weeks pregnancy until the commencement of labour.
There were no side effects identified for mother or baby.
The analysis of the findings suggested that raspberry leaf tablets shortened the second stage of labour by an average of 10 minutes but made no difference to the length of the first stage of labour.
Are 10 minutes less in the second stage of labour enough for an overall recommendation for consuming raspberry leaf?
A systematic review of controlled clinical trials by Dante G et al (2013) concluded: "Despite the widespread, popular use of herbal remedies during pregnancy, too few studies have been devoted to specific clinical investigations. With the exception of ginger, there is no data to support the use of any other herbal supplements during pregnancy."
Our bodies are designed to give birth without help. There should be no recommendation for regularly consumption. And there is no risk for overstimulation of the womb ending in prematurity, therefor no reason to feel guilty with a premature birth after drinking.
Every pregnant women who likes to drink raspberry leaf tea should enjoy it.
Should I choose a caesarean section instead of a normal delivery?
These days, we recommend vaginal birth for most women. A scheduled caesarean section can usually be carried out without any complications for the mother or child but the risk of complications is always slightly increased in the case of an operation rather than a normal delivery.
A caesarean section prevents tears to the vagina and perineum. On the other hand you will have a visible scar. A caesarean section cannot prevent problems with incontinence in later life and scientific studies indicate that pregnancy in itself is the most decisive risk factor for subsequent problems regarding incontinence.
You can obtain specific gudiance regarding your situation from your midwife or obstetrician.
I had an anal sphincter rupture at my first birth. Can I give birth normally next time?
If you have previously experienced a severe tear of the anal sphincter, you should consult your obstetrician regarding a subsequent delivery.
Together, you can plan the most suitable method for your next birth. You will be encouraged to give birth normally again if you have not experienced problems with incontinence or other issues with healing postpartum.
Your risk of sustaining another severe laceration to the anal sphincter is equivalent to that of a first time mother.
As an alternative to a vaginal birth you could have a caesarean section. You can discuss the most suitable method with your obstetrician.
How long does the pain last after giving birth?
It is normal to feel sore around the vagina and perineum some weeks after delivery. The body works intensely to heal the wound which can lead to swellling and itching in the scar area.
Tears to the labia and the perineum take about a week to heal.
An episiotomy may take about 2 to 3 weeks to heal.
Lacerations involving the anal sphincter can take about a month to heal.
You can use ice packs to ease the pain and reduce swelling. You can also use a sanitary towel soaked in water and freeze it. An ice pack can be used several times daily.
Pain killers may be taken under advice from your doctor or midwife. If the pain in the area around the stitching continues for more than a week, you should contact your midwife or doctor to have your stitches examined.
Should I go to post natal classes after the delivery?
Pregnancy and birth are a strain on your pelvic floor muscles. Therefore attending post natal classes is a good way to receive advice about effective training of the pelvic floor.
Physiotherapist Ulla Due from Hvidovre Hospital, Denmark has developed a programme especially for women who have recently given birth.
You can watch the training videos here ...
When can I have sex again after childbirth?
It is quite normal to have a less desire for sex some months after giving birth.
The hormonal balance in your body will be different while you are breast feeding your baby. This can result in vaginal dryness. It may help to use a lubricant during sex.
It is possible to become pregnant again before your first menstruation after giving birth. You should therefore ask your midwife or doctor about effective methods for safe family planning.
Should the stitches be removed?
You have been sutured with self soluble thread. This is absorbed by the body after one or two months. There is therefore no need for you to have the stitches removed.
If the thread irritates you, or you experience irritation from one of the knots, you can have them removed by your doctor.