Perineal care for childbirth tears

Read our guide below to help you understand about tears during childbirth.

You can also download a PDF version of this patient information by following the link on the right.

What happens during the birth of my baby?

As you give birth, your perineum (the part of your body between the opening to your vagina and back passage) stretches to allow the birth of your baby.

Most women (90% or 90 in 100) tear during childbirth, especially when giving birth for the first time.  You don’t always need stitches. Even if you don’t tear, you’ll have some bruising and tenderness.

What kind of tears can happen during child birth?

Thes include

• labial tears, mostly superficial skin breaks which heal naturally. You’ll need stitiches if they bleed or happenon both sides
• first degree tears (very small perineum tears) which only involve the skin and usually heal naturally over 7 to 14 days
• second degree tears which are deeper and affect the perineum muscle as well as the skin. You’ll need stitches
• third degree tear extends down from your vaginal wall and perineum to the anal sphincter (the muscle that controls the anus)
• fourth degree tear extends to the anal canal and maybe into the rectum.

Third and fourth degree tears are less likely to happen than first and second degree tears.

For first time mums they happen in up to 6% of people. In second or subsequent births, they happen in around 2% (2 in 100).

Can you prevent tears?

During pregnancy, research shows that massaging the perineum in the last few weeks may reduce the chance of tearing. Ask your midwife for more details about perineal massage.

During labour and birth keep mobile or sit in an upright position. Gravity will help your baby move down the birth canal. Try to choose a comfortable position.

Your midwife may put warm compresses on your perineum during the second stage of labour as your baby’s head stretches your perineal area.

During the birth your midwife will encourage you to breathe slowly to control and slow the birth of your baby’s head and shoulders. This can reduce the risk of severe perineal trauma by up to 50%.

Your midwife or the doctor will talk to you if they think you need an episiotomy. If you need forceps to deliver your baby, we’ll recommend an episiotomy to make more space.

We’ll always ask for your consent before any procedure.

We use specially designed surgical scissors to reduce the risk of third and fourth degree tears. You’ll have stitches to your perineum afterwards and a local anaesthetic before we apply your stitches.

Is there an increased risk of tears?

Everyone’s different and it’s hard to predict whether or not you will tear.

It’s also hard to predict what will cause a third or fourth degree tear, but there are some things that increase the risk. These include:

• having a large baby (more than 4kg / 8.8lbs)
• a quick labour and birth because there’s less time for your perineal muscles to stretch
• a long pushing (second) stage of labour because your perineal muscles get tired
• your baby’s back lying towards yours (back-to-back)
• having a forceps birth, because of the extra space needed to insert the forceps
• difficulty with your baby’s shoulders being born (shoulder dystocia).

What’s the difference between an episiotomy and a tear?

A tear happens as the perineum stretches during birth.

An episiotomy is a surgical cut to the perineum that a doctor or midwife makes to make more space to deliver the baby.

You’ll have an episiotomy only if you consent and if it will help you and/or your baby.

About 8 in 100 (8%) of people in the UK giving birth vaginally have an episiotomy. If you have an episiotomy you’ll have a pain relief injection to numb the area.

How do you repair tears and episiotomies?

With stitches that hold the edges of the wound together to help healing. A midwife or doctor will give you an anaesthetic, unless you already have an effective epidural. They’ll then do the stitches.

The material used for stitches will dissolve gradually, usually over 10 to 14 days, so that you don’t have to have your stitches removed.

If needed, we’ll give you pain relieving, anti-inflammatory medicine during your stay in hospital and to take home. This medicine won’t stop you from breastfeeding your baby.

If it stings when I pass urine, what can I do?

Drink plenty of water so that your urine is less concentrated.

Some people find it helps to pass urine during a bath or shower. Pat the area dry afterwards. Remember to wash your hands before and after touching your perineum.

What can I do to help the tear heal?

Keep the area clean

Have a bath, shower or use a bidet or a bowl at least once a day and change your sanitary pads regularly. There’s no need to add anything to your bath to promote healing.

Drink plenty of water and other fluids and eat a healthy balanced diet including fruit, vegetables, cereals and wholemeal bread and pasta. This will give you iron and vitamins to promote healing and stop you getting constipated.

Regular pain relief will help you to move more easily. Walking helps prevent stiffness and reduce swelling

Will pelvic floor exercises help after birth?

Yes. They’re very important as they will help increase the blood supply to the perineal area and aid the healing process.

Pelvic floor exercises can also help you to regain the muscle tone preventing incontinence. You can start the exercises as soon as you can and they’re very easy to do.

Begin by trying to tighten the area, squeezing all the muscles in the vagina and around the anus for the count of 10, repeating 10 times.

You can get more more information about pelvic floor exercises in your postnatal guide that you had at 36 weeks of your pregnancy.

How can I prevent infection in the tear?

Always wash your hands before and after using the toilet, changing your sanitary pad or touching your stitches. This is especially important if you have a sore throat or chest infection, or you’re in close contact with someone who has.

It’s important your midwife checks your stitches at each postnatal visit. They’ll make sure it’s healing and there’s no infection.

Get advice early from your community midwife or GP if:

• your stitches get increasingly painful, swollen or there’s an offensive smell
• you think your stitches have opened
• you can’t pass urine
• you can’t control your urine, bowels or wind
• you have urinary urgency or faecal urgency (need to rush to the toilet to open your bowels).

How might a tear affect future births?

It’s very unlikely that a perineal tear will stop a subsequent vaginal birth. If your tear completely heals and you don’t have any symptoms from the tear, you should be able to have a vaginal birth.

Your midwife or obstetrician will discuss this with you at your follow-up appointment or early in your next pregnancy.

What happens if I have a third or fourth degree tear?

You’ll have a detailed examination of your perineum and anus. The obstetrician will confirm the extent of the tear and tell you about further management.

You’ll need an anaesthetic, usually an epidural or a spinal anaesthetic but occasionally this may be a general anaesthetic. Stitching of the damaged anal sphincter and tear will happen in an operating theatre.

The advantage of doing this in the operating theatre is that there’s pain-relief, a good light source, and appropriate surgical instruments. We do the repair in under sterile conditions. There may be a delay in performing your repair if the doctor or labour ward is busy.

Care following repair of a third or fourth degree tear

A drip in your arm will give you fluids until you feel able to eat and drink. A catheter (tube) in your bladder will drain urine until you can walk to the toilet. The Midwives will want to
measure the amount of urine you pass the first few times to make sure everything’s ok.

Antibiotics

We’ll tell you to take a course of antibiotics for a week to reduce the risk of infection because the stitches are very close to the anus.

Pain-relieving medicine

We’ll offer you pain-relieving medicine such as paracetamol or a non-steroidal anti-inflammatory medicine such as ibuprofen to help with any
discomfort. We recommend taking them regularly in the first few days.

Laxatives

We’ll tell you to take laxatives twice a day for 7 to 10 days to make it easier and more comfortable to open your bowels.

It’s important that you avoid getting constipated after the operation as it may cause the repair to breakdown during straining. You can increase the laxative dose to 3 times a day or, you can reduce or stop it if your stools are soft and you can achieve this without too much straining. The treatments offered won’t stop you from breastfeeding.

Stitches

They’re dissolvable but they can take up to 3 months to completely dissolve. You may notice them as they fall out and sometimes they can irritate as they heal but this is normal.

When can I go home if I sustained a third or fourth degree tear?

As soon as you feel ready to do so and we’ve checked your stitches to see that they’re healing properly. You should be able to continue with all your usual daily activities and caring for your new baby.

What are the long-term effects of a third or fourth degree tear?

Most women make a good recovery, particularly if the tear is recognised and repaired promptly.

It’s normal to have some perineal pain and soreness but you can relieve it with simple pain relief such as paracetamol and a non-steroidal ant-inflammatory medicine such as ibuprofen to help with any discomfort.

Most women who tear feel worried about having sex. Wait until you’re ready and use a lubricant gel.

You may also feel urinary urgency or a need to rush to the toilet to open your bowels urgently but this should ease over time. This can take up to 6 to 8 weeks.

You should avoid strenuous exercise or sexual intercourse until the tear is fully healed.

Everyone’s affected differently. Talk to your midwife or doctor to discuss your individual concerns.

Your follow-up care after a third or fourth degree tear

We’ll offer you a follow-up appointment at the hospital 6 to 12 weeks after your delivery to check your stitches have healed properly. This appointment gives you the opportunity to discuss any concerns that you may have.

You’ll also get an appointment with a specialist physiotherapist for more intensive muscle training.

Useful information

Find out more about third or fourth degree tears during childbirth

Learn more about antenatal perineal massage for reducing perineal trauma.

How can I help reduce healthcare associated infections?

Infection prevention and control is important to the wellbeing of our patients so we have procedures in place. Keeping your hands clean is an effective way of preventing the spread of infections.

You, and anyone visiting you, must use the hand sanitiser available at the entrance to every ward before coming in and after you leave. You may need to wash your hands at the sink using soap and water. Hand sanitisers are not suitable for dealing with patients who have symptoms of diarrhoea.