BIRTH IN GENERAL

The Perineum Tear

A vaginal tear or ripping is a spontaneous laceration to the perineum (the area between the vagina and rectum) which might occur when the baby is actively pushed out of the vagina.

During the hours of labor, the vagina has to stretch extremely to allow a baby to decent and rotate in the birth canal, usually head first , which is the biggest and hardest part of baby’s body coming through and stretching vagina and pelvic floor.

At the end of labor, during the extraordinary need of pushing the baby out, the vagina , specially at the end of it, where the perineum is located, receives a lot of power.

Depending on how much instruction for pushing or no pushing the birthing mother will follow, her tissue will stretch or tear easier.  

I have seen all kinds of tearing and lots of intact perineum after birth, specially when ladies had time to birth and a birthing position which they chose and liked.

In a loving environment, where natural oxytocin is running in the air and woman’s body has time to settle into opening up to bring the baby into the world, where the medical care providers (midwives or gynecologists) let the mother push or breath her baby out in her rhythm, tears mostly not occur, not even in first time mothers.

Often I read that nearly a 100% of first time moms have the chance to experience any form of tearing during delivery.

This is true, if nobody educated her for breathing the baby out, or only indicated how to push a baby out on an operation table, legs up and not in a natural position at all.

 The perineum tissue is not flexible, people say, that is not true. It opens up and goes back nearly immediately into its form right after the baby is born.

It might happen in very quick birth, and just a few urges to push , that a big baby with all its power of a contraction and urge to push might tear your perineum.

But a clear concentrated mom, without fear to breathe the baby out or fear to tear, usually does not tear in a hand and knee position on land or water.

In case of a posterior position of the baby, birth can take longer and the circumference of the head will be bigger, and it might tear easier.

But then still by having time to push, putting hot cloth or some essential oils on the perineum, the chance of tearing is very low.

If some doctors have to provide a forceps or vacuum delivery for the baby’s health, usually they will proceed an episiotomy, and not let you tear when they pull the baby down.

In case of really long labour and hours and hours of pushing, it might be that your vagina and vulva/ lips and perineum are swollen , so then a tear is nearly impossible to avoid. Very swollen tissue has no ability to stretch even more.

One good thing is: in case of a tear, you do not have to worry about feeling it. A tear only happens, when the tissue doesn’t have any blood circulation any more, and then it also has no sense of feelings, it will just break to open the path and let the baby out.

There are 4 different types( degrees) of tears, small ones and bigger ones.

In my opinion we should mostly repair the tears and like this stabilize the perineum‘s strength again, not the ones on the labia, if out of the tear it is not bleeding strong, specially on the upper part next to the clitoris.

If the muscle part of the perineum is involved, and it is not just a 1 cm tear of the skin tissue of the perineum, then I would always recommend to stitch it up.

Stitches are not hard to stand, when the care provider gave you a good amount of lidocaine inyection in the teared area and you have your baby with you to enjoy its beauty and so wished arrival.

Any big tears including vagina, or anal sphincter , or cervix, bleed a lot and should be stitched up by professionals, specially when involved the delicate part, the anal sphincter, to avoid any problems of  incontinence for the future.

Here the different degree classifications:

  • First-degree tear:The tear is just into the lining of the vagina, this does not involve muscle, very rarely needs stitches.
  • Second-degree tear:The most frequent laceration when long pushing or forced pushing occurred. This tear involves the vaginal lining and submucosal tissues of the vagina and requires definitely a few stitches.
  • Third-degree tear:This laceration goes through the deeper layers of the vagina and the muscles that even make up the anal sphincter.
  • Fourth-degree tear:This deep and uncommon tear includes all of the above mentioned tissues and extends right through to the rectal lining. Requires a good professional to stitch all layers properly and usually even an epidural anestesia or a short mask anestesia which puts you to sleep for a moment to avoid pain .

Recovering from a first or second degree tear is not a very painful experience, it will give you discomfort for the first 24 hours by peeing or sitting and feeling the pressure of the uterus still on the wound. Recommendation is to avoid long time sitting, rinsing the vagina with warm water when peeing and have some calendula oil on the female pad to help quick healing.

Coughing and sneezing might be uncomfortable, and the first poop second day after birth might give you anxiety, but please do not worry, if your poop is not hard, then it won’t give you any problems.

In case of a 1. Or 2. Degree tear after 3-7 days usually you won’t have any discomfort anymore, the tissue will be healed and the stitched will fall out around day 10, these days all gynecologists and midwives use for stitching absorbable suture material.

The deeper tissue, like muscles in perineum or anal sphincter need weeks to heal properly, to recover their strength and function. During the healing process it might be that you have to take pain killers, eat a special fiber rich diet to soften stool and to put compresses on with essential oils and even do some exercises to help rcover the sphincter function.

After 40 days post partum , in case you would like to start being sexual-active again, please be careful and very gentle the first times, lubrication because of breastfeeding might not be the same like before, and your energy level is probably not so high. And the scar might be still not soften enough, so it could give you a discomfort.

Yoga ladies told me , they had a hard time stretching after tear scars, and it took them up to 6-12 months to have their fully stretching ability recovered.

Since severe tears into the vagina or rectum can cause pelvic floor dysfunction and prolapse, urinary problems, bowel movement difficulties, and discomfort during intercourt, please go and talk to your midwife or gynecologist about your symptoms, in case they occur to help healing and interfering the discomfort.

So please remember :

It is physiological, that a baby passes through the naturally stretched birth canal and by knowing the perfection of our bodies, we should not fear or doubt ist perfection.

If you would like to minimize the risk of tearing, first stop fearing a tear ! If you feel confident and safe pushing or breathing your baby out, then most likely you won’t rip, your tissue will stretch and it doesn’t  matter how big your baby is, your body will work together with your baby to be as gentle as possible on your skin.

Choose the right position ( very recommended hands and knees position, leaning forward position to minimize the pressure on the perineum), and be the leader when it comes to pushing, do not push over your limit by being guided to push.

And preventive start daily for 10-15minutes from 6 weeks before estimated due date the perineum massage with some essential oils, which help soften and stretch the tissues of vagina and perineum. Day by day you will feel the improvement of more flexibility.

Ingreso a la tina con 4-7cm. de dilatación y franco trabajo de parto, la misma debe tener el agua a 37ºC. Ahí disfruta tus contracciones y muévete ligeramente en libertad en esta agua tibia que te deja relajar y descansar. La posición de pujo puede ser variable dentro de la tina.

El control de latidos fetales se efectúa con amplificador de latidos adaptado para el medio acuático. El nacimiento se produce completamente bajo el agua, el tiempo de inmersión completa es corto y es evaluado teniendo en cuenta las condiciones del recién nacido (Apgar).

Cubra cualquier parte expuesta del bebé (hombros, cuello) con un paño de forma que el bebé no se enfríe. Acune al bebé en sus brazos en una posición vertical o semi-vertical, pecho con pecho preferiblemente. La costumbre de aspirar (succionar) no es necesaria, y puede ser traumática. La aspiración (succión) del bebé debe hacerse solamente si el bebé jadea o parece no poder respirar debido al moco.

Aunque los bebés todavía reciben el oxígeno del cordón umbilical después de salir del cuerpo de la madre (muchas veces más de cinco minutos), el fluir de oxígeno puede parar después de dos o tres minutos. Se estimula al recién nacido a mamar en forma inmediata para facilitar el posterior amamantamiento. Con la salida del niño de la tina se evacua la misma y la mujer expulsa de manera espontánea la placenta y luego de secarse pasa a la cama.