There are some unsavory parts of childbirth, and one of them is an almost-certain consequence of first-time vaginal deliveries: tearing. "It's important to normalize the notion of vaginal tearing and not to fear it, because it happens so often," says Katie Page, a certified nurse-midwife in Forest, Virginia. Get the facts about vaginal tears, so you know what to expect down there before and after birth.
What is Vaginal Tearing?
A vaginal tear is a laceration to the perineum (the area between the vagina and rectum) that occurs when the baby is pushed out. The tears are spontaneous, meaning a doctor didn't make a cut. "During birth, the vagina has to stretch enough to allow a baby, whose head is the size of a cantaloupe, to come through it," says Sherry Ross, M.D., an OB-GYN and women's health expert at Providence Saint John's Health Center in Santa Monica, California. "Hopefully, the vagina will stretch just enough without tearing, but often a tear does happen."
The Odds of Vaginal Tearing
Unfortunately, the odds of getting a vaginal tear are fairly high: First-time moms have a 95 percent chance of experiencing some form of tearing during delivery, since the tissue down there is less flexible.
Other factors also contribute to your likelihood of lacerations, such as being overweight or having a fast birth, since the tissue has less time to adapt and stretch as the baby comes down. The position of the baby can be another factor—for example, babies facing up put extra pressure on the bottom of the vagina. Having a vacuum- or forceps-assisted delivery or an especially long labor that results in severe vaginal swelling increases your chance of tearing as well.
The good news? "Typically, after your first vaginal birth, your tissue is more flexible so tearing becomes less likely," Dr. Ross says.
Vaginal Tear Symptoms and Treatment
There are four degrees of vaginal tears; all can be painful, but some require several stitches after birth. Severe tears can affect your anal sphincter, too. Follow your doctor's advice for how to heal vaginal tears after delivery.
If you experience a first- or second-degree tear, you can expect some discomfort—especially when you're sitting straight up—for a week or so. Having a bowel movement or doing anything that causes an increase of downward pressure, like coughing or sneezing, will hurt as well. By week two, the tear should be pretty well healed and the stitches will have dissolved, "but the nerves and full strength of the muscles can take several more weeks to heal," says Page. (Sex at six weeks will likely be uncomfortable, too, depending on the location of the vaginal tear and the quality of the stitching.)
Healing for third- and fourth-degree lacerations takes longer, with two to three weeks of initial pain. And discomfort during sex, or while having a bowel movement, may last for several months. Stool softeners and a diet of fiber-rich foods can help with the latter, says Page, as can cold compresses and herbal sitz baths. Stitches after birth are necessary with these types of lacerations.
Since severe tears into the vagina or rectum can cause pelvic floor dysfunction and prolapse, urinary problems, bowel movement difficulties, and discomfort during intercourse, it's important to share all of your symptoms with your doctor, no matter how embarrassing they may seem. These professionals are trained to understand your vagina before and after birth.
Decreasing the Severity of Vaginal Tearing
To decrease the severity of vaginal tearing, try to get into a labor position that puts less pressure on your perineum and vaginal floor, like upright squatting or side-lying, Page says. Hands-and-knees and other more forward-leaning positions can reduce perineal tears, too.
It also helps if you lead the pushing phase of labor. "When Mom takes the lead, she does just enough for her to feel her baby move, which allows the vagina to stretch slowly, reducing the likelihood of tearing," says Page. On the flip side, when you're directed to push as hard as you can while someone counts, there's a lot of additional pressure on your perineum, which can increase chances of tearing.
In addition, you may reduce your odds of vaginal tears by applying a warm compress to the perineum during the pushing phase of labor, says Dr. Ross.
Finally, four to six weeks before your due date, practice a 10- to 15-minute perineal massage daily. "Frequently massaging the base of the vagina with oil or a water-based lubricant is thought to soften the tissue, making it more supple and improving its flexibility," says Page. (Always consult your doctor before beginning the practice, especially if you have a history of herpes, as practicing perineal massage with an active herpes outbreak increases the risk of the virus spreading throughout the genital tract.)
Should I Ask for an Episiotomy?
You might want to retain the look and feel of your vagina before and after birth, and are wondering if you should ask for an episiotomy. An episiotomy—an incision made in the perineum to widen the vaginal opening—is sometimes necessary, but is no longer routine during a vaginal delivery, says Dr. Ross. What's more, an episiotomy may actually worsen the damage and the healing process. The decision is up to you, but most doctors advise against an episiotomy unless there's a medical need for one.