During the birth of a baby, certain tissues are frequently torn. These obstetric tears are most noticeable in the perineum (the space between the vaginal and anal openings) and vaginal area, and more rarely in the vulva and cervix.
While it may startle you to read this, it’s worth pointing out that with current research, evidence shows that a tissue tear is more respectful of personal anatomy and seems to bring less pain and less bleeding to the woman postnatally, unlike a technical cut (episiotomy) which takes no account of the woman’s natural fibers.
If we focus on perineal tears, 28% of women will have no injury or barely a scratch to their perineum after childbirth.
For the others, tears are classified in grade or degree, from level 1 to 4.
Degree 1 tear :
A 1st-degree tear accounts for around 32% of perineal injuries, and corresponds to a simple, isolated lesion involving only the first layer of tissue (the skin, at cutaneous level).
Degree 2 tear :
A 2nd-degree tear will be a little deeper and will involve, in addition to the skin, the fibrous core of the pelvic floor (muscular portion). This level also affects around 32% of women who suffer a tear during childbirth.
Degree 3 tear :
The 3rd degree tear is of greater importance. Approximately 5.75% of women will have damage to the skin, the fibrous core of the pelvic floor and the external sphincter of the anus. In this case, the tear has extended to the anal opening.
Degree 4 tear :
The fourth-degree tear, although affecting far fewer people – around 1.92% – has many more potential consequences for the woman in her postnatal recovery.
Risk factors for a tear :
a woman giving birth for the first time (primiparous, tissue never stretched like this);- a large baby (macrosomic);
- long labor and/or long pushes that lead to swelling of the perineum;
- the use of instruments to deliver the baby (suction cup, forceps);
- poor presentation of the baby (posterior, facial, etc.);
- too rapid a delivery (the tissue doesn’t have time to stretch).
Possible complications :
- bleeding;
- disunion (stitches that break);
- infection;
- pain during urination and/or discomfort in certain positions.
Later, depending on the degree of tearing, the following may be noticed:
- sexual pain in the 6 months following childbirth;
- with grade 3 or 4 tears, it is possible to have difficulties with stool continence (the ability to retain or let go of stool).
How can I prevent a tear?
Although there’s no magic formula for avoiding tears, the fact remains that a pregnant woman can, to some extent, influence her postnatal future by putting all the chances on her side prenatally.
Here are a few suggestions:
- Specific physiotherapy can help you better prepare your pelvic floor during pregnancy, and help you push during childbirth with greater control.
- Daily stretching of the perineum by the woman herself or her partner can help to ease the birth situation, if practised from the 34th week onwards and if the woman is not in premature labour.
During your pregnancy follow-up, your health care professional can show you how to do this. Although the positive and significant effect of stretching is still mixed in several studies, the fact remains that there seems to be a potential benefit to doing it compared with not doing it. Some literature points to a 50% reduction in injuries for people who stretched well, compared with those who did nothing. So why not do it as a couple? Even if you do end up with a small tear, it will heal more quickly with tissues that are well vascularized and in good shape. So you don’t lose anything in the end! - Practicing the push-up in the lateral position can also help reduce tension in the perineum.
- Applying warm, moist compresses to the perineum can help elasticity.
- Slow, regular breathing with gradual thrusting and no heavy blows is also a way to get the baby out, limiting the drastic stretching of the perineal tissues.
Related topic:
Marie Fortier
The baby expert
