Tearing During Childbirth: What I Wish I'd Known
How can increased knowledge about the risks of tearing prepare people for a successful physical and emotional recovery?
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If there was just one thing I could have known before giving birth to my daughter in 2017, it’s this: over 90% of first-time mothers who deliver vaginally will experience tearing.
I had a vague awareness about the possibility of tearing, of course. But I had no idea just how likely it was to happen to me. I didn’t know about the four degrees of tearing a person may experience. Despite diligently preparing for my birth, I still didn’t have a clear, in-depth understanding of the possible risks that interventions posed when it came to birth injuries (to be honest, I probably glazed over some of that information out of fear– I wish I hadn’t). And I certainly wasn’t well-versed in what an aftercare plan might look like, were a birth injury to happen.
Before we go deeper, let’s take a look at what a vaginal tear actually is. Also called a perineal laceration, this is a tear in the tissue (skin and muscle) around your vagina and perineum. The perineal area (also called the perineum) is the space between the vaginal opening and your anus.
There are four different grades of vaginal tears. These grades are determined by the severity of the tear.
First-degree tear: The least severe of tears, this small injury involves the first layer of tissue around the vagina and perineal area.
Second-degree tear: This second level of this injury is actually the most commonly seen tear during childbirth. The tear is slightly bigger here, extending deeper through the skin into the muscular tissue of the vagina and perineum. For most people, first and second-degree tears are considered minor and heal relatively easily.
Third-degree tear: A third-degree tear extends from your vagina to your anus. This type of tear involves injury to the skin and muscular tissue of the perineal area, as well as damage to the anal sphincter muscles. These muscles control your bowel movements.
Fourth-degree tear: This is the least common type of tear during childbirth. Extending from the vagina, through the perineal area and anal sphincter muscles and into the rectum, this injury is the most severe type of tear.
During a typical vaginal delivery, the skin of your vagina prepares for childbirth by thinning out. This part of your body is meant to stretch and allow the baby’s head and body to pass through without trauma. However, there are several reasons why a vaginal tear might happen. These reasons can include:
A large baby (more than 8lbs).
A very quick delivery (the skin hasn’t had time to stretch and thin).
Use of forceps or vacuum during delivery.
The position of the baby (such as face up).
An episiotomy (a cut of the perineum by a doctor).
After labouring for over 50 hours, my daughter, Neva, was delivered via forceps weighing 8lbs 6oz. The impact of the forceps left me with a broken tailbone and a third degree tear. It took over an hour for two doctors to stitch me up. It took over two years for my vulva to stop hurting.
If you are pregnant and reading this, please know that we understand how disconcerting reading about tearing may be. It’s important to remember that, while tearing itself if common, the majority of tears are minor (first- and second-degree). We believe that knowledge is power. When you know what can happen and plan into it, you can be better informed to make decisions should medical interventions be necessary. You can include a recovery strategy in your birth plan, just in case you experience a severe tear. We also believe that sharing our stories helps others know that they are not alone. This is especially true when it comes to talking about vaginal tearing. Sharing that your vagina, perineum, and possibly anus and/or labia has torn is extremely intimate and personal and, for many, difficult and embarrassing to talk about. Suffering a birth injury is a peculiarly lonely experience: outside of cyberspace, it's rarely mentioned. But if we don’t talk about it, how can we support one another?
In this edition of Body of Knowledge, I speak to two leading professionals about the physical and emotional impact of trauma from vaginal tearing. Dr. Laura Laursen, an advisor with Nyssa and OB-GYN with Chicago’s Rush University Medical Group, provides straightforward information about the anatomical impact of tearing and strategies to help minimize tearing and encourage a positive physically recovery. Magdalena Watling is a midwife and founder of Birth Therapies in Bath, U.K. A large part of Magdalena’s work involves birth trauma resolution and therapy and she offers some extremely effective and actionable advice to help mothers on their journey towards healing.
If you are reading this and still recovering from a birth injury, please know that you are not alone. We’ll be starting a conversation thread on here next week, specifically to talk about this subject and share our experiences. I’d love for you to join us.
Next time we’ll be discussing the lexicon of women’s health and the language that has got to go (I’m looking at you, “geriatric pregnancy” and “inhospitable womb”…and that’s barely scratching the surface). Feel free to reach out and share your ideas while I’m working on the piece– you can reach me at email@example.com.
Mia (Body of Knowledge Editor-in-Chief)
Disclaimer: Body of Knowledge aims to bring together real life experience with knowledge that we source from experts in our network combined with additional research from reputable sources. We are women’s health advocates, not medical professionals. If you require medical advice, please contact your healthcare provider.
Carrie Moyer, Frieze, 2011
Vaginal Tearing in Childbirth: What to Know and How to Physically Recover with OB-GYN Dr. Laura Laursen, MD.
Vaginal Tearing in Childbirth: Healing from Emotional Trauma with Midwife and Founder of Birth Therapies, Magdalena Watling.
Knowing What I Know Now, How Would I Have Prepared Myself for the Likelihood of Tearing During Childbirth?
Yes, tearing is almost certainly going to happen if you have a vaginal delivery. Most people will have a first- or second-degree tear. The more severe injuries– which are far more challenging to recover from– are uncommon (about 6 in 100 births) and scary to contemplate. But not talking about it consequently means that many people have trouble getting adequate information prior to delivery and feel unprepared and unsupported during recovery. Now knowing first-hand the risks and severe consequences of tearing in childbirth, here’s some advice I’d share with other mothers-to-be:
Knowledge is power. Educate yourself on the risk factors of severe tears and incorporate prevention and aftercare strategies into your birth and postpartum care plans. You cannot actually prevent a significant tear– it’s largely due to forces outside of your control, such as the size of your baby and your anatomy. But seeing a Pelvic Floor Therapist in the months before giving birth may help reduce recovery time after delivery, no matter how severe the tear. Perineal massage and stretching prior to delivery may also help with muscle pliability and help mitigate the impact of the tear.
Be your own advocate. During delivery, you can ask your doctor, doula, or midwife to support your perineum with their hand as you push as it’s been proven to help reduce the severity of tear. Push for a proper diagnosis and review of your injury (many moms I know were told they had a tear, but had no idea to what degree). If you suspect something is wrong, don’t brush it away: you know your body best. Talk to your doctor. If you suffer from a major tear, request regular check-ups with your medical provider until you are fully healed. If you are working and still in discomfort, speak to HR and see if there are ways for your company to help support you as you heal. And if you think you may have PTSD from your delivery experience, reach out to a mental health professional. There are some incredibly effective techniques to help resolve feelings of anger, grief, and shame that can arise from a difficult birth.
See a Pelvic Floor Therapist after delivery– no matter what. Every OB-GYN, doula, and midwife I’ve ever spoken to says the same thing: they wish Pelvic Floor Therapy was mandatory and accessible for every single person who gives birth. Pre-book some sessions for a couple of weeks after your due date. You’ll be glad you did.
There are ways to ease the pain. Ice therapy is proven to help ease discomfort and speed up recovery time. Sitz baths are a blessing. Stool softeners are your best friend. Use a peri bottle when you pee to help dilute the sting of urine. Donut cushions are really helpful, too, as they prevent your vulva/perineum from coming into direct contact with your chair.
Know that you are not alone. Research indicates that women's pain levels after experiencing a second-degree tear or greater can be linked to their risk for developing postpartum depression. Combined with the intimate nature of the topic and how so many of us don’t feel comfortable talking about our vulvas in general, it’s little wonder that so many women feel isolated and alone in their pain. But you are not. The statistics alone prove it. You do not need to suffer silently, as so many of us have been conditioned. By talking, sharing, and ensuring we have the means to take care of ourselves– and each other– mothers and birthing people can find a connective, collective resilience and invaluable support system to help us as we move through the pain, to the other side.
Carrie Moyer, Rock Candy Chrysalis, 2011
HELPFUL RESEARCH STUDIES:
Risk Factors for Perineal and Vaginal Tears in Primiparous Women (BMC Pregnancy and Childbirth, 2020). The aim of this study was to estimate the incidence of second-degree perineal tears, obstetric anal sphincter injuries (OASI), and high vaginal tears in primiparous (someone who is pregnant/birthing for the first time) women, and to examine how sociodemographic and pregnancy characteristics, hereditary factors, obstetric management and the delivery process are associated with the incidence of these tears.
Perineal Tears- A Review (Australian Journal of General Practice, 2018). The aim of this article is to provide general practitioners (GPs) with a good understanding of perineal tears by discussing the different classifications, immediate and long-term management, and recommendations for future deliveries.
Women's Experiences of Second Degree Perineal Tears (NHS Health Research, Authority, 2015). With a goal to explore the full range of women’s experiences, positive and negative, in order to inform future clinical care and research, this study invited women who had sutured and un-sutured second degree tears to take part in focus groups to explore their experiences of second degree perineal tears and how this affected them in the weeks after giving birth (physically and emotionally). The researchers also interested in whether women were involved in the decisions about the management of their tears and what information they were offered by clinicians on postnatal management.
“Don’t fear the tear, it’s the undiagnosed tear without repair.”
A great Today We Tried episode that explores birth injuries, the healing process, and much more, including the critical importance of paid leave, why OB-GYN departments are chronically underfunded, and how to advocate for yourself in the Fourth Trimester and beyond.
When You Give Birth, Your Body…Rips. That Might Suck a Little Less if We Talked About It More– Dr. Emily Oster in Slate
“Many American women don’t realize that childbirth can involve such extreme injury. When Chrissy Teigen revealed on Twitter recently that the birth of her first child had resulted in a tear, repaired with many stitches, people responded in bewilderment. “What are the stitches for? I thought they only used stitches in c-sections?” one commenter wrote. Teigen responded, “lol bless you this is so cute.” – Frances Denny in Harper’s Baazar
Torn Apart by Childbirth– Joanna Moorhead in The Guardian
Massaging Away a Potential Complication of Birth? – Dr. Jen Gunter in The New York Times
The problem of women being injured in childbirth has for years been exacerbated by poor diagnosis, improper care and an unwillingness to speak about the issue, experts say.
Tips from the Royal College of Obstetricians and Gynaecologists on reducing the risks of perineal tears in childbirth.
Sarah Sudhoff, Focusing Screen No. 2, 2022
A Note from Body of Knowledge: Exclusive Nyssa x Sarah Sudhoff Print Sale
You may have seen the photograph we use as the header for Body of Knowledge. It’s the work of a Houston-based artist we love, Sarah Sudhoff. Sarah selected three prints from her important and moving series, Focusing Screen (which features Nyssa’s VieVision Between Legs Mirror) for a special limited edition print sale. There are still some left, so if you’re interested this is the time to snap one up!