Vaginal and Perineal Tear During Delivery – Home Treatment for Quick Healing
There are some unpleasant parts of childbirth we don’t love to talk about. And one of the unpleasant experiences is the vaginal tear during delivery. Read through to normalize the idea of vaginal tearing as it is a very common delivery complication.
Every vaginal delivery requires some stretching of the vagina. The tearing in the vagina occurs when the head of the baby moves through the vaginal canal and the skin is unable to stretch enough to accommodate the baby. This tears up the skin. Tearing is a fairly common phenomena during the delivery, however, some tearing are larger than the others.
Classification – Types of vaginal tears
Tearing depends on person to person and case to case. Generally, repairing require tearing longer than 2cm. The doctors typically classify vaginal tear into following four categories:
- First-degree tears – These can be called as small superficial tears that usually doesn’t require stitching and heal on their own. The tearing involves the skin around the vaginal opening, also known as perineal skin.
- Second-degree tears – These tears are slightly deeper that involves the perineal muscles which lie between the vagina and the anus. A second-degree tear requires some stitches and is the most common among all.
- Third-degree tears – This tearing goes deeper into the vaginal layers that include the perineal muscles and extending down to the anal muscles. This type of tearing need surgical intervention to repair and might take months for full recovery.
- Fourth-degree tears – This is the deepest tearing involving all the three above and may extend to the rectal lining. This is the least common tear and mostly require surgical repair.
Third and fourth-degree tears are rare. These are more common when baby’s shoulder gets stuck (shoulder dystocia) during delivery or when the delivery is done using forceps or vacuum extractor.
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Is vaginal tear common?
Vaginal tear is fairly high and about 95 percent of the first time moms goes through some form of tearing during the delivery. This is because the skin down there is flexible and cannot accommodate large head and shoulders of the baby.
Risk factors of vaginal tears
While it’s the most common condition, especially for the first time mothers, some may get severe tearing depending on their case. The risk factors include:
- Being of Asian lineage
- When childbirth takes place using forceps or vacuum
- When baby’s shoulder gets stuck behind the pubic bone
- Labor induction
- Large baby (fetal macrosomia)
- Advanced maternal age
- Prolonged labor
Can vaginal tearing bring up complications?
Vagina after tearing takes time to restore and if the case is severe, it can take months to heal. During this period of time, a woman can experience following discomfort:
- Constipation or problem passing stools
- Infection due to exposure of tissue to the bacteria
- Painful intercourse due to sewing of the tear
- Soreness in the vagina
- Trouble peeing due to stretching of the bladder and temporary damage to nerve and muscles
- Fecal incontinence or uncontrolled bowel movements
- Urinary incontinence due to impact on pelvic muscles
Treatment of vaginal tear – Medical and home-based care
If the doctors see that the vaginal tear may occur during the delivery, they would go for episiotomy. This procedure is an incision in the perineum (area between the anus and the genital organs) to make the opening larger for the baby’s head to pass through. Almost all gynecologists in India prefer to do episiotomy for vaginal deliveries. So you are likely to get stiches.
Once the doctor or midwife sees the head of the baby, they will try to ease it and chin out. If the doctor sees that the opening is not large enough, he would then go for episiotomy. Before that, the area will be numbed using anesthetics. Now when the baby is pushed during the labor, the doctor will use a scalpel or surgical scissors to make a cut in the perineum.
Once the child is delivered followed by placenta, the doctor would like to check for additional tearing in the area before stitching up the region with dissolvable sutures. Remember, episiotomy does not improve post-delivery symptoms.
Whether you experienced vaginal tear or episiotomy, the doctor would perform stitching in the affected area. The doctors typically avoid stitching small tears. The stitching might be done if:
- Bleeding doesn’t stop.
- Tearing seems to be longer and does not appear to heal on its own
- Tear is uneven and might not heal properly without appropriate stitching
The stitches usually dissolve in 7-10 days of time. The wound will likely to hurt for several weeks, so relax in the meantime.
Home based remedies
It is important to get prepared in advance for post-delivery pain and discomfort. For this, you can apply following home-based treatment to reduce severity of your symptoms.
Apply ice pack to the affected area every 2 hours and not more than 20 minutes at a time. This will help you reduce swelling.
Spend most of your time lying down rather than sitting up for the first few days
Take doctor prescribed stool softener or you can also take over-the-counter laxative such as docusate sodium for this purpose. This would reduce the strain while passing the stools.
The post-surgery tenderness must be managed properly. It is important that the perineum region remain moist and clean after the delivery. Your doctor may provide you with a squeeze bottle that you can rinse after going to the washroom. You should also take sitz bath (sitting in a warm bathtub) to prevent infection.
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Avoiding products or activities which can worsen condition
Strenuous activities or using irritating product might worsen your symptoms. So you should avoid following things:
- Perfume lotions and talcum powder
- Applying hot water to the perineal regions
- Sexual activity until full recovery
- Vaginal cleansers
- Salt baths
Don’t forget to call the doctor if you experience foul-smelling vaginal discharge, significant swelling, pain at the site of incision and fever.
Prevention – How severity of vaginal tearing can be reduced?
If the doctor sees that you are likely to get a vaginal tear, he would suggest perineal massage weeks before baby’s birth. This technique helps stretch the tissues between the anus and the vagina. This will allow the tissue to relax during childbirth and let the baby pass through easily.
Perineal massage may be started at around 34th week of pregnancy. It should be practiced for 10-15 minutes daily to strengthen the base of the vagina. However, in case of vaginal infection such as herpes, this technique should not be practiced as it may increase the risk of the virus spreading throughout the genital tract.
Vaginal tear heal own their own and they can also bring complications post-delivery. So make sure you have good support of family and friends who will take good care of you and your baby, and help you recover as quickly as possible. If you notice some symptoms of infection or your pain worsens, then call your gynecologist for help.