The tear scare
Does everyone tear? This is the first question my girlfriends ask when I offer them honest answers to their most secret labor and delivery worries. There are a lot of differences of opinion when it comes to how you want to bring your baby into the world, but I think we can all agree that tearing “down there” is one thing we’d like to avoid.
Let’s get the bad news out of the way first: Almost everyone will have a tear (or laceration) after delivery. In fact, according to a new study from a group of doctors in Brazil, around 78 percent of women birthing a baby will have a tear. Thankfully, the vast majority of these are minor tears that your doctor or midwife can repair with a suture.
The good news is that if you’ve already had one vaginal delivery, you are less likely to tear with your next. In general, about 90 percent of first-time mothers have a tear, but only about 70 percent of veteran mothers do.
Pay attention to prevention
Once you know the odds you’re up against, the next question is obvious: Is there anything I can do to avoid tears? If there’s a way to keep tearing at bay, you’re eager to try it. (It’s worth a shot, right?)
There has been a great deal of research attempting to figure out what techniques or devices can stop—or at least minimize—tearing. However, the most important thing you can do is open up a dialogue with the person who will be delivering your baby. Ask what has worked for her in the past and what she recommends. Decide together what practices you are most comfortable with. You might be surprised how eager your midwife or doctor will be to talk to you about your options.
One easy route is to fill a basin with warm water and soak a washcloth in it. While you’re pushing, your partner or provider can use the cloth as a warm compress, placing it over your vagina and the surrounding skin. Some providers also use a technique called “counter-pressure.” They’ll use their hand to apply pressure against the skin between the vagina and anus to slowly help guide your baby’s head out. This method can also help save your tissue.
Many researchers have studied what makes a woman more likely to tear, and unfortunately, some of the risk factors can’t be changed. For instance, older mothers and first-time mothers have a higher risk of tearing. And, as you might have guessed, bigger babies are also linked to worse tears.
Other factors relate to the way your labor plays out. For example, the amount of time spent pushing can be influential. Women who push longer are more likely to experience bad tears.
When delivery is difficult, your practitioner may need to use a vacuum or forceps, both of which have pros and cons when it comes to tearing. If the doctor needs to use forceps, which are like giant tongs that grasp the baby’s head, you are at risk for a severe tear. A vacuum extractor, which looks like a suction cup that the doctor applies to baby’s head, is less likely to result in a tear—but it’s also less likely to get the baby out.
If it happens to you
Tears occur most often in the perineum (the area between the vagina and the anus), but they can occur in other places, too. There are four classifications, depending on what tissue is affected. Most tears are first or second-degree tears. These are minor and involve only the outermost layers of skin or muscles. More severe tears are called third or fourth-degree tears. Third-degree tears involve the muscle that surrounds the anus; fourth-degree tears go all the way down through the rectum. Take heart, only about 2.5 percent of tears are considered third or fourth degree. Although you’re likely to experience some tearing, chances are it will be minimal.
Midwives and doctors are trained in specific techniques to repair the different types of tears that can occur. For an average tear, most care providers will use one long stretch of suture that will absorb, so you don’t have to come back to get the stitches out. (No one would want to come in for that appointment!)
They’ll start by putting together any muscles that have separated and finish with suturing the skin back together. You’ll have a beautiful new babe to distract you from the discomfort during the process, and you likely won’t even be able to see the stitches afterward.
After all is said and done
The No. 1 rule of after-care is to be gentle. Don’t rub or scrub the affected area. When you shower, simply let the water run over the skin. The same goes for after you’ve used the bathroom. Wiping is off-limits, so put that peri bottle (a squirt bottle filled with room temperature water) the hospital or birth center staff gave you to good use, and rinse as needed.
If you notice a burning sensation along the tear when you urinate, your peri bottle can help. Squirt water over the whole area as you pee—the flowing water will dilute the urine and take the sting out of the experience.
Taking stool softeners to keep your No. 2s the consistency of toothpaste will give your muscles some time to rest and heal. Most women fear their first bowel movement post-delivery, but a stool softener can go a long way in making it less painful.
You probably have more questions—don’t be shy! It might be awkward to start the conversation, but your health care provider wants to know your concerns. Her goal is to make your birthing experience a positive one, so ask away.
By Eva Martin, MD