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Perineal Tears During Childbirth: Stages Of Labour, Types, Risk Factors And Recovery

Perineal tears, also termed perineal lacerations, episiotomy or vaginal tears, are common complications during vaginal birth or normal delivery. Around 85 per cent of women experience tears or cuts in their external genitalia during the time of delivery. [1]

Though the lacerations are temporary and heal within a few days, in some cases, it may cause long-term complications such as dyspareunia, pelvic floor dysfunction and chronic vaginal pain.

In this article, we will discuss the details about perineal tears. Take a look.

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What Are Perineal Tears?

Perineal tears refer to the surgical incision or cut made in the perineum, the area between the vagina and the anus. The process is carried out by a medical expert or midwife. The incision or cut is made during the second stage of labour which causes the vagina to enlarge.

An episiotomy is carried out when the baby's head is too big to come out from the vaginal opening, especially during first-time births. This surgical cut prevents the blood loss and sudden tearing of the skin and muscles during the delivery. An episiotomy is carried out before the baby's head comes to the lower pelvis. Once the delivery takes place, the area is stitched.

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Stages Of Labour

There are two birthing methods for pregnant women: vaginal and caesarean. Vaginal delivery is a birth process in which the baby comes out from the vaginal opening after a full-term gestation i.e. 37 to 42 weeks.

There are three stages of labour; in the first stage, uterine contractions occur to dilate the cervix so that the baby can come out efficiently. The process lasts for several hours and is considered the longest of all the three stages. [2]

In the second stage, the cervix has reached a point where it is totally dilated (opened). At this stage, the fetal head enters the lower pelvis and exerts full pressure on the perineum (the most inferior part of the pelvic). This causes intense pain and a tremendous urge to push the baby, resulting in the delivery of the baby. It also lasts for around two hours or more, depending to the condition of a mother.

The third stage comes when the baby is finally delivered. It lasts between 15-30 minutes. At this stage, the placenta is detached from the uterus and umbilical cord is clamped. [3]


What Are The Degrees Of Vaginal Tears?

There are around four degrees of a vaginal tear. [4]

1. 1st-degree vaginal tear: It involves incision of only the perineal skin, with no involvement of the underlying tissue. It is the least severe tear in which only mild pain or stinging sensation is observed.

2. 2nd-degree vaginal tear: It involves incision of the underlying subcutaneous tissue and skin and muscles of the perineum.

3. 3rd-degree vaginal tear: Here, the anal sphincter muscles are involved in the tear. It may result in stool leakage and pain during intercourse. It takes a few weeks to heal.

4. 4th-degree vaginal tear: It is the most severe of all the vaginal tears. The process involves the extension of the tears to rectal muscle into rectal mucosa.


Risk Factors Of Perineal Tears

There are certain factors which can increase the risk of perineal tears. They include:

  • Nulliparity (first-time birth)
  • Operative vaginal delivery (or vacuum deliveries)
  • People who belong to the Asian race
  • Increased weight of the foetus [5]
  • Cut in the midline of the perineum or midline episiotomy
  • Advancing gestation age
  • Severe maternal obesity [6]
  • Forceps mode of delivery
  • Prolonged pushing during the delivery [7]
  • Wrong positioning of the mother during birth

Recovery From Perineal Tears

  • Use ice packs in the perineum
  • Have a warm bath
  • Take prescribed pain medicines
  • Take stool softeners
  • Keep the perineal area clean to prevent infection due to surgical wounds.
  • Avoid lifting heavy loads
  • Avoid sexual intercourse immediately after the delivery

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To Conclude

Not all women need perineal tears to deliver their baby. Methods like perineal massage can make the vaginal tissues more flexible and prevent the chances of tears. Also, pay attention to birth positions during labour to lower the chances of perineal tears.

For women who have had a third or fourth-degree vaginal tear and are experiencing pain, discomfort and signs of infections in the vaginal area, consult a medical expert soon to prevent related complications.