What You Need to Know About Vaginal Tears and Healing in the Fourth Trimester

It’s common knowledge that childbirth is hard and painful. What isn’t as openly spoken about is what comes next: healing from childbirth.

After delivering my daughter and as the epidural wore off, I was in complete shock. Is this pain normal? The nurse mentioned a second-degree tear and that it might hurt to sit for a while. I figured a while meant a couple of days. My husband (thankfully) asked for clarification on what “a while” meant. The response was four to six weeks — far longer than I ever would have guessed.

I did not feel prepared for the pain and healing that was ahead of me. In my childbirth class, the aftercare information we were given was to use a peri bottle when peeing because after childbirth it might sting. That was it.

The day in the hospital after childbirth and the weeks following were surprisingly challenging. I spoke to friends, and many of them said they had gone through the same thing. So, why aren’t we talking about this? I’ll admit that vaginal tears aren’t the most enjoyable conversation to have, but it is helpful to know what you might experience and also how to heal from it.

 

Why aren’t we talking about this? I’ll admit that vaginal tears aren’t the most enjoyable conversation to have, but it is helpful to know what you might experience and also how to heal from it.

 

Knowing what I know now about the road to recovery, there are so many questions I wish I had asked before giving birth. I spoke with Dr. Christine Sterling, M.D., FACOG, board-certified OB-GYN, to get all the answers and help moms be in-the-know when it comes to tears and healing. Dr. Sterling is a mom-on-a-mission to better prepare women for the fourth trimester and beyond and shared her professional knowledge and insights with me.

 

 

What are the types and degrees of tears?

Dr. Sterling explained that there are many types of tearing that can occur in childbirth. Tearing can occur inside the vagina, around the urethral opening (where urine comes out), in the labia, by the clitoris, and in the perineum. On occasion, the cervix can also tear.

You may hear your OB reference a degree of tear following birth. The degrees refer to lacerations that occur in the perineum. The perineum is the area between the vaginal opening and the anus. 

  • First-Degree Tear: a superficial tear at the vaginal opening (these are very common)
  • Second-Degree Tear: lacerations are slightly deeper but do not extend into the external anal sphincter (these are also very common)
  • Third-Degree Tear: occurs when the wound extends into the external anal sphincter, the muscle that keeps the anus tightly closed (minor third-degree tears are relatively common)
  • Fourth-Degree Tear: extends all the way into the rectum, essentially connecting the rectum and vagina (these are rare)

Aside from these tears, tearing around the urethra, called periurethral lacerations, are quite common. They often do not require repair (stitches), though can be quite uncomfortable at first, especially when urinating, as urine is acidic and often stings.

 

Can you do anything during pregnancy that will prevent tearing? 

This is unclear; there is mixed data. Some claim that perineal massage starting around 34 weeks can help. As long as it is done with clean hands, there is no harm in trying this. Your OB can teach you and your partner how to do this at home, or you can visit a women’s health physical therapist who can do the massage for you.

 

Is there anything that can be done during labor to prevent or lessen tearing? 

There are many factors that go into whether you will tear, many of which are out of your control. Things like position and size of the baby, the position you deliver in (hands and knees and other forward-leaning positions may reduce tearing), and the amount of time the delivery takes may impact tearing. There are some steps that an OB or Labor and Delivery Nurse might follow to lessen tearing during labor. A perineal massage (slowly stretching the tissue between the vagina and anus) and the application of a warm compress before or while the baby’s head is crowning may help. 

 

 

What about episiotomies? Can this make tearing better or worse?

The once-common practice of episiotomies (an incision made to the women’s vaginal opening during childbirth) is no longer believed to be beneficial. While it was once believed that a clean incision helped prevent fourth-degree tears and was easier to stitch than a naturally occurring tear, more recent research has shown that episiotomies may cause more serious pain and injury and are slower to heal than a natural tear.

Some doctors do still perform them so it is a good question to ask in advance to know their practices and voice your opinion.

 

What can you do to heal a tear after childbirth?

Everything tends to be an exhausting, confusing, and overwhelming blur in the hospital following birth, and this is why Dr. Sterling recommends talking to your OB in your third trimester to learn about recovery and to know your options.

Pain management will depend on the severity of the tear. Dr. Sterling says, “For first and second-degree tears, over-the-counter medications such as acetaminophen and ibuprofen, are typically enough. For more severe tearing your doctor may recommend opioid pain medication.” While the pain relief is tempting, keep in mind that opioids tend to cause constipation, a not-fun side effect to battle, particularly when recovering from a tear.

 

Everything tends to be an exhausting, confusing, and overwhelming blur in the hospital following birth, and this is why Dr. Sterling recommends talking to your OB in your third trimester to learn about recovery and to know your options.

 

If you are going to use an opioid, take it as-needed and combat constipation as best you can with plenty of fluids and a fiber supplement.

For natural pain relief, consider making padsicles (make and freeze these during your third trimester) or using a sitz bath (ask your OB if this is advised for your particular healing).

 

How do you know if you are healing properly and should you consider going back to the doctor before your 6-week check-up?

Many current practices have a six-week postpartum follow up appointment set for mom, and that is it. ACOG has come out with new recommendations of a visit or check-in at three weeks with ongoing care, as opposed to a single follow-up visit. If you are feeling continuing or worsening pain, do not feel that the pain levels are improving, or are experiencing other issues, it is a good idea to call your doctor, even if it is before your six-week appointment.

Dr. Sterling reminds us: “After birth, people should not accept pain with intercourse or loss of urine as a new normal. Yes, it might not be a big deal that you leak a bit with jumping or sneezing, but as we age, our pelvic floor strength often declines, and we can end up with far more troublesome incontinence later in life. If you are experiencing pelvic pain, pain with intercourse, or loss of urine after birth, this should be discussed with your OB provider as there are things (like kegel exercises and pelvic floor physical therapy) that can drastically improve these symptoms.”

 

Source: @mrsjenfrick

 

What products can help during the recovery period?

Prepare yourself in the third trimester so you aren’t scrambling if you’re in pain when you return home from the hospital. There are a number of products to have at home to lessen pain during this recovery period.

A doughnut cushion will make sitting slightly more comfortable. As noted above, stock your freezer with padsicles for cooling relief (made of pads frozen with alcohol-free witch hazel, aloe, and lavender). Witch hazel wipes can also offer cooling relief. The hospital may give you a peri bottle to take home. If you live in a multi-story home, consider buying a second peri bottle (Frida Mom makes a great one), so each bathroom is stocked with the necessary healing products.

And a tip for before you even leave the hospital: consider packing one of your comfortable maternity dresses for your ride home from the hospital. Tight pants and even leggings may be uncomfortable after a vaginal tear or C-section.

 

The process of healing from childbirth isn’t the most fun part of new-mom life. Not to mention, as you’re healing, you’re also responsible for a brand new baby, which is no easy task. Unlike other injuries, you can’t sleep it off for eight hours a night and wake up feeling like a new woman. The first few weeks can be brutal, but keep in mind that, eventually, you will heal, and you will feel better.

 

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