FOLLOW US ON SOCIAL MEDIA
Written by Valerie Paul, RN
Some of the questions I get all the time as an L&D nurse are “Am I going to tear?” or “How many stitches did I get?” Most women don’t have a good understanding of this topic. Some women have a lot of fear and anxiety about what happens to the perineum after a vaginal delivery because they read too deep on the mommy blogs about one person’s bad experience. Either way, it’s a good thing to know what happens to the perineum during delivery. So, let’s jump right into it.
Your Odds of Experiencing a Tear
Are you going to tear? Probably. At least for the first vaginal delivery. About 85% of women will experience some sort of perineal tear after their first vaginal delivery. The good news is that for subsequent deliveries this number decreases (Goh et al, 2018).
Types of Tears
Next, there are different types of tears. A perineal tear is labeled based on severity. A first-degree laceration is a tear of the vaginal mucosa or skin. Although this is a minor tear and can heal on its own, your physician may put in a stitch or two to help with healing. A second-degree laceration involves the perineal muscles. This is still a minor tear, but sutures will be placed to help with wound approximation. If you already have an epidural, the physician is able to repair it right then and there. You probably won’t even notice while holding your newborn. If you deliver without an epidural, no big deal. Local anesthesia can be given for the quick repair. Next is the third-degree laceration. This is a more severe tear that involves a tear into the anal sphincter muscles. And last but not least is the dreaded fourth-degree laceration. This tear goes all the way through the vaginal wall and anal sphincter. Both of these last two lacerations will be repaired right away by your physician. You will be made comfortable with either more medication through the epidural if you already have one, regional anesthesia, or general anesthesia only if necessary.
Now, I don’t want you to panic. While fourth-degree lacerations do happen, they are the least common. In fact, the incidence of a third-degree is approximately 3% and a fourth-degree less than 0.5% (Arnold et.al, 2021). There are certain risk factors that may put you at greater risk for these tears which include but are not limited to large fetal weight (>4000g), shoulder dystocia, or instrument delivery (forceps or vacuum). There are a few techniques used to try and prevent tears however the only ones that were found to be effective in preventing third and fourth-degree tears are the use of warm compresses and perineal massage from 35 weeks on (Goh et al. 2018).
Postpartum Care
Lastly, Let’s talk about postpartum care. Motrin and Tylenol should be sufficient enough to help with pain control. Opiates are avoided, if possible, because of the increased risk of constipation. Stool softeners may still be prescribed to keep the stool soft. Ice packs can also be applied to help with swelling and pain. Try to avoid sitting for long periods of time. Keep the perineum clean to prevent infection. Follow-up with your OB/GYN is important around 6 weeks postpartum to make sure healing is appropriate. Pelvic floor exercises are important postpartum to help strengthen tone and decrease urinary incontinence (Arnold et. al, 2021).
Contact Us Today
If you are interested in learning more about perineal lacerations or postpartum care, contact Dr. Alex Tepper today! With more than 20 years of experience as an OB/GYN offering concierge care, you can be sure that you are in good hands with Dr. Tepper.
References:
Arnold, M. J., Sadler, K., & Leli, K. (2021). Obstetric Lacerations: Prevention and Repair. American family physician, 103(12), 745–752.
Goh, R., Goh, D., & Ellepola, H. (2018). Perineal tears – A review. Australian journal of general practice, 47(1-2), 35–38. https://doi-org.rlib.pace.edu/10.31128/AFP-09-17-4333
BOOK AN APPOINTMENT
Whether you are a new or returning patient, Dr. Tepper can assess your concerns and discuss your options to find the most comfortable and convenient care for you. To get started, call our office to set up an appointment.
CALL FOR APPOINTMENT