Tears, episiotomies and vaginal grazes oh my! Here’s what really goes on down there…
The thought of pushing a baby out of your vagina can be a hard one to grasp. The thought of not only pushing a baby out of your vagina but also experiencing a massive rip while doing so can easily send you into a panic. And with good reason.
So let’s get down to the bottom of vaginal tearing and episiotomies during labour. What are the facts? What are the myths? And what can you do to help ease your mind?
Let’s talk about tearing
It’s one of the things many mothers don’t like to discuss at the dinner table – vaginal tearing. In most instance the tear occurs in the perineum, the tissue that lies below the vagina opening and above the anus.
Often this happens due to the speed of the birth ( (the perineal tissues don’t have enough time to stretch). Having an assisted delivery or giving birth to a larger sized baby can also increase your risk of tearing. Other times there is no clear reason why it happens. It just does.
Knowing there is a possibility of tearing can cause some panic – who really wants to add a vaginal tear to their list of things to recover from after giving birth?
The tear test
When your child is born, he or she will go through a testing system called the AGPAR which tests bub’s breathing and skin colour, among other things. Your vagina also goes through a testing system as doctors do an examination to see just how it fared in war.
So what grade will your vagina get?
No tear means your vagina is intact with no obvious injury. Women who manage to escape childbirth unscathed may be mythological creatures with superhuman powers because it doesn’t seem possible to go through childbirth without a single graze.
Some women will experience a slight graze to the perineum, vagina or labia but won’t require stitches. If you’re in this category, then your vagina is awesome and deserves a medal. Or at least a Tough Mudder headband.
First and second degree tears
Then comes the first degree tears where there is a small tear of the perineum usually at the very base of the vaginal opening. You may need a stitch or two or you may not.
Second degree tears are a bit bigger in size and will require stitches. I’ve pushed two babies out, both of which gave me the gift of second degree tears (thanks a lot, kids) and the recovery really wasn’t that bad. A few hours of painful peeing, a few days of waddling around like someone kicked you in the crotch, a few hot water bottles and you’ll be on your way.
Third and fourth degree tears
Third and fourth degree tears are a little more intense. A third degree tear extends through the vaginal skin, the underlying tissue, the pelvic floor muscles and to the edge of the opening of the anus. A fourth degree tear extends completely through the anus.
You’re wincing right now, aren’t you? It’s okay. An obstetrician can stitch you up nice and neatly and give you medication. And remember, these types of tears are extremely rare.
What about an episiotomy?
An episiotomy is an intentional surgical cut given by the caregiver into the perineal tissue and one that 16 per cent of Aussie mums will experience. It normally occurs during the crowning phase and often in conjunction with an epidural.
The episiotomy cut is the equivalent to the size of a second degree tear and is usually done with scissors. There are two types – one cut that goes straight down towards the anus (called a midline) or one that involves cutting at a 45 degree angle to one side of the anus (mediolateral).
Why in the world would anyone choose to have her vagina cut? Sometimes it’s necessary, especially during assisted birth or if bub’s head is in an abnormal position. Sometimes it can help speed up labour and sometimes it’s simply recommended by certain health practitioners.
Of course, if you want more information, ask your doctor during your next visit. He or she will be able to provide you with all the information and statistics you need.
Keeping your vagina intact – tear prevention tips
No one can tell you if you will tear or not. There is no exact science to it. But approximately 40 per cent of Aussie mums will require stitches due to a tear or episiotomy. So if you do, you’re in great company!
There are, however, a few things that have been shown to help reduce your risk of tearing.
Massage the perineal area during the final few weeks of pregnancy (this is known as a perineal massage).
Aim to give birth kneeling, on all fours or side-lying as these are the ‘less-chance-of-a-tear’ positions.
When you feel the urge to push, try panting instead of pushing, which can help ease the baby’s head out slowly reducing the risk of a tear.
And, most importantly, try not to stress. Relax, especially your pelvic floor muscles. If you tear, you tear. It’s part of the joy that is labour, along with potentially pooping, vomiting and throwing a bottle of Gatorade at your partner’s head.
Tears during labour, like stretch marks during pregnancy, are the marks of a mother. Wear them with pride. And pick up a few hot water bottles at the shops, you know, just in case.