During birth, the area between the vagina and anus (the perineum) needs to stretch a lot and it might tear. Here we find out more about perineal tears.
What is a perineal tear?
The area between their perineum usually stretches well during childbirth, but it might tear. Most often this happens in women who are giving birth vaginally for the first time (RCOG, 2015).
What’s the difference between a tear and an episiotomy?
An episiotomy is a cut made by a health professional. A perineal tear happens on its own during the second stage of labour. In first-time vaginal births, you’re more likely to have worse injuries if the perineum tears on its own than if you get an episiotomy (NHS Choices, 2017).
When might an episiotomy be required?
An episiotomy is not a routine part of childbirth but there might be medical reasons why it’s needed (NICE, 2014). An episiotomy might be needed to speed up delivery if your baby is in distress, or if forceps or ventouse are required, or to help avoid a tear (NHS Choices, 2017).
Preventing perineal tears
A midwife will try to help you avoid a tear during labour. As your baby’s head is emerging, they will ask you to stop pushing. You’ll be asked to puff a couple of quick, short breaths, blowing out through your mouth to let your baby’s head come out slowly and gently. This gives your perineum time to stretch without tearing (NHS Choices, 2017).
Massaging the perineum from 34 weeks of pregnancy might reduce your chances of tearing or needing an episiotomy if it’s your first-time vaginal birth (Beckmann and Stock, 2013). Read more about this in our article on perineal massage.
How common is a perineal tear?
It’s common for women to experience some degree of perineal tear during childbirth. It is slightly more common with a first vaginal birth than in women who have had a vaginal birth before (RCOG, 2015).
At least one third of women in the UK and US have perineal tears that need stitches (Frolich and Kettle, 2015). About three in 100 women having a vaginal birth have the more severe perineal tears.
Perineal tears are described in degrees, which indicate their size and effect:
- First-degree tears are small, skin-deep tears. These usually heal naturally.
- Second-degree tears are deeper and affect the muscle of the perineum. These usually require stitches.
- Third-degree tears involve the muscle that controls the anus (the anal sphincter). Stiches will be needed.
- Fourth-degree tears are the same as third-degree but extend into the lining of the anus. Stiches will be required. (RCOG, 2015).
Recovery from perineal tears
- Recovery from a tear will depend on the size and depth.
- If you had a tear that needed stitches, you will usually have dissolvable stitches done soon after your baby is born.
- It’s important to keep an eye on the area around your stitches for any signs of infection, like red swollen skin or pus. If you have any concerns, talk to your midwife, health visitor or GP. (NHS Choices, 2017)
You can talk to your midwife or GP about which activities you should avoid while your tear heals. Read more in our article on recovering from childbirth.
What does it mean for my next pregnancy and labour?
If you have had a baby and your perineum was badly torn, this puts you at greater risk of having a similar tear again (RCOG, 2015). You can talk to your midwife about this.
If you are concerned about how you are healing following a perineal tear or episiotomy, it’s important to talk to your midwife, GP or health visitor. You can then get treatment if needed.
This page was last reviewed in May 2017.
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The Royal College of Obstetricians and Gynaecologists (RCOG) has an information hub for perineal tears and episiotomies in childbirth. You can find out more about the types of tears that can occur during childbirth, how to minimise your risk of deeper tearing, and what can be done to help your recovery if you do tear. It also covers what to do if you have any concerns about your recovery, helping you feel better informed when discussing any topics with a healthcare professional.
Beckmann M, Stock O. (2013) Antenatal perineal massage for reducing perineal trauma. Cochrane Database Syst Rev. (4):CD005123. Available from: http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD005123.pub3/abstract;jsessionid=CF32264FB13246A8540B877017B34E8C.f02t04 [Accessed 1 September 2018].
Frolich J, Kettle C. (2015) Perineal care. BMJ Clin Evid. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4356152/[Accessed 16th May 2017].
NHS Choices. (2017) Episiotomy and perineal tears. Available from: http://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/episiotomy.aspx [Accessed 16th May 2017].
NICE. (2014) Intrapartum care for healthy women and babies. Available from: https://www.nice.org. uk/guidance/cg190 [Accessed 16th May 2017].
RCOG. (2015) Patient leaflet. A third of fourth degree tear during birth (also known as obstetiric anal sphincter injury – OASI). Available from: https://www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/pregnancy/pi-third--or-fourth-degree-tear-during-birth.pdf [Accessed 16th May 2017].
RCOG. (2015) The management of third- and fourth-degree perineal tears. Available from: https://www.rcog.org.uk/globalassets/documents/guidelines/gtg-29.pdf [Accessed 16th May 2017].
RCOG. (2016) Patterns of maternity care in English NHS trusts 2013/14. Available from: https://www.rcog.org.uk/globalassets/documents/guidelines/research--audit/maternity-indicators-2013-14_report2.pdf[Accessed 16th May 2017].