-By Bushra Hatahet, UK-Trained Clinical Midwife
During a vaginal birth, the tissues between the vagina and anus (the perineum) stretch significantly to allow your baby to be born.
Many women experience some degree of tearing, while others have no tears at all.
Although the thought of tearing can sound worrying, most tears heal very well with appropriate care.
The perineum is the area between:
During birth, this tissue stretches to allow your baby’s head and shoulders to pass.
Some women remain completely intact, while others experience a small graze or a deeper tear.
An intact perineum means:
Even without a tear, it is normal for the area to feel bruised for a few days.
A graze is a very small superficial injury involving only the skin.
These often:
Your midwife or doctor will decide whether stitches are needed.
⸻
First-Degree Tear
A first-degree tear involves:
It is the mildest true tear.
Some first-degree tears require stitches, while others heal well without them.
Healing is usually quick with minimal long-term problems.
⸻
Second-Degree Tear
A second-degree tear extends into:
These muscles support the pelvic floor and help control the vaginal opening.
Most second-degree tears require stitches.
This is the most common type of tear after a vaginal birth.
With appropriate repair, most women make an excellent recovery.
⸻
Third-Degree Tear
A third-degree tear extends further into the muscles that control the anus (the anal sphincter).
This type of injury requires specialist repair.
Third-degree tears are divided into:
3a
Less than 50% of the external anal sphincter is torn.
3b
More than 50% of the external anal sphincter is torn.
3c
Both the external and internal anal sphincter muscles are torn.
Because these muscles are responsible for bowel control, careful repair is extremely important.
⸻
Fourth-Degree Tear
A fourth-degree tear is the most severe type of obstetric tear.
It extends through:
Although uncommon, these tears can usually be repaired successfully by an experienced obstetrician.
Not all tears occur in the perineum.
Labial Tears
Small tears involving the labia.
These may or may not require stitches depending on:
⸻
Vaginal Tears
These occur inside the vagina.
Some are small and heal naturally.
Others require stitches to stop bleeding and encourage healing.
⸻
Clitoral Tears
These are uncommon but can occur because the tissues around the clitoris are highly vascular.
Small tears often heal well.
Your doctor will decide whether stitches are required.
⸻
Urethral Tears
These occur around the opening where urine passes.
Depending on the location and bleeding, they may or may not require repair.
Some women may temporarily require a urinary catheter while swelling settles.
Your comfort is extremely important.
Before repairing any tear, your healthcare team will ensure you have adequate pain relief.
Depending on your birth and the type of tear, this may include:
Epidural
If your epidural is already working well, it can often be topped up to provide excellent pain relief during the repair.
⸻
Local Anaesthetic
For smaller tears, local anaesthetic is injected into the area before stitching.
This numbs the tissues so you should feel pressure but not pain.
⸻
Entonox (Gas and Air)
Gas and air can also be used alongside local anaesthetic to help you feel more comfortable and relaxed.
⸻
Spinal Anaesthetic
If you require repair in theatre and do not already have an epidural, a spinal anaesthetic may be recommended.
This provides complete numbness from the waist down during the procedure.
Third- and fourth-degree tears are repaired in an operating theatre rather than the birth room.
This provides:
These factors help achieve the best possible repair and reduce the risk of future complications.
Following your repair, your healthcare team will discuss your recovery plan with you.
This may include:
Antibiotics
Women with third- and fourth-degree tears are routinely offered antibiotics to reduce the risk of infection.
⸻
Pain Relief
Regular pain relief helps you move comfortably and care for your baby.
Do not wait until the pain becomes severe before taking medication.
⸻
Stool Softeners
Laxatives or stool softeners are routinely prescribed after third- and fourth-degree tears.
These help prevent constipation and reduce strain on the repair while it heals.
⸻
Diet
To promote healing and comfortable bowel movements:
⸻
Pelvic Floor Physiotherapy
Women who sustain third- or fourth-degree tears should be referred to a Women’s Health Physiotherapist.
Physiotherapy can help with:
Many women find this an important part of their recovery.
Women with third- and fourth-degree tears are usually reviewed in a specialist follow-up clinic approximately 6–12 weeks after birth.
At your appointment, your healthcare professional may discuss:
Please tell your healthcare provider if you experience ongoing pain, leakage of stool or wind, or concerns about your recovery.
While your stitches heal:
• • Contact your healthcare provider if you notice increasing pain, offensive-smelling discharge, fever, or your wound appears to be opening.
An episiotomy is a surgical cut made in the perineum to enlarge the vaginal opening.
It is not performed routinely but may be recommended if:
An episiotomy is performed using local anaesthetic (or an existing epidural/spinal) and is repaired with dissolvable stitches after birth.
Recovery is very similar to that of a second-degree tear.
If you are looking for calm expertise and genuine continuity of care, let’s talk.
