Patient education: Vaginal tearing during childbirth (The Basics)

What is tearing during childbirth? — Sometimes, giving birth vaginally can cause tearing around the vagina and perineum. (The perineum is the area between the opening of the vagina and the anus.) This type of injury happens when the baby's head or shoulders tear the skin and muscle during birth.

Often, the tearing is minor and only affects the skin. Other times, it is more serious, and both the skin and muscle tears. If a tear goes from the vagina to the anus, it is also called a "perineal injury."

What causes tearing during childbirth? — Tearing is more likely to happen if:

●You are giving birth for the first time.

●Your baby is very large.

●Your doctor or midwife uses a tool called "forceps" or a special vacuum to help get your baby out. This might be done if the baby gets partly stuck in the birth canal.

Doctors and midwives sometimes cut the perineum just before the baby comes out. This makes the opening of the vagina larger. This is called an "episiotomy." It is needed in fewer than 1 in 10 births.

How are tears from childbirth treated? — Minor skin tears often need no treatment and heal on their own. If you have a tear that goes deeper, your doctor or midwife will use stitches to repair the tear. These stitches dissolve over time and do not need to be taken out.

What can I do to feel better while I heal? — Some people feel better if they:

●Take sitz baths – A sitz bath is a shallow, warm bath that helps clean and heal the perineum. Take them at least twice a day for 5 to 10 minutes each. You can do it more frequently if you find it soothing. You do not need to add soap or any medicines to the water unless your doctor recommends to. Pat the area dry with a soft towel. Do not rub.

●Use a peri-bottle after going to the bathroom – A peri-bottle is a small squeeze bottle that you fill with warm water then use to clean yourself. Use it to rinse the area after you urinate or have a bowel movement. Try to do this instead of wiping with toilet paper.

●Take medicines to relieve pain, such as acetaminophen (sample brand name: Tylenol) or ibuprofen (sample brand names: Advil, Motrin).

●Apply cold packs – For the first few days after giving birth, putting cold packs in your underwear can help with pain and swelling. Do not put these directly on your skin. Use a thin towel or piece of cloth between the cold pack and your skin.

To help with healing:

●Your doctor or midwife might recommend foods or medicines to keep your bowel movements soft. This makes you less likely to strain to push out a bowel movement. Straining can reopen the tear.

●Do not have sex until you have healed. Sex can be painful and might reopen the tear. You should also not use tampons, or put anything else in your vagina, until after you have healed.

You should make an appointment with your doctor or midwife after birth to check how you are healing. You might need more than 1 follow-up visit. They will tell you when it's OK to start having sex and using tampons again. When you are ready to have sex again, you can use a water- or silicone-based vaginal lubricant to help protect the tissue and make it more comfortable for you. Examples of lubricants include K-Y Liquid, Replens, and Astroglide. Tell your doctor or midwife if the discomfort doesn't go away with time.

How long will vaginal bleeding last after birth? — After giving birth vaginally, you might have vaginal bleeding for up to 6 weeks. If you have bleeding that is heavier than a period, call your doctor or midwife.

When should I call the doctor? — Most tears heal without problems in a few weeks. Larger tears might take longer.

Call your doctor, nurse, or midwife if you have:

●Fever higher than 100.5°F (38.1°C) that lasts longer than a few hours (some people get a low fever when their breast milk comes in)

●Pain that gets worse

●Vaginal discharge that looks like pus or smells very bad

●Any other new symptoms or concerns

Is there a way to prevent tearing during childbirth? — There is nothing that you can do before delivery to prevent a vaginal injury. During the birth, your doctor or midwife can help get the baby out in a way that lowers your chances of a bad tear. Some doctors and midwives use a warm cloth to put pressure on the perineum during delivery. But there is not good evidence that this works to prevent tearing.

Even if you had tearing during your first delivery, you might not have tearing during later deliveries.

More on this topic

Patient education: Labor and childbirth (The Basics)
Patient education: How to take a sitz bath (The Basics)
Patient education: When your baby is measuring large during pregnancy (The Basics)