Perineal Tears & Birth Injuries

Knowledge can take away some of the fear and help you feel more prepared for birth

Understanding what can happen during birth can help you feel informed, prepared and less frightened of the unknown.

What are birth tears?

During a vaginal birth, the tissues around the vagina and perineum stretch as your baby is born.

Sometimes this can result in a graze or tear.

Tears can happen in different places and vary considerably in depth. Some are very small and heal naturally without stitches, while deeper tears require repair and additional follow-up.

It can sound worrying when you first hear terms such as first, second, third or fourth-degree tear.

During my antenatal education and birth preparation sessions, I believe in explaining these things calmly and honestly. Understanding what the terminology means can make it feel much less frightening if you hear it during or after your birth.

Grazes and Superficial Tears

Some women experience small grazes or superficial tears around the vaginal opening during birth.

These involve the surface tissues and may not require stitches if the edges come together well and bleeding is minimal. Your midwife or doctor will examine the area after birth and discuss whether any treatment is needed.

Labial Tears

Tears can occur in the labia as the tissues stretch during birth.

Some labial tears are small and heal without stitches, while others may need to be repaired, particularly if they are bleeding or the tissue does not sit together naturally.

Clitoral and Peri-clitoral Tears

Tears can also occur around the clitoris and the surrounding tissue.

These are less commonly talked about, which is one reason I think it is useful for women to know beforehand that tears are not limited to the perineum.

Vaginal Wall Tears

A tear can occur inside the vagina, sometimes referred to as a vaginal wall tear.

These may be identified during the examination carried out after your baby is born. Whether a vaginal tear needs stitches will depend on its location, depth and bleeding.

First-degree Tears

A first-degree tear involves the skin of the perineum.

These are generally small tears. Some first-degree tears require stitches, while others can be left to heal naturally depending on the individual tear.

Second-degree Tears

A second-degree tear involves the skin and the muscles of the perineum.

These usually require stitches to bring the tissues and muscles back together and support healing.

Third-degree Tears

A third-degree tear extends through the perineal muscles and involves the muscles surrounding the anus, known as the anal sphincter.

You may hear a third-degree tear described as 3a, 3b or 3c. These classifications describe how much of the anal sphincter has been affected.

A third-degree tear requires careful repair, usually in an operating theatre, with appropriate pain relief given.

Fourth-degree Tears

A fourth-degree tear extends through the perineum and anal sphincter and into the lining of the anus or rectum.

Third and fourth-degree tears are collectively known as obstetric anal sphincter injuries, or OASI.

Although these are more significant injuries and require specialist repair and follow-up, it is important to remember that appropriate treatment and ongoing support are available.

Rectal Buttonhole Tears

A rectal buttonhole tear is a rare type of birth injury involving the tissue between the vagina and rectum while the anal sphincter remains intact.

It is different from a fourth-degree tear and requires specialist identification and repair.

What is an Episiotomy?

An episiotomy isn't a spontaneous tear. It is a surgical cut made through the vaginal wall and perineum during birth.

An episiotomy may sometimes be recommended when your baby needs to be born more quickly or during an assisted vaginal birth, such as a forceps or ventouse birth.

If an episiotomy is recommended, your midwife or doctor should explain why they believe it is needed.

Can I Reduce My Risk of Tearing?

It isn't possible to guarantee that you won't tear during birth, and experiencing a tear does not mean that you did anything wrong.

From 32 weeks of pregnancy, perineal massage may help reduce the likelihood or severity of perineal trauma for some women.

During my Antenatal Education & Birth Preparation sessions, we can talk about perineal massage, how to do it and other ways you can prepare for birth.

What Happens if I Tear During Birth?

After your baby has been born, your midwife or doctor will assess your perineum and surrounding tissues where appropriate to determine whether there has been a tear and whether it needs repairing.

If stitches are required, you should be offered appropriate pain relief or anaesthesia. The type of repair and where it takes place will depend on the extent of the tear.

The stitches used following most birth tears are dissolvable, so they do not usually need to be removed.

Looking After Stitches and Healing

Your perineum can understandably feel sore following a tear, episiotomy or repair.

During the postnatal period, we can talk about keeping the area clean, changing maternity pads regularly, pain relief, passing urine and opening your bowels comfortably.

Keeping well hydrated and avoiding constipation can be particularly important following a significant tear.

We will also talk about your pelvic floor and gradually returning to normal activities as your body recovers.

When Should I Ask for Help?

Please seek advice if your pain is increasing rather than improving, you notice an unpleasant smell or discharge, the area becomes increasingly swollen or painful, you develop a temperature or feel generally unwell, or you are concerned that your wound or stitches may have opened.

Following a more significant tear, symptoms such as difficulty controlling wind or your bowels should also be discussed with a healthcare professional.

You should never feel embarrassed about asking someone to check your stitches or talk about symptoms involving your bladder or bowels. They are an important part of your postnatal health.

How I Support You After Birth

During my Postnatal Checks for Mum, I don't simply ask whether your stitches are okay and move on.

We can talk about your birth, how you are feeling about what happened, your pain and comfort, your bleeding, bladder and bowel function, pelvic floor and how any stitches or wounds are healing.

Your emotional recovery matters too. A difficult birth, significant tear or unexpected intervention can affect people very differently, and having an opportunity to talk about your experience is an important part of postnatal care.

Future Pregnancies and Births

Having experienced a significant tear previously does not automatically determine how you will give birth in a future pregnancy.

Your individual circumstances, recovery, symptoms and previous birth experience can all form part of discussions with your maternity team when considering your options for another birth.

Further Information

For detailed information about perineal tears, episiotomy and recovery, the Royal College of Obstetricians and Gynaecologists (RCOG) provides specialist patient information and guidance.

Every birth and every recovery is different. Understanding what may happen doesn't mean expecting something to go wrong. It simply means having the information to understand your body, your choices and your recovery.

If you would like personalised support during pregnancy, birth or the postnatal period, I offer private midwifery care across London, Essex and Hertfordshire.

Whether you would like to feel more prepared for birth, talk through your options or have additional support during your recovery, please get in touch to discuss how I can support you