First Degree Perineal Tears – 4 Things To Know

First Degree Perineal Tears – 4 Things To Know

In most of my childbirth classes, the fear of labour pain and the fear of experiencing a perineal tear top the list of concerns.

It’s always a bit intimidating to wonder what could happen during labour and birth, but most women leave the classes feeling less anxious. This is because knowing the details actually helps.

Why is that? Because one of the worst fears is the fear of the unknown.

It’s common to tear, and most tears are minor and easily treated. If you aren’t aware of this, the idea of tearing can be very scary.

First Degree Perineal Tears – 4 Things To Know

Once women realise tears aren’t traumatic for most birthing women, their fear begins to diminish.

They are also less fearful when they learn more about ways to reduce the risk of tearing.

What Is A First Degree Perineal Tear?

In obstetrics and gynecology, the term ‘perineum’ typically refers to the region between the vaginal opening and the anus.

During childbirth, the vagina and perineum are quite flexible and able to stretch to allow the baby to be born.

Sometimes, the baby’s positioning or size, the mother’s positioning during birth, the mother’s anatomy, the speed of birth, or intervention can cause a perineal tear.

The severity of the tear is classed as a first, second, third or fourth degree tear; the first degree tear is the least severe.

First degree tears are sometimes called superficial tears. They involve just the skin of the vaginal opening and perineum. They might also affect the outermost layer of the vagina itself, but don’t involve any muscles.

Here are 4 things you need to know about first degree perineal tears:

#1: First Degree Tears Cause Little To No Additional Discomfort Or Pain

Anyone who has had a child knows there’s some postnatal discomfort. Not only did you grow a human being (no small feat), you also just gave birth (also no small feat).

While our bodies are designed to give birth, we need to allow them time to heal. For most women, after birth healing is necessary due to swelling, sore muscles, and some abrasions or tears.

Women who experience a first degree tear, rarely have additional discomfort due to the tear, in the immediate postnatal period. Everything that is recommended for postnatal healing in general typically provides adequate relief for these minor tears as well.

#2: First Degree Tears Require No Or Very Few Stitches

I am unreasonably afraid of needles, so one of my biggest fears during my first pregnancy wasn’t simply tearing, but potentially needing to have stitches. In fact, I was far more worried about stitches than labour pain during an unmedicated birth, mainly because medicinal pain relief during labour usually means needles!

I was fortunate to have only very minor tearing with my first birth. It required three stitches. I was still quite terrified of those few needles, but after I survived that irrational fear, there was no additional pain or discomfort due to the minor tear.

In my subsequent four births, there was very minor tearing, or none. And the very minor first degree tears required no stitches.

#3: You Can Reduce Your Risk Of Tearing

One way to reduce your fear of tearing, is to make choices about your birth to help reduce the risk of tearing.

There are several things birthing women and their birth attendants can do to reduce the risk or the severity of perineal tears.

If you still tear, it’s likely to be less severe than if you hadn’t tried to reduce the risk.

Around 90% of labours have some tearing, which sounds like a lot. However, of those tears, 99% are minor.

Some things you can do to reduce your risk and severity of tearing:

  • Maintain good nutrition and stay well hydrated during pregnancy, to help your skin and tissue be its healthiest.
  • Strengthen your pelvic floor muscles during pregnancy, in preparation for labour and birth.
  • Breathe baby out, rather than use forceful directed pushing; push only when your body feels the urge.
  • Use warm compresses during pushing and crowning, to help support the tissue stretching.
  • Choose birthing positions that avoid extra pressure on the pelvic floor and perineum.

Be sure to read Tearing During Birth – 9 Ways To Help Prevent Tearing for more tips on reducing the risk or severity of tearing.

#4: First Degree Tears Often Heal Very Quickly And Without Complication

Most women who have first degree tears find they heal very quickly. Good hygiene and general postnatal perineal care will typically be enough to make sure you heal properly and with little discomfort or pain.

You can help your perineum and any tearing to heal by:

  • Allowing yourself plenty of rest
  • Using witch hazel to relieve swelling and irritation
  • Trying an herbal or Epsom salt soak
  • Using ice packs

You can learn more healing tips by reading 6 Ways To Heal Your Perineum After Giving Birth.

The thought of tearing during birth can definitely be scary. However, it can be helpful to know most tearing is very minor and heals quickly. Few women experience complications or long-term discomfort from perineal tears.

If it’s more than six weeks since the birth and you’re still experiencing continued pain, discomfort or irritation (regardless of the severity of the tearing), be sure to reach out to your maternity care provider or a pelvic specialist.

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Maria Silver Pyanov is a mama of four energetic boys and one unique little girl. She is also a doula and childbirth educator. She's an advocate for birth options, and adequate prenatal care and support. She believes in the importance of rebuilding the village so no parent feels unsupported.

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