Third Degree Perineal Tears – What You Need To Know

Third Degree Perineal Tears – What You Need To Know

Perhaps you’re thinking, “Need to know about third degree perineal tears? I’d rather not know!”

When it comes to childbirth, tearing tops the list of pregnant women’s concerns.

Perhaps you’ve experienced a more severe tear, and you’re wondering what to expect, in terms of healing and even during future births.

If you’re a first time mama-to-be, rest assured that knowledge really is power.

Third Degree Perineal Tears – What You Need To Know

If you’ve recently given birth and experienced a more severe tear, it’s good to know many women heal quite well and even go on to give birth again without severe tears.

Although reading up on third degree tears might not be your favourite activity, this information might help you avoid the risk or reduce the severity of a tear. It will also suggest ways to make sure you heal properly.

What Is A Third Degree Perineal Tear?

The perineum is the area between your vaginal opening and your anus. This area is built to facilitate the birth of your baby.

The strong and flexible muscles and tissue in your vagina, perineum and anus typically cope well during birth.

Occasionally, factors like baby’s positioning and size, a mother’s position during pushing, a mother’s anatomy, and certain birth interventions can increase the risk or severity of tearing.

Perineal tears are classed as either first, second, third or fourth degree tears; first degree tears are the least severe.

A first degree tear involves just the skin of the perineum and/or the top layer of vaginal tissue. A second degree tear involves the same area, as well as some muscle tissue. Third degree tearing affects vaginal tissue, perineal skin, and the perineal muscles, which go as low as the anal sphincter.

How Is A Third Degree Tear Treated?

Minor tears are treated with a simple local anaesthetic. In the case of a third degree tear, which includes muscle tissue, a more effective local anaesthetic might be used.

You shouldn’t feel anything after being given the anaesthesia. An injection of anaesthetic into the vaginal walls might be used for a pudendal nerve block; this will numb the entire genital area.

It can be scary to think about being stitched up, but many mamas are totally distracted by their new babies. In many cases, if mothers wish, they can remain in skin to skin contact with their babies while any repairs are being made.

However, should you need to focus on yourself, your partner, doula, midwife, or a relative can care for your newborn. Skin-to-skin with mama has wonderful benefits, but those same benefits will be there afterwards, if you’re feeling overly anxious and need extra support while you’re being stitched up.

Your midwife or doctor will stitch each layer separately (muscle, vaginal tissue, skin, etc.) to make sure everything heals properly.

Right after you’re stitched up, you might like to use an ice pack to help reduce swelling and discomfort. This can be helpful for several days postpartum as well.

How Long Does It Take For A Third Degree Tear To Heal?

Growing and giving birth to a human being is a big deal. It takes a lot of time and energy, so it shouldn’t be a surprise that it takes a bit of time to recuperate after the birth.

Even if you’ve had a smooth pregnancy, and a birth without complications or tearing, you should expect to need at least six weeks for resting and healing.

You might wonder whether that means a more severe tear will require a lot more healing. Not necessarily. Most women with tearing will recover quite well within the six weeks immediately after birth.

If you have a third or fourth degree tear, you might experience some discomfort, and healing can continue for three months or so. However, you’ll feel improvements every day – especially if you listen to your body’s need for rest.

Recovery after birth can be quite unpredictable. One woman might have an apparently smooth birth, but need several months to recover. Another woman might experience severe tearing and heal more quickly.

Regardless of how your birth unfolds, typically those who have the most rest have the quickest healing.

Read Why You Should Have A Post-Natal Month After The Birth to learn about additional benefits to making rest a priority.

What Can I Do To Help Heal A Third Degree Tear?

Experiencing a more severe tear doesn’t have to mean an awful recovery. With a bit of TLC, many women heal quite well.

To relieve discomfort and help with healing, you might find the following things useful:

  • Ice packs and cool compresses
  • Applying witch hazel, or using frozen witch hazel pads
  • A sitz bath or soak with Epsom salt and/or herbs
  • Taking plenty of time to rest, and staying off your feet
  • Being proactive about preventing and treating postnatal constipation
  • Using a peri-bottle and dabbing rather than wiping after using the toilet

Be sure to read 6 Ways To Heal Your Perineum After Giving Birth for more ways to help healing after a third degree tear.

How Can You Prevent Third Degree Tears?

Maybe you’re a first time mama and you’ve heard about your cousin’s severe tearing. Perhaps you grew up hearing about your mama’s experience with tears. Or you might have experienced a third degree tear and you’re worried about future births.

While the thought of a more severe tear can be scary, fortunately there are things you can do to reduce the risk or the severity of tearing.

You and your maternity care providers can do the following:

  • Avoid any unnecessary episiotomies; there is rarely a medical indication for an episiotomy.
  • Choose a birthing position that allows you to be more upright, or other positions that keep extra pressure off your pelvic floor.
  • In the prenatal period, work on strengthening your pelvic floor.
  • Be sure to have adequate nutrition and hydration to help your tissue be its healthiest.
  • Use a warm compress during the pushing stage, to help with blood flow and to provide perineal support.
  • Avoid directed or ‘purple’ pushing. Try to breathe your baby out and push only when you feel the urge.

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

Will I Experience Another Severe Tear In Future Births?

After a severe tear, many women wonder whether another vaginal birth is ideal. The thought of another severe tear can be quite intimidating. There are many factors that come into play in cases of severe tearing, but for many women, another birth doesn’t mean another severe tear.

Take time to read Vaginal Birth After Severe Tearing to learn more about giving birth again after a severe tear.

Even a more severe tear will often heal quite well in the initial postnatal period. Many women, whether they’ve experienced tearing or not, can benefit from postnatal physiotherapy with a women’s health physiotherapist.

If you are experiencing continued discomfort or pain, an inability to have intercourse, or if you have any other concerns after your initial postnatal follow up, be sure to talk to your midwife or doctor, or reach out to a pelvic specialist.

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Maria Pyanov CPD, CCE CONTRIBUTOR

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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