Vaginal Birth After Severe Tearing

During vaginal birth, it’s common for women to experience a small tear or cut to their perineum.

This is the area between your vagina and anus, and as it stretches to accommodate your baby’s head, it becomes paper-thin.

Around half of all women giving birth vaginally will find they have at least a small tear after birth.

A small percentage of women will have more severe tearing that may require surgery to repair.

Tears are classified as:

• First-degree tears (where only the skin is torn)
• Second-degree tears (when skin and vaginal muscle are torn)
• A third degree tear extends downwards from the vaginal wall and perineum to the anal sphincter, the muscle that controls the anus
• Fourth degree tear extends to the anal canal as well as the rectum

Giving Birth After Severe Tearing

Third and fourth degree tears occurring in a first time labour appear to be on the rise. In the UK, the rate of severe tears has tripled from 1.8% to 5.9% between 2000 and 2012. A study found an increased risk of severe tearing during childbirth in women who had such a tear in a previous birth.

What Makes A Severe Tear More Likely?

It’s very difficult to predict who will experience a severe tear during birth. There are some factors that are known to increase the risks:

• First baby
• Shoulder dystocia
• Long pushing stage of labour
• Very fast pushing stage of labour
• Baby is large or has head in an awkward position
• Baby is in posterior position
• Forceps assisted birth
• Episiotomy is performed, which extends further
• Having an epidural
• Labour is induced
• Giving birth lying down or with legs up in stirrups

Can My Next Birth Be Natural?

If you’ve experienced a severe tear, it’s important to discuss with your care provider why it may have occurred. Were you induced or have an epidural? Was your baby born very fast when pushing? What position were you in? Being aware of the factors that may have lead to the original tear may help you to prevent or limit tearing again in your next birth.

It’s very normal for women who have experienced a severe tear to be fearful and nervous about their next birth. Being able to discuss these concerns with your care provider can help you make the best decision about how you wish to give birth.

You may be offered the choice to have an elective c-section. Or you may opt to have a normal vaginal birth. How you decide to give birth is ultimately your decision and should take into consideration all factors.

Avoiding Another Tear

There are some things you can do to minimise the chances of another severe tear during your next birth:

• Have continuity of care from an experienced midwife who will not be hands on unless absolutely necessary. A review of hands on techniques shows that trauma to the perineum is more likely to occur than if care providers watch expectantly for the need for physical support.
• During pregnancy, ensure optimal fetal positioning by being aware of your own posture and seek body therapy assistance if your baby’s position is not optimal
• Independent birth education classes can teach you relaxation exercises and how to work with your body during labour, so you are not carrying a lot of fear and tension into your next birth
• Avoid induction and any interventions that will limit your movement during labour, such as continuous electronic fetal monitoring and epidural
• Stay upright and active during labour – avoid lying on your back or reclining as this limits your pelvic opening and can encourage your baby into an awkward position for birth
• For the birth of your baby choose positions that reduce stress on the perineum such as all fours, side lying or leaning forward. Squatting and kneeling with legs wide apart can increase tension on the perineal skin
• Avoid episiotomies unless required in a medical emergency. Current evidence shows that episiotomy is not best practice and can cause increased tearing that is less likely to heal well
• During the pushing stage, breathing down with contractions rather than pushing with all your might can help your perineum stretch gently and allow your baby’s head to pass through without trauma. Most women will naturally alter their breathing at this time and should be supported by their midwife to do what feels right for them.

Sarah Tells Her Story Of Birth After A 3^rd Degree Tear:

“After experiencing a third degree tear which required surgical repair with my second baby I was absolutely terrified of it happening again with my third. I expressed this fear at nearly every appointment I had with my care providers throughout the pregnancy and they were aware this was a very big issue for me. I was reassured by my obstetrician that having had a previous third degree tear does not guarantee that it will happen again in subsequent births.

I went on to give birth to a 9lb baby, my biggest yet! I remember the first thing I asked was “how bad did I tear?” I was so surprised to hear that there had been NO tearing, only a slight graze. The factor that I consider to have made the difference this time around was that the pushing stage was a lot slower, allowing my body enough time to stretch properly.”

Having another baby and birth after a severe tear can seem daunting, frightening and impossible. Taking the time to allow your body to heal and to take care of yourself physically and emotionally is important. Preparing and planning for your next baby’s birth means being informed and choosing the care providers who will support you in making the best choice for your individual situation.

Recommended Reading: Tearing During Birth – 9 Ways To Help Prevent Tearing