What is the difference in 1st, 2nd and 3rd degree tear?

[DoulaRelle]

OK - I have asked my Ob on several occasions how many stitches I had with each child, but he never gives me an answer.

I have found a copy of my discharge notes and my first birth describes a 2nd degree tear. Can anyone please explain to me what the difference, and I guess the severity of a 1st, 2nd and 3rd degree tear?

[kristi14]

Hi,

I had a 2nd degree tear with my first baby also. I asked how many stitches i had recieved and was told lots. The couldnt really count them cos i tore in lots of spots not in a straight line. So i wasnt given a number either.

I thought a 1st degree tear is one not requiring stitching, 2nd degree tear is one requiring stitching but will heal fine, 3rd degree tear is a severe one that can cause alot of damage and possibly end in you needing to go to theatre to get fixed up (like a tear that tears through to your anus-pretty severe, sorry if thats TMI).

I could be wrong but this is what i thought they are.

[DoulaRelle]

Thanks Kristi!

I just googled it as well and you are spot on! I was in shock by the time my obs was stitching me, so I didn't ask at the time after a forcep delivery and it was 6 weeks later that I actually asked him and he probably wouldn't have remembered by then!

[DoulaRelle]

Thanks Tulip! I am waiting on a copy of my hospital notes, so they may have more info on them - maybe!!!!!! Glad to hear your anus is intact though!!!! lol

[chelleg]

1st degree tear involves only the fourchette which is the bit of skin just below the vaginal opening that stretches up beautifully to birth your baby. These do not always need suturing. The midwife or doctor might pop a stitich in if it is bleeding alot or does not 'sit' back together nicely.
2nd degree tearinvolves the fourchette and the superficial perineal muscles.
3rd degree tear involves the aforementioned structures and also involves damage to the anal sphincter.
and some women are unfortunate enough to sustain 4th degree tears where the tear extendes into the rectal mucosa and effectively turns '2 holes into 1'.
In most cases 3rd and 4th degree tears will be repaired in theatre, require the woman to have IV antibiotics for 24 hours and then a course of oral antibiotics and also stool softeners. At my hospital we see these woman at 3, 6 and maybe 12 weeks postpartum to assess for any incontinence of urine, flatulence or faeces.
Of course, regardless of perineal trauma, it is important to remain vigilant with pelvic floor exercises! 3 quick, 3 slow, 3 times a day

[SuzL]

:eek: I had no idea that a 4th degree tear was that bad! Just noticed I was reading this with my legs crossed!

Thanks for the info girls! Gonna start on those PF exercises now

[DoulaRelle]

Thanks Chelleg - you are a wealth of information!

Suzl- I have to say the recovery from the stitches was worse than the labour!

[SuzL]

OMG Relle, thanks for your honesty!

[BellyBelly]

I was actually reading a report of the first 100 births in an Australian midwifery led centre. There were 0 third degree tears which was fantastic - they have such great outcomes!

[bon]

OMG now I have these horror images of 3rd and 4th degree tears flashing through my head...

I think mine with Grace must have been 2nd degree as I was stitched up in labour room and recovered fine.

[Cougar]

hi girls

my first bub was a 3rd degree tear (warning TMI) i tore all the way to the anus, which basically meant i had one hole, the reason being when he was crowning the midwives told me i needed an episitomy, so they got ready for that, after TWO pairs of blunt scissors the 3rd pair he finally came out, the midwives keep walking out of the room to get more scissors each contraction.That is why i had such a servere tear, i was stiched up by the doc, and was on antibiodis, and had to have stool softener, so i would not burst when i finally went, and i had to sit on a blow up donut cushion, but i recovered ok.

[chelleg]

I was actually reading a report of the first 100 births in an Australian midwifery led centre. There were 0 third degree tears which was fantastic - they have such great outcomes!

It all comes down to the continuity of midwifery care and one-on-one midwifery care! The evidence clearly states the enormous benefits to women and babies - less intervention and consequently less perineal trauma (including episiotomies), better satisfaction with labour and birth.... i could go on and on!! Such a shame that even in light of all of the evidence, the midwifery model of care isn't widely avilable. One day

Kelly, were those statistics from the Belmont service?

[Yael]

I was going to add, might have already been said, that 1st degree can need sitches.

I had 2 first degree tears (in different spots), and when i asked my obs he said i had about 13 knots there (wasn't all in a line)...

3rd and 4th degree tears are nasty... my mum does colo-rectal nursing - from what she tells me you REALLY want to avoid this!