Tearing and episiotomy jargon

[Jellymaker]

Ok Ladies,

I have read all the benefits of tearing naturally over having an episiotomy, but all the stuff i've read on tearing is a little confusing. What is the difference between a graze and a tear and what are the different degrees, 1st, 2nd and 3rd? Are we talking tearing up the length of the vagina inside? Tearing outward externally?(labia etc,) or tearing into pelvic floor muscle?

I'm not trying to scare myself but would like to know what all the lingo means.

Help anyone? It may be TMI but i would like to know specifics.

[Mildez]

A graze is a graze basically. Its where the top layer of skin gets riped off. These hurt as much if not more as its the top layer where the nerve endings are.
A first degree tear is only a short laceration to the perineum and involving the skin.
A second degree tear damages the skin and muscle of the perineum so its much deeper and usually longer. A second degree tear can extend all the way to the anus but not through it or into the sphincter.
A third degree tear involves the skin, muscle of the perineum and the anal sphincter. This is much more nasty and not common. Often a third degree tear is from an episiotomy that has extended through the anus (again uncommon)
A graze can also need suturing although usually not. Some first and even second degree tears don't need suturing although most second degree tears are sutured. It all depends on how the skin comes back together. If its gapping or can only been seen if pulled open and if its bleeding. A tear that sits together normally and doesn't bleed sometimes wont be sutured.

[Mummato2]

:yeahthat:

Brilliantly summarised

[Linzy]

Aha! I was a little confused, I had an episiotomy with my son (36 stitches - 3 rows of 12) and the scar goes from the bottom of my fufu to my butthole. I had to sit in salty water every couple of hours, and hold a maternity pad against my stitches when having a poo. I took anti inflammatories for the pain..but to be honest I wasn't in agony or anything, it was more uncomfortable than anything. I found sitting on a rolled up towel (like a donut) helped alot. I was too busy ogling my new born and feeding to feel the stitches. I have always wanted to know what a 'normal' amount of stitches for an episiotomy is but can't find out that information. The ob's and midwives just ignore that question and move on to the rest of the labour questions.

As for the tearing, I only found out this pregnancy that I also tore. My doctor told me while she was doing an internal. And it is on the inside of my fufu extending to the outer area. This is wear I have all this blue/purple swollen lumpy bits that ache from time to time so I don't know what happened there. I didn't even know I had one but it certainly explains the lumpyness this pregnancy..I thought I was prolapsing!

As a result of the epi and the tear I was already considering a c section this time to escape any possibility of it happening again. Even though I know it's not always the case. But in the end I had other reasons that convinced the Ob to do a c section this time. Now I get to feel how much a c sections hurts to recover from, I have heard it can be a more painful recovery than an epi or tear!

And they call us the weaker sex... If a bloke had a rip in his ball bag you'd never hear the end of it and the tear would gradually get larger with everytime the story was told.

[Mildez]

Linzy I agree on the man thing increasing the size of the whole in his ball bag.

As for how many stitches for an episiotomy that is a difficult one to say. I haven't seen any vaginal suturing done is seperate sutures so to speak (for birth trauma) the dr's were I work all do a continuous suture like a coil if that makes sense. Because they loop from one to the next it would make it difficult to count them and perhaps why you can't find an average amount of sutures in any research you might have looked for. Depending on how deep the laceration depends on if you need more then one row of sutures. Like one for the muscle and then another for the skin on top of the muscle. You can also tear inside and have what is describes as an intact perineum so no tearing from the exit of the vagina to the anus. Thats why after birth the Dr or midwife usually inserts a finger or two and a clean clothe to look for internal trauma that can't be seen from the outside.
I think in comparison to the birth the sutures or trauma usually aren't bad. A bit uncomfortable. I know with mine they were very tender and it really stung to pee but mine were up around the urethra not down the bottom.

[Mummato2]

And they call us the weaker sex... If a bloke had a rip in his ball bag you'd never hear the end of it and the tear would gradually get larger with everytime the story was told.

[Cass72]

A graze is a graze basically. Its where the top layer of skin gets riped off. These hurt as much if not more as its the top layer where the nerve endings are.

:yeahthat: I had some grazing (as the doc so elequently put it!) which hurt way more than my epi. FWIW I remember them saying to me that they were going to snip but with everything else going on I didn't notice.

Also, if you do end up with stitches, the whole "holding it while you poo" (thanks Linz - almost forgot this one!!) is a really really really good tip that my sister gave me!!

[Linzy]

Linzy I agree on the man thing increasing the size of the whole in his ball bag.

As for how many stitches for an episiotomy that is a difficult one to say. I haven't seen any vaginal suturing done is seperate sutures so to speak (for birth trauma) the dr's were I work all do a continuous suture like a coil if that makes sense. Because they loop from one to the next it would make it difficult to count them and perhaps why you can't find an average amount of sutures in any research you might have looked for. Depending on how deep the laceration depends on if you need more then one row of sutures. Like one for the muscle and then another for the skin on top of the muscle. You can also tear inside and have what is describes as an intact perineum so no tearing from the exit of the vagina to the anus. Thats why after birth the Dr or midwife usually inserts a finger or two and a clean clothe to look for internal trauma that can't be seen from the outside.
I think in comparison to the birth the sutures or trauma usually aren't bad. A bit uncomfortable. I know with mine they were very tender and it really stung to pee but mine were up around the urethra not down the bottom.

Ahhhhh this makes sense now! I don't know where I got 36 stitches or 3 rows of 12 from, must have been my ex partner as it's not on my records either. Thanks for that

[*TripleJ*]

i had 15 stitches or thats wat DH said lol he counted 15 times obviously lol i had a second degree tear through my perinium and a graze upwards i think the graze hurt more especially to pee lol Ural works wonders coz it nutralises ur pee lol i would have torn upwards but the middie pushed him down as he was coming out there was a lot of blood but they say it wasnt much lol

[Linzy]

Ah yes I remember drinking Ural! I had boxes of the stuff lol you just reminded me

[Nelle]

It's good to be informed, but try not to worry, it sounds horrific, but it was surprisingly okay for me. I can't comment on a 3rd degree tear, which I understand can be difficult because in some cases a bit of reconstruction can be required.
But the reason grazing hurts is because, like a carpet burn, it stings. Some people don't graze at all! For those who do, peeing with hands on the floor and butt in the air helps (and you also have the benfit of looking super classy while peeing), and URAL can help take the sting out of peeing too.

With stitches, I think the worst part (because it's unexpected) is that healing itch. Showers help, salt baths help, as well as the flushable toilet wipes you can get. Ice helps with swelling. I think the midwives used to cut into the stuffing of a pad from the end and fill it with ice.

I hope you feel more informed now, and not that scared. Many women tear (many women don't!) and in the great scheme of things, while inconvenient and uncomfortable, usually isn't as bad as is sounds in theory. xo

[Inanna]

Emma gave you a great run down. As Nelle said it's great & necessary to be informed - but don't dwell on it!

I had a second degree tear with my first baby & I made an informed decision to not have sutures. My peri healed beautifully in a very short amount of time. It was stingy for a few days but it certainly wasn't agonising.

[Jellymaker]

Thanks very much for all the advice ladies.

I was a bit concerned about the whole tearing/epi thing (which is strange when you think about the pain of labour as a whole) but hopefully if it does happen it won't be too bad, and like Linzy said, i'll have other things on my mind to distract me

On a related note, can anyone extol the virtues of Perineum massage coming up to labour? I guess the theory is sound as far as preparing the area, but considering the vagina etc are so stretchy in the first place, wouldn't any massage just bounce back IYKWIM? Has anyone done it and noticed a benefit, or is it a bit of a myth?

[M22]

I had a 3rd degree ( 2nd stage 2 hrs)with no.1 the got infected and had to be restiched. (blurgh)
still went natural again with number 2 seconds stage 10mins! ( 2nd deg tear) I only tore cause cord was around her neck and they had to pull her out.

no peri massage or anything like that.
doc siad lots of scar tissure form first birth- but so glad i didint get a c. OB siad i still did right thing going for a fufu birth!!

HTH

[Mildez]

I did peri massage with no1 religiously from 34weeks and didn't have any tears or grazes. With my second I started half heartedly at 35weeks and had DD at 36weeks so it didn't have time to work well I guess. I had multiple thick grazes to the urethra, clitoris and labia minora. I guess peri massage doesn't exactly massage the urethra lol so I guess it wouldn't have helped. I definately believe it helped with my first. I was young (17) and hadn't been sexually active long (not to say that has anything to do with it) and was much smaller down below and didn't have any tears with no1 but did with no2. They were also the same size.
I re-read what I wrote before and I didn't intend to scare anyone. Personally as a midwife I can't say people complain about their vagina's post birth except they might be tender and request ice or panadol. Mine stung when peeing but TBH DH has made me feel worse then my births did in that department.

[Jellymaker]

On the contrary Emmy, your straightforward factual info was exactly what i was after! I have noted that OB's and Midwives are sometimes reluctant to go into a lot of detail about episiotomies and tearing, probably trying not to freak us preggos out, but honestly, the more info I know the more prepared i feel and calmer.

I know after reading almost three pages of birth stories that i am way more prepared and less nervous on what's to come.

Thanks for your candor.

[lismith25]

I had a second degree tear with dd, didnt feel it when it happened or while I was being stitched but the weeks after were so painful. I can remember being in tears everytime I needed a no.2 as they would start to bleed ......salt baths and frozen maternity pads were a blessing

But on a positive Doc says its a sign of a small vagina

[Cricket]

Warm compresses on the perineum during labour, and being in water during labour and/or birth if you can, are supposed to help reduce the amount of tearing. With my first, the nurses used warm compresses (felt SO GOOD!!!) as my baby was crowning, and I didn't tear. A bit of grazing, which did sting for a few days, but nothing that required repair.
All the best!