Tearing and episiotomies: what you need to know

pregnant mum at doctors

One of the biggest fears women have before giving birth is tearing during labour – will it happen, how can it be avoided, how do I recover are all common concerns.

Midwife Edwina Sharrock says she’s asked about perineal tearing daily, so we invited her to host a live chat with our expectant mums in our closed Mum’s Grapevine Due Date Group to educate and empower their birth journies.

Edwina spent a couple of hours answering questions about tearing, episiotomies and recovery after birth.


Edwina Sharrock a registered midwife and mother of two. She’s also the founder of Birth Beat – an online antenatal course that is simple, easy and convenient to watch from the privacy of your home. One of the most common fears pregnant women have before birth is tearing during labour. Edwina will be answering all your questions about perineal tearing and how to care for that sensitive area after birth, and you don’t even have to leave home!

Edwina is passionate about women having the very best evidence-based education and she wants mums-to-be to feel empowered, not fearful.

 


As a midwife I see women labour so beautifully and labour well and cope really well with their labour but when it’s time to start pushing often it’s women who aren’t educated or haven’t had honest education about that pushing stage, that are really fearful around tearing.

If you missed the live chat, here’s a roundup of Edwina’s expert information on tearing, episiotomies and recovery.

Q: Where is the perineum?

So there’s a little hole, which is your bottom hole – your anus. And then there’s that stretchy bit down the bottom of your vagina. And your perineum is actually just all that skin and all that tissue from the bottom of your vagina around to your bottom.

As you labour and particularly as you start to crown this area begins to stretch and becomes a very stretched, wide area.

Q: What happens to the perineum during pregnancy?

What happens when you’re pregnant is that you start to produce a lot of oxytocin. They call it the hormone of love but it also helps induce your labour. So oxytocin is produced in your brain, talks to your uterus, your uterus contracts, pushes on your baby. What happens though is all that oxytocin actually helps your perineum naturally stretch and prepare to birth your baby. You are designed to stretch and for that to happen. So that area, that tissue becomes really elastic it gets a great elasticity to it.

Q: What’s the difference perineal tearing and a graze?

Perineal tearing is where that tissue between the vagina and the anus is damaged or tears.

But in most labours, you will have some sort of graze or tear to the vaginal mucosa, so when your vagina stretches. It’s really important to understand that’s very common, it also heals super quickly. I want to be clear about the difference between perineal trauma and a normal graze or tear of your vagina.

We say first, second, third and fourth-degree tear. 80 per cent of women will have some sort of damage to their vagina. But I don’t want you to feel scared because that’s such a vascular area and within a day or two you can be completely healed from that. So if it’s just a mild graze, you don’t need any suturing, you don’t need any repair to the area and it very, very quickly recovers.

Q: Why do we tear?

Essentially there’s surgical tearing and non-surgical tearing.

So when we refer to surgical tearing, that’s an episiotomy. It means there’s some sort of surgical cut to the perineum. A small cut and that would only be if an intervention such as ventouse or forceps were needed. Or if there’s a reason maternally, which means for mum, or for the baby. So if there’s a clinical indication that very quickly that baby needs to be born, that can be a reason for an episiotomy.

A non-surgical tear is when it’s happened just due to the birth of the baby. Very common, more common in first-time mums.

Common factors for tearing:

  • First-time babies, because the vagina hasn’t stretched to that position before.
  • The position that you’re in during labour (upright position decreases the chance of tearing).
  • The length of your second stage (pushing stage).
  • If you’ve had an active labour.
  • What drugs you’ve had during labour (epidural).

Q: How do I overcome my fear of tearing

I get it, it’s ok to be scared, everybody is. But my biggest ask of you is to get childbirth education. Because with that education, it will help remove the fear. And that is just so incredibly important.

Q: What can decrease your chances of tearing?

Perineal massage can help decrease your chances of tearing. So whether you choose to massage your perineum yourself or use something like the EPI-NO, that’s a decision for you to make. But know that it does decrease your chances of tearing.

What women anecdotally report is that having a hot compress applied to the perineum as you’re birthing the baby’s head, it slows the time the baby has to come out, which gives the perineum time to stretch, which is a good thing. It decreases your chances of tearing, plus the hot compress on your perineum provides comfort to the mum.

Q: How do I look after my perineum after birth?

After you’ve birthed your baby, I have three important points for you:

1. Ice is your friend

Your vagina is going to be quite swollen and quite tender after you have your baby. It sort of feels really heavy and full. So get a condom, fill it with water and freeze it. Then cut open a maternity pad and once the condom full of water is frozen, tuck it into the pad. It’s like the perfect ice pack for your vagina.

2. Rest

It’s really important, giving birth is like running a marathon, so go easy on yourself.

3. Do your first wee in the shower

After you’ve birthed your baby I really encourage you to get up and do your first wee in the shower. If you’re not going to do it in the shower, get a water bottle with a squirt lid and pour warm water over your vagina as you do your first wee. If the area does have a little tear or graze, your wee is very acidic and it’s like acid on a cut, it’s very painful. The warm water helps to dilute the acidity of the wee. You can also introduce some Ural during the first couple of days.


Mum’s Grapevine regularly hosts expert live chats in our closed Pregnancy and Baby Groups. If you’re expecting a baby, you should the join thousands of other mums all due at the same time as you. There a safe place to talk about babies and your changing bodies all day and night. Click the image below to choose your group.