Patient information

Perineal tears following

childbirth
What type of tears can occur during childbirth?
Most women (85%) tear to some extent during childbirth. Most tears occur in the
perineum, which is the area between the vaginal opening and the anus (back
passage). These may be:
First degree tears small, skin deep tears which heal quickly without treatment.
Second degree tears deeper tears affecting the muscle of the vaginal wall as
well as the skin. These usually require stitches

For a few women who tear (up to 9% of vaginal births) the tear may be more serious
including:
A third degree tear extending downwards from the vaginal wall to the muscle
around the opening of the anus (anal sphincter).
A fourth degree tear extending to the anal canal as well as the rectum (further
into the anus).
An episiotomy is a cut that is made by a doctor or midwife through the vaginal
wall and perineum to make more space to deliver the baby.

What is the difference between a tear and an episiotomy?

A tear happens spontaneously as the baby stretches the vagina during birth.

Can anything be done to prevent tears?

It is hard to predict until you are actually giving birth whether a tear will occur.
Research has shown that massaging the perineum in the last few weeks of
pregnancy can reduce the chance of tearing. Ask your midwife for more details.

How are tears/episiotomies repaired?

Tears and episiotomies can be repaired with stitches that join the edges of the
wound together to help it to heal. The material used for stitches will dissolve
gradually so you will not usually need to have your stitches removed. The stitches

Maternity Services
will be put in by a midwife or a doctor. A local anaesthetic will be used to numb the
area unless you already have an epidural that is effective.

You will be given pain-relieving drugs during your stay. Youll also be given pain
relief medication for you to take home if needed.

NB: None of the treatment offered to you will prevent you from breastfeeding
your baby.

What can I do to help the tear to heal?

Keep the area clean. Have a bath or a shower once a day and change your sanitary
pads regularly. You should wash your hands before and after using the toilet,
changing your sanitary pad or touching your stitches. This will reduce the risk of
infection and is especially important if you have a sore throat or chest infection, or
are in close contact with someone who has one.

Drink two or three litres of water every day and eat a healthy, balanced diet (fruit,
vegetables, cereals, wholemeal bread and pasta). This will prevent you from
becoming constipated.

Do pelvic floor exercises as soon as you can after birth. This will increase the
circulation of blood to the area and aid the healing process. You will be given advice
about pelvic floor exercises. These exercises should be continued for the rest of your
life (See Post Natal Exercises leaflet).

When can I go home?

You shouldnt need to stay in any longer because of your tear. Once your stitches
have been checked and you feel ready, youll be able to go home.

Seek advice early from your community midwife or GP if:

Your stitches become increasingly painful or smell offensive as these may be
signs of an infection.
You cannot control your bowels or wind
You have faecal urgency (feeling a need to rush to the toilet to open your
bowels).

Is the treatment different for third and fourth degree tears?

Third and fourth degree tears will be repaired by a doctor. The stitches need to be
done in theatre using a spinal (epidural) so that you have good pain relief. You will
have a drip inserted in your hand. This will be removed once you are able to eat and
drink. You may have a catheter (tube in your bladder) until you can walk to the toilet.

Antibiotics will be given to you via the drip in your hand whilst you are in theatre.
This is to reduce the risk of infection that can occur due to the closeness of the
stitching to the anus. Oral antibiotics will then be prescribed for you after this.

You will be given laxatives to make it easier and more comfortable to open your
bowels.
What causes third or fourth degree tears?
Its very difficult to predict when tears will happen, but this type of tear is more likely
when:
One of the babys shoulders becomes stuck behind your pubic bone or is lying in
an unusual position.
There is an extended second stage of labour (the time from when the cervix is
fully dilated to birth).
This is your first vaginal birth.
You have a large baby (over 4kg/9lb).
There has been an assisted birth (forceps or ventouse delivery).

Can anything be done to prevent it?

In most situations, a third or fourth degree tear cannot be prevented because it
cannot be anticipated. Scientific evidence has shown that episiotomy does not
prevent a third or fourth degree tear occurring.

What are the long-term effects of a third or fourth degree tear?

Women report a wide range of pain in the perineum. Some women are very sore
after surgery and the stitches are slow to heal. Others experience much less
discomfort.

Some women are apprehensive about having sex after birth; others feel less
nervous.
Some women find they are not able to control opening their bowels or passing wind.

Can I have a vaginal birth in the future?

Most women have a vaginal birth in a subsequent pregnancy because the chance of
another third degree tear is low. You will be advised to attend our specialist clinic to
discuss if this is appropriate for you. Some women develop bowel problems after
another vaginal delivery and investigations may be needed to ensure that this wont
be the case.

Follow-up for third and fourth degree tears

You will be given an appointment for our specialist postnatal clinic around 6-12
weeks after giving birth. Its important you attend in case you need any further care.
Youll be asked questions about your urine and bowel function and youll be able to
discuss any concerns, e.g. around sexual intercourse.
References

This leaflet has been adapted for local use from the Royal College of Obstetricians
and Gynaecologists information leaflet: A third or fourth degree tear during childbirth,
RCOG, March 2007. National Guideline Clearing House www.guideline.gov

Patient Advice and Liaison Service

If you need general information or advice about Trust services, please contact the
Patient Advice and Liaison Service (PALS) on 020 3594 2040 or visit
www.bartshealth.nhs.uk/pals. Alternatively please contact staff who are providing
your care if you require clinical advice.

Large print and other languages

For this leaflet in large print, please ring 020 3594 2040.

For help interpreting this leaflet in other languages, please ring 020 8223 8934.

Reference: BH/PIN/153
Publication date: November 2013
All our patient information leaflets are reviewed every three years.

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