Giving birth vaginally can result in vaginal tearing or lacerations for many women. This is part of the normal process of a baby passing through the birth canal and out the vagina. It tends to be more common in women giving birth for the first time or among those who have larger babies. Sometimes, episiotomies are done to make delivery easier and to avoid tearing.

After you give birth and the placenta is delivered, your doctor or midwife will look at the outside of your vagina (also known as the vulva and perineum) as well as the inside to see if any tears are present. This can be entirely pain-free if you have an epidural that is blocking these nerves or a little uncomfortable if you did not use any pain medications or if your epidural is not blocking this area as well (and it doesn’t always).

Here are the different kinds of tears you can have:

1. Periurethral tears.

These are tears that are around your urethra, or the opening where urine comes out. These usually only need to be sutured (or stitched up) if they are bleeding, otherwise, they often heal well on their own. Very small stitches are used so that you won’t have any difficulty urinating, but if there is any concern that you won’t be able to (either because of swelling or where the stitches are placed), a catheter may be placed in your bladder at first to help your bladder drain.

2. First-degree lacerations.

These can occur inside the vagina or outside on the perineum. The degrees mentioned here relate to how deep the tears are. A first-degree tear is only when the skin tears, with everything beneath it being intact. If bleeding, these can be repaired with stitches. These stitches dissolve and do not need to be removed. Many women often ask how many stitches they are getting, and usually, it is one long continuous one rather than a bunch of smaller ones, so there usually isn’t a total “number.”

3. Second-degree laceration.

This is deeper than a first-degree tear and is when both the skin and muscle below tear as well. These kinds of tears are very common and again are simply repaired with a long dissolvable stitch.

4. Third-degree laceration.

This deeper tear is when the skin and muscle tear, as well as part of the external anal sphincter. This sphincter is a band of muscle that functions to help hold stool in. Additional stitches are placed to help bring this sphincter back together. Women who have this kind of tear are often put on stool softeners to help avoid constipation since this can be painful and can disrupt the stitches. Sometimes these women also need stronger pain medication to help as they heal, too.

5. Fourth-degree laceration.

This is the deepest tear of all after giving birth is when the tear extends completely into the rectum so that there is a direct passage from the vagina into the rectum. Additional layers of the suture are used to help close this backup and separate the vagina from the rectum. Since this can take longer to repair, requires the obstetrician to be able to see things very clearly, and can be painful, many times this kind of repair is done in an operating room with the woman receiving either a higher dose epidural or sedating pain medications. As with third-degree lacerations, avoiding constipation and good pain control are key. To avoid complications, most doctors will see these women in the office soon after delivery to make sure that healing is appropriate.

Sources:

• The American College of Obstetricians and Gynecologists
• Episiotomy: Procedure and repair techniques
• Gabbe SG et al
• Obstetrics: Normal and Problem Pregnancies
• 5th ed.

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