Preventing & Treating Perineal Tears

For many Birth You Desire clients, one of the most dreaded outcomes of childbirth is perineal tears or repairs due to an episiotomy.  Perineal trauma is when the area between the vaginally opening and the anus is damaged, either torn or cut during childbirth.

Perineal lacerations during childbirth affect more than 65% of women in the United States.  These lacerations range from minor to more significant repairs. Some women report long-term effects ranging from healing, scaring, and pain.


But what if we could prevent perineal trauma?

Here are four ways that you can reduce your risk.

  • I believe that a healthy diet is a factor in the skin’s elasticity and its ability to stretch and not tear during birth. Focus on a diet high in Vitamin C and protein.
  • A controlled slower delivery while crowning is one of the best ways to reduce the risk of a laceration. You can discuss this with your provider and request perineal massage and warm compresses during crowning.
  • Perineal massage started at 35 weeks of pregnancy has been shown to be helpful for some women, especially first-time mothers. This handout from the American College of Nurse-Midwives explains how to do the massage step by step.
  • Practicing yoga, Pilates, and active stretching of the pelvic floor muscles may also help at delivery.
  • Routine episiotomy is no longer practiced today but can be helpful when the tissue is tearing in an unhealthy direction, or with the use of manual delivery methods like forceps or vacuum.
  • NOTE that an elective cesarean to avoid perineal trauma does not always prevent damage to the pelvic floor or other tissues.


Understanding your repair if necessary

Just after delivery your provider will examine your tissues and inform you of any need for a repair and the degree of the repair.  They will numb the tissue with a local anesthetic and stitch the tissue back together with dissolving stitches. The repair is usually done in a bed with your legs pulled back for better visibility.


There are four degrees of tears. The most common ones are:

Skidmark- An abrasion of the tissue that is NOT a tear. It usually doesn’t require repair.

First-degree tear- A superficial tear of the perineal tissue, vagina, or labia.

Second-degree tear- A deeper tear involving the skin and underlying muscle structure.  These usually extend towards the anus.


Less than 5% of all women will have a significant tear. These types of tears are:

Third-degree tears- A more severe tear involving skin and muscle towards the anus.

Fourth-degree tears- Like a third-degree but extending all the way to the rectum.


Taking care of your stitches

The repair with dissolvable stitches usually heals quickly, within two weeks.  To facilitate healing consider the following:

  • A diet high in Vitamin C and protein.
  • Increase circulation to the area with pelvic floor muscles while sitting or lying down. Kegels can be done by gently tightening and then relaxing the muscles of your perineum (pelvic floor muscles). Start with 2 – 3 seconds per tightening (contractions), moving up to 5 and then to 10 seconds.
  • Keep the area clean by bathing the area in a shower or tub. Lavender oil in Epsom salt can be helpful in a tub. Third and fourth-degree tears may use a sitz bath.
  • Apply ice packs for the first 24 hours unless your provider instructors you otherwise.
  • Use a donut cushion for sitting if needed.
  • Take pain medications as prescribed by your provider if needed.
  • Wear a belly binder to support your abdomen and reduce pulling on your repair.