Preventing Vaginal Tears During Childbirth

Introduction

When the birth of a child occurs through the vagina, it is called vaginal delivery. They are the most common and most preferred type of delivery. During a vaginal delivery, the uterus contracts and open the cervix to push the baby through the vagina. The contractions and relaxations of the muscles in the uterus, cervix, and vagina cause the baby to be pushed out. There can be some injury to the vaginal tissues and the tissues in the surrounding structures as the baby passes out. These are termed vaginal tears.

What Is a Vaginal Tear?

A vaginal tear is an injury to the tissues around the vagina and the perineum during vaginal delivery. The space between the vagina and the anus is called the perineum. It is also called perineal laceration. During a vaginal delivery, the vagina prepares for the child's birth by becoming thin. It stretches to let out the baby without much damage or tissue injury. However, it is common for the vagina to tear to some extent. Studies show that about ninety percent of people who gave birth vaginally have had vaginal tears to some extent.

What Are the Types of Vaginal Tears?

There are four types of vaginal tears, depending upon the severity of the tear. They can include:

1. First-Degree Tears: These are the least severe vaginal tears. It involves just the layer of skin around the vaginal and the perineal area. These tears usually do not require a stitch.

2. Second-Degree Tears: This is the most common type of vaginal tearing. This is slightly deeper, extending from the skin to the underlying muscles around the vagina and the perineum. Second-degree tears require stitches.

3. Third-Degree Tear: This extends from the vagina to the anus and requires stitches. This type of tear damages the skin, underlying muscles, and the anal sphincter (the part of the body that controls the passage of stool outside the body).

4. Fourth-Degree Tear: This is the most severe type of vaginal tear and the least common one. It extends from the vagina through the perineal area, the anal sphincter, into the rectum. The patient might be shifted to the operating room to be sutured.

A second-degree tear is the most commonly seen vaginal tear. It involves the skin and some of the perineal muscles near it. A third or fourth-degree tear is rare and is seen only in about five percent of people. They are called severe perineal trauma. They can cause long-term consequences like pain and incontinence in women.

Who Are More Likely to Have a Vaginal Tear?

Some factors increase the risk of vaginal tearing during vaginal birth. They can include:

• First-time mothers.

• The baby's face was up (face up position) during the delivery.

• The use of forceps or vacuum during delivery.

• A large baby or a baby of more than eight pounds.

• Prolonged second stage of labor.

• Those who take epidural anesthesia.

• Asians have a higher risk of vaginal tears during the birthing process.

• Giving birth at an older age.

What Could Be Done to Reduce the Vaginal Tear?

While a tear in the vagina is an inevitable part of the birthing process, research has shown that some measures could aid in reducing the severity of the tear. Some are done during pregnancy, while others are done during delivery. They can include:

• Perineal Massage: Perineal massage is manipulating the perineal tissues using fingers. It stretches the perineal tissues and reduces the risk of vaginal tears. Studies show that perineal massage helps in reducing the pushing time during labor. It also reduced the chance of severe vaginal tears during childbirth. The massage also decreased the pain in the vaginal area after birth. APGAR scores (a quick way to evaluate the health status of a newborn) were improved at one and five minutes after birth in those who did perineal massage. It is usually recommended to start doing perineal massage within eight to four weeks before the expected due date. It can be done at least three times a week to prevent severe vaginal tears during delivery. Studies show that there were no perineal tears during the birthing procedure in those who practiced this daily. However, a medical consultation must be sought before starting the massage. Those on pelvic rest and those with an increased risk of an early delivery are advised not to practice this massage.

• Kegels Exercise: These exercises are also called pelvic floor muscle contractions. Studies showed that those who did Kegels exercise along with perineal massage had a higher chance of reducing the risk of vaginal tears. They also had less pelvic pain following vaginal delivery. The chances of severe vaginal tears were also reduced considerably. Both these practices aided in protecting the pelvic floor. Five seconds Kegels were repeated five to ten times twice a day eight weeks before the expected due date. This is also helpful in preventing urinary incontinence (dripping of urine when one coughs or sneezes) after delivery. Medical advice must be sought before starting these exercises.

• Practice Birthing Positions Beforehand: Some positions are more likely to cause large perineal tears. These are mainly the ones where the sacral bone (a shield-shaped bone at the end of the vertebrae) is pressed against the surface. Studies show that upright postures are less likely to cause more vaginal tears. At the same time, horizontal positions increase the chance of an episiotomy (an incision between the vaginal opening and the anus at the time of a vaginal birth).

• Discuss with the Medical Team: Talk with the gynecologist or midwife assisting with the delivery about ways to reduce vaginal tears. When things are discussed before the labor starts, it is easier for the birthing mother and the medical team. This would enable them to include strategies to prevent tears in the birthing procedure.

• Lesser Vaginal Examinations During Labor: Studies show that more than five vaginal examinations during labor increase the risk of vaginal tears.

• Get in the Water During the Pushing: Studies show that getting into the water during the pushing period helps to reduce the risk of vaginal tears. Those interested in water birth should check with the hospital if water birthing facilities are available.

Conclusion

The human body can heal after all the tears and episiotomies during childbirth. It can heal from any type or amount of tears. No one is at fault for vaginal tears, as they are part of the natural process. Some amount of tear is inevitable, despite the precautions taken.