do all women need to be stitched together after giving birth?
exceedingly common, like over 70% of women experience some level of tearing:http://www.babycenter.com/0_perineal-tears_1451354.bcPerineal tears
Reviewed by the BabyCenter Medical Advisory Board
Last updated: December 2011Highlights
Is it common to tear during a vaginal birth?
How are tears treated?
What's the recovery like from a serious tear?Is it common to tear during a vaginal birth?
Yes. As your baby makes his entrance into the world, you might end up with a tear. Often the tear occurs in your perineum – the area between your vagina and your anus.
Tears are more common in women having their first vaginal birth and range from small nicks and abrasions to deep lacerations affecting several pelvic floor muscles. It's possible to tear even if you have an episiotomy. In fact, an episiotomy raises your risk of getting severe tears.
The most superficial tears involve the skin of the perineum and the tissue around the opening of the vagina or the outermost layer of the vagina itself, but no muscles. These tears, called first-degree lacerations, are often so small that few or no stitches are required. They usually heal quickly and cause little or no discomfort.
Second-degree lacerations go deeper, into the muscles underneath. These tears need to be stitched closed, layer by layer. They'll cause you some discomfort and usually take a few weeks to heal. The stitches dissolve on their own during the healing period.
About 4 percent of women who deliver vaginally end up with a more serious tear in their perineum that extends to or through the rectum. This kind of tear can cause considerable pain for many months and increases your risk of anal incontinence.
These severe tears are called third- or fourth-degree lacerations. A third-degree laceration is a tear in the vaginal tissue, perineal skin, and perineal muscles that extends into the anal sphincter (the muscle that surrounds your anus). A fourth-degree tear goes through the anal sphincter and the tissue underneath it.
It's also possible to tear in other places. Some women tear at the top of the vagina, near the urethra. (This is known as a periurethral laceration.) These tears are often quite small, and if you get one, you'll probably need only a few stitches or none at all.
These tears don't involve muscle, so they usually heal more quickly and are less painful than perineal lacerations. The main complaint is a burning feeling when you pee.
Less commonly, a woman may tear her cervix or her labia (the folds of skin just outside the vagina) or tear deeply into the tissue of her vagina (known as a sulcus tear).Who is most at risk for a third- or fourth-degree tear?
These serious tears can happen to anyone, but they're more likely in the following situations:
This is your first vaginal delivery.
You've previously given birth vaginally and had a third- or fourth-degree laceration.
You have an assisted delivery, particularly if forceps are used.
You have an episiotomy or you had one in a previous delivery.
Your baby is big.
Your baby is born in the posterior position (face-up).
You push for a long time.
The distance between your vaginal opening and anus is shorter than average.How are tears treated?
If you have a tear (or an episiotomy, or both) that requires stitches, a local anesthetic is first injected directly into the areas that need numbing. Or, if you have an extensive tear, you may get a pudendal block – an injection of a local anesthetic into the walls of your vagina, which bathes the pudendal nerve and numbs your entire genital area. Then your practitioner will stitch you up, layer by layer.
After being stitched up, you'll need to apply ice packs to the area for the next 12 hours or so. If you have more than a small nick, chances are you'll be quite uncomfortable – so don't be shy about asking for pain medication.What's the recovery like from a serious tear?
The pain will lessen over time, but your discomfort may last for three months or more. Here are some tips for recovering from a third- or fourth-degree tear:
Urinating or having a bowel movement can be painful. Make sure your practitioner orders a stool softener so you can start taking it right away and continue taking it for the first few weeks that you're home.
Don't fight the urge to move your bowels or you could become constipated.
Don't have sex until you get your caregiver's okay.
Avoid putting anything, including suppositories or an enema, into your rectum.
Women with tears into the sphincter or all the way through to the rectum are more likely to have incontinence of gas or feces later. Let your caregiver know if you suffer from either of these problems.
For more advice on how to take care of yourself after a tear (or an episiotomy), see our article on managing postpartum perineal pain.
Is there anything I can do to prevent tearing?
Possibly. Doing perineal massage in your third trimester may help make the skin of your perineum more stretchy and make it less likely that you'll tear or need an episiotomy.
You're also less likely to tear if you have a slow, controlled delivery that allows plenty of time for your perineum to stretch to accommodate your baby. This can mean waiting and fighting the urge to push for a while when the baby's head is crowning, for example.
In one study, the use of warm compresses on the perineum during the latter part of the second stage of labor (pushing) was linked to a lower risk of serious tears.
Finally, look for a practitioner who doesn't routinely perform episiotomies and is experienced at helping women give birth with an intact perineum. But remember that you and your caregiver can't control everything. There may be no way to avoid tearing, especially if your baby is large or in a difficult position, or if you have particularly "fragile" tissue.