What is a Perineal Tear?
The perineum is the layer of tissue and muscles between the vaginal opening and the anus which connects to the muscles of the pelvic floor. During labour your pelvic floor thins and stretches to allow for the passage of the baby through the vagina. The perineum will stretch as baby's head emerges and in some cases this will cause tearing.
How Common are Tears?
About 85% of women will have some degree of tear or episiotomy with 65-70% needing stiches. Tears are most common in first time mums are they are degrees of tearing
1st degree - injury to the skin only
2nd degree - injury to the muscle and skin layers
3rd degree - involves the muscles that control the anus
4th degree - extends further into the anus/rectum
What are the Risk Factors?
You are more likely to have a tear if you
are having your first baby
if your baby is over 4kg
if you are induced
if you have an epidural
if you have a very quick labour
if your baby is in the back to back (OP) position
if you have an instrumental (forceps or ventouse) delivery
If you have previous 3rd or 4th degree tear
are of Asian origin
Tips for Prevention of Tears
The following tips can help prevent or minimise tearing
Regularly use upright positions for labour and especially in the 2nd (pushing) stage. If you have an epidural and can't use your legs then lie on your side.
Labour/birth in water as the warmth will help the tissues to stretch. It will also decrease your risk of an episiotomy and shorten the second stage.
If not giving birth in water then apply warm compresses to the perineum as baby crowns.
Practice perineal massage in the weeks before the birth to gently stretch the tissues. Start at 34 weeks 3/4 times a week for 5-10mins.
No coached (purple pushing). Holding your breath while pushing increases your risk of tearing. Slow controlled breathing is best.