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.

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