Tears

Although tears are not an intervention as such, it seems appropriate to mention them at the same time as we’re talking about episiotomies.

There are 4 types ranging from mild to severe:

First-degree vaginal tear
This is the least severe and involves only the skin around the vaginal opening. They are not particularly painful and will usually heal on their own without the need for any stitches.

Second-degree vaginal tear
Second-degree tears involve both the vaginal tissue and the perineal muscles. They do require stitches but will usually heal within a few weeks.

Third-degree vaginal tear
Third-degree tears involve the vaginal tissues, the perineal muscles and the anal sphincter which are the muscles that surround the anus. These tears will require an obstetrician to repair the damage and will be done in an operating theatre as opposed to the delivery room. It could also take several months to heal. Complications such as faecal incontinence and painful intercourse are possible.

Fourth-degree vaginal tear
Fourth degree tears are the most severe. They involve the vaginal tissues, the perineal muscles, anal sphincter and the tissue lining the rectum. Again, these need repairing in an operating theatre, can take many months to heal and complications mentioned above are possible.

After your baby has been born the midwife will check your perineum to see whether it is intact or not and whether any repairs are going to be needed.
Warning: it may (actually it should) involve a finger up the anus to check there is no tear in the back passage. Any injury in that part of the body is going to involve some discomfort whilst it heals.

Obviously the most severe tears are going to take a lot longer and may require physio as well as treatment by someone who specialises in the field. Any of the tears above are susceptible to infection so it’s important you’re scrupulous with your personal hygiene, especially as there will still be blood loss from the pregnancy (lochia). It is important to wear specific maternity pads because the ones we buy for periods are often plastic backed and can make the area sweat more. You’ll be encouraged to change maternity pads regularly to prevent infection and not to use anything too perfumed for obvious reasons.

If you find it stings when you do a wee, it can help to pour warm water over the area as you pee to dilute it – weeing in the shower or in the bath can also help and is probably an easier manoeuvre!

Doing the first poo, after stitches can be interesting because it may feel as though everything is going to fall out – it won’t, but it is unnerving nevertheless.
Holding a wadded-up piece of toilet paper against the perineum can give peace of mind. It can also help to make sure you drink lots and have lots of fibre in your diet to keep stools soft.

There is some evidence to suggest the perineal massage can help avoid tears (Beckmann and Garrett, 2006) and anecdotally, there seems to be lots of evidence to support that. Perineal massage helps because it enables you to make both physical and mental contact with your vagina. I know that sounds weird but, certainly in Western culture, we don’t tend to talk about ‘down there’  unless you are in a Ripple class when we talk about EVERYTHING and even though we know where a baby comes out of, it often makes us feel squeamish even in the context of childbirth. Spending a bit of time prior to birth, exploring, stretching the muscles around the vagina helps to make everything, including accepting that’s where a baby’s head is going to emerge from, a lot more normal.