Understanding Vaginal Tears During Labor and Delivery

A common fear many pregnant people have is tearing during labor and delivery. Tearing is pretty common during a vaginal delivery, but it’s not a definitive that you’ll experience a vaginal tear when delivering your baby. 

“The majority of the time, a body can do all the things needed to deliver a baby vaginally,” says Julie Goodwin, MD, an OB/GYN who practices in Little Rock, Arkansas. “Sometimes that includes tearing the vagina, of the tissue, in order to accomplish the delivery.”

It may help you to prepare to learn more about how tears occur and what can be done about them, including recovery. 

What Is a Vaginal or Perineal Tear?

During childbirth, you may experience some tearing in the area between the vaginal opening and the anus, which is known as the perineum. In the most common situation, the vaginal skin and underlying muscles can tear, but in more severe cases, it can also involve tearing to the anal sphincter muscles. 

What Causes a Vaginal Tear?

The vagina stretches open during delivery, but sometimes the baby (and the baby’s head) is a little too large for the opening to accommodate. Many of the factors that increase your chances of experiencing a tear are beyond your control.

For example, if you’re giving birth for the first time—or have given birth to just one baby—you may be at greater risk for experiencing a more serious tear, according to the American Journal of Obstetrics and Gynecology. The rate of second-degree tearing is estimated to range from 35-78% among this group of pregnant people.

Additionally, you may be more likely to experience a more severe tear if your doctor has to use a vacuum or forceps to deliver your baby. Pushing for a long time before delivering can also boost your risk.

Other factors that can increase the risk of severe tears include larger babies or if the baby’s head is in a position called persistent occiput posterior. That means the back of the baby’s skull is in the back of your pelvis. (Some people also call this the “sunny side up” position, since your baby is essentially facing upward).

How Likely Will a Vaginal Tear Happen?

You might tear, but you might not. Aneesha Varrey, MD, an obstetrician with GBMC HealthCare in Towson, Maryland, talks to her patients about the possibility of tearing when they discuss birth plans during the 36-week prenatal visit. “I counsel them that vaginal delivery can be associated with tears in the vagina,” she says. “This can be a normal process of vaginal delivery; 50-80% of women have tearing during a vaginal delivery.”

However, if you do tear, you’re more likely to experience a milder tear than a more serious tear. According to the American Urogynecologic Society, only about 2% of people experience a third or fourth degree tear. However, a Cochrane review of research about perineal tears during vaginal births gave a broader range, estimating that about 1-to-8% percent of people giving birth vaginally experience a third or fourth degree tear.

What Are the Four Types of Vaginal Tears?

There are four degrees of tearing that can occur. Here's a look at each type.

First Degree Tear

A first-degree tear is the least severe type of vaginal tear. It’s a relatively superficial tear of the vaginal and perineal area.

Second Degree Tear

This tear is a little bigger and deeper than a first-degree tear, reaching down into the muscle tissue of the vaginal and perineal area. 

Third Degree Tear

A third-degree tear involves tearing into the area also known as the anal sphincter complex, the muscles that help control bowel movements.

Fourth Degree Tear

The most severe kind of tear, a fourth-degree tear involves tearing to the anal sphincter complex and the rectum. However, it’s also the rarest kind of perineal tear. 

How Are Vaginal Tears Treated?

If you experience a tear, you may need some stitches or surgical repair to close up the torn skin or tissue, especially third and fourth degree tears.

However, your doctor may evaluate your tear and suggest that you don’t need stitches if it’s a first-degree or even possibly a second-degree tear. That’s because some tears may not need repairing, notes Dr. Varrey. “The vagina is a very forgiving organ, capable of very good healing,” she says. 

Afterward, you’ll need to give your perineal area some TLC for a while so it can heal. For example, you might welcome some acetaminophen or ibuprofen to provide pain relief. “These typically won’t make you constipated nor drowsy, which is a win-win with a newborn baby’s non-existent sleep schedule,” says Dr. Goodwin. 

Also, avoid straining when you need to have a bowel movement, she adds. “Keep the stools soft and easy,” she says. “This requires lots of water and stool softeners.” It may also help to use a squirt bottle to clean the perineal area after urinating or having a bowel movement. 

Other coping-while-healing techniques include using cold packs on your perineum, says Kimberly Langdon, MD, an OB/GYN who consults with MedZino. You might also try using a topical numbing spray and taking sitz baths. 

“Epsom salts in warm water or just plain warm water are fine as sitz baths,” says Dr. Langdon. “You don't want to add any bath bombs or fragrances or oils to the water. You can use any of these products or behaviors for as long as you have discomfort."

Talk to your doctor about any concerns that you may have along the way, too.

How Long Does it Take to Heal From a Vaginal Tear?

It may take a few weeks for your laceration to heal. Some experts suggest you can anticipate having some pain and soreness in the perineal area for four to six weeks. If you receive stitches, they will dissolve over time, but you may still be able to feel some of them for up to three months.

If you experience a second degree tear or greater, don’t be surprised if it takes longer to heal. Research suggests some women experience some pain in the perineal area for a couple of months after tearing during vaginal delivery. If you’re still experiencing pain and discomfort beyond the first few weeks post-delivery and you’re having trouble managing it, talk to your obstetrical provider and ask for guidance in treating or coping with the pain. Some people experience longer-range problems, such as impaired sexual function, later on after a tear. 

Also, you might consider pelvic floor therapy down the road. “Vaginal birth itself without tears has been associated with weaker pelvic muscle tone than women who delivery with cesarean sections,” says Dr. Varrey. “Therefore, I refer them to pelvic floor therapy, educate them on kegel exercises, and refer them to a urogynecologist with complicated tears.”

Can You Prevent Vaginal Tears?

Warm compresses on the perineal area may help prevent or reduce severe tearing, according to the American College of Obstetrics and Gynecologists (ACOG). Perineal massage may also reduce the likelihood of experiencing a severe perineal laceration or tear. In fact, research suggests massaging the perineum with a substance like glycerin during the first and second stages of labor can be helpful.

You might also try a little massage at home prior to going into labor. “I usually counsel my patients that perineal massage can be helpful when done during their shower beginning at 34 weeks,” says Dr. Varrey. 

You could also talk to your provider about trying an upright position when delivering your baby, although research has shown mixed results. 

“Listen to your doctor or healthcare provider when you are delivering,” says Dr. Goodwin. “They may tell you to stop pushing at one point in order to allow for a more controlled delivery and therefore lower chance of laceration.”

Is it Better to Have an Episiotomy or Tear?

You might wonder if it’s better to have your doctor go ahead and create an incision pre-emptively rather than just risk a tear. This type of procedure is known as an episiotomy. A doctor may perform an episiotomy to cut the skin and widen the vaginal opening right before the baby’s head is delivered. 

But actually, it’s better to tear spontaneously, says Dr. Goodwin. “There is always the chance that a tear won’t happen, or it will be minor and not require a repair,” she says. “If you perform an episiotomy, then you are ensuring trauma to the tissue that will require a repair.”

In fact, episiotomies are not routinely recommended. The ACOG emphasizes episiotomies should only be done when absolutely necessary. 

“I only perform episiotomies when there are complications with vaginal birth such as shoulder dystocia or when the baby’s heart rate is in a critical state and the delivery needs to be expedited,” says Dr. Varrey. 

She added that research suggests natural vaginal tears heal better and result in fewer anal incontinence-related symptoms than episiotomies.

A Word From Verywell

Tearing happens to a lot of people who give birth vaginally. Talk to your doctor about your risk and discuss how you may be able to reduce the chances of tearing when you’re delivering your baby. Understanding your risk and knowing how to cope afterward may help you better prepare for the possibility if it does happen to you.