Healing down there after childbirth

Hema Brazell, MD

Urogynecology

Perineal lacerations, or tears, are common for women to experience during childbirth. Some tears, such as third- and fourth-degree tears, can be pretty severe. OB/GYN Hema Brazell, MD, shared information on how to care for a severe tear after delivery.

What are perineal lacerations?

Perineal lacerations are tears in the vagina or skin near the vagina. These commonly occur during a vaginal delivery and they range from a level one to a level four tear, with level one being the least severe and level four being the most severe.

What are third- and fourth-degree tears?

Less common are the third- and fourth-degree tears which can extend into the muscles of the rectum and even into the anus. These are more severe tears and sometimes they do not heal well. These tears can lead to infection, bleeding, wound breakdown, pain and/or fistula (an abnormal connection between the vagina and rectum through which stool or gas is passed from the vagina instead of the anus).

What are the risk factors for third- and fourth-degree tears?

“While a severe tear cannot be prevented, there are certain risk factors that may make a level three or level four tear more likely to occur,” said Dr. Brazell.

• First vaginal delivery
• Operative vaginal delivery (one in which an assisted device is used to help deliver the baby)
• Episiotomy (a cut on the perineal skin at the time of delivery to facilitate delivery of the baby)
• Large baby (bigger than 8.5 pounds)
• Babies delivered “sunny side up” (face looking toward the ceiling)
• Asian ethnicity

How do I care for myself after a tear?

Tears that occur during delivery are repaired with stitches that dissolve over time. You will likely have increased pain and sensitivity after a repair. Here are some ways you can manage the pain while you heal:

• Take over-the-counter medications such as acetaminophen and ibuprofen
• Take a stronger medication, if needed, that has been prescribed by your doctor
• Use ice packs
• Rest as much as possible
• Take warm sitz baths (a warm shallow bath that cleanses the perineum)
• Use a doughnut shaped pillow to sit on

Sometimes, it is difficult to relax enough to urinate due to pain. Talk to your doctor if this is the case. “Also, make sure to keep your stools soft by taking stool softener so you do not have to strain. Do not insert anything into the vagina or rectum while you are healing and most importantly, keep the area as dry as possible,” said Dr. Brazell.

What do I need to watch out for after a tear?

Dr. Brazell said the risks of infection and wound breakdown are high after this type of tear. Call your doctor for any increase in pain, swelling, discharge, bleeding or involuntary loss of stool. You should also call your doctor if something just doesn’t feel right. Typically, an initial wound check will be performed within two weeks of delivery after this level of tearing occurs.

“Most women will go on to have another successful vaginal delivery after a third- or fourth-degree tear and most women heal just fine,” said Dr. Brazell. Depending on how you’ve healed, a cesarean section may be the best delivery option for following births, but this is rare. It is important to discuss all your options with your OB/GYN.