Tearing: Why Me?


Introduction


The body undergoes so many changes when it comes to childbirth. One thing many women experience during birth is natural tearing. Tearing is very common! 85% of moms experience some minor tearing during childbirth. A baby’s crowning head is often the moment a tear occurs because of the pressure the head puts on the surrounding skin and muscles. Most tears occur along the perineum: the area between the vulva and the anus.


Natural tears are particularly common in women having their first child. Most tears occur because the vagina hasn’t stretched enough to relieve the pressure of the baby’s head.


How common are natural tears?


3 out of 4 first-time moms experience moderate tears (2nd-degree tears)
3 in 100 first-time moms experience severe tears (3rd- and 4th-degree tears)
1 in 100 moms who’ve given birth before experience severe tears (3rd- and 4th-degree tears)

Of course, everyone is different and there are many factors that make moms more prone to tearing than others. For example, tearing is more common in smaller women with naturally shorter perineums. Learn more about other predisposing factors below in the section, “Who is more at risk?”


The 4 degrees of tearing

There are 4 different types of vaginal tears from childbirth: (1)


1st-degree: tearing of the perineal skin and mucous membrane

2nd-degree: a deeper tear that reaches the perineal muscle

3rd-degree: tear that reaches the anal muscles

4th-degree: tear that reaches the anus membrane

Healing times and pain often increase with higher degrees of tearing. The deeper the tear, the more muscle is damaged, and torn muscles take particularly long to heal. The most severe case, tears that reach the anus, also has a lengthy recovery and is often the most tedious and painful.


Who is more at risk?


Are you worried about perineum tearing? It is natural, but avoiding a tear altogether is also ideal. Here are a few things that might make perineal tears more probable for some mothers:

1.Undergoing an episiotomy during birth (incision of the perineum to widen the birth canal)
2. Having assistance from forceps or vacuums during particularly difficult births
3. Giving birth for the first time
4. Delivering an unusually large baby
5. Having a small or petite stature
6. Being overweight
7. Having gestational diabetes (diabetes onset during pregnancy) and recurring low blood pressure


Strong evidence suggests that episiotomies increase a mother’s chance of tearing further along the incision. Once the vulva is cut, its resilience is compromised and the perineum is more likely to tear, especially under the pressure of a crowning head. Furthermore, episiotomies are often paired with forceps or vacuums to help get the baby out.


Tools alone create additional pressure on the vulva and have been linked with perineal tearing. Assisted births are stressful and the mother is likely tense and scared. Pressure from the baby combined with added pressure from instruments can heighten a mother’s chance of tearing. (2)


First-time moms tend to tear more often than moms who’ve given birth in the past. This is likely because the skin and muscles of the perineum are stretching to a large extent for the first time and the body is undergoing dramatic and unprecedented physical changes to deliver the baby. During a second or third birth, the vulva has stretched to that extent before, so the skin and muscles stretch more readily. (2)


A particularly large baby causes more pressure on the perineum during birth. Large babies have also been associated with higher degrees of tearing (2nd-, 3rd-, and 4th-degree tears). This is because the skin and muscles of the perineum can’t stretch enough to make way for the baby, so strong pressure builds which could lead to a tear. (2)


Mothers who have a small physique might be more at risk of tearing because their perineum is shorter. There is less room for the vagina and outer skin to stretch during delivery. It has been seen that 1 in 5 teenage mothers experience a perineal tear from childbirth. This points to some additional risk of tearing for mothers who have a smaller physique and thus a shorter perineum. (3)


But it’s not just small women—heavier women may also be more at risk of tearing. Perineal tears have been associated with mothers who are overweight. Skin elasticity and muscle health may be impaired by a particularly high body mass index, which could affect a mother who is birthing a large baby or giving birth for the first time. (3)


Recurring low blood pressure may limit a mom’s muscles during birth. Gestational diabetes is a form of diabetes that occurs in women during pregnancy. Gestational diabetes often causes high blood pressure in both the mom and baby. If not monitored carefully, the high blood pressure can lead to the baby being overfed (through the umbilical cord) and cause the baby to grow extra large, leaving the mom more at risk of tearing at birth. (4)


Conclusion


There are many things that might cause natural tearing at birth! Some things are hard to avoid, such as delivering a particularly large baby or having poor muscle health due to gestational diabetes. There is nothing moms can do to change their frame or are giving birth for the first time, either! However, there are some ways to be proactive about tearing during pregnancy.



References

  1. Elizabeth R Cluett, Ethel Burns, and Anna Cuthbert, 2018. “Immersion in water during labour and birth” Cochrane Database of Systematic Reviews, doi:10.1002/14651858.CD000111.pub4

  2. Sam McCulloch Dip, 2018. “Tearing During Birth – 9 Ways To Help Prevent Tearing” BellyBelly Birth & Early Parenting Immersion

  3. María Teresa Sánchez-Ávila et al. “Prevalence of high-grade perineal tear during labor in Mexican adolescents” Colomb Med (Cali). 2018 Oct-Dec; 49(4): 261–264. Published online 2018 Dec 30. doi: 10.25100/cm.v49i4.3515

  4. “Gestational Diabetes and Pregnancy” Centers for Disease Control and Prevention. U.S. Department of Health & Human Services. Page last reviewed: June 1, 2018