Perineal Tears and Stitches After Vaginal Birth

Between 50-80% of people who have a vaginal birth will experience some level of tearing in/around the vagina/vulva. Although this subject is one most people don't like to talk or think about, it can help to know that about 30% will have only a small a tear or "graze" that does not require stitches (a peri spray bottle filled with warm water for relief while peeing, however, is vital!). For those with a more significant perineal tear, stitches are necessary for proper healing. Below are some key facts and tips to know about vaginal tears and stitches to help you become more informed and prepared for the early hours and days postpartum. 

1. Many small tears do not require stitches. Your care provider will inspect your vagina/vulva and perineum after birth to determine if intervention is required for repair. Your provider should tell you if there is a small tear or graze, even if stitches aren't required. This will be helpful to know as you move through the first hours and days after birth. 

2. "Down there" is tender after vaginal birth, no matter what. Whether you've experienced a tear or not, small or big, your perineum and vaginal area will be sore and you'll want to treat it tenderly. 

3. Healing tears feel better with a "peri bottle." The little plastic squeeze bottle they tell you to use when you pee? Do it. Tears, big or small, will cause stinging when urine hits them. Spraying warm water on your vulva while urinating will greatly reduce or eliminate stinging pain. 

4. Most minor tears heal within 1 to 3 weeks. 

5. A first degree tear is the least severe and often does not require stitches. The tear involves the first layers of tissue. A second degree tear is the most common and slightly larger, involving tissue and muscle. Repair requires stitches. A third degree tear involves skin and muscle, and extends to the anus. A fourth degree is the most severe and least common and includes the above, plus injury to the sphincter muscles and rectum. Second degree tears can take 3-4 weeks to heal. Third and fourth degree tears can take up to 3 months to heal. 

6. Stitches used to repair vaginal tears are dissolvable and do not need to be removed. 

7. Stool softeners are key to comfort in healing from a vaginal tear. Stool that is easy to pass prevents unnecessary straining, stretching, and discomfort from perineal skin that is tender and needs to heal. 

8. A vaginal tear in your first birth does not mean you'll necessarily have a tear in a later birth. In fact, tears are less common with subsequent births. 

9. There is little evidence to support perineal massage as a way to prevent tears, except for a first-time birth. Learn more at Connecting the Dots. 

10. Interventions like forceps- and vacuum-assisted birth can increase the incidence and severity of a tear. 

11. Episiotomies are not evidence-based and can increase the severity of a vaginal tear.

12. Use of a warm cloth/compress over the perineum during pushing in birth has been shown to reduce the rate of tearing.

13. Witch hazel, sitz baths, and ice packs are excellent ways of soothing a perineum healing with tears after birth.  

14. Call your doctor if you experience a fever, foul-smelling discharge, or pain that doesn't go away, even with medication, as these may be signs of an infection.