Different Types of Tearing That May Occur During Childbirth

Most blog posts don't get a foreword, but this one does:

Before you full-body cringe reading this blog post, let me proactively hit the pause button. Perineal tearing and vaginal tearing during vaginal birth is incredibly common. Periclitoral tears, periurethral tears and vaginal or sulcus tears are far less common. While there are things we can do to reduce the risk and severity of certain types of tearing, like massaging the perineum during pregnancy, tearing is not entirely preventable. In fact, tearing may be a necessary component of some births in order to assist your body in creating space to allow for a vaginal birth.

If you experienced tearing during childbirth, it is not your fault. If you are scared of tearing during childbirth, you are not alone. Just know that if you tear during childbirth, regardless of the type of tear, the severity of the tear, your body can recover. You do not have to accept pain, leakage or other symptoms as your forever, no matter the severity of your tear. PT can help.

If you haven't already downloaded our free perineal massage guide, download it here. This guide will talk you through when to begin the perineal massage, why massaging your perineum during pregnancy may help your prepare for birth, how much perineal massage is too much and what to do if massaging your perineum hurts. If you’re interested in learning more about how to prepare your pelvic floor for birth, check out our self-paced online course Birth Preparation and Postpartum Planning.

Now, on to the good stuff.

One of the most common concerns I hear from pregnant people is about tearing. While there are many forms of tearing that can occur during childbirth, perineal tearing gets the most press. This is both because perineal tearing is the most common form of tearing and also because it is the most researched form of tearing. This blog post breaks down the different forms of tearing that can occur during childbirth, including some you may not be as familiar with.

Keep in mind, while tearing is a common occurrence during vaginal birth, there are some ways to reduce the likelihood and severity of tearing during childbirth. Check out this Youtube video on perineal massage to learn one technique you can utilize during pregnancy to reduce the severity of perineal tearing.

Now, below we'll break down different types of tearing that may occur during vaginal birth, including:

• perineal tears

• periurethral tears

• clitoral and periclitoral tears

• labial tears

• sulcus tears

• vaginal wall tears

If you want a visual, check out this great visual by OBGYN Academy.

Perineal tearing

Perineal tearing, as mentioned above, is the most common form of tearing during childbirth. It's also the one we know the most about. Perineal tearing is tearing that occurs in the perineum (obvious, I know). The perineum is the band of tissue that runs between the vaginal and anal opening.

This form of tearing is graded on one to four scales. A grade 1 tear is a superficial tear of the skin at the bottom of the vagina and typically does not require any stitching. A grade 2 tear is slightly deeper, tearing both the skin and into the muscle layer in the perineum. A grade 3 tear impacts the skin and muscle of the perineum but goes deeper into the external anal sphincter. A grade 4 tear, also called a full-thickness tear, is a tear that spans from the vaginal opening to the anal opening.

Before you panic, it's important to call out that grade 1 and 2 tears are extremely common, occurring in up to 85% of vaginal births according to RCOG. These tears may or may not require stitching and typically heal relatively quickly. More severe tearing, such as a grade 3 or 4 tear, is far less common and occurs in roughly 5% of vaginal births. While grade 3 and 4 tears are more typically associated with pain and leakage postpartum, there is so much that can be done to help someone recover from any degree and any form of tearing. In the case that someone experiences pain or symptoms associated with a tearing, pelvic floor physical therapy, scar massage and a topical estrogen cream can all be extremely helpful.

Our Birth Preparation and Postpartum Planning Course goes into reducing the risk and severity of perineal tearing at length. Check it out here if you want to learn more.

Periurethral tearing

Periurethral tears occur in the opposite direction of a perineal tear. Rather than tearing down towards the anal opening, periurethral tears occur when someone tears up, towards the urethra.

Clitoral and periclitoral tearing

Periclitoral tears occur in the same direction as periurethral tears, but rather than tearing near the urethra they refer to tearing next to the clitoris.

Labial tearing

Labial tearing refers to tearing of the labia, typically in reference to tearing of the labia minora.

Sulcus and vaginal wall tearing

Sulcus tearing refers to tearing of the upper vaginal wall in absence of a grade 3 or 4 perineal tear. With that said, folks can experience tearing of the vaginal wall at any level.

Episiotomy

An episiotomy is when the OB makes an incision in the perineum to assist in a vaginal birth. Episiotomies are no longer a routine part of vaginal birth, however, there are still reasons your provider may need to perform an episiotomy. The episiotomy may be midline or lateral, starting from the bottom of the vagina and extending into the perineum.

Like I said in the beginning, regardless of the severity or form of your tear, pelvic floor physical therapy can help. You do not need to accept pain and leakage as your new forever, no matter what kind of tear you experience during birth. Pelvic floor physical therapy, scar massage and a topical estrogen cream can all be extremely effective in helping address leakage, pain and other symptoms associated with tearing.

If you're wondering what you can do to reduce your risk and severity of perineal tearing, check out our birth prep course or schedule a 1:1 visit with us!