Hey lovely, I’m going to assume you’re reading this as the fear of tearing when giving birth is high up on your worry list! Let’s start off by saying that some degree of tearing is very common for women giving birth vaginally. It is also one of the most common fears I hear from clients during my hypnobirthing courses. So, rest assured it is completely normal if you are feeling worried or anxious about this!
Tearing occurs when the vagina or area between the vagina and anus (the perineum) is stretched during a vaginal delivery. Tears can also happen inside the vagina or other parts of the vulva, including the labia. You may also hear tearing referred to as ‘perineal lacerations’ or ‘perineal tears’.
According to the Royal College of Obstetricians & Gynaecologists (RCOG) up to 9 out of 10 first time mothers will experience some sort of tear, graze or episiotomy (if having a vaginal birth). For the majority of women, these tears are minor and will heal very quickly.
But, you’ll be glad to hear there are some things you can do to reduce the chance of this happening. Keep reading to find out more…
Why Do Tears Occur When Giving Birth?
Tears happen spontaneously as your baby stretches the vagina and perineum during vaginal birth. When it stretches the area can potentially become damaged due to a graze, tear or bruising.
There are many factors that can impact the chance of a tear occurring:
speed of delivery
baby’s size
first baby
position of baby during delivery
coached pushing vs waiting for fetal ejection reflex
prolonged pushing / second stage of labour
assisted delivery via forceps / ventouse
shoulder dystocia (baby’s shoulder becomes stuck behind pubic bone)
Are There Different Types of Tears?
Yes, there are several different types of tear that can occur during a vaginal birth. The types are summarised below:

1st Degree: small, skin-deep tears, which normally heal on their own.
2nd Degree: deeper tear affecting the perineal muscles, which usually needs stitches to heal (about 3 / 10 women will have a 1st or 2nd degree tear).
3rd Degree: tear that involves the muscle that controls the anus (anal sphincter). This will need stitches in theatre with anaesthetic.
4th Degree: a tear that goes further into the lining of the anus / bowel. This will need stitches in theatre with anaesthetic.
Is a Tear the Same as an Episiotomy?
No, they are different. A tear happens spontaneously as baby stretches the perineum. An episiotomy is a cut made by a healthcare provider to your perineum and vaginal wall to make the vagina wider and make more space for baby to be born, allowing them to be born more easily or quickly. Sometimes an episiotomy can extend and become a deeper tear.
Why Might an Episiotomy be Recommended?
There are several reasons why your healthcare team might recommend an episiotomy during childbirth:
if your baby needs to be born quickly due to a concern i.e. raised heart rate
during assisted delivery (forceps / ventouse)
if you are at risk of serious tearing
to create more space for your baby to be delivered
if your baby’s shoulder becomes stuck behind the pubic bone (shoulder dystocia)

An episiotomy must only be performed with your consent, so make sure you understand what the procedure is, the benefits / risks of having it VS not having it, and any alternatives i.e. changing position. If you are unsure always ask questions so that you can make an informed decision.
Before having an episiotomy you will have an injection of local anaesthetic into the muscle to numb the area. Stitches are put in after your baby is born to help repair the area - these will dissolve over the next 2-4 weeks.
How Can I Prevent My Chances of Tearing during Childbirth?
Perineal massage during pregnancy
Doing this from 34 weeks can really help to stretch the perineum to prepare for birth. Ideally do this somewhere quiet, maybe after a bath when you and your perineum are all relaxed! Practicing this gets you used to the feeling of the skin stretching, so it is less of a shock when baby is being born!
Birth Positions
There are certain positions to use in labour which will reduce the pressure on the perineum, to help control the delivery of baby’s head. Avoid lying on your back if you can, as this will increase the pressure on the perineum. Instead, try positions that include kneeling, being on all fours or lying on your side. Upright, forward leaning and open (UFO) is the best position to be in, as gravity can also help in delivery. I love talking about different positions in my hypnobirthing courses, as often people don’t realise how many there are!
Hypnobirthing
Everything you learn in a hypnobirthing course will really help you stay calm and relaxed in labour birth, especially during the ‘pushing’ stage, leading to a more gentle birth and allowing time for the tissues to stretch gradually and carefully. Breathing techniques, visualisations and powerful affirmations can really help; these are all techniques and tools I teach in my courses.

Water in labour and delivery
Using a bath or shower in labour can help soften the vagina and perineal tissues to stretch more easily. Water also helps your body relax, reducing any tension you may experience, and therefore reducing pain and chance of tearing - all things I cover in my birth prep course!
The POOL study performed by a research team at Cardiff University, found that water births did not lead to more serious tears during birth. You can read the summary of the study here.
Listen to your body and await spontaneous delivery.
Rushing the final phase of birth increases your chances of tearing, so instead follow your instincts, listen to your body and go with it. Avoiding coached or forced pushing helps the perineum to stretch gradually. Listening to your body in the second stage of labour allows your body to rest when needed, allowing for a more gentle delivery. Allow your baby to emerge on their own, slowly and gently. This allows the skin, tissue and muscles to stretch slowly, reducing the chance of tearing.
Postpartum Recovery - What to Think About
Even with the best preparation, some tearing is extremely common. It's also reassuring to know that many women who have experienced a tear in the last stages of labour report that they didn't even feel it, due to all the different sensations going on down there!
Here’s a few pointers on how to look after yourself after giving birth:
Keep the area clean: use warm water to rinse the perineum after going to the toilet each time.
Pain relief: paracetamol and ibuprofen can really help, you can also get numbing sprays/creams, chilled witch hazel pads, or try a sitz bath.
Change your pads regularly, every few hours, to keep the area clean and free from infection.
Pelvic floor rehab: gentle pelvic floor exercises can help recovery.
Eat lots of fibre and stay hydrated to avoid constipation and make going to the toilet more comfortable.
While tearing can’t always be avoided, there are things you can do to really reduce the likelihood and severity when giving birth. Listed above are some great techniques to start building into your birth preparation. If you want to learn more about these techniques and lots of other ways to keep your body relaxed and calm in labour to reduce tearing, then make sure to sign up to one of my hypnobirthing courses to get fully prepared for the arrival of your little one! My next Pregnancy Relaxation Course starts on Sunday 12th January and there are only a couple of spaces left - another way to help prepare for birth in a calm and relaxing way. Check out the Services tab to get booked on!
Thanks for reading, I hope this blog post on tearing was informative and helpful!
Fi x

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