Perineal tears widely vary in severity. Some tears can cause significant bleeding, long-term pain or dysfunction. Tears are classified into four categories. First-degree tears which are superficial, don’t require any stitches as they are able to heal by themselves. Second-degree tears require few stitches that can usually be completed by the midwife. Third-degree tears are a little more complicated. They are subdivided into further subcategories:
- 3a: partial tear of the external sphincter involving less than 50% thickness
- 3b: greater than 50% tear
- 3c: internal sphincter is completely torn
Finally, Fourth-degree tears go through the anal sphincter all the way into the anal canal or rectum, this means they will require an operation after giving birth.
Among women who experience a third or fourth degree tear, at leat half suffer from some type of incontinence for up to a year after. The symptoms associated with perineal tears are not always due to the tear itself, since there are often other injuries, such as avulsion of pelvic floor muscles, that are not evident on first examination. Thankfully, I was lucky enough to not suffer with any of this long term and everything had cleared up after eight weeks, which I have been told was due to having a good pelvic floor prior to giving birth first time round. I was also sent to see a physio every other week after giving birth which helped improve my pelvic floor after giving birth.
With Tobias, I laboured in a water birth but after several hours it was seen as unsuccessful and went onto a bed where I was given an episiotomy as his head was large and because of this incision I suffered with a type 3b tear. Immediately after giving birth I was rushed into the operating theatre where I was sewn up. It wasn’t until later that I discovered the ongoing affects of this.
When I was sent home with Tobias I was given medication, stool softener for 2 weeks and told to take pain relief every four hours for the following month. I suffered no pain or discomfort because of this medication. All I seemed to suffer from was itchiness from the stitches!
It wasn’t until my second pregnancy that I found out the extent of the damage. I was sent for tests (which were very embarrassing and uncomfortable) to see the scaring of my anus. It was found that I had substantial scarring that could impact a vaginal birth as I didn’t have the strength nor the ability to hold for long periods of time. I met with specialists who helped me prepare for birth, listened to what I wanted and gave me the opportunity to try to give birth naturally. I was advised to do a number of things prior to giving birth to prepare myself, mentally and physically. So I had a birth plan drawn up for me and was told I would be having a stretch and sweep two weeks before due date to try and get a lighter baby (smaller head)!
For two weeks before my stretch and sweep I had to do a nightly perineal massage. Every day I bounced on my ball for three hours (not all at once) to coax the baby (Hamish) into the correct position. Hot compressions – during the pushing stage of labour, which is a warm towel placed on the perineum, encouraging the skin to stretch.
My main thought throughout, was will I have another tear and if so am I doing more damage. The answer isn’t always straight forward, it’s all a chance game because there are many factors that come into play in cases of severe tearing, but for many women, another birth doesn’t mean another severe tear. Once Hamish was born I was given a thorough examination and there was a second degree tear found but in a different place to the existing scar, the midwife was able to sew me up and I haven’t had any problems since. In fact my pelvic floor is stronger than ever as I’m now able to bounce on a trampoline without any mishaps!
However, I don’t know what will happen in the future with any new babies nor when I go through the menopause or into later life. Time will tell, I guess!