How to easily care for an episiotomy or vaginal tear after childbirth.
I think as women we can all agree that we would like to preserve our vaginas in the best state possible; especially after we have experienced childbirth.
Whether or not this is your first delivery, the thought of tearing or having to get an episiotomy is not a pleasant one.
Or perhaps you have already experienced one of these with previous labor and want to avoid it again at all costs.
But what is the big difference between tearing and having an episiotomy and why does it happen?
Or are they even necessary in the first place?
Is one of them better or worse than the other (if that’s even possible)?
If it does happen, what are some safe ways that you can care for your body afterward?
So I wanted to share some quick tips on what you can do to care for yourself if you do experience a laceration during labor.
But before we get into that, let’s take a look at the difference between the two, some facts that won’t give you a great mental picture (but are important to know), and if one is actually better than the other.
Yup, it’s just about as terrible as it sounds.
Natural tearing, also known as perineal lacerations, happens when either the baby’s head or shoulders are too large for the vaginal opening.
It can also happen when the vagina does not stretch enough during delivery. Natural tearing happens without any medical intervention and is spontaneous.
Whereas a tear is spontaneous, an episiotomy is a medical intervention of a physician cutting the perineum.
An episiotomy is performed to prevent natural tearing and make the delivery easier through widening the vaginal area. While an episiotomy used to be routine in many deliveries, it is not the common recommendation now. According to the MayoClinic, there are three main scenarios in which an episiotomy should and would be performed:
- Your baby’s shoulder is stuck behind your pelvic bone (shoulder dystocia)
- Your baby has an abnormal heart rate pattern during your delivery
- You need an operative vaginal delivery (using forceps or vacuum)
You Are More Likely to Experience Perineal Trauma If…
I know what you’re thinking…
What are the chances that this is going to happen to me during labor?
There are a few scenarios in which a woman is more likely to experience tearing or have an episiotomy performed during labor.
- If this is the first labor and deliver
- If the doctor has to do an operative vaginal delivery and use forceps or a vacuum
- If you are of Indian or Chinese descent
- Having longer labor where you are actually pushing
- Getting an epidural
- Giving birth the traditional hospital way with your legs up in stirrups
- If the baby’s head is in an abnormal position or is too big
You should have a takeaway from this though…
- There are certain things you can do to prevent perineal trauma, such as:
- Having a natural birth without drugs
- Not using stirrups and laying on your side, sitting upright, or squatting
- Putting warm packs on the perineum
- Using midwives, having a home birth, of using a birthing center
Degrees of Tearing/Episiotomy
I’m giving you a fair warning…these descriptions might make you cringe a bit.
With both tearing and episiotomies, they are rated in degrees, first through fourth, just like a burn. First-degree is tearing or cutting of the skin only.
Second-degree is a tearing or cutting of the underlying tissue of the perineal and or vagina.
With both first and second degree tearing and cutting, they can easily be corrected with a few stitches and you will be back to normal within a month or so.
Third and fourth are not as easy and even pains me to write about.
Third-degree tearing or episiotomy affects the anal sphincter, or the muscle surrounding the anus. A fourth-degree tear or cut goes completely through the anus and affects both the internal and external anal sphincters.
This can also sometimes damage the internal wall of the bowel or rectum. Both of these lacerations require anesthesia and an operating room to correct. These are also both known as an Obstetric Anal Sphincter Injury (OASI) and will take a bit longer to heal and require more care.
While a first and second-degree tear or cut should not have any long-term lasting effects, a third and fourth-degree might. This could lead to incontinence and other issues later in life.
Which is Better?
While neither is preferred, technically speaking natural tearing poses less health risk both immediate and long-term. Episiotomies can lead to a more uncomfortable delivery, longer healing times, and potential infection.
The surgical incision of an episiotomy might be more severe than what a natural tear would have been. Having an episiotomy might also lead to pain during sex or having to take over the counter pain medication or stool softeners for longer periods of time.
If a midline episiotomy is performed, which is a line cut directly from the vagina to the anus, then the patient runs the risk of tearing further and creating a fourth-degree tear. This can also possibly result in a weakened rectum and fecal incontinence; which neither sounds pleasant.
The goal here is to avoid tearing or having an episiotomy all together.
To learn more about that, here are 10 more ways to prevent tearing during childbirth.
Safe Ways to Care for Your Body After a Vaginal Laceration
Not sure where to start, check out our postpartum recovery kit checklist.
No matter the degree of your tear or incision, there are a lot of different things that you can do to ease recovery and attempt to make things better.
If necessary, get an over the counter pain medication recommendation from your doctor.
This can be very helpful if you have pain with just sitting or standing. Make sure you consult with your doctor before taking any over the counter medication, especially if you are breastfeeding. If the pain gets too bad, you might need to ask for a prescription pain reliever.
Easing The #2
Take a stool softener. This will help to move things along smoothly…if you know what I mean.
Even if you are not feeling constipated at first, it is not a bad idea to take a stool softener as a preventative measure. Painful pooping is just no fun!
It also helps to stay hydrated and drink lots of water.
Not only does this help you have smoother poops, but it also helps to make more breastmilk if you are breastfeeding. Plus all the other things that keeping good water intake benefits, your waistline, your skin, and having more energy, which you’re gonna need!
Make sure your drinking enough water with this nifty water bottle that helps to track how much you are drinking.
Another tip if you are having problems going, get a squatty potty. Without getting too technical, a squatty potty helps to align your colon so that your bowels can move your feces easier. Which means you have to do less work to do your duty.
Use a doughnut pillow. This helps to take the pressure off of the incision area and makes sitting more tolerable.
Also, don’t wear any restricting undergarments. Time to invest in some granny panties, if you don’t already have them. When possible, try and stick with basic cotton clothing down there. Cotton is breathable and helps to create some airflow in your nether regions, which is important for the healing process.
Treat Your Peri with Care
If it is painful to wipe down there, use a peri bottle to help wash.
You are going to want to keep that area as clean as possible, this will help to prevent any potential infection.
Use a postpartum cooling pack. These reusable perineal hot and cold packs can be used to reduce swelling and relieve itching associated with healing.
You could also place a chilled witch hazel pad in the area to also help reduce swelling and relieve itching.
Take a Bath
Do a sitz bath for up to 20 minutes in the days following your delivery.
This is where you sit in a tube with warm water just above your hips and butt. If the warmth of the water is not comforting, then you can also use cool water. Try adding some sitz bath soak to your tub for some extra comfort.
With either a natural tear or an episiotomy, it is going to take time to heal. Don’t rush it!
Ask your partner for help with your care and the care of your new baby.
Bringing a new life into this world is a lot of work, while it can be easy to get wrapped up in only caring for your little one, don’t forget about yourself.