Perineal tears and stitches

Tearing during a vaginal birth is one of the most common worries, and it’s a very normal thing to be anxious about. The reassuring truth: some tearing is common, most tears are minor and heal well, and your care team is experienced at repairing and supporting them. Here’s what actually happens, so it feels less frightening.

Why tears happen. As your baby is born, the perineum (the skin and muscle between the vagina and anus) has to stretch a lot, and sometimes it tears. It’s more likely with a first vaginal birth, a bigger baby, a fast birth, an assisted birth (forceps or vacuum), or certain positions. It’s a normal part of birth for many people, not a failure or something you did wrong.

The degrees of tearing. Tears are described by how deep they go:

• First-degree — small, skin-only tears that may need a stitch or two, or none.
• Second-degree — involve the perineal muscle as well; these are the most common and are stitched.
• Third- and fourth-degree — less common, deeper tears extending toward or into the back passage, which need careful repair (usually in theatre) and more follow-up.

Most people who tear have a first- or second-degree tear that heals well.

Episiotomy. Sometimes, instead of (or as well as) a natural tear, your doctor or midwife makes a small cut called an episiotomy to enlarge the opening — for example, to speed things up if your baby needs to be born quickly, or during an assisted birth. It’s done with pain relief (local anaesthetic or an epidural top-up) and stitched afterwards. It’s not routine — it’s used when there’s a clear reason, and you’ll be told if it’s needed.

Stitches. Tears that need repair are stitched with dissolvable stitches that don’t need removing — they disappear on their own over the following weeks. The repair is done with good pain relief so you’re comfortable, and your midwife or doctor will explain what they’re doing.

Can you reduce the chance of tearing? Nothing guarantees no tearing, but a few things may help: perineal massage in the last weeks of pregnancy (there’s a separate guide), a warm compress on the perineum during the pushing stage (ask your midwife), upright or side-lying birth positions, and pushing in a slow, guided way as your baby’s head is born so the tissue can stretch gradually. Your midwife can support all of these.

How it’s likely to feel. Right after birth, the area will be sore, and the stitches can sting, especially when weeing, in the first days. This is normal and eases over the following weeks as you heal. Good aftercare — pain relief, keeping the area clean, ice, and pelvic-floor exercises — makes a big difference, and there’s a separate guide on caring for stitches and your perineum after birth.

Try not to let the fear take over. It’s completely natural to dread tearing, but for most people it’s a minor, well-managed part of birth that heals without lasting problems. Talk to your midwife about your worries and your birth positions, and know that whatever happens, you’ll be looked after and repaired with care.

A note on grazes and no tears. Not everyone tears — plenty of people have only a minor “graze” that needs no stitches, or no tearing at all, especially with second and later babies. So while it’s sensible to know about tearing, don’t assume it’s inevitable or that you’ll need a big repair. Every birth is different, and many are very straightforward on this front.

Some tearing is a common, usually minor part of vaginal birth — most heal beautifully with simple stitches and good aftercare. Focus on the things that may help (perineal massage, a warm compress, upright positions), lean on your midwife, and be reassured that this is very familiar territory for the people looking after you.