Advice following 3rd or 4th degree tear

What is a third or fourth-degree tear?

It is common for birthing people who have a vaginal delivery to experience some degree of grazing or tearing to their perineum during childbirth. The perineum is the area of skin and muscle between your vaginal opening and your back passage.

There are four types of perineal tears:

• 1st degree tears involve injury to the vaginal skin only
• 2nd degree tears involve injury to the perineal muscles
• 3rd degree tears involve injury to the perineal muscles and anal sphincter
• 4th degree tears involve injury to the perineal muscles, anal sphincter and lining of the rectum.

Images by Student Midwife Studygram Ltd

What will happen if I have a third or fourth-degree tear?

The tear will be repaired in theatre under spinal anaesthetic or epidural. These stitches will eventually dissolve and will not need to be removed. Following the repair, antibiotics are prescribed for seven days to reduce the risk of infection. Regular painkillers and anti-inflammatory medication will help keep you comfortable. You will also be prescribed laxatives. It is important to take a laxative dose sufficient to ensure the easy passage of soft stools but not so much that bowel control is a challenge. Sometimes, this balance can be difficult to achieve, so discuss this with your midwife if you are having any problems.

It is normal for stitches to feel sore at first, particularly when walking or sitting. Try and rest when your baby sleeps, you may find lying on your back with your knees bent up or on your side with a pillow between your legs comfortable. When sitting for any length of time, arrange a rolled-up towel under your thighs to reduce the pressure on the area of injury. You can also try some feeds lying on your side with your baby next to you.

Rest

It is normal for stitches to feel sore at first, particularly when walking or sitting. Try and rest when your baby sleeps, you may find lying on your back with your knees bent up or on your side with a pillow between your legs comfortable. When sitting for any length of time, arrange a rolled-up towel under your thighs to reduce the pressure on the area of injury. You can also try some feeds lying on your side with your baby next to you.

Hygiene

Whilst you are healing, it is important to keep your stitches clean and use warm water to wash the area. Avoid using a sponge or flannel to wash around your stitches. If possible, take a shower rather than a bath to avoid soaking your stitches in the dirty bath water. Pat the area dry with toilet paper or a soft, clean cloth.

It is important to wash your hands before as well as after using the toilet to reduce the risk of infection and ensure that you change your maternity pads regularly.

Ice

Placing an ice pack wrapped in a clean towel over the vaginal area or over your stitches will provide temporary pain relief and help reduce swelling. A bag of frozen peas is the ideal shape for this. The ice pack can be left in place for 5-10 minutes and should not be placed directly on your skin as it can cause damage.

Opening your bowels

You can safely open your bowels without damaging your stitches. To make this comfortable, avoid constipation and do not strain.

You may find the following tips helpful:

• If you have been prescribed laxatives, continue to use as needed.
• Ensure that you are drinking enough fluid. Aim to drink 1.5-2 litres of liquid a day.
• Include high-fibre foods in your diet, such as fruit and vegetables.
• Sit on the toilet with your feet on a footstool and lean forward, resting your forearms on your knees. In this position, your knees will be higher than your hips. This position will reduce the need to strain.
• Support your perineum with a clean maternity pad or a pad of clean toilet paper when you bear down to empty.

Images by Student Midwife Studygram Ltd

Emptying your bladder

Pouring a jug of warm water over your stitches whilst emptying your bladder will dilute the urine and reduce any stinging. Drinking plenty of fluid will also keep your urine diluted.

When should I contact a healthcare professional?

• If your stitches become more painful
• If your stitches start to smell or you develop unusual discharge
• If your wound oozes or doesn’t heal
• If you have trouble controlling your bladder or bowels
• If you have any other concerns about your wound

Pelvic floor exercises

All birthing people should practice pelvic floor exercises regardless of their type of delivery. These exercises strengthen the muscles around the vagina and back passage and prevent incontinence and pelvic organ prolapse. It is important to do these as soon as you can empty your bladder normally after childbirth and continue practising them for the rest of your life.

• Find your pelvic floor muscles
• Exercise in pregnancy
• Sussex Wellbeing & Exercise in Pregnancy Programme (WEPP)