Vaginal Tears During Childbirth

Vaginal tears happen during most births. If you’re preparing for delivery or recovering from one, understanding what these injuries are, how they’re treated, and what to expect can help you feel more prepared and less alone in the experience.

What Are Vaginal Tears and How Common Are They?

Vaginal tears, also called perineal lacerations, are injuries to the tissue between the vaginal opening and the anus that occur during childbirth. This area, called the perineum, stretches significantly as the baby moves through the birth canal. Sometimes this stretching causes the skin and underlying tissue to tear.

These tears are incredibly common. Between 53% and 79% of all vaginal deliveries involve some form of tearing. If you’re having your first baby, the numbers are even higher. Up to 9 in 10 first-time mothers experience a tear, graze, or episiotomy during vaginal birth.

The good news is that most tears are minor and heal well with proper care. Each year in the United States, over 1.3 million obstetric laceration repairs are performed, and healthcare providers have well-established protocols for managing these injuries.

The Four Degrees of Vaginal Tears Explained

Not all tears are the same. Doctors classify them into four degrees based on how deep they go and which tissues are affected.

First-Degree Tears

These are the most superficial tears, affecting only the skin around the vaginal opening and perineum. Think of them as similar to a shallow cut on your skin. They often heal on their own without stitches and typically cause minimal discomfort.

Second-Degree Tears

Second-degree tears go deeper, extending into the perineal muscles beneath the skin. These are the most common type of tear that requires suturing. While they need more care than first-degree tears, they generally heal well within a few weeks with proper treatment.

Third-Degree Tears

This is where tears become more serious. Third-degree tears extend into the anal sphincter muscle, which controls bowel movements. These require careful, intricate repair by an experienced provider. Because they involve the muscle that helps control your bowels, there’s an increased risk of complications like fecal incontinence if not properly repaired.

Fourth-Degree Tears

Fourth-degree tears are the most severe. They extend through the anal sphincter and into the rectal lining, which is the tissue inside the rectum itself. These tears often need to be repaired in an operating room and require specialized surgical technique. They carry the highest risk of long-term complications.

Severe third- and fourth-degree tears occur in approximately 2–5% of vaginal deliveries. While this percentage may seem small, it translates to thousands of mothers each year who need extensive repair and recovery support.

Risk Factors That Increase the Chance of Tearing During Delivery

Certain factors make vaginal tears more likely. Understanding these can help you have informed conversations with your healthcare provider about your individual risk.

• First vaginal delivery: If this is your first time giving birth vaginally, your perineum hasn’t stretched before, which increases tear risk
• Instrument-assisted delivery: The use of forceps or vacuum extractors significantly raises the likelihood of more severe tears
• Larger baby: Babies weighing more than 4,000 grams (about 8 pounds, 13 ounces) put more pressure on the perineum
• Prolonged pushing stage: A longer second stage of labor gives more time for tissue stress and potential tearing
• Episiotomy: Contrary to old thinking, surgical cuts to the perineum can actually extend into more severe tears
• Baby’s position: When the baby is facing up (occiput posterior position) rather than facing down, tearing is more common
• Asian ethnicity: Research shows higher rates of severe tears among Asian mothers, though the exact reasons aren’t fully understood

If you have multiple risk factors, it doesn’t mean you’ll definitely tear severely, but it’s worth discussing prevention strategies with your provider.

What Happens Immediately After a Vaginal Tear

Right after delivery, your healthcare provider will carefully examine you to assess whether you have a tear and how severe it is. This examination happens while you’re still in the delivery room, often while you’re meeting your baby for the first time.

For minor tears, repair happens quickly at the bedside. Your provider will use local anesthesia to numb the area if you don’t already have an epidural, then use dissolvable stitches to close the tear. The process usually takes 15 to 30 minutes.

More severe tears require different management. Third- and fourth-degree tears need repair by a provider experienced in these techniques, and fourth-degree tears are often repaired in an operating room where lighting and positioning are optimal. The repair involves carefully reconstructing the layers of tissue, including the muscle and, in fourth-degree tears, the rectal lining.

After repair, you’ll receive specific care instructions and typically a prescription for antibiotics to prevent infection in cases of third- and fourth-degree tears.

Short Term Recovery and What to Expect in the First Weeks

The first few weeks after a vaginal tear can be challenging. Your body is recovering from childbirth while you’re also caring for a newborn, which doesn’t leave much time for rest.

Pain and Discomfort

Pain is normal, but it should be manageable with the medications your provider prescribes. Most mothers with first- or second-degree tears find that pain improves significantly within the first week. With more severe tears, discomfort may last longer.

You can help manage pain by:

• Using ice packs on the perineum for the first 24 hours
• Taking pain medication as prescribed, before pain becomes severe
• Using a peri bottle with warm water when urinating to dilute urine and reduce stinging
• Sitting on a pillow or cushion rather than hard surfaces
• Avoiding constipation, which puts pressure on healing tissue

Wound Care

Keeping the area clean is essential but doesn’t need to be complicated. Gently pat the area dry after using the bathroom; don’t wipe. Change your pad frequently. Most providers recommend using pads rather than tampons for postpartum bleeding.

Bathroom Challenges

Many mothers worry about their first bowel movement after tearing. This anxiety is completely understandable, but constipation makes things worse by creating harder stools that strain the repair. Your provider will likely prescribe a stool softener; take it. Drink plenty of water and eat fiber-rich foods when you’re able.

Urination might sting at first, especially with second-degree or worse tears. Using the peri bottle with warm water while you urinate creates a barrier between urine and the raw tissue.

When to Call Your Healthcare Provider About Healing Concerns

Most tears heal without complications, but infections and wound problems can occur. You need to know the warning signs that require immediate medical attention.

Contact your provider right away if you experience:

• Pain that’s getting worse instead of better, or pain that isn’t controlled by your prescribed medication
• Foul-smelling discharge from the vaginal area
• Fever over 100.4°F (38°C)
• Stitches that seem to be coming apart or opening
• Increased redness, swelling, or warmth around the tear
• Pus or unusual drainage from the wound

These symptoms could indicate infection or wound breakdown, both of which need prompt treatment. Don’t wait or feel like you’re bothering anyone by calling. These concerns need professional evaluation.

Long Term Complications and What Research Shows

While most vaginal tears heal completely, some women experience lasting effects, particularly with third- and fourth-degree tears that involve the anal sphincter.

Ongoing Pain and Discomfort

Some mothers continue to experience pain in the perineal area months after delivery. This can range from mild discomfort to significant pain that affects daily activities. Chronic pain occurs more often with severe tears but can happen with second-degree tears as well.

Painful Intercourse

Dyspareunia, or painful sex, is a common concern after vaginal tears. The scar tissue that forms during healing is less elastic than the original tissue, which can cause discomfort during intercourse. This often improves with time, but some women benefit from pelvic floor physical therapy to address scar tissue and muscle tension.

Incontinence Issues

This is the complication that worries many mothers most, and it’s primarily associated with third- and fourth-degree tears that damage the anal sphincter. Fecal incontinence, or the inability to control bowel movements, can range from difficulty controlling gas to inability to control stool. Urinary incontinence can also occur, though it’s often related to other birth factors beyond just tearing.

Research shows that proper surgical repair and pelvic floor rehabilitation significantly reduce the risk of incontinence. If you’re experiencing these issues, specialized pelvic floor physical therapy often helps, and in some cases, additional surgical procedures can improve function.

Scarring

All tears create scar tissue as they heal. Usually this scarring causes no problems, but sometimes it can create tightness or irregular tissue texture that causes discomfort. Some women notice excess scar tissue growth (called hypertrophic scarring) that may benefit from massage or other treatments.

Specialized Treatment for Severe Tears

Third- and fourth-degree tears require more intensive management than minor tears, both immediately and in the weeks following birth.

Surgical Repair

The repair itself is performed in layers, carefully reconstructing the anal sphincter muscle and, in fourth-degree tears, the rectal lining. This is meticulous work that requires experience and proper technique. Don’t hesitate to ask about your provider’s experience with these repairs if you’ve had a severe tear.

Antibiotics

Unlike with minor tears, antibiotics are standard after third- and fourth-degree tears to prevent infection in the deeper tissues and around the anal sphincter. Take the full course even if you feel fine, because infection in these repairs can have serious consequences for healing.

Pelvic Floor Physical Therapy

This isn’t the same as regular physical therapy. Pelvic floor physical therapists specialize in the muscles and tissues involved in bowel, bladder, and sexual function. They can assess your muscle strength and coordination, work on scar tissue, and teach you exercises to restore function.

Many insurance plans cover pelvic floor physical therapy, especially when you’ve had a third- or fourth-degree tear. Ask your provider for a referral before you leave the hospital, so you can start treatment as soon as you’re ready, typically around 6 weeks postpartum.

What a Severe Tear Means for Future Pregnancies

If you’ve had a third- or fourth-degree tear, you’re probably wondering what this means if you want more children. The research offers some reassurance.

The recurrence rate for severe tears in subsequent vaginal deliveries is relatively low, between 6% and 8%. This means that about 9 out of 10 women who had a severe tear in their first birth won’t experience another one in their next vaginal delivery.

That said, having had a severe tear is something your healthcare team should know about and plan for. Some providers may recommend certain interventions during delivery to reduce risk. In rare cases where there were significant complications or lasting problems from the first tear, you and your provider might discuss whether a planned cesarean section makes sense for future deliveries.

These are deeply personal decisions that depend on your individual circumstances, how you healed, and what complications you experienced. There’s no one-right-answer, and you deserve a provider who will discuss all options with you openly.

Evidence Based Prevention Strategies

While not all tears can be prevented, research has identified several techniques that can reduce the risk of severe tearing.

Perineal Massage

Studies show that massaging the perineum in the weeks before delivery can reduce the risk of tearing and the need for episiotomy, particularly for first-time mothers. This involves gently stretching the tissue between the vaginal opening and rectum, usually starting around 34-35 weeks of pregnancy.

Your provider or a pelvic floor physical therapist can teach you the proper technique. While it may feel awkward at first, many women find it becomes part of their routine.

Controlled Delivery of the Baby’s Head

The moment of crowning, when the baby’s head is emerging, is when most tears occur. Slow, controlled delivery of the head gives tissues time to stretch rather than tear. Your provider may ask you to stop pushing and breathe through contractions at this point, or to push very gently.

This requires good communication between you and your delivery team, which is easier when you’ve discussed this approach beforehand.

Restrictive Use of Episiotomy

An episiotomy is a surgical cut made in the perineum to enlarge the vaginal opening during delivery. For decades, episiotomies were routine, with the thinking that a clean cut would heal better than a tear. Research now shows this isn’t true. Episiotomies actually increase the risk of the cut extending into a third- or fourth-degree tear.

Current guidelines recommend restrictive use of episiotomy, meaning it’s only done when medically necessary, not routinely. If your provider suggests an episiotomy, it’s reasonable to ask why it’s needed in your specific situation.

Warm Compresses

Some research suggests that applying warm compresses to the perineum during the pushing stage may help reduce tearing, though the evidence is mixed. It’s a low-risk intervention that some providers use routinely.

Positioning

While more research is needed, some positions may reduce tearing risk compared to others. Side-lying and upright positions may be better than lying flat on your back, though the most important thing is finding a position where you can push effectively.

The Emotional Side of Recovering From Vaginal Tears

The physical aspects of vaginal tears get most of the attention, but the emotional impact deserves recognition too.

Many mothers feel shocked or traumatized by the experience of tearing, particularly if it was severe or if they felt unprepared for the possibility. Some feel angry if they believe the tear could have been prevented. Others experience anxiety about future deliveries or about their body healing properly.

These feelings are valid. Birth doesn’t always go the way we hope, and processing that disappointment or trauma takes time. Some women find it helpful to talk through their birth experience with their provider at the postpartum checkup, asking questions about what happened and why. Others benefit from talking with a therapist who specializes in postpartum care.

Pain and physical recovery challenges can also affect bonding and early parenting. It’s hard to focus on your baby when you’re in significant discomfort. If you’re struggling, reaching out for help, whether from your healthcare provider, a lactation consultant, a postpartum doula, or a mental health professional, isn’t a sign of weakness. It’s taking care of yourself so you can take care of your baby.

Understanding the Research and Statistics

The numbers and statistics about vaginal tears come from large-scale studies tracking thousands of births over many years. This research guides clinical practice and helps providers identify which mothers might benefit most from prevention strategies or closer monitoring.

The CDC, through its National Center for Health Statistics, collects data on childbirth outcomes including perineal lacerations. The American College of Obstetricians and Gynecologists (ACOG) reviews this research along with international studies to develop clinical guidelines that providers use nationwide. The National Institutes of Health funds additional research into prevention, repair techniques, and long-term outcomes.

What these organizations emphasize is that while tears are common, most women recover well. The focus of current research is on reducing the rates of severe tears and improving outcomes for women who experience them. This includes better training for providers in repair techniques, identifying risk factors earlier, and supporting mothers through recovery.

Moving Forward After a Vaginal Tear

Whether you’re still pregnant and trying to understand the risks, in the early days of recovery, or months postpartum and still dealing with complications, you’re not alone in this experience. Millions of mothers have walked this path, and while the journey looks different for everyone, understanding what’s happening to your body helps you advocate for yourself and make informed decisions.

Vaginal tears are common, but that doesn’t make your individual experience less significant. If you’re struggling with pain, complications, or the emotional weight of recovery, reaching out for help is important. Most postpartum complications improve with proper treatment and time. You deserve support during this challenging transition into parenthood.