Delving into the World of Perineal Tearing
“I just remember my care provider saying the degree of tear...But none of this was really EXPLAINED to me”
As a 4TFM instructor, I am always striving to learn more in order to better serve the participants in my classes. My recent Postpartum Recovery ® series promoted discussion on the topic of vaginal tearing, as 3 out of 12 women opened up about their experience with 4th degree tears. A fellow 4TFM instructor, Felecia Thurman, chimed in to me about her experience with this topic, “I just remember my care provider saying the degree of tear, and another OB came in that was better at stitching. But none of this was really EXPLAINED to me, and I didn’t ask any other questions.”
Dr. Bridget of Slainte’ Chiropractic in Jacksonville, FL, revealed from her experience of having a 4th and 3rd degree tear* with her two births, “I had no idea this was a thing. Never prepared for it. No clue it existed.” She revealed to me that she struggled with being able to do things as she normally would, like walking, standing and holding her baby, and intimacy.
You’ll never look at Kiwi the same!
* 3rd and 4th degree tears make up what is known as OASIS (Obstetric Anal Sphincter Injuries) and involve a greater likelihood of experiencing fecal and flatus incontinence, as well as pelvic organ prolapse.
I KNOW that these women are not alone in their stories, and it got me thinking about a way to help MORE women better understand the varying degrees of tearing that can happen during birth, and what it means for postpartum recovery and beyond. Let’s dive right in for a visual explanation we can all connect to.
Warning, you may never eat kiwi again after watching this video
Whoa!
How do I recover from this?
If YOU are someone who experienced tearing during childbirth, what do you need to keep in mind for recovery? Check out these recovery tips below that I have learned from personal experience, and also my work as a birth doula:
Keep the area clean to prevent infection. Peri bottles with warm water can be used during/after toileting, and drops of lavender can be added to increase healing, as well as initiate feeling fresh and clean. Consider healing sitz baths as well, which can be combined with postpartum herbal formulas or epsom salt. Also, PAT the area dry, avoiding rubbing.
Peri bottle and hemorrhoid wipes!
Frozen pads (with witch hazel) can be worn in the general area to help with inflammation. Change pads frequently as well to avoid infection.
Discuss pain medication options with your care provider.
For 3rd and 4th degree tears, sit on a donut hole, especially when riding in the bumpy car.
Use stool softeners as needed, drink plenty of water and eat fiber foods. Consider eliminating bowel movements with the use of a squatty potty to avoid straining, and use low pitch sounds to open the glottis in the throat, relaxing the pelvic floor muscles.
A heat lamp can help promote healing and blood flow to the area, so consider using when able to lie in bed without pants on. Keep at a safe distance to avoid getting burned.
Begin your recovery with mindfulness on posture and breathing exercises to start connecting to the pelvic floor and core. “Gentle” pelvic floor exercises can be performed to start stimulating blood flow and healing, and offer support to the area of weakness (especially with 3rd and 4th degree tears). During PF exercises, make sure to emphasize focus on the BACK half of the pelvic floor, around the anus area.
After 6 weeks postpartum, begin looking into perineal scar massage (see video below).
When resuming intimacy, consider using plenty of lubrication, and focus on “relaxing” the pelvic floor muscles. Consider perineal massage “before” intimacy if discomfort occurs during penetration. If discomfort occurs during the orgasm, do the massage “after” intimacy. If needed take penetration off the table so your mind learns to associate intimacy as pleasure rather than pain. Dyspareunia is a common occurrence for women after birth for more reasons than simply perineal tearing. Know that you are NOT alone, and you can seek a Pelvic Floor PT for additional support, or join any 4TFM classes for open support and discussion on this topic and more!
Keep in mind that tearing during birth IS a physical event, but it is very much emotional as well. If you feel any symptoms of anxiety, panic attacks, negative mental thoughts associated with your birth, lack of connection and bonding with your baby, persistent irritability or trouble sleeping…etc you may be experiencing postpartum PTSD. Please reach out to a local therapist or contact PSI International for support (https://www.postpartum.net/learn-more/postpartum-post-traumatic-stress-disorder/)
Know that you are NOT alone in this and that there is help for you!
Researching this topic has helped me not only to be able to better serve the participants in my classes, doula clients, and the community at large, but it has provided healing and understanding for MYSELF, having experienced a 3rd degree tear after having my first baby. Delving into this topic helped validate for ME the feelings I had about 8 years ago, of trauma during birth, discomfort with my recovery, and emotional issues I had to work through when resuming intimacy. This topic greatly matters, whether you personally experienced tearing recently or many years ago; it even matters for women simply wanting to become better educated about birth and recovery options.
Sources:
OASI Care Bundle Project Team, et al. “Care of a Third- or Fourth-Degree Tear That Occurred during Childbirth.” Royal College of Obstetricians & Gynaecologists, 2020, www.rcog.org.uk/en/patients/patient-leaflets/third--or-fourth-degree-tear-during-childbirth/.
“Slide Show: Vaginal Tears in Childbirth.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 11 Oct. 2019, www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/multimedia/vaginal-tears/sls-20077129?s=4.
Our guest blogger is Anne Homan, a former early childhood education teacher and mother to 3 children. Anne is a well-loved and experienced DONA certified doula, a certified prenatal and postpartum fitness instructor, and all around pelvic floor and core fitness enthusiast. She loves CrossFit and Jazzercise and being out in nature. She founded and leads a local group “Mama Moves” in her community in Amelia Island, Florida. Her passion is to educate women in their birthing choices and encourage them through their postpartum journey. Anne is certified to teach Birth Ball Basics™, Postpartum Recovery® Fitness and Pelvic Floor, Core & More™. We are blessed to have her in our instructor family.
