Perineal trauma is classified by health care providers in degrees: first degree trauma involves just the perineal skin and vaginal lining; second degree trauma involves the skin, perineal muscles and connective tissue; third degree trauma involves the perineal muscles through to the anal sphincter; and fourth degree trauma involves opening the entire perineal area into the rectum itself. To view images of the different types of tears, check out http://gynaeonline.com/perineal_tear.htm.
Perineal trauma includes both tearing and episiotomy. Episiotomy is a medical procedure where the perineum is cut to allow the baby to be delivered faster. Because an episiotomy often cuts deeper than a perineal tear would have gone, and because it cuts through nerves and muscles that may be spared during natural tearing, many health care providers don’t use episiotomies as often as they used to. It is still a valuable medical procedure in some settings, but the stature of this “man-made” perineal trauma has fallen for normal births.
Both tears or episiotomies can be sutured or stitched after childbirth to facilitate healing. No matter what the cause, perineal trauma increases healing time and postpartum complications. Perineal pain from trauma after childbirth is high with:
- 40% of women reporting pain during the first two weeks after giving birth (is that really all!)
- 20% reporting pain at two months
- 9% still feeling pain at three months.
Women who have an intact perineum report significantly less pain than women who have experienced perineal trauma.