Pregnancy is one of the most exciting and nerve-wracking times in any woman’s life. For most of us – it is not the pregnancy that we worry about, it is the impending labour. The pain, can we survive it, can we do it? (not to mention the many outcomes that could occur).
Everyone knows that one of the most painful things anyone ever goes through is labour. I mean just the word “labour” gives you a rather good idea of why it is named so.
Aside from the long and painful process of contractions, there is also the fear of what happens to you DOWN THERE as your bundle of joy exits. I am talking about the tough stuff – episiotomy, tears, incontinence, pooing. It is almost inevitable that you will have some degree of tearing or injury to the perineum during birth to accommodate the baby as it passes through.
As I am dietitian, I won’t provide any advice around how to
avoid a tear during labour – as that’s an area for your midwife, pelvic floor physiotherapist or your obstetrician (i.e., not in my scope) BUT I CAN HELP WITH THE HEALING PROCESS!
When we talk about tearing and different degrees of tearing what are we even referring to?
The perineum is the area between your vagina and your anus. During the birthing process the perineum can tear. Most commonly this tear will be a first- or second-degree tear.
What does this mean though?
A first-degree tear is a superficial tear to the skin of the perineum, you do not always need stitches for this kind of tear, and you often will not need any further intervention other than to make yourself comfortable and keep the area clean during healing. A second-degree tear is a tear to both the skin and muscle layers of the perineum, and this type of tear often needs stitches. A third-degree tear is a tear through the perineal muscle down to the anal sphincter. A fourth-degree tear is a tear from the vagina through to the anus (Nope. I am not kidding). A third- or fourth-degree tear will often require surgery by a skilled surgeon to repair the area, and continued long-term care and follow up from multiple health professionals.
Only 3% of women in 2018 experienced a third- or fourth-degree tear during birth (1). Approximately a quarter of all women will experience no tearing at all, 23% will have a first-degree tear or an injury that doesn’t require any stitches and around 26% of women will have a second-degree tear that requires stitches (2). Alternatively, around 20% of Australian women will have an episiotomy (controlled surgical cut) during birth (1).
If we summarise those statistics, it really means:
- Half of us will experience a degree of perineal tear during birth
- If this includes episiotomy – the bottom line is that ¾ of us will sustain a vaginal/ perineal injury during a natural vaginal birth. WOW!
AUSMED: Third- and Fourth-degree perineal tears explained” Published 15th February 2021
This makes it super important that all women are informed and educated around how to best avoid this, but also how to manage a tear post birth. The first place to start (since I am a dietitian) is with your nutrition! If you did sustain a tear during birth (2nd or 3rd degree) immediately post birth it is recommended that you have a high fibre diet. This means you should have;
- Wholegrain/multigrain breads and cereals
- Brown rice and pasta
- Legumes and beans All vegetables and fruits
- Nuts and seeds
This will promote easy to pass and regular bowel movements. This type of eating pattern is good to continue long term as it focuses on general healthy eating principles. Your primary doctor/obstetrician should also recommend a stool softener (e.g., Coloxyl stool softener) to assist with easy to pass, well-formed bowel movements with no straining to avoid aggravation of your wound or the perineal area.
If you are in the unfortunate small percentage of women who had a 4th degree tear during birth it is recommended you have a low fibre diet post birth (1 – 2 weeks). This means;
- WHITE carbohydrates (bread, pasta, rice, refined cereals)
- Peeled and well-cooked vegies/peeled fruit
- Any dairy foods
- Soft skinless meats (e.g., chicken and fish) tofu, and eggs
This is to let the area heal, with less bulk to pass. Hydration will be super important for making the stools easier to pass, so you should be aiming for 2L of fluid through the day, and some gentle physical activity. Gradually though it is recommended that you slowly move to a high fibre diet. Medically you will have more involvement with a team of professionals to make sure you are given the best care and advice going forward. Hospitals will often have guidelines around management for each perineal tear category and they will be lead by those guidelines and assist you with the best management.
The real take home message from this blog:
Be gentle with yourself, utilise your health team, always ask for help and remember what an amazing thing you did growing and bringing your little angel into the world.
Until next time,
Big Sis x
References
(1) Australian Institute of Health Welfare (AIHW). National Core Maternity Indicators (2018) Cat. no: PER 95. Last updated. 27 Oct 2020
https://www.aihw.gov.au/reports/per/095/ncmi-data-visualisations/contents/birth-outcomes/c1a
(2) The Conversation [Internet] What we know about perineal tearing, and how to reduce it during childbirth. Published 2016.
https://theconversation.com/what-we-know-about-perineal-tearing-and-how-to-reduce-it-during-childbirth-63212
