An increase in childbirth injuries is not down to poor quality care

A recent report from the RCOG has highlighted that a high percentage of women experience tearing during childbirth. Tommy's midwife Sophie explains that the reasons for childbirth injuries are varied and complicated.

Pregnancy blog, 04/10/2016, by Tommy's midwife Sophie

A recent publication from the Royal College of Obstetricians and Gynaecologists (RCOG) reports that around 90% of women experience vaginal tearing during childbirth - with varying degrees of seriousness.

While there is an increase in the amount of women experiencing tears at birth, it is important to highlight that this rise does not mean a fall in the quality of care. Tearing is a complicated issue which could be caused by a number of things.

What is vaginal tearing?

During childbirth, the vagina stretches to enable the baby to be born. The entrance to the vagina and the perineum – the skin between the vagina and the anus – need to stretch to allow the baby’s head to emerge (or whatever part of the baby is arriving first).

A tear happens when the baby stretches the vagina during birth to the point at which the skin of the perineum strains and then tears. Most women will tear to some extent during childbirth.

Types of tear

Tears are described in ‘degrees’ which indicate their size and effect:

  • 1st degree – This involves the skin of the perineum and the back of the vagina. These tears are often so small they don’t need stitching, and in fact they heal better naturally.
  • 2nd degree – This is when the skin and back of the vagina plus the muscles of the perineum are torn. These tears need to be stitched closed.
  • 3rd degree – This involves the skin, back of the vagina, muscles of the perineum and extends partially or completely through the anal sphincter. Stitches are needed to close these tears.
  • 4th degree – This is the same as the third degree tear, but extends into the rectum. Stitches are needed to close these tears, too.

What causes vaginal tearing?

Possible reasons for the rise in tearing include higher maternal weight and an increase in the average age of mothers who are giving birth for the first time. Injuries are also linked to higher birth weight babies – likely to be caused by a number of pre-existing, or pregnancy developed, medical complications.

Education is a key to preventing childbirth injuries

Women should be taught by their midwives (in antenatal classes or antenatal appointments) about pelvic floor exercises and perineal massage. A strong routine of exercises and massage during pregnancy can help women prepare their bodies for the physical strains of labour and birth. It doesn't however guarantee that there will be no tearing. Minimising injury at the time of birth helps the body to recover after birth and in the early postnatal period.

Severe tears at birth can affect a woman’s short and long term health, including both her physical and mental wellbeing. We as midwives need to help women to understand the physical aspects of childbirth in the antenatal period and to support them to make informed decisions for themselves which will benefit their health in the long term.

Women who have experienced a tear during birth should not feel ashamed to discuss any problems they might have in the postnatal period- with their midwife, no matter how long since birth it has been. We want women to feel empowered to seek help and advice when they need it and not to suffer alone.

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