Damm tear and other birth injuries

Every expectant mother probably wishes for a complication-free birth. The topic of injuries is rarely discussed in connection with the big day. However, injuries to the intimate area during a natural birth are not unusual – but they are usually not as bad as your mind might imagine. ;) In this article, you will learn which birth injuries can occur, whether they can be avoided, and what you can do to promote the healing process.

1. What birth injuries are there?

During a vaginal birth, various injuries can occur throughout the entire birth area, including the perineum, vagina, labia, clitoris, internal pelvic muscles, sphincter, and cervix.

Most women feel a slight after childbirth. Healing sensation at the vagina and perineum, as this area is particularly stretched and stressed during childbirth. The reason for the wound sensation is tiny fiber tears , which can occur due to the intense stretching of the sensitive tissue. Many women hardly notice the abrasions, while others feel them similar to severe muscle soreness.

Also Bruises ( Hematoma ) can occur in the vaginal area: When the tissue is stretched significantly during childbirth, blood vessels can be damaged. The blood then leaks into the surrounding tissue, causing swelling and a bruise to form. Not all hematomas are visible after birth; they usually manifest as mild pain when sitting, walking, or going to the bathroom.

Even if it may sound uncomfortable at first, both minor tears and bruises usually heal on their own within a few days after birth.

Apart from these minor injuries that most women sustain after a natural birth, it can lead to Tear injuries in the entire birth area. The most well-known (and most feared) is probably the perineal tear. But don't worry: Only very few women experience a severe perineal tear; most of the time, it involves minor injuries that heal without complications.

2. What is the difference between a perineal tear and an episiotomy?

The perineum is the connecting bridge between the vagina and the anus, consisting of skin, muscles, subcutaneous fat, and connective tissue. During a natural birth, the delicate tissue is constantly stressed and stretched by the pressure of the baby's head. When your baby's head and shoulders emerge into the world, it can happen that the perineum is stretched so much that it tears. Depending on the severity and extent of the tears, the injuries are classified as four severity levels classified.

1. Degree

• Superficial tears of the vaginal and/or perineal skin

• Depending on the size, the cracks are closed with a small stitch under local anesthesia or heal on their own

• Wound healing generally proceeds without complications

2. Degree

• In addition to skin tears, superficial perineal muscle injuries occur

• Injuries are stitched under local anesthesia

• Wound healing generally proceeds without complications

3rd degree

• Partial or complete tearing of the sphincter

• Injuries are usually stitched under local anesthesia, in rare cases under general anesthesia

4. Degree

• Injuries to the sphincter muscle and tearing of the intestinal mucosa

• Injuries are stitched, usually under general anesthesia and by a general surgeon

• May in exceptional cases lead to subsequent complications, such as infections, fecal incontinence, or pain during intercourse

When of Damaged the speech is about, it is about mostly about injuries of first or second degree . More severe birth injuries and especially a fourth-degree perineal tear occur only in very rare cases.

Also the Dam Cut ( Episiotomy ) is considered a birth injury. In this procedure, the perineum is cut during childbirth – usually during a bearing-down effort – just to the right side past the anus, in order to to avoid uncontrolled tearing of the tissue and thus a fourth-degree perineal tear, as well as tearing of the intestinal mucosa . Additionally, a controlled episiotomy towards the end of the birth can help to Speed up the childbirth process . Even if they usually do not feel the cut itself during childbirth, many women find the healing process after an episiotomy more uncomfortable than after a tear. Not only for this reason is this procedure controversial nowadays: some experts argue that an episiotomy does not reduce the likelihood of perineal and vaginal tears and is often avoidable. Although the number of episiotomies has decreased significantly in recent years, there are certain situations that make a targeted cut necessary: when the birth needs to proceed quickly, for example because the care of the child can no longer be adequately ensured, an episiotomy can be, depending on the situation, sensible.

3. Can I prevent birth injuries?

Not every vaginal delivery necessarily results in birth injuries. Factors such as the baby's weight, position, and head circumference, the speed of delivery, as well as the height and elasticity of the perineum, influence whether the sensitive intimate area sustains injuries. The likelihood of birth injuries also decreases with the number of vaginal births a woman has already had.

Even before birth, you can prepare your perineum with a Dam massage prepare for the load and the strain and thus try to, a To prevent dammariss . While a perineal massage does not guarantee that birth injuries will be avoided, it helps to make the tissue more supple. Additionally, it assists many expectant mothers in preparing for the birth and approaching it with more calm. You can find everything about the massage and a detailed guide in our article „ Damp massage for childbirth preparation ".

Even during birth, there are some things you can do to reduce the likelihood of injuries. For example, the plays an important role: In the "classic" birth position, for example, lying on your back with bent legs, the strain on the perineum is highest. In the hands-and-knees position or lying on your side, the pressure on the perineum is somewhat lower, and the likelihood of tears in the sensitive tissue decreases. It’s best to discuss with your midwife which posture is most advantageous in each . She may guide you during labor to change positions periodically. Depending on the progress of the birth and the position of your baby's head, your midwife can best assess which position is currently most suitable for you and your baby.

Birth injuries most often occur in the final phase of labor, the so-called pushing phase. During this phase, when the baby's head stretches the perineum the most, your midwife can your Support beams from the outside , to slightly slow down the tension of the head. Additionally, it will guide you to consciously die Contractions for use in pressing . This prevents your perineum from being unnecessarily strained by constant pushing. Even if you can hardly wait to finally bring your baby into the world in this situation, it is quite helpful to pause briefly between contractions or even breathe through them. This allows the perineal tissue to stretch gradually and can reduce tissue tears.

Your gynecologist / your midwife will monitor your perineum during the birth process and will do everything possible to minimize the risk of injury.

4. How are birth injuries treated?

After birth, your gynecologist or midwife will examine the birth area for possible injuries and decide whether wound care is necessary. For abrasions and minor, superficial tears, stitches are usually not required, as they heal on their own within a few days. However, in cases of bleeding or if the wound edges are not perfectly aligned, stitches may be beneficial even for small tears to promote healing. If stitches are needed, they are typically performed immediately after birth, usually in the delivery room and under anesthesia – you probably won't notice much of it, as you will be holding your baby for the first time at the same time.

Your midwife or your gynecologist will also continue to regularly monitor the birth injuries during the postpartum period to ensure that the healing process is progressing well.

5. Do I have to expect pain after birth injuries?

Even if you only sustained minor injuries during birth, they can be uncomfortable or even painful in the first few days. Since each woman experiences these injuries differently, it is difficult to make precise statements about them. If you find the pain very uncomfortable, you can discuss with your doctor or midwife whether taking painkillers is advisable and which ones you can take. For persistent pain, swelling, bleeding, or other abnormalities, you should definitely inform your doctor. These could possibly be due to a wound healing disorder or an infection, which should be treated.

Many women with birth injuries are worried about the first bowel movement after childbirth. By maintaining a high-fiber diet (fiber is found, for example, in flaxseeds or dried fruit) and drinking enough fluids, you ensure that your stool stays soft and hopefully causes no difficulties. The stitches should not be affected by going to the toilet.

6. How can I support the healing process?

If your injuries were stitched after the birth, the stitches usually dissolve within 10 to 14 days. However, it can take several weeks for a birth injury to fully heal. The healing process is very individual and depends on the type and severity of the injuries. However, there are some things you can pay attention to in order to support the healing process:

• Keep the wound clean and dry

  Rinse the wound several times a day with warm water and then gently pat it dry. Many women associate this with using the toilet. Simply use a measuring cup with lukewarm water to help, letting the water run along your intimate area between your legs while urinating. This not only improves hygiene but also dilutes the urine, so urination hurts less in the first few days.

  You should also change your pad regularly—depending on the intensity of the lochia —every few hours to prevent infections from spreading in the moist, warm environment. Allowing air to reach the wound from time to time also positively influences healing. For example, you can lie on your stomach without underwear from time to time (don’t forget a protective sheet).

• Minimize Strain

  To allow injuries to heal undisturbed, make sure to put as little strain as possible on the entire birth area. That means: If you take the postpartum period seriously, stay lying down as much as possible and walk, sit, or stand as little as possible. When sitting, you should choose a position with as little strain as possible, avoiding cross-legged sitting and similar positions to prevent overstretching the wound. A soft pillow or a special sitting ring as a support can help protect the wound area.

  When breastfeeding your baby, some positions are better suited than others to protect your perineum and pelvic floor. In our article “ The ABCs of Breastfeeding Positions ” you will learn how to position your baby immediately after birth without putting too much strain on the still-sensitive birth area.

• Cooling and Care

  In the first days, your perineum may still feel somewhat uncomfortable. You can gently cool it to provide relief and promote swelling reduction. To do this, you can soak some pads in nourishing oil and freeze them. Then, place the frozen pads on your perineum several times a day for as long as it feels comfortable.

  You can also care for the stressed perineum with sit baths, starting around the fourth or fifth day after birth. There are special bidet attachments for this, but a clean bowl or a plastic bag stretched over the toilet bowl will also do. Make sure the water temperature does not exceed 37°C and that the sit bath does not last longer than 15 minutes. If you like, you can add an anti-inflammatory supplement from the pharmacy or a small amount of essential oil such as lavender or chamomile to the sit bath. If you prefer not to take a sit bath, there are also special regeneration sprays for perineal care after birth. It’s best to ask your midwife which product she can recommend.

7. What are possible consequences of birth injuries?

Even if birth injuries can be uncomfortable in the first few days, they usually heal without issues and without leaving long-term scars with proper aftercare. However, it can happen that some women have to deal with the consequences in the long term. In rare cases, infections in the wound area may occur, which need medical treatment. Give your body enough rest and time for undisturbed wound healing. This also includes not rushing into your first postnatal sex: While sexual intercourse is generally possible during the lochia, you should definitely use a condom due to the increased risk of infection and to avoid an unintended pregnancy. Our midwife Sissi recommends waiting six weeks after birth before having sex for the first time. In cases of significant scarring, you may initially find sexual intercourse uncomfortable. Take it slowly and give yourself the time you need to truly feel ready for it.

In cases of severe birth injuries where the sphincter has been damaged, temporary (fecal) incontinence may occur. However, the muscle function usually normalizes within a few months.

Every birth leaves traces – in the figurative sense, but sometimes also in the literal sense. Even if you want to avoid birth injuries as much as possible, don’t let the thought of them unsettle you too much, but try to approach the birth as relaxed as possible. Your midwife has a lot of experience with injuries and will be there to answer all your questions and support you with practical tools. And holding your little explorer finally in your arms will compensate you for all the pain, so that it will soon be forgotten.