Tearing and cutting during delivery

Tearing and cutting during delivery

Tearing and cutting during delivery. During a normal delivery, the baby passes through the pelvis, the vagina, and the muscles and skin of the pelvic floor. When tears occur in the skin, the mucous membrane of the vagina, or the muscles of the pelvic floor, we speak of tearing. Another word for a tear is rupture.

During a first delivery, many women have a tear to a greater or lesser extent. This happens less often during a subsequent birth because the tissues stretch more easily.

In some cases, the person accompanying labor has to cut the muscles and skin of the pelvic floor. Clipping is done to help the baby be born faster, when labor is stagnant or the baby is in need. Usually no cutting is done to prevent tearing.

How does tearing occur during delivery?

Tearing During pressing, the muscles and skin of the pelvic floor are gradually stretched, creating enough space for the child to pass. Especially when the head and shoulders are born, tears can easily develop in the skin, the mucous membrane of the vagina or in the muscles of the pelvic floor.

Depending on the size of the tear or rupture, we make a distinction between:

First degree rupture

  • only the skin and mucous membrane of the vagina are torn
  • occurs in one in three to four women who give birth for the first time

Second degree rupture

  • the skin, mucous membrane of the vagina, underlying connective tissue and muscle tissue are ruptured (the anus sphincter is not ruptured)
  • occurs in one in ten women

Third degree rupture

  • this is like a second degree rupture where the sphincter muscle of the anus and sometimes the lining of the rectum have also been torn
  • occurs in one in three hundred women
  • is often referred to as total rupture

The severity of a rupture depends on:

  • the speed and force with which the baby is born
  • the extent to which the skin, vaginal mucosa and muscles of the pelvic floor can stretch

Cutting The following situations can be reasons to decide to cut during childbirth:

  • you had a third degree rupture in a previous delivery
  • failure to progress in the delivery where the head is already on the pelvic floor. Longer pushing will cause problems for you or your child. The cutting speeds up the delivery
  • the delivery must be accelerated by the use of a vacuum pump or birth forceps, cutting is always necessary

What can you expect when tearing and cutting during delivery?

  • Tearing

When giving birth to a first child, almost all women have a tear. With a subsequent delivery, the chance of a tear is a lot smaller, because the skin and muscles have already been stretched. Most women do not notice the tearing: the pain of stretching the muscles and passing the child dominate.

A small first degree rupture does not always need to be stitched. This is necessary for a second and third degree rupture. This is to properly restore the muscles and thus the pelvic floor function.

Good pelvic floor function is important for preventing urinary incontinence. Pelvic floor function is also important to prevent prolapse of the uterus, bladder or intestinal wall. Suturing of a third degree rupture is done in the operating theater. This must be done very carefully to avoid accidental loss of stool.

  • Cut in

If it seems necessary to cut in, the obstetrician or gynecologist who supervises the delivery usually gives an anesthetic first. The anesthetic fluid is administered into the skin and muscles between contractions, where the cut is made. During the height of a contraction, the midwife or gynecologist makes the cut. As a result of the pain and the anesthetic, you will usually not notice this much.

After cutting, the baby is usually born smoothly or there is enough space to place the vacuum pump or the birth forceps on the child’s head. The tear is then stitched to allow the skin and muscles to heal properly.

See also, Pregnancy and medicine use

What can you do about it yourself?

Usually rupture during childbirth cannot be prevented. The severity of the rupture depends on:

  • the speed and force with which the baby is born
  • the extent to which the skin, vaginal mucosa and muscles of the pelvic floor can stretch

It is important that the tissues are given time to stretch. The more time the tissues have to stretch, the less likely it is to have a serious rupture.

That is why the midwife or gynecologist who supervises your delivery sometimes asks you not to press during a contraction during the birth of the head. Try to sigh away the contractions as much as possible. By sighing or puffing during the pushing process, the strength of the contraction is reduced. Sighing away from a contraction during strong contractions can be very difficult. It is important to listen carefully to the directions given by the midwife or obstetrician.

Despite these measures, it can still happen that a serious rupture occurs; unfortunately this cannot always be prevented. Usually, ruptures heal better than cuts. As a result, it is generally no longer cut to prevent a tearing.

See also, Folic acid use before and during pregnancy

General advice and precautions

It is not possible to prepare the skin and muscles of the pelvic floor for stretching during labor. During a pregnancy course, you can learn how to sigh off a severe contraction, in order to give the skin time to stretch. You can also learn to relax the pelvic floor, which also reduces the risk of tearing.

In the past, a cut was often made to prevent tearing, but in recent years it has become apparent that the repair of a tear is faster and with less discomfort than the repair of a cut. For that reason, people are now often reluctant to make a cut and this is only done when there is no other option.

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