Most women who give birth vaginally experience some form of rupture of the vagina or perineum. These tears occur when tissues are stretched during childbirth and are divided into different degrees depending on how deeply the tissue is affected.

Different degrees of tears

During a birth, the midwife assists to minimize the risk of rupture. Ruptures are divided into four degrees:

• Grade 1: Superficial tears in the vagina and/or labia.
  Sewn by midwife in the delivery room.
• Grade 2: Rupture engaging muscles of the perineum.
  Sewn by midwife in the delivery room.
• Grade 3: Rupture involving the rectal muscle, in whole or in part.
  Sewn by a doctor, usually in surgery.
• Grade 4: Rupture involving the wall of the rectal canal.
  Sewn by doctors, usually in surgery.

How common is it?

Larger ruptures (grades 3 and 4) are uncommon and occur at about three percent of all births. If it is your first time giving birth, the figure is slightly higher, around five percent.

Minor ruptures (grades 1 and 2) are much more common and often heals quickly, especially if you follow the aftercare advice.

Factors that can increase the risk

The risk of a major rupture may be slightly higher if:

• you give birth with suction bell,
• you are circumcised, or
• you give birth to a big child (over 4.5 kg).

Healing and recovery

After a vaginal birth, you stretch the pelvic floor muscles up to three times its length. Muscles and tissues need time to recover.

• Minor skin and mucosal tears often heal within a couple of weeks.
• The muscles of the pelvic floor can take several months to heal completely.
• Full recovery may take up to one year.

To strengthen the pelvic floor, it is important to do squats on a regular basis. If you need help, you can contact a physiotherapist or your midwifery clinic.

When should you seek help?

If you have anxiety, pain, swelling or problems with healing, you should always seek help. Contact in the first instance:

• your midwifery clinic,
• and gynecological clinic, or
• the maternity clinic where you gave birth.

Tips for recovery

• Look at your genitals before childbirth to have a reference image.
• Look again after childbirth and after you have been stitched.
• Use a mirror to follow the healing process at home.

It is common for a rupture to looks bigger than it is, but following the healing yourself can provide reassurance and better understanding.

Rapid responses

What is a rupture of membranes?

An injury to the vagina or perineum that occurs when the tissue is stretched during childbirth.

How common is a grade 3-4 rupture?

Approximately 3% of all births, slightly more common with the first child.

Who sews the tear?

Midwife sews grade 1-2, doctor sews grade 3-4.

How long does it take to heal?

Between a few weeks and up to a year depending on the extent of the rupture.

When should I seek medical help?

If you are in pain, worried about healing or suspect infection

FAQ - frequently asked questions

1. How common is it to have a tear during childbirth?
It is very common. Most people who give birth vaginally experience some form of rupture, usually grade 1 or 2.

2. Who sews the stretch marks?
The midwife stitches grade 1 and 2 tears. Grade 3 and 4 tears are stitched by doctors, usually in surgery.

3. How long does it take for the tear to heal?
Minor tears often heal within a few weeks. Pelvic floor muscles take longer - sometimes several months or up to a year.

4. What affects the risk of having a major rupture?
The risk increases if you give birth with a suction cup, are circumcised or give birth to a large baby over 4.5 kg.

5. How can I monitor my healing at home?
By looking at your abdomen with a mirror after giving birth and comparing it to how it looked before, you can follow the healing over time.

6. Where do I turn if I have problems after giving birth?
Contact your midwife's office, gynecological clinic or the maternity hospital where you gave birth.

Want to read more about childbirth? Click on the link here!