A third- or fourth-degree tear during birth 


This information is for you if you want to know more about third- or fourth-degree perineal tears. It may be helpful if you are a relative or friend of someone who is in this situation.

What is a perineal tear?

Many women experience tears to some extent during childbirth as the baby stretches the vagina. Most tears occur in the perineum, the area between the vaginal opening and the anus (back passage).

Small, skin-deep tears are known as first-degree tears and usually heal naturally. Tears that are deeper and affect the muscle of the perineum are known as second-degree tears. These usually require stitches.

An episiotomy is a cut made by a doctor or midwife through the vaginal wall and perineum to make more space to deliver the baby.

What is a third- or fourth-degree tear?

For some women the tear may be deeper. A tear that also involves the muscle that controls the anus (the anal sphincter) is known as a third-degree tear. If the tear extends further into the lining of the anus or rectum it is known as a fourth-degree tear.

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What increases my risk of a third- or fourth-degree tear?

These types of tears usually occur unexpectedly during birth and most of the time it is not possible to predict when it will happen. However, it is more likely if:

  • this is your first vaginal birth
  • you are of South Asian origin
  • your second stage of labour (the time from when the cervix is fully dilated to birth) is longer than expected.
  • you require forceps or a ventouse to help the delivery of your baby one of the baby’s shoulders becomes stuck behind your pubic bone, delaying the birth of the baby’s body, which is known as shoulder dystocia
  • the patient have a large baby (over 4 kg or 8 pounds and 13 ounces)
  • you have had a third- or fourth-degree tear before.
What will happen if I have a third- or fourth-degree tear?

If a third- or fourth-degree tear is suspected or confirmed, this will usually be repaired in the operating theatre. Your doctor will talk to you about this and you will be asked to sign a consent form. You will need an epidural or a spinal anaesthetic, although occasionally a general anaesthetic may be necessary.

Also, there might be a need a drip in your arm to give you fluids until you feel able to eat and drink. You are likely to need a catheter (tube) in your bladder to drain your urine. This is usually kept in until you are able to walk to the toilet.

After the operation you will be:

  • Offered pain-relieving drugs such as paracetamol, ibuprofen or diclofenac to relieve any pain.
  • advised to take a course of antibiotics to reduce the risk of infection because the stitches are very close to the anus
  • advised to take laxatives to make it easier and more comfortable to open your bowels.

Once you have opened your bowels and your stitches have been checked to see that they are healing properly, you should be able to go home.

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You will be able to discuss your options for future births at your follow-up appointment or early in your next pregnancy. Your individual circumstances and preferences will be taken into account.




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