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What Are Third and Fourth Degree Perineal Tears During Childbirth?

A: During delivery, moms may experience tears of the perineum (the tissue between the vagina and anus). Usually, such tears are relatively minor and do not cause significant damage. However, in 4 percent of childbirths, women suffer much worse tears called third and fourth degree tears.

During labor and delivery, obstetricians can make mistakes that cause third or fourth degree tears. Read a case study on third or fourth degree perineal tears.

The tears that you most often hear about and occur most commonly are tears of only the vaginal skin. Since these tears do not extend deeper into tissue and muscle or further to the anus, they are easy to repair with a few stitches and heal relatively swiftly.

Second-degree tears are worse and involve more repair and recovery because they go deeper into the muscle underneath the skin. Each layer of tissue must be stitched separately, first the muscle, then the skin.

Third degree tears involve vaginal skin and vaginal tissue including muscle but also extend further down the perineum to the anal sphincter muscle that rings the anus. A fourth degree tear is all the above plus a tear through the anal sphincter. These tears require extensive repair and can be avoided in certain circumstances.

Certain factors increase a woman's risk for suffering a third or fourth degree perineal tear. These are:

• A first time labor and delivery;

• Previous third or fourth degree tears;

• Assisted delivery, especially with forceps;

• Episiotomies can actually increase your risk even though they are done to prevent tears. Some women tear after episiotomies which results in more serious tears than if the episiotomy had not been done;

• Large babies;

• Babies born face up;

• A shorter than average perineum.

To reduce the risk of third and fourth degree tears, expectant mothers can massage their perineum to make the skin and tissue more elastic. Slow deliveries that are not pushed by the doctor or anyone else allow time for the perineum to stretch.

During labor and delivery, obstetricians can make mistakes that cause third or fourth degree tears. Read a case study on third or fourth degree perineal tears. 

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