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Third- or fourth-degree tear during childbirth

Published: 12/06/2015

Many women tear to some extent during childbirth. Most tears occur in the perineum, the area between the vaginal opening and the anus (back passage). They may be:

  • First-degree tears – small, skin-deep tears which usually heal naturally
  • Second-degree tears – deeper tears affecting the muscle of the perineum as well as the skin; these usually require stitches

For some women with a tear, the tear may be more extensive. This may be:

  • A third-degree tear extending downwards from the vaginal wall and perineum to the anal sphincter, the muscle that controls the anus
  • A fourth-degree tear extending to the anus or rectum

This leaflet provides information and advice about third- and fourth-degree tears during childbirth. It covers:

  • Whether third- and fourth-degree tears can be prevented
  • What to expect after a third-or fourth-degree tear
  • What you can do to help you recover
  • Follow-up
  • Implications for future births

This information is based on the RCOG Green-top Guideline No. 29 The Management of Third- and Fourth-degree Perineal Tears.

In line with the College process of reviewing all guidance every 3 years, this information is currently under review. The information in this version is still valid.


Information hub on perineal tears and episiotomies

Types of tears, reducing your risk, and helping your recovery

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