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Third- or fourth-degree tear during childbirth

Published: 01/11/2008

Most women, up to 9 in 10 (90%), 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, up to 9 in 100 (9%), 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 anal canal as well as the rectum (further into the anus).

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

  • Whether third- and fourth-degree tears can be predicted or prevented
  • What happens after birth
  • What treatments you’ll be offered
  • What you can do to speed up healing
  • Long-term effects
  • Follow-up
  • Implications for future deliveries

This information is based on the RCOG guideline The Management of Third- and Fourth-degree Perineal Tears.

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

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