Vaginal childbirth often results in a perineal tear or laceration, which involves the perineum—the area of skin and muscle located between the vaginal opening and the anus. Tearing is extremely common, with the majority of women who have a vaginal delivery experiencing some form of laceration. The severity of these injuries is classified using a standardized system, with the 1st degree tear being the least severe type.
Understanding Perineal Tears and Degrees of Severity
Perineal tears are categorized into four degrees based on the depth of the injury and the specific structures involved. This classification system allows healthcare providers to quickly assess the injury and determine the appropriate method of repair. The severity ranges from 1st degree (least severe) to 4th degree, which indicates a tear extending into the lining of the rectum.
A 1st degree perineal tear is defined as a superficial injury that involves only the skin of the perineum and the tissue directly beneath it, called the vaginal epithelium. This minor laceration does not extend into the deeper muscle layer. Because it affects only the surface layers, a 1st degree tear is considered uncomplicated and generally heals quickly.
In contrast, a 2nd degree tear is deeper, extending through the skin and into the perineal muscles, but still sparing the anal sphincter. Tears that involve the anal sphincter muscle are classified as 3rd degree, and those that extend further into the rectal lining are classified as 4th degree, making them the most complex injuries. The superficial nature of the 1st degree tear makes its repair distinct from these higher degrees of injury.
Repairing a 1st Degree Tear: Addressing the Stitches Question
The answer to how many stitches a 1st degree tear requires is often none at all. Since the tear involves only superficial skin and tissue, many minor lacerations are left to heal naturally without intervention. Clinicians decide not to stitch when the edges of the tear are well-aligned and there is minimal bleeding.
If the edges of the superficial tear are gaping slightly, or if the clinician determines that a small amount of suturing will better align the tissue for optimal healing, a few stitches may be placed. In these cases, the number of sutures is very small, typically involving only a few simple, superficial stitches required to close the small skin separation. These sutures are almost always made of dissolvable material, meaning they will not need to be removed later.
The repair process, when needed, is straightforward and is performed by the doctor or midwife in the delivery room using a local anesthetic to numb the area. This minimal repair contrasts sharply with higher-degree tears, where suturing is almost always required and the repair of muscle layers is necessary. The use of simple, dissolvable sutures for a 1st degree tear ensures the wound is closed without the need for a separate removal procedure weeks later.
Immediate Postpartum Comfort and Recovery
Recovery from a 1st degree tear, whether stitched or not, is generally rapid, with the surface layers of the skin usually healing within a few days to a week. Initial discomfort, which may include mild pain or stinging, is common, particularly when walking, sitting, or urinating. This short healing time is one of the benefits of the injury being limited to the superficial layers of tissue.
Practical self-care measures are important for managing discomfort and promoting healing during the postpartum period. Applying a cold pack wrapped in a cloth to the perineum for 10 to 20 minutes at a time can help reduce swelling and pain. For hygiene and to reduce stinging when passing urine, a peri-bottle can be used to gently spray the area with warm water during and immediately after using the toilet.
Taking a stool softener or ensuring a high-fiber diet with plenty of water intake helps to keep bowel movements soft, preventing strain on the healing area. Over-the-counter pain relievers, such as acetaminophen or ibuprofen, can effectively manage the mild soreness. Any stitches used will dissolve on their own within about six weeks, and long-term complications are rare for this type of superficial injury.