Re: maternal injury during childbirth

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• In reply to: mary: "maternal injury during childbirth"

A small introitus is almost certainly the cause of your 3-degree tear. As the baby is born, it stretches the opening of the vagina. Whether or not an episiotomy is performed, the stretching is worse when the opening is smaller.

I don't know about 3-degree extensions with mediolateral episiotomies, because this type of episiotomy is not commonly performed in the US (it's quite popular in many European countries). In the US, the overwhelming majority of episiotomies are midline. In fact, I would bet that your doctor was thinking "wow, that's a small introitus...I better cut a mediolateral to decrease the chance of tearing (yes, we actually think this stuff during a delivery)" Poor guy probably thought he was pretty cool, until he saw the 3-degree tear! You win a few, lose a few.

Congratulations on the baby. I usually prescribe stool softeners for 6-8 weeks after a 3- or 4th degree tear.

Best wishes,

--
Ashley Hill
David Ashley Hill, M.D.
Associate Director
Department of Obstetrics and Gynecology
Florida Hospital Family Practice Residency
Orlando, FL
http://home.mpinet.net/dahmd

The above is intended for general medical education,
and is not for specific medical advice.
I apologize, but I am unable to answer personal e-mail
due to time constraints.

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