“You’ve got two minutes to make your decision.”
The delivery doctor looks up from between my legs. I gaze at the ceiling and focus on a fluorescent light, trying to push my fear into its glow.
“What are the risks?” I ask.
“If you have an emergency c-section at this stage, the primary risk is permanent damage to your uterus and risk of hemorrhage,” the doctor replies. “If I deliver with forceps, there’s a chance your baby may have a small amount of facial bruising. If you go with forceps, it’ll be over in a matter of minutes.”
I choose forceps. Twelve people suddenly appear in the room: doctors, nurses, paramedics, students. They line up solemnly against the back wall. Someone wheels a tray of gleaming metal instruments to the bottom of the bed.
“Right,” I hear. “One big push.”
Then there she is. My daughter. Pale and silent. Then red and screaming. I hold her as I shake convulsively, in a stupor after 50 hours of labor.
Two doctors spend an hour sewing me up. I don’t understand what is happening to my body, only that my baby and I have made it to the other side. Alive. At that moment, that is enough.
“You have a severe third-degree tear and a shattered tailbone,” my obstetrician tells me later that day. “Keep icing it. Use Dermaplast. See me in two weeks. You may experience fecal incontinence, so I’m going to refer you to a pelvic floor therapist.” He glances at my exposed stomach, riddled with a furious network of stretch marks. “Oh dear,” he grimaces. “Your poor belly.”
A critical fact I did not know at the time is that about 90% of people who give birth vaginally will experience tearing. Tears are classified in grades of severity, from one to four. The more common first- and second-degree tears involve lacerations in the vaginal and perineal tissue. With third-degree injuries, the tear extends from the vagina to the anus. In a rarer fourth-degree tear, the laceration extends from the vagina through the perineal area and anal sphincter muscles and into the rectum. Interventions such as forceps and vacuums can significantly increase the risk of a severe tear.
When the epidural wore off, the pain was indescribable. Back at home, I waddled around with my newborn strapped to my chest, legs as far apart as they would go, giant ice packs falling out of the flimsy mesh underwear provided by the hospital. Simply sitting in a chair sent pain shooting through my body. Getting out of it took an agonizing ten minutes. I didn’t dare look at my Frankenvulva in the mirror.
When I went back for my obstetrician appointment two weeks later, it turned out that one of the stitches wasn’t sewn correctly and there was a piece of skin hanging where it shouldn’t. It had to be burned off. A shadowy sense of shame began to surround me. Despite the traumatic nature of the delivery, I felt okay talking about my birth and my broken tailbone. But the fact that my vagina had ripped almost to my ass? I didn’t really discuss it with anyone ― including my husband.
“Simply sitting in a chair sent pain shooting through my body. Getting out of it took an agonizing ten minutes. I didn’t dare look at my Frankenvulva in the mirror.”
I felt as though I’d been neutered. Unsure of how I could ever even entertain the idea of having sex again. Convinced that the pain would last forever (ultimately, it took over two years for me not to be aware of it).
Every time I peed, I had a water bottle on hand to help dilute the searing sting. Like so many other women, I just dealt with it in silence. My pelvic floor therapy sessions petered out as I went back to work a couple of months later. I could barely make time in my schedule to pump, let alone take a cab into downtown Chicago for twice-weekly appointments.
Well, this is motherhood, I thought. The moment a child is born, the mother stops being the patient. We’re expected to smile. Be grateful for our baby. Be quiet. Just deal with it.
Many women don’t realize that childbirth can involve such extreme injury. Fortunately, that’s starting to change. In 2018 ― a year after I gave birth to my daughter ― Keira Knightly wrote a personal essay about her first childbirth experience. “My vagina split,” she wrote. “You came out with your eyes open. Arms up in the air. Screaming.” She wrote that women are then expected to hide: “Hide our pain, our bodies splitting, our breasts leaking, our hormones raging.” In 2020, Chrissy Teigen tweeted in response to people complaining about taking PCR tests, “My vagina was ripped to my asshole giving birth to Luna. I had a vagasshole. Fuck your swab pain.”
The rise of celebrities talking about their own birth injuries helped catalyze a tide change in the types of conversations I heard around me. Other mothers began to talk more openly about the brutality of birth. I joined in, galvanized by the knowledge that I was not alone. Instagram became a hub of support and community, with pages such as Life After Fourth Degree Tears dedicated to sharing people’s stories.
One day in 2019, two close friends and I were frustrated by the fact that we still couldn’t go to our local Walgreens or Target to pick up items to help our other new mom friends heal during their fourth trimesters. So we decided to do something about it. We innovated and secured two patents for our dream postpartum recovery underwear and a suite of ice/heat packs specially contoured to fit between the legs or over the uterus. They can be inserted directly into the underwear and stay in place to help with tenderness and swelling. We wanted to ensure that the next wave of people giving birth had access to a more functional and therapeutic option than the mesh hospital freebie.
Yes, tearing is almost certainly going to happen if you have a vaginal delivery. Most people will have a first- or second-degree tear. The more severe injuries ― which are far more challenging to recover from ― are uncommon (about 6 in 100 births) and scary to contemplate. But not talking about it means that many people have trouble getting adequate information prior to delivery and feel unprepared and unsupported during recovery.
Now knowing firsthand the risks and severe consequences of tearing in childbirth, here’s some advice I’d share with other mothers-to-be:
1. Knowledge is power.
Educate yourself on the risk factors of severe tears and incorporate prevention and aftercare strategies into your birth and postpartum care plans. You cannot actually prevent a significant tear ― it’s largely due to forces outside of your control, such as the size of your baby and your anatomy. But seeing a pelvic floor therapist in the months before giving birth may help reduce recovery time after delivery, no matter how severe the tear. Perineal massage and stretching prior to delivery may also help with muscle pliability and help mitigate the impact of the tear.
2. Be your own advocate.
During delivery, you can ask your doctor, doula or midwife to support your perineum with their hand as you push, which has been proven to help reduce the severity of tearing. Press for a proper diagnosis and review of your injury (many moms I know were told they had a tear, but had no idea to what degree). If you suspect something is wrong, don’t brush it away: You know your body best. Talk to your doctor.
If you suffer from a major tear, request regular check-ups with your medical provider until you are fully healed. If you are working and still in discomfort, speak to HR and see if there are ways for your company to help support you as you heal. And if you think you may have PTSD from your delivery experience, reach out to a mental health professional. There are some incredibly effective techniques to help resolve feelings of anger, grief and shame that can arise from a difficult birth.
3. See a pelvic floor therapist after delivery ― no matter what.
Every OB-GYN, doula and midwife I’ve ever spoken to says the same thing: They wish pelvic floor therapy was mandatory and accessible for every single person who gives birth. Book some sessions for a couple of weeks after your due date in advance. You’ll be glad you did.
4. There are ways to ease the pain.
Ice therapy is proven to help ease discomfort and speed up recovery time. Sitz baths are a blessing. Stool softeners are your best friend. Use a peri bottle when you pee to help dilute the sting of urine. Donut cushions are really helpful, too, as they prevent your vulva/perineum from coming into direct contact with your chair.
5. Know that you are not alone.
Research indicates that women’s pain levels after experiencing a second-degree tear or greater can be linked to their risk for developing postpartum depression. Combined with the intimate nature of the topic and how so many of us don’t feel comfortable talking about our vulvas in general, it’s little wonder that so many women feel isolated and alone in their pain. But you are not. The statistics alone prove it.
You do not need to suffer silently, as so many of us have been conditioned. By talking, sharing and ensuring we have the means to take care of ourselves ― and each other ― mothers and birthing people can find a connective, collective resilience and invaluable support system to help us as we move through the pain, onwards to the other side.
Mia Clarke is a writer and the co-founder of the women’s health innovation company, Nyssa, which released its bestselling FourthWear Postpartum Recovery Underwear in 2019 and has been featured in Forbes, Vogue, Fast Company and more. She also edits Body of Knowledge, a new content platform dedicated to interrogating the under-discussed realities of womanhood and has written about miscarriage for The Washington Post. Prior to working in women’s health and innovation, Mia was a music journalist and the guitarist in the British indie rock band, Electrelane.