Q: Please throw more light on genital tract tears and uterine ruptures, its effect on a woman who had a big baby through vaginal birth. Thanks and God bless

A: Genital tract tears or perineal tears during childbirth (vaginal delivery) as well as uterine ruptures are quite common especially in the resource poor nations where most pregnancies/deliveries do not receive adequate care or supervision.

Genital tract tears, in most cases occur when the baby’s head passes through the birth canal, or for a number of other reasons, and to differing degrees. The tear can range from a first degree tear involving the skin around the vagina alone, and no muscles involved to a fourth degree involving the perineal muscles, and extending up the anus and rectum. The risk factors include, a big baby(as you have mentioned) or if the baby’s head is big, having a previous perineal tear, an episiotomy(a cut given by a midwife to enlarge the birth canal, may get extended resulting in a tear), excessive bearing down between contractions (when the cervix is not fully dilated),when a certain instrument called a forceps is used to assist in bringing out the baby, prolonged labor (labor lasting more than 20hours in a ‘first-timer’ and 14hours in a woman who has previously given birth) and very fast labor (precipitate labor) are also risk factors.

Genital tract tears are repaired by the health worker, as soon as they are identified, to prevent bleeding. Following the repair, ice packs may be applied to the area for a few hours. Painkillers, antibiotics and vitamins prescribed by your doctor, may help to relieve the pain and aid healing. Sitz bath (sitting in a bowl of warm water which has been mixed with a handful of salt for 10 -15 minutes twice or thrice a day) is also recommended for pain relief and to prevent infection.

Uterine rupture on the other hand is not as common, but most often the major risk factor is a scar from a previous caesarean section. Attempting a vaginal delivery after one or more previous caesarean sections is a controversial issue for both women and their doctors. In the typical African setting, the woman is seen as weak if she does not experience labor pains and have a vaginal delivery. With this pressure, most women would want to give it a try, even when strongly discouraged by their care giver. Following a caesarean section, the lower uterine segment, this is the part of the uterus which was cut open to deliver the baby, is not that strong. So, during labor, with regular strong contractions that area which is already weak undergoes further stretching, and may tear/rupture. It is advisable to have a vaginal birth after a caesarean section (VBAC), supervised by a trained healthcare worker and in tertiary hospital. The labor is made as short as possible and closely monitored to prevent a uterine rupture.
Other risk factors for rupture of the uterus include, previous uterine surgeries like fibroid surgery, excessive stimulation (hyper-stimulation) of the uterus during labor with the use of oxytocin or prostaglandins, high parity (having 5 or more deliveries), over-distension of the uterus (either from amniotic fluid or carrying more than one baby), trauma to the uterus from maybe a car accident, a difficult manual removal of the placenta and a prolonged labor in a woman with a big baby.

Prevention of both genital tract tears and uterine rupture lies primarily in receiving qualitative and efficient antenatal care, peripartum (around the time of birth) care and postnatal care. Risk factors like being overweight or being diabetic (which are risk factors for having a big baby) should be identified and managed proactively (focus on dietary modifications, weight management, and exercise). Women should be given adequate support and care through pregnancy and more especially during labor.

Thanks for your question and God bless you too.

******This answer was provided by a guest doctor blogger.

For related posts, please click on https://chatwithdrketch.com/2014/07/22/daily-health-tips-can-i-have-a-baby-normally-after-a-cervical-tear/

Have a great weekend y’all 😀