Distribution of genital tract trauma in childbirth and related postnatal pain

The full extent of genital tract trauma in spontaneous births is not well documented. The purpose of this study was to describe the range and extent of childbirth trauma and related postnatal pain using data from a large randomized clinical trial of perineal management techniques (n = 5471).

Descriptive analysis was conducted on trial participants who delivered spontaneously at term and were examined by their midwife after birth (n = 5404). Data are reported for sites of trauma, and the relation to episiotomy, suturing, and maternal reports of pain at 2 days, 10 days, and 3 months after birth.

Eighty-five percent of all women experienced some form of trauma, with first- or second-degree perineal lacerations occurring in two-thirds of women and outer vaginal tears occurring in one-half. Tears to the rectum and vaginal vault were more common with episiotomy. Nearly all unsutured trauma was restricted to perineal first- or second-degree, outer vaginal, and labial sites. Pain declined over time, and a gradient in pain was observed according to the site and complexity of trauma.

Genital tract trauma is extremely common with spontaneous vaginal birth. Effective measures to prevent or reduce its occurrence would benefit many new mothers.