Distribution of genital tract trauma in childbirth and related postnatal pain

Background: The full extent of genital tract trauma in spontaneous births i s 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 = 54 71). Methods: Descriptive analysis was conducted on trial participants who delivered spontaneously at term and were examined by their midwife after bi rth (n = 5404). Data are reported for sites of trauma and the relation to e pisiotomy, suturing, and maternal reports of pain at 2 days, 10 days, and 3 months after birth. Results: Eighty-five percent of all women experienced some form of trauma, with first- or second-degree perineal lacerations occu rring 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. Nea rly all unsutured trauma was restricted to perineal first or second-degree, outer vaginal, and labial sites. Pain declined over time, and a gradient i n pain was observed according to the site and complexity of trauma. Conclus ions: Genital tract trauma is extremely common with spontaneous vaginal bir th. Effective measures to prevent or reduce its occurrence would benefit ma ny new mothers.