Instrument Assisted Delivery and Perineal Tears: What You Need to Know

Sometimes birth doesn’t go exactly as planned. One intervention that may come up is an instrument assisted delivery. While it sounds intimidating, understanding what it means and how it connects to vaginal tears can help you feel more informed and less fearful if it becomes part of your birth story.

What Is an Instrument Assisted Delivery?

An instrument assisted delivery uses tools like forceps or a vacuum to help guide the baby out during a vaginal birth. This is usually considered a last resort before moving to an emergency C-section.

In most cases, your OB will do everything possible to support a vaginal delivery if that’s your preference. Instrument use is rare, happening in about 3 percent of births, but it does occur when needed to prevent complications or emergencies.

Risks and Considerations

Although instrument assisted delivery can be helpful, it does carry some risks. These include:

• Fetal injury

• Perineal injury (such as tears)

• Longer recovery time for the pelvic floor if a tear occurs

This brings us to perineal tears, which range in severity and may or may not be linked to instrument use.

Types of Perineal Tears

Perineal tears are categorized into four degrees:

• First Degree – A small, superficial tear involving only the skin. Stitches are often not required.

• Second Degree – Extends into the pelvic floor muscles and usually requires stitches.

• Third Degree – Involves the anal sphincter. This is more complex and requires surgical repair.

• Fourth Degree – A complete tear through the anal sphincter and part of the rectum. This is the most severe and requires surgery.

Risk Factors for Higher-Level Tears

Tears don’t only happen with instrument assisted deliveries, but instruments do increase the likelihood. Other risk factors include:

• Large baby (macrosomia)

• Baby’s head larger than 35 cm in circumference

• Induction

• Connective tissue disorders

• Prolonged pushing phase (long stage two of labor)

• Baby positioned “sunny side up” (facing forward instead of backward)

Implications of Tears

Higher-level tears can sometimes lead to:

• Painful sex (dyspareunia)

• Anal incontinence

Interestingly, having a perineal tear does not necessarily increase your risk of stress urinary incontinence (leaking urine with coughing, sneezing, or exercise). Some people experience this after birth, and others do not, regardless of whether a tear occurred.

The Role of Pelvic Floor Physical Therapy

While no one wants a perineal tear, it’s important to remember that these injuries are treatable. With the right care and support, most people recover well. Pelvic floor physical therapy can address painful sex, incontinence, and overall pelvic floor healing so you can return to daily life with more comfort and confidence.

Final Thoughts

Instrument assisted delivery and perineal tears may sound scary, but they are not the end of your story. If either happens during your birth, know that recovery is possible and help is available. You don’t have to live with long-term pain or incontinence; support and solutions exist.