Feeling
Many women worry about feeling themselves tear. The reality is that women rarely do, or they feel 'something different' but do not equate it to tearing at the time. If the perineum does tear it will do so in the final moment before the baby's head is born (or occasionally with the birth of their shoulders). At this point the perineum is stretched to the maximum, when the nerves in the area become quite numb. This is different from an episiotomy (if local anaesthetic is not used but it usually is), as the pain can be felt with the cut before the muscles are fully stretched.
After the birth the most likely responses of women who have torn are "Did I Tear?" or "I think I felt something give".
Seeing
It may be the last thing you (or your partner) feels like doing, but you could consider the option of looking at the extent of any tears, to help make judgements about whether you would like them to be stitched or not. It may be that you are not sure what you are 'looking at', or blood is obscuring the area, and you need your caregiver to point the tear out. Some women choose not to be stitched if the tear is not very deep, or if it only involves the labia.
Small tears do not necessarily need stitches, but you may wish to see for yourself and come to a decision with your caregiver. For some women looking at any injury helps them to envisage what they are feeling, as often the tear is not as bad as they imagined.
Bleeding
The most common injuries to the perineum are grazes, 1st and 2nd degree tears. If they do happen they will normally only produce a trickle of blood, but do not generally bleed very heavily. Most of the blood lost with a vaginal birth is from the site where the placenta separates from the wall of the uterus after the birth. Very deep tears, cervical tears and 3rd and 4th degree tears may bleed heavily.
Updated June 2008