Caring for your perineum after giving birth

Most tears happen in your perineum. Tears can also occur inside your vagina and to your labia (sets of skin folds around the opening of your vagina).

• 1st degree tears are small and only skin deep, which can heal naturally. Sometimes stitches may still be recommended for these tears. 
• 2nd degree tears are deeper tears affecting the muscle of your perineum as well as the skin, stitches would be recommended for these tears.
• Episiotomy is a cut made through your vaginal wall and perineum to make more space to help deliver your baby. These cuts are carried out in emergency cases and with your consent/agreement.
• Other tears can involve damage to your vaginal walls, urethra (the tube that lets your pee out), clitoris (small sensitive organ) or your labia (sets of skin folds around the opening of the vagina), during your baby’s birth.
• 3rd or 4th degree tears are more extensive. They happen in about 3 in every 100 vaginal births. It is slightly more common with your first vaginal birth, happening to around 6 in 100 first vaginal births, compared to a 2 in 100 chance if you have had a vaginal birth before.

The doctor or midwife will carefully look at your vagina and anus and let you know the type of tear you have. 

• Keep your stitches clean by showering or bathing every day. Using the shower head or pouring water over the area each time you pass urine will help prevent stinging and keep the area clean.
• Keep the stitches dry after washing and using the toilet. Pat gently with toilet tissue from front to back (to prevent germs from your anus infecting your stitches). We do not advise using a hairdryer over your perineum to speed the drying process as this can damage the stitches and delay healing. 
• To help keep the area dry, wear breathable materials such as cotton or disposable briefs, with loose clothing.
• Change your sanitary pads often to reduce the risk of infection.
• Wash your hands before changing your pads as well as before and after going to the toilet. This is to help reduce the risk of you developing an infection in your stitches.
• It is recommended to avoid seeing members of your family or friends if they have any symptoms of Streptococcus A virus, as these infections spread very easily.

In the first few days, your midwife will offer to check your perineum to make sure everything is healing properly. You are likely to have some discomfort after the birth of your baby but this should start to improve over the coming days.

You may notice some suture material (stitches) coming away as they start to dissolve around a week after giving birth. However, you need to seek medical advice if you have any concerns or if you experience any of the following symptoms: 

• any new swelling or increasing pain/swelling  in your perineum
• your wound looks red and inflamed 
• you notice the wound opening up or large amounts of suture material coming away from you
• there is a smelly discharge or odour coming from your wound
• you develop a fever and feel generally unwell 
• you start not being able to hold in wind or faeces (poo),and cannot control your back passage.

Painkillers 

Painkillers such as paracetamol can help with stinging, and anti-inflammatory drugs such as ibuprofen can help reduce the swelling. Both these drugs are safe when breastfeeding. Read the label carefully and/or seek advice before taking if you are unfamiliar with these drugs. 

Cold therapy

Cold therapy such as ice or cool packs can help reduce swelling in the first 2 to 3 days. 

It is important that it be wrapped in a clean, damp cloth before it is applied to separate the skin from the pack. Do not put them directly on your skin.

These can be applied for example for 15 to 30 minutes at a time but we recommend you check for ice burns after 5 minutes by using a mirror. If there is an ice burn (redness) then please remove the ice or cool pack. 

Position

Resting is good to allow your body to repair itself.

Alternative therapies to ease discomfort

Aromatherapy oils

Adding aromatherapy oils to a warm bath, such as lavender, which have antiseptic and soothing qualities may help. However, the evidence is limited as to the benefits. We don’t advise using salt in the water as it does not help the healing process and may cause dryness and irritation.

Creams and sprays

Creams and sprays containing local anaesthetic may be available in chemists. However, they are expensive and there is no proof that they are effective. 
Do not use anything containing steroids in the area as these are known to slow down healing. 

Pelvic floor exercises

These muscles prevent the leakage of urine (pee), wind and faeces (poo). During birth they are stretched and may be damaged. They must recover their strength (tone) in order to maintain bladder and bowel control in later life. 

The exercises can be started as soon as possible (even with stitches). They will help the tear heal by increasing the blood supply to the damage tissue.

Begin with gentle squeezes on your pelvic floor, ask your midwife for advice or for separate information on pelvic floor exercises.

If you have any concerns then please contact your community midwife or your GP.

Greenoaks Antenatal Clinic

01709 424347 

Labour Ward

01709 424491

Your local midwife and GP contact numbers will be on your handheld maternity notes.