• Michelle Rey

Care of the perineum after the birth of your baby

Oxford University HospitalsNHS Trust

Maternity Services

Care of the perineum after the birth of your baby

It is common for the perineum (the area between your vagina and back passage) to either tear or be cut by the doctor or midwife during the birth of your baby (an episiotomy).

The doctor or midwife will repair the tear/cut using dissolvable stitches. These take about a month to dissolve completely. We will do our best to make these as comfortable as we can for you by placing most or all of the stitches on the inside, so that there are no knots to cause discomfort when sitting down.

Your perineal area will normally feel sore after childbirth, whether or not you have had stitches. This discomfort may last days, sometimes weeks. The following advice can help with healing, reduce discomfort and lower the risk of infection.

If you have had a tear and do not have any stitches, the tear may take longer to heal completely. We do not know whether it is less painful in the short or long term if the area is stitched, because there is mixed evidence on this.

Keep your perineum clean

Use plain warm water to clean your perineum. There has been research into other remedies, such as adding salt or witch hazel to the bath water. These products can have a slight soothing effect for some women, but make no real difference to the time it takes to heal, compared with plain water.

Wash your perineum after every visit to the toilet. You may find it helpful to lean forward over your knees to direct the urine away from your stitches or use a small jug to pour warm water over your perineum during and after passing urine. This can help to reduce stinging.

We do not advise using a hairdryer over your perineum (even on a cool setting) as this can damage the tissues and delay healing. Using toilet paper to pat dry over and around the stitches is enough.

To help with healing, try to wear breathable materials. For example, cotton or disposable briefs worn with loose trousers or a skirt are better than synthetic materials.

Change sanitary pads frequently to reduce the risk of infection. It is normal to bleed for 2-4 weeks after birth.

Use your pelvic floor muscles

These muscles prevent the leakage of urine, ‘wind’ and stools. During birth they are stretched and may be damaged. They must recover their strength in order to help you keep control of your bladder later in life. If you need advice about some very easy and painless strengthening exercises, please ask any midwife or physiotherapist. We have a useful leaflet that we can give you to take home.

When you use and exercise your pelvic floor muscles it increases the blood flow to the damaged tissue. This helps to speed up the healing process.

Preventing ‘Strep A’ infection

Group A Streptococcus (Strep A) is a bacteria that can be found on the skin and in the throat. It is a cause of some common infections. Usually these infections can be easily treated. However, for up to 6 weeks after the birth of your baby, if the infection gets into your bloodstream it can be serious. To reduce the chance of this happening and to protect yourself, remember to wash your hands before and after using the toilet, changing your sanitary pad or wound dressing.

If you or a family member has a sore throat, earache or impetigo (skin infection) and you are worried about how your wound/ stitches are healing, contact your midwife or GP urgently.

To ease discomfort

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

‘Cold therapy’ such as ice/cool packs used in the first 2-3 days can help reduce swelling and ease discomfort. Apply the pack for up to half an hour at a time and allow at least an hours rest in between. It is very important that the ice/cool pack does not come into direct contact with your skin as this can cause painful ice-burn. You can wrap it in a flannel or tea towel.

Air filled valley cushions or rubber rings can relieve pressure on your perineum when you are sitting and provide some relief. However, do not use these for longer than 30 minutes, as they can restrict your circulation. This can cause swelling and longer-term discomfort.

Taking a warm bath brings great relief to many women. Adding aromatherapy oils such as chamomile or lavender, which both have antiseptic and soothing qualities, may also help. It is also an excellent opportunity to relax undisturbed.

Creams or sprays containing local anaesthetic are available in chemists. However, they are expensive and there is no proof that they work. Do not use any creams, lotions or sprays that contain steroids, as these are known to slow down the healing process.

Arnica (Leopard’s bane) is a popular herbal remedy believed to reduce bruising and stimulate tissue repair. There is no conclusive evidence that it is effective but many women find it reassuring to take. However, until there is further medical evidence to prove its benefits we are not able to actively recommend it.

Opening your bowels for the first time

As your baby is born, the rectum (end of your large bowel) is pushed against your pelvis, leaving it feeling bruised. Stitches often feel nearer the back passage than they actually are but they will not fall out when you open your bowels.

Avoid constipation to minimise discomfort

Fibre in your diet, lots of water to drink, or gentle laxatives will soften your bowel movement if needed. Please speak to your midwife or GP to see what they can do to help.

Resuming sex

There is no right time – it may be weeks or months before you feel ready. Take things slowly and be prepared for it to be different. When women breastfeed, this can often cause the vagina to be drier, so try using a lubricating jelly.

It is also important to think about birth control before you return to sexual intercourse.

If intercourse is painful, see your GP or Health Visitor for advice.

Further information

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

V. Currer-Briggs, Practice Development Midwife September 2014 Review: September 2017 Oxford University Hospitals NHS Trust

Oxford OX3 9DU

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