Allowing yourself time to heal and recover after childbirth is not often talked about in detail. We can sometimes expect to be up and about and resuming normal life just a few days after giving birth, but this can be both physically and mentally detrimental when trying to adjust to life with a newborn family member. Resting is essential to optimize the recovery process, so try to engage any help you can from your partner, family, older children and friends to help out during this period.
Soreness around the perineal area (vulva, vagina, anus) after a vaginal birth is extremely common, whether you have a tear and/or any stitches in this area.
What is a tear?
With first babies some sort of tearing or an episiotomy happens in 9 out of 10 births, in subsequent births this reduces to around 7 out of 10. As your baby’s head is stretching your perineum you will feel a burning sensation and, as your tear occurs, that burning stops. There are different types of tears and they can be placed into four categories depending on their severity:
- First degree. These involve just the skin and, if small and not bleeding, will probably not need any stitches.
- Second degree. These involve the muscle layer and can range from being very simple to repair with local anaesthetic, to more complicated and needing regional anaesthetic (epidural/spinal) and a trip to theatre - the former is much more common.
- Third degree and fourth degree. These involve the anal sphincter and/or part of the rectum. They need to be repaired in theatre under regional anaesthetic. This type of tear happens in approximately 2.5% of births.
What happens if I have a tear or a cut?
If you sustain a second-degree tear, current advice is that having it sutured reduces the risk of infection and allows it to heal quicker. If your tear is bleeding, whether it is a first or second degree tear, you will be advised to have it sutured as this can prevent excessive blood loss.
You should always have good pain relief while having your perineum repaired. If you have an epidural you shouldn’t feel any pain and if you haven’t had one, local anaesthetic will be used to numb the area before suturing. Your legs will usually be placed in stirrups and the repair itself usually takes around fifteen minutes - maybe less if the tear is small. You may be able to feel a pulling sensation during the stitching process, but you should not experience any pain during the procedure, so do ask for more pain relief if you do. There is no need to have these sutures removed as they will dissolve.
What is an episiotomy?
Occasionally, an episiotomy - a surgical cut of your perineum to help you give birth - may be required. You will always be informed of why your midwife or obstetrician wishes to do it and they will need your consent to do it. Episiotomies are no longer a routine practice during childbirth in the UK and, if you agree to one, the area will be numbed with a local anaesthetic before it is performed.
When would I need an episiotomy?
There are only really 3 reasons when an episiotomy may be required:
- If you require the assistance of forceps or a ventouse for birth.
- If your baby has become distressed and by doing an episiotomy he will be born immediately.
- In some circumstances, if you are giving birth to your baby in a breech position, to allow for extra space in your vagina.
After a vaginal birth your body can often recover quickly, but you may still have some soreness for a few days or weeks, even if you didn’t need any stitches. Start by making sure you are always in a position that makes you feel relaxed, as sitting in a very upright position could become quite uncomfortable after a while. Here are some tips to make things feel a little comfier:
- Remember to take regular pain relief that you’ve been prescribed or bought over the counter- this will help to relieve any soreness and keep you more comfortable.
- Find a position that is comfortable for you, especially if breastfeeding for long periods. A side lying position is often good and will relieve any pressure if you have stitches.
- Keep the area where you’ve had stitches very clean by bathing or showering at least twice a day, as this will minimise the risk of infection.
- Change your sanitary pads very regularly, at least every four hours as this reduces the likelihood of getting an infection in the area.
- Wash your hands before and after going to the toilet to limit the spread of bacteria.
- If you feel as though the area is becoming sorer as each day goes by, has an unusual smell, is oozing or becoming more swollen, make sure you see your midwife or GP. If it is becoming infected, you may need some antibiotics.
- Think about starting to practise your pelvic floor exercisesas soon as you feel able to. This will help you feel more in control of your bladder and bowel, both now and in later life.
- Eat healthily (plenty of fresh fruit, vegetables etc) and drink plenty of fluids to help your body heal from any wounds such as an episiotomy or tear.
Vaginal birth can leave you feeling uncomfortable and sore afterwards but with a few adjustments to your lifestyle you can quickly make things feel a little better and optimise your recovery from childbirth.