Care of the perineum and the vulva after birth is a common concern among people who are looking ahead at what to expect when their baby is born, so we put together a few thoughts on this topic that we typically share with our clients toward the end of their pregnancies.
The first thing we’d like people to know is that we work hard at supporting and guiding you during the latter part of the pushing phase of your labor so that, hopefully, you will not have a tear. If you are able to emerge from your birth without a tear, your recovery will be easier, and it is very common in our practice for this to be so. Of course, there is a small percentage of people who will have a small perineal tear, because it is not always possible to avoid it. Thankfully, these tears are almost always minimal and manageable at home.
So, the first step to good perineal care is a slow and easy crowning out of the baby’s head over a supported perineum. Some people appreciate warm compresses on the perineum as the tissue stretches. We will help guide you to listen to your body’s messages about the stretching sensations that come along with this, which help you know when to slow down to let things relax and open.
After baby is born, while we are waiting for the placenta, we will assess your perineum, vagina, and labia for tears. If there is a tear that requires sutures, the repair usually occurs shortly after the delivery of the placenta. We will numb your tissues for this, of course, and will move efficiently through this step so as to allow you to get back to focusing on bonding with your baby, instead of worrying about your perineum.
At or after this point, some people really like to apply an ice pack to the region to cool down swollen tissues and provide some relief from discomfort. Our birth kit does provide a couple of conventional ice packs, but there are lots of great recipes out there for homemade ice packs, such as these padsicles, or these diaper ice packs. If you decide to use an ice pack, just make sure to use it for no more than twenty minutes at a time, to allow for healthy, healing circulation.
A common time for women to experience discomfort in the early postpartum period is when they go to use the toilet. Even if you didn’t have any significant tears, urination can cause micro-abrasions to sting. To help avoid this, you can make use of the peri bottle that is included in your birth kit. We will typically fill this up for you with either plain, warm water, or add some herbs, if desired, and you can get great relief by spraying a gentle stream of water over your urethra as you urinate. We also recommend using this bottle to rinse off after urination or moving your bowels for the first 24 hours or so, and then gently patting dry with toilet paper, to avoid irritation.
Another great thing to consider is a sitz bath with healing herbs in a few inches of warm water in a clean bathtub, or using a basin that fits over the toilet. The warm water and herbs are so soothing, and help promote healthy circulation for healing. There are lots of good recipes out there, like this one.
Witch hazel can be a useful tool to have in your postpartum care basket. There are some awesome, soothing sprays such as this one, and witch hazel pads can be wonderful for relieving hemorrhoids and other swollen tissue.
Speaking of hemorrhoids, sometimes they come with the territory when you push a baby out. But keeping your stools soft at this time is of particular importance, as your body has had a pretty big disruption. Make sure you are drinking lots of water, eating fruits and vegetables, and try to have a bowel movement within 24 hours after the birth. Try not to strain when you go, as this could cause your hemorrhoids to bulge and perineal tissues to swell. If you have a tear, straining can be potentially harmful to healing. Softer stools and making sure you are moving your bowels on a regular schedule (daily, ideally), will go a long way to helping you avoid these problems.
Lastly, we encourage you to do a little “lying in” after the baby is born, for a period of about three days. If you can spend as much of this time as possible skin to skin with your baby, and just getting up to go back and forth to the bathroom, it will set your body on a good path to recovery, and give you and your baby time to bond and establish breastfeeding. If you have had a tear, especially, we advise that you avoid going up and down stairs or sitting cross-legged for a few days, to allow the tissues to begin their healing process.
After this lying-in period, it’s a good idea to avoid standing for long periods (such as shopping, or doing chores) for a few more weeks – this helps keep pressure off of your healing tissues (trust us – you’ll feel it in your vulva if you stand for too long), and also allows your uterus to involute and your bleeding to slow to a stop.
We hope these tips help you on your postpartum recovery journey. Have fun snuggling that new baby!