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While you are still on the delivery table and your baby is being taken care of by the nurses, your perineum will be checked for injury. Injury to the perineum can be stretching of the skin, natural tears, or an episiotomy.
Natural tears in the perineum can happen as your baby passes through the vagina. Injury to the perineum can be:
➪ when the surface is nicked, but may not need stitches for repair
➪ when the lining of the vagina and some connective tissue is torn
➪ a tear that goes through the muscle around the anus
➪ a tear that goes through the vagina and into the rectum
Stretching of the skin and small tears may not need repair. An episiotomy or tears that need repair will be repaired with stitches while you are on the delivery table. If anesthesia is needed, you will be given a local anesthetic before the repair is done. Stitching usually takes about 10 to 20 minutes. The stitches are absorbed into the body within 3 to 6 weeks or they fall out on their own; they do not have to be removed. By the time the stitches are absorbed, the skin is strong and the edges should not separate. If you see stitches on your sanitary pad, check your episiotomy with a mirror to make sure the skin is still closed and looks healed.
While you have stitches, you can take tub baths or showers, depending on what your doctor tells you. You may wash the incision with mild, unscented soap. If the episiotomy stitches hurt or the bleeding gets heavier when you go up and down stairs, limit stair climbing as much as you can. You can expect complete healing without complications in about 6 weeks. Eat a diet high in fiber and fluids to help prevent constipation. Don’t take aspirin for pain, use acetaminophen instead.
Proper perineal care is important in preventing infection of the episiotomy, bladder, and uterus. Keep the perineum clean and free from caked or dried blood. Change sanitary pads at least every 4 hours to help prevent infection. Change pads every time you use the bathroom and when you bathe. Do not use tampons until your doctor says it is OK. Use proper perineal care every time you change pads, urinate, or have a bowel movement until all vaginal discharge (lochia) has stopped.
Steps for Proper Perineal Care
(See Tip 2) :
1. Wash your hands. “Peel” off the sanitary pad from front to back. This avoids dragging germs from the anal area to the vaginal area. Throw soiled pads in a lined trash can or plastic bag, not in the toilet. Be careful not to touch the soiled area of the pad.
2. After urinating and while still sitting on the toilet, squirt warm tap water over the outside of the perineum, beginning at the front and moving toward the back. Do not squirt water up into the vagina. Pat the area dry from front to back with toilet paper. Once done, gently wipe the entire area from front to back with witch hazel pads. Use a clean piece of toilet paper or witch hazel pad for each wipe. Drop used toilet paper or witch hazel pads into the toilet after each wipe. White, unscented toilet paper is best.
3. Put on spray or ointment if your doctor has ordered it. The spray or ointment promotes healing and allows comfort.
4. Do not flush the toilet until after you stand up, flushing water may splash onto the perineum. When opening or while putting on a clean pad, don’t touch the side that goes against your body. Put on the clean pad from front to back.
5. Wash the peri-bottle and your hands thoroughly. Urine can irritate the skin of the perineum and sting the episiotomy or tears. To keep urine from getting on this area, urinate while standing astride the toilet so urine will fall straight down or urinate while taking a shower. If you feel the urge to urinate but can’t, try sitting in a tub of warm water until the perineal muscles relax, then urinate while sitting in the water. Afterwards, rinse off well and finish your perineal care.
After a bowel movement, wipe from front to back with toilet paper. Then gently wipe or pat, again from front to back, with witch hazel pads to reduce minor itching or burning from hemorrhoids. Use a clean piece of toilet paper or witch hazel pad for each wipe. Drop used toilet paper and pads into the toilet after each wipe.
Always wash your hands thoroughly before and after going to the bathroom or changing a sanitary pad. Proper handwashing is the best thing you can do for yourself and your baby to prevent infection. The following are steps for proper handwashing.
1. Wash your hands for at least 30 seconds in warm water and with soap. Keep your fingertips pointed toward the bottom of the sink, and your hands lower than your elbows. This allows the soap, water, and germs to run down the drain, not down your arms.
2. Pay special attention to fingernails, between your fingers, and areas that look dirty.
3. Don’t touch anything while washing your hands.
4. Rinse your hands and wrists well, then dry them well with a clean towel.
5. Use the towel to turn off the water without touching the faucet with your clean hands.
Ways to Speed Healing and Relieve Discomfort
These are things you can do to speed healing of the perineum and make yourself more comfortable:
✔ expose the perineum to the air by letting your pad down while you are resting or napping. Be sure to protect your furniture and bedding by placing a thick towel or plastic-lined pad under you.
✔ avoid standing and sitting positions that put pressure on this area; avoid standing or sitting for long periods of time
✔ take the sting out when you urinate by pouring warm water over your perineum while you pee
✔ lie on your side while resting or napping
✔ sit on a pillow or rubber “donut” ring
✔ take sitz baths, or sit in a tub of warm water
✔ place a witch hazel pad between your stitches and the sanitary pad for about 15 minutes
✔ use ice packs made of gauze soaked in cold witch hazel to relieve pain
✔ try not to strain with bowel movements, you can press a pad of toilet paper against your stitches when you bear down
Sitz Bath You may be allowed to take home the sitz bath you used in the hospital. Take at least three 20 minute sitz baths every day for the first 7 days. The sitz bath speeds healing and relieves discomfort. Test the water temperature with your wrist before you sit in it. The perineum may not be sensitive to heat or cold while it is healing or if you are using a spray or ointment to relieve discomfort. It you don’t have a sitz bath, wash your feet and legs, then fill the bathtub with 3 inches of warm water and sit in it.
Strengthening the Perineal Muscles
No one can tell that you are doing Kegels and you can do them anywhere. The perineal muscles carried the increasing weight of your uterus and your baby during pregnancy. Then the perineal muscles stretched around your baby during birth. This extra weight and stretching can cause these muscles to lose some of their strength and tone. The perineal muscles will gradually regain much of their strength and tone the first 6 weeks. Doing Kegel exercises can help regain muscle strength and tone sooner.
Doing Kegel exercises can reduce problems with leaking urine. It is not uncommon for small amounts of urine to leak from your bladder until the perineal muscles are back to their pre-pregnancy state. Leaking urine, called incontinence, can happen when you cough, sneeze, strain, laugh, or pick up your baby. (See Tip 3)
Kegel exercises will help regain control of your bladder and reduce discomfort from the perineum. You probably did Kegel exercises during your pregnancy. You should keep doing these exercises when you return home from the hospital. Pressure on the perineum during birth can cause a temporary loss of feeling in nearby nerves. At first, the perineal area may feel numb and you may not feel yourself doing Kegel exercises. However, feeling should gradually return over the next few weeks.
Kegel Exercises To do Kegel exercises, squeeze the perineal muscles as if you were trying to stop the flow of urine. Hold for 5 to 10 seconds and then relax. Do this exercise 10 times a day in sets of 10 repetitions. Do at least 10 Kegel exercises every time you urinate and at least 100 Kegels each day. No one can tell that you are doing Kegels and you can do them anywhere. Do a few during the commercials while you watch TV.
You may notice that you have to urinate quite often for the first 4 to 5 days while your body gets rid of f luid it no longer needs. Due to the effects of anesthesia and pressure on the bladder and urethra during childbirth, the return of normal bladder function may take 4 to 7 days.
If it is hard for you to urinate, try pouring warm water over the perineum while sitting on the toilet or listen to water running in the sink. If you cannot urinate or have signs of a urinary tract infection, call your doctor.
More About Self Care After Vaginal Birth
Introduction to Self-care After Vaginal Birth
Preventive Self Care
Physical Changes and Healing
Activities and Healthy Exercise
Nutrition and Diet
Family Planning and Birth Control
Normal “Baby Blues” or Postpartum Depression
Your Postpartum Check-Up
Get as Much Rest as You Can
When to Call Your Doctor
Involution is a normal process where the uterus continues to contract until it shrinks to its non-pregnant size of a pear.
When you are ready to change sanitary pads, have a clean sanitary pad, witch hazel pads, and the peri-bottle (squeeze bottle) nearby. Rinse out the peri-bottle and fill it with warm, not hot, tap water. Then follow steps 1 through 5 under Proper Perineal Care.
You can make witch hazel pads with soft 2” x 2” non-sterile gauze pads and witch hazel. Always apply the witch hazel to a clean gauze pad so you will not get germs into the witch hazel. You can buy pre-soaked witch hazel pads at your drug store.
To make cold witch hazel pads, keep the bottle of witch hazel or some pre-soaked witch hazel pads in the refrigerator.
It’s common to be afraid the episiotomy stitches will tear if you cough. Coughing, sneezing, straining, and laughing put a lot of pressure on your stitches. You will be more comfortable if you tighten the perineal muscles before you cough, sneeze, strain, or laugh and then relax them afterward.
You can relieve discomfort by pressing your pad against your stitches for support before you cough or sneeze.