Healing After a Vaginal Birth: Tears, Stitches and Perineal Care

Tears and stitches

• Most people who give birth vaginally for the first time have some tearing. Tears are graded 1 to 4: first and second degree involve skin and muscle and heal well; third and fourth degree reach the anal sphincter and need extra follow-up.
• Stitches usually dissolve on their own within a few weeks. You may find bits on your pad.
• An episiotomy (a cut) heals like a second-degree tear.

The first few days

• Cold: ice packs or a chilled pad for 10-20 minutes at a time in the first 1-2 days ease swelling. Put a thin cloth between ice and skin.
• Peri bottle: squirt warm water over the area while you pee to dilute the sting, then pat dry front to back. Don't wipe.
• Numbing spray or cooling pads from the hospital can help; ask what's safe.
• Pain relief: take the medicines your provider recommends on a schedule for the first days.
• Lie down often, on your side, to take pressure off the perineum and reduce swelling.

The first weeks

• Warm sitz baths (a shallow soak) a few times a day after the first day or so feel good and keep the area clean.
• Sitting: a pillow or folded towel under each thigh is often better than a ring cushion.
• Pads, not tampons, until your provider says otherwise. Change them every 4-6 hours.
• Bowels: drink water, eat fiber, use the stool softener you're offered, and don't strain. Pressing a clean pad against your stitches when you poop can make it feel safer. Your stitches won't burst.
• Hemorrhoids are common and usually shrink over weeks; cool packs and avoiding straining help.
• Leaking a little urine with a cough or sneeze is common early on and often improves; see the pelvic floor guide.
• Look: a hand mirror at a week or two can be reassuring. Swelling and bruising fade; the area usually looks more like itself by 6 weeks.

How healing usually goes

• Soreness should improve a bit every few days. Most first- and second-degree tears feel much better by 2-3 weeks.
• After a third- or fourth-degree tear, ask for a check at 2 weeks or so and a referral to pelvic floor physical therapy. Some people need a longer course; that's common, not a failure.
• Sex and exercise: see the sex and birth control guide and the pelvic floor guide.

When to check in

• Mention at your postpartum visit any pain with sitting or sex, leaking of urine, gas or stool, or a bulge or heaviness.
• Contact your provider soon if pain gets worse instead of better, the area is hot, red or oozing, there's a bad smell, the wound opens, you can't pee, or you have a fever of 100.4°F (38°C) or more.
• If you're soaking a pad in an hour and feel dizzy or faint, call 911.