Most women want a normal delivery with an intact perineum but
unfortunately, this may not always be possible and the majority of
women will have a wound to take care of in the postnatal period.
Perineal wounds are either a tear or an episiotomy. During the
second stage of labour, the perineum has to stretch to allow the baby
to be born. A tear usually occurs during delivery of the widest
diameter of the baby's head or the baby's shoulders. A tear normally
extends from the vagina downwards to the anal region and it heals very
quickly. Although rare, the tear may extend into the anus, which is
more complicated and requires extra care. An episiotomy is a surgical
cut in the perineum to facilitate vaginal delivery of the baby, which
may be normal, by forceps or vacuum extraction. The tear or episiotomy
needs to be stitched to facilitate healing and hopefully get it back to
its' pre-pregnant state.
Care of perineal wounds
During the first postnatal days, the perineum will be bruised,
swollen and sore. You may find it painful to walk or sit therefore it
is best to lie down as much as possible for the first few days.
Sometimes when you pass urine, you may feel a stinging pain on the
wound. To reduce this effect, pour cool water on the area as you pass
urine so that the water will dilute the stinging effects of the urine.
To help reduce the swelling and for the wound to heal quickly, the
best treatment is to soak the perineum in cool salt water for 5-10
minutes once or twice daily until the wound has healed. Hot water will
increase blood flow to the area which may make it more painful later.
During the healing process, the tissues will shrink causing the
wound to become tight and uncomfortable. Sometimes the sutures
(stitches) may become hard and stick into the flesh, which can be very
painful. If you feel any uncontrollable pain, you must go back to your
obstetrician who may remove a couple of stitches to relieve the pain.
Keep the area as clean and dry as possible by changing your sanitary
pad regularly. It is better to use sanitary towels with loops as these
can provide some counter pressure on the wound therefore making it less
painful.
Do not use air rings. It does give relief when you sit but it may
restrict blood flow to the area if used too long, which may delay
healing of the episiotomy. It is better to sit on a soft pillow.
Please do not use feminine sprays or powder as they may interfere with the healing process.
A caesarean section is an operation whereby the baby is delivered
through a cut in the lower abdominal and uterine walls. Normally, the
cut is in the lower segment of the uterus at the bikini line.
Care of the section wound
Initially, the wound may be painful especially when you move or
cough. This is due to internal pressure on the wound. Placing a hand
firmly on the wound when you cough or move will counteract this
pressure and reduce the pain. The pain is also due to tissue trauma
therefore it may be necessary to take some painkillers. Keep the wound
dry until any stitches are removed (normally about 7 days) so no
bathing allowed. Use cotton dipped in salt water to soak and remove the
scabs. Salt water also helps healing and reduces itching when the wound
is healing. Do not lift heavy items for at least 6-8 weeks after the
delivery.
Care tips for both types of wounds
- As far as possible, try not to bathe the baby yourself until the wound has healed properly.
- To help the wounds heal quickly, do not eat ginger for the first 10 days.
- Take extra vitamin C.
- Do not walk too much especially up and down stairs as your wound needs to 'rest' in order to heal.
- After 2 weeks, massage the wound with vitamin E oil to prevent keloid formation.
- Do not worry if the wound feels itchy even after many weeks or months.
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