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Peri What?? Healing from episiotomies and vaginal tears

Hello, dear readers! Looks like Spring may finally be making its much anticipated arrival after all. It’s been a long winter…but you don’t need me to tell you that!

Speaking of arrivals, of course, leads me to thinking about birth; the arrival of your precious baby. I asked some of our doulas for pertinent birth topics on which to write and two doulas suggested a blog about postpartum episiotomy care. So I hit the books, well, the Internet, and gleaned some useful tips and helpful aids in the care of an episiotomy. Let’s learn more, shall we?

“What is an episiotomy, anyways?” you may ask. Perhaps this medical term was foreign to you before you were pregnant, right up there with Braxton Hicks contractions and transition. An episiotomy is an incision made in the tissue between the vaginal opening and the anus, or the perineum, during childbirth, to enlarge the vaginal opening. It was once believed that an episiotomy would help prevent more extensive vaginal tears during childbirth. Also, healthcare professionals thought episiotomies would heal better than a natural tear. Until research suggested that episiotomies do not prevent these problems after all, they were a routine part of childbirth. However, although episiotomies are no longer recommended, there are still some cases in which the procedure is warranted. If extensive vaginal tearing seems likely, if your baby is in an abnormal position, or needs to be delivered quickly, an episiotomy may be suggested.

If you have had an episiotomy during delivery, the wound may be painful for a few weeks, with the most intense pain lasting from 3 to 5 days after delivery, especially while walking or sitting. Any stitches used to repair the incision will usually be absorbed on their own and will not need to be removed. While you heal, there are certain things you can do to promote comfort and healing.

During the first 12 hours after delivery, an ice pack can be helpful in preventing both pain and swelling of the episiotomy site. The incision should be kept clean and dry to avoid infection. The nurses in the hospital should provide you with an ice pack and will inform you as to how to use it.

Frequent sitz baths, soaking the area of the wound in a small amount of warm water for about 10-15 minutes, 3-5 times a day, can be helpful in soothing and keeping the episiotomy area clean. Many new moms find heat can be comforting. Apply warm, wet compresses as needed for about 5-10 minutes. Be sure to gently pat the area dry when you are done with a soft cloth or clean gauze. For some moms, alternating heat and cold is particularly helpful.

Most likely you were given a squeezable plastic bottle that has several tiny holes in the spout shortly after having your baby. Your nurse strongly suggested that you bring this bottle with you every time you use the bathroom. What is this bottle? It’s your new best friend, the “perineal cleansing bottle”, or the “peri bottle”. Make sure you bring this home with you; it’s the second most important thing you bring home from the hospital, your baby being the first, of course. This little bottle can provide tremendous relief!

Fill your peri bottle with warm tap water before using the bathroom and make sure it is in reachable distance from the toilet. After you gingerly sit down on the toilet, use your peri bottle to spray the incision area with the warm water as you begin to pee. Sound odd? Believe me, you’ll want to do this. The warm water will dilute your urine, which can be an irritant to the episiotomy site… irritant = stings or burns the incision. Remember that the more fluids you drink, the more diluted your pee will be, so this might be a good time to practice that “8 glasses of water a day” recommendation.

Also, continue to slowly spray after using the toilet, moving from front to back, vagina to rectum. The water is cleansing and very soothing. Wait a minute or two and then pat the area dry with a soft, clean cloth or gauze. Do not wipe, especially since you have stitches.

Of course, to put this delicately, what goes in must come out. Yes, I’m talking about elimination, aka doing number two, pooping. (You may as well get used to “potty slang”, you can be guaranteed your little one will come up with his/her own term for “pooing”) Make sure to stay well-hydrated, increase your fiber intake, and perhaps even ask your healthcare professional about a stool softener. The softer the stool the easier it is to pass and the easier going to the bathroom will be on the episiotomy site.

You can put 4-5 soft baby wipes, yes, the ones you are using on your precious baby’s little tush, on a plate and microwave them for about 10 seconds. They will be hot, but they’ll have time to cool while you are using the toilet, but please, be careful! Take them into the bathroom with you, along with your peri bottle full of warm water. Make sure they are within arms’ reach. I am not going to mince words here; your first few bowel movements will cause some discomfort, maybe even pain. Go slowly and patiently.

After pooing, take your warm wipes (make sure they are not hot) and gently dab. Yes, gently dab. Do not tug or pull. Generously use your peri bottle, and then dab again with a clean wipe as needed. Pat the area dry with a soft, dry cloth or clean gauze. You did it!

Remember, most, if not all, baby wipes are not flushable. The last thing you (or your partner) need to deal with right now is a clogged toilet!

Some mothers have found it helpful to dip a washcloth in witch-hazel and place it “anywhere it hurts” in the incision area. You may want to use dark-colored, inexpensive washcloths you won’t mind throwing away after use. But of course, that’s up to you. The witch-hazel soaked cloth can be placed in the refrigerator before use as the chilled cloth can be very comforting and reduces swelling. Also, small bags of frozen peas or corn kernels covered with a soft cloth can be used as an icepack. Other moms have reported that wetting a sanitary napkin, placing it in sealed Ziploc bag, and then freezing it works well for an easy ice pack and provides cool relief. Whatever you chose to use, apply the cold for 15-20 minutes, as needed.

Other new moms have found relief by dabbing the episiotomy site with Calendula and using compresses soaked in lavender or chamomile oil. Many midwives have information and directions on the use of herbal remedies to reduce pain, inflammation, and promote healing.

Be sure to ask your healthcare provider about using pain relievers, such as acetaminophen or ibuprofen, to “stay on top of the pain” and preventing it from getting to be too much. If you are breastfeeding and are concerned about the use of pain relievers, please speak with a lactation professional to get the most up to date information.

Remember, your body has just done some amazing, albeit hard, work. It will take some time to heal and return to normal, although “normal” now may be completely different than it was pre-pregnancy. Kegel exercises will help in improving the control you have over your continence levels and speed the healing time after birth. You may find Kegel exercises will also improve your sex life later on when you have been “cleared” to resume having sex….and you actually have the energy to be interested.

Some mothers who have had episiotomies experience discomfort or ever pain during arousal and intercourse. Waiting to resume intercourse until the site is fully healed, usually about 6 weeks, is important for long-term recovery. When you are ready to have sex, both physically and emotionally, try a position that allows you to control the depth of penetration, perhaps side-by-side or woman-on-top. Use a water-based lubricant. If it is painful, say so! Keep communication open with your partner. Don’t silently “put up with” the pain. Pain and discomfort should improve over time.

If your pain becomes chronic, please let your healthcare provider know. You are not the only new mom to experience this and your doctor or midwife can provide suggestions to ease any discomfort. Also, she may refer you to see a physical therapist (PT) who specializes in pelvic rehabilitation. The PT will evaluate your pelvic floor muscles, which stretch from the pubic bone to the tailbone, cradling your bladder, bowel, and uterus, and help you control your urine, bowel movements, and sexual functioning. The PT will determine if these muscles are contributing to your pain. If they are, the PT can work on the muscles and tissues to ease restrictions and teach you exercises for you to do at home that will relax tightened muscles and strengthen those that are weak.

And of course, rest is an important component in healing after having an episiotomy. Take naps when you can. Be kind to yourself. Appreciate the awesome work your body has performed, even your “lady bits”. Try sending some calming, loving, healing vibes throughout your whole body. Practice deep breathing and allow yourself to practice self-care of your body, mind, and soul. And enjoy every precious moment with your darling baby.

If you have any further questions about episiotomies, the possibility of avoiding the need for one, signs of episiotomy infection, or episiotomy care, please contact your healthcare provider.

Happy healing to you!

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