Postpartum recovery and care after a vaginal birth – Your step-by-step midwife guide
Updated: Mar 28, 2022
Congratulations! Now, the real fun begins. 😊
No matter the type of vaginal birth that you experienced, the recovery and care of your perineum is so important.
If you’re sitting there wondering what the hell a perineum is, you wouldn’t be the first woman. The perineum is the area between your vulva and your anus. It’s the area that may be intact (meaning without a tear or cut after giving birth) or it may have a tear or episiotomy (a cut) to allow more room for your baby to be born. This all sounds really scary, but it’s all part of giving birth. The body has an amazing way of healing, if you look after it correctly.
Once you have given birth it’s important to know how your perineum is. Ask the question, “Is my perineum intact or did I tear? And if I did tear, what degree is it?”
Having a tear after a vaginal delivery is common. You will most likely have that sutured – also known as having stitches. The tear and suturing is graded in degrees, not in the number of stitches. So, you may have a first-degree, second-degree, third-degree or fourth-degree tear. A third- and fourth-degree tear will need the most care postnatally, and often beyond. It’s something that you can recover from, but you will need extra care.
Look after your perineum – you only get one
You’ll need to wash your perineum twice a day with water, to prevent infection. Keep the area clean and dry.
Wear one sanitary pad on top of another for support, while also providing cushioning.
Although you may feel like wearing loose undies, what you need is support. Think Bridget Jones – the undies girls wear under dresses to appear smaller, smooth and toned. You need the boy-leg or bicycle-shorts ones that go all the way up to just under your bra or above your bellybutton. You’re not going to a party, so they don’t need to be so tight that your post-baby belly is up around your neck. They need to be the size you are now, while providing soft and comfortable compression. In the first couple of days you may just want to wear firm undies or a double pair of undies for softer support. Post birth, both your pelvic floor and abdominal muscles are relaxed. They need to be scooped up and cradled with support to heal. In short, your undies need to be the shapewear type. Buy yourself a few pairs from Target, Myer or any major underwear store. I recommend you wear them on top of your normal undies so you can get a few wears out of them. Wear these for a minimum of six weeks after giving birth, especially when you get back into walking and exercise.
Next, for the first 48 hours after giving birth, unless you are feeding yourself or your baby, stay off your bottom – meaning keep your weight off your bottom. Sit on your side or lie down, allowing your pelvic floor and perineum to heal, recover and rest completely. This doesn’t mean you stay in bed all day – you need to attend to yourself and your baby. But when you sit down, shift your weight to your hip by sitting on your side, and choose to lie down versus standing and sitting.
Ice is also your friend, to reduce swelling and to numb the pain. It works like treating a sports injury. Ice for 20 minutes at a time and repeat every two and a half to three hours. The number of women who leave the ice pack on until it has melted, beyond all recognition of anything resembling an ice pack, would surprise you. It isn’t good for a wound to be wet and soggy. For optimum healing the muscle only needs 20 minutes of icing. Keep the area clean and dry. Set an alarm for 20 minutes. Use this ice treatment to reduce swelling in the first 48 hours after giving birth, and after that you can still use it for comfort. It’s a great form of natural pain relief.
After 48 hours you may want to have a salt bath. This can be great for your stitches and relaxation. Some hospitals have a bath that you can use for this. If not, you can use a jug of water with added salt and pour onto or rinse your perineum into the toilet or shower.
Drink lots of water and empty your bladder every two to three hours. Having a full bladder puts extra pressure on your pelvic floor and, after all the work its done, it needs all the breaks it can get. If you don’t empty your bladder regularly, you could end up with a little urine incontinence. Don’t freak out. This can happen, but with care and restrengthening, you can help prevent it. If this continues to happen, please see a postnatal physio so they can check that you’re doing your pelvic floor exercises correctly.
If you’re getting a stinging sensation when passing urine, you can discuss this with your midwife. She can check your perineum and give you Ural, to help take the acidity away from your urine. You can also pour warm water from a jug into the toilet as you are passing urine, which will also decrease the acidity that can sometimes sting your stitches or grazes after you’ve given birth. This is all temporary.
After giving birth your bowels may go on strike, partly because women are often scared to use them. That area can feel a little fragile. The changes in your diet during your hospital stay, as well as analgesia (pain relief), can also lead to temporary constipation. You need to drink lots of water and add extra fibre to your diet, through fruits such as pears, kiwis or prunes. You can also request fibre supplements like Fybogel, lactulose / Actilax or Metamucil and do a lap of your ward to get your bowel moving. A coffee may also help. If all these fail, you’ll need a stronger laxative such as Coloxyl or, as a last resort, a suppository. These are not things that you continue to take; they’re just to get the initial movement or to help soften the process.
If you’ve had a third-degree tear, supporting your pelvic floor as described above is very important, as well as keeping your bowel movements soft and regular. Please request extra information from your healthcare professional. With the right care, you’ll have the best possible recovery. You will also most likely need to see a postnatal physio for ongoing care and support.
When your bowels are ready to go, don’t be afraid. You’ve given birth; this is a walk in the park. Please ensure that you are sitting on the toilet correctly. Use a foot stool to raise your knees. (If you don’t have a foot stool, you can place one toilet roll under each foot, or raise your feet to your tiptoes). Lean forward and place your elbows on your knees. This will reduce the pressure on your perineum and provide your bowel with direct flow to exit. This is how women should always sit on the toilet. (Please teach your daughters when they start to use a toilet. You may find that they do this naturally.) You may like to support your perineum for peace of mind and comfort. If you’re concerned, fold some toilet paper and with your hand support your pelvic floor. Relax and breathe. You can do this.
I have talked a lot about your pelvic floor. To strengthen your pelvic floor muscles, sit comfortably and squeeze and release the muscle ten times. Don’t hold your breath, and make sure that you’re not tightening other muscles, such as your stomach, bottom or thigh muscles. Then if you are feeling up to it, repeat this exercise by holding each squeeze for a few seconds, gradually grading up to five seconds, release for five seconds and repeat this 10 times, at least three times a day. For the first week after giving birth, just activating them on and off is fine. Repeat this for the rest of your life.
You’ve got this. The body has a phenomenal ability to heal. Quite often, when I check a perineum after a mother has given birth, you honestly cannot even tell that they’ve had a baby. Your body was made to do this. ☺ Give it time to recover.
Always check with your own Doctor, midwife or healthcare professional prior to following any information here - to ensure it's safe and adequate for you and your situation. This is not a midwife - patient - client relationship.