Doctor's Notes on Postpartum Perineal Care
The perineum is the area between the urethra and the anus. In women, this are includes the vaginal opening. The perineum undergoes stress and change during pregnancy and delivery, and it needs special care afterward. Some women have the perineum surgically cut (episiotomy) when they deliver a baby. Other women perform perineal massage during their pregnancy to prevent pain and other problems after delivery.
Symptoms of injury to the vagina and the perineum during delivery may include
- bruising, or
- a collection of blood under the skin (hematoma).
- Small hematomas may go away on their own.
- Larger hematomas may need to be drained.
- Tears in the tissues (lacerations) may heal on their own or need to be repaired by suturing.
The episiotomy will scar as it heals. After giving birth there will be some vaginal discharge called lochia that will be red at first and gradually become white, or clear like mucus.
What Is Postpartum Perineal Care?
After delivering a baby, the perineum must be kept clean. Episiotomy scars need to be kept clean and closely monitored for infection. Small amounts of bleeding may happen for several days from the perineum area. Also, lochia may drain for up to four weeks, so pads should be changed frequently.
Things that can be done to help the perineum heal and decrease symptoms after delivery include:
- Drink lots of fluids to avoid dehydration which can make bowel movements harder
- Eat fiber rich foods to avoid constipation
- Cold sitz baths help reduce swelling and discomfort after delivery
- Take a bath or a shower once or twice daily, especially after a bowel movement (a sitz bath can help with this as well)
- Ice packs or cool compresses to the area as tolerated
- Cleanse hemorrhoids and apply topical steroid cream to soothe the area
- Do not use tampons
- Avoid heavy lifting or strenuous lifting for a few weeks (talk to your doctor about when to start exercising again)
- Over-the-counter (OTC) pain medications such as acetaminophen (Tylenol) or ibuprofen (Motrin, Advil) may be used
- Use Kegel exercises to restrengthen the muscles in the area of the vagina and perineum
Must Read Articles:
How Painful Is Labor and Delivery?While labor and delivery are expected to be painful, there are many ways to manage the pain. Labor pains vary from woman to woman and even one pregnancy to the next. Pain during labor is described as extreme menstrual cramps, strong cramping, severe pressure, extremely strong waves similar to diarrhea cramps, bad back pain, an achy feeling, and a broken bone.
Postpartum DepressionPostpartum depression occurs in 10%-20% of women after having a baby. Symptoms and signs include frequent crying, sleep disturbance, and weight loss. Treatment may involve psychotherapy and medication.
Pregnancy, BleedingBleeding during all phases of pregnancy may be dangerous, even though it can be caused by a large variety of factors. You should call your health care professional if you have any signs of vaginal bleeding during your pregnancy.
Signs of LaborEarly signs of pregnancy labor begin between 37 and 42 weeks after the last menstrual period. Symptoms of labor signs include lightening (dropping), blood show, nesting instinct, nausea and diarrhea, increased Braxton Hicks contractions, and water breaking. False labor has different symptoms and can be recognized from true labor.
Vaginal DischargeVaginal discharge is a fluid or semisolid substance that is normal and helps keep the vagina clean. Normal vaginal discharge is clear or milky white and does not have an unpleasant odor. Bacterial vaginosis, yeast infections, or sexually transmitted diseases (STDs) including trichomonas, gonorrhea, or Chlamydia can cause a change in color or odor. Symptoms of infection may include yellow-green or gray discharge, strong odor, or irritation of the genitals. Treatment depends on the infection.
What Are the Stages of Labor and Delivery?There are four stages of labor and delivery, starting from the contractions that help the cervix to thin (effacement) and start to open (dilation), which later progress to the point of pushing out the baby and placenta. In the recovery stage, the baby is delivered and the mother may feel joy, relief, and fatigue.
What Is Normal Vaginal Discharge?Vaginal discharge describes fluid or mucus that comes from the vagina. Vaginal discharge helps protect the vagina and urinary tract from infections and helps lubricate vaginal tissues. A certain amount of vaginal discharge is normal, unless it occurs with bothersome symptoms.
Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.