What to expect when you're expecting (168 page)

Everyone who delivers vaginally (and sometimes those who have a lengthy labor before delivering via cesarean) can expect some perineal pain. But, not surprisingly, that pain’s likely to be compounded if the perineum was torn or surgically cut (aka an episiotomy). Like any freshly repaired wound, the site of a laceration or episiotomy will take time to heal, usually 7 to 10 days. Pain alone during this time, unless it is very severe, is not an indication that you’ve developed an infection.

What’s more, infection (though possible) is really very unlikely if your perineal area has been well cared for since delivery. While you’re in the hospital or birthing center, a nurse will check your perineum at least once daily to be certain there is no inflammation or other indication of infection. She’ll also instruct you in postpartum perineal hygiene, which is important in preventing infection not only of the repair site but of the genital tract as well (germs can get around). For this reason, the same precautions apply for those who delivered completely intact. Here’s the self-care plan for a healthy postpartum perineum:

Use a fresh maxipad at least every four to six hours.

Pour or squirt warm water (or an antiseptic solution, if one was recommended by your practitioner or nurse) over your perineum while you pee to ease burning, and after you’re done on the toilet, to keep the area clean. Pat dry with gauze pads or with the paper wipes that come with some hospital-provided sanitary pads, always from front to back. Gently does it—no rubbing.

Keep your hands off the area until healing is complete.

Though discomfort is likely to be greater if you’ve had a repair (with itchiness around the stitches possibly accompanying soreness), the suggestions below will likely be welcome no matter how you delivered. To relieve perineal pain:

Ice it.
To reduce swelling and bring soothing relief, use chilled witch hazel pads, a surgical glove filled with crushed ice, or a maxipad with a built-in cold pack, applied to the site every couple of hours during the first 24 hours following delivery.

Heat it.
Warm sitz baths (a bath in which only your hips and buttocks are submerged) for 20 minutes a few times a day or hot compresses will ease discomfort.

Numb it.
Use local anesthetics in the form of sprays, creams, ointments, or pads recommended by your practitioner. Acetaminophen (Tylenol) may also help.

Keep off it.
To keep the pressure off your sore perineum, lie on your side when possible, and avoid long periods of standing or sitting. Sitting on a pillow (especially one with an opening in the center) or inflated tube (usually marketed to hemorrhoid sufferers) may also help, as can tightening your buttocks before sitting.

Keep it loose.
Tight clothing, especially underwear, can rub and irritate the area, plus slow healing. Let your perineum breathe as much as possible (for now, favor baggy sweats over spandex leggings).

Exercise it.
Kegel exercises, done as frequently as possible after delivery and right through the postpartum period, will stimulate circulation to the area, promoting healing and improving muscle tone. Don’t worry if you can’t feel yourself doing the Kegels; the area will be numb right after delivery. Feeling will return to the perineum gradually over the next few weeks—and in the meantime, the work’s being done even if you can’t feel it.

When to Call Your Practitioner Postpartum

Few women feel their physical (or emotional) best after delivering a baby—that’s just par for postpartum. Especially in the first six weeks after delivery, experiencing a variety of aches, pains, and other uncomfortable (or unpleasant) symptoms is common. Fortunately, what isn’t common is having a serious complication. Still, it’s smart to be in the know. That’s why all recent deliverees should be aware of symptoms that might point to a postpartum problem, just in case. Call your practitioner without delay if you experience any of the following:

Bleeding that saturates more than one pad an hour for more than a few hours. If you can’t reach your practitioner immediately, call your local emergency room and have the triage nurse assess you over the phone. He or she will be able to tell you whether or not you should come into the ER. While waiting or en route to the ER, if necessary, lie down and keep an ice pack (or a ziplock plastic bag filled with ice cubes and a couple of paper towels to absorb the melting ice) on your lower abdomen (directly over your uterus, if you can locate it).

Large amounts of
bright red
bleeding any time after the first postpartum week. But don’t worry about light menstrual-like bleeding for up to 6 weeks (in some women as many as 12) or a flow that increases when you’re more active or when you’re nursing.

Bleeding that has a foul odor. It should smell like a normal menstrual flow.

Numerous or large (lemon-size or larger) clots in the vaginal bleeding. Occasional small clots in the first few days, however, are normal.

A complete absence of bleeding during the first few postpartum days

Pain or discomfort, with or without swelling, in the lower abdominal area beyond the first few days after delivery