Physical health

Looking after yourself

Perineal care

When your baby is born, his or her head stretches the opening of the vagina. The skin inside and surrounding the vagina will often stretch well to allow your baby to be born, however during this process it is common for women to sustain a tear to the skin, inside the vagina or both – which may require stitches. The stitches used will always be dissolvable and should not need to be removed.

• first degree tears affect the skin of the perineum/vagina. Some of these tears require stitches and some may heal well without stitches. Your midwife will advise you on this after birth.
• second degree tears affect the skin and muscle of the perineum/vagina. Most of these tears require stitches to assist with healing.
• third and fourth degree tears affect the skin and muscle of the perineum/vagina, as well as some of the structures associated with the anal sphincter. These tears require an operation in theatre to repair them.
• labial tears occur to the labia minora, and will often require sutures to aid healing. Your midwife will advise you on this after birth
• episiotomies are sustained during the birth, when your doctor or midwife makes a cut to facilitate the birth of your baby. These are similar to second degree tears and will require stitches.

Perineal after-care

• always wash your hands before caring for your stitches, particularly if anyone in your household has a cough or cold.
• shower or bath daily if possible for the first two weeks. Prolonged bathing can cause the stitches to dissolve too quickly. Rinse with warm water and avoid soaps and perfumed products. Dry with a clean towel and avoid rubbing the area do not apply any creams, salts, oils or lotions to the stitches.
• sanitary towels should be changed frequently, and leaving the stitches exposed to the air can assist with healing.
• when passing urine, some mild stinging can be expected in the first few days. Avoid dehydration which can worsen this sensation. Rinsing with plain water during or after urination may reduce this discomfort.
• when opening your bowels the stitches won’t come apart. Avoid constipation or excessive straining and ensure good personal hygiene is maintained to reduce the risk of infection.
• mild/moderate discomfort is to be expected in the first few days after birth and can be relieved with common pain relief medications such as paracetamol and/or ibuprofen. Please speak to your midwife regarding the recommended dose and other methods to relieve discomfort of your stitches.
• using ice can reduce inflammation and pain. You can use ice wrapped in a clean towel or use a sanitary pad that has been placed in the freezer for a couple of hours. Place over the tender part of your perineum for 10 minutes. Repeat the process three to four times for the first few days.

If your stitches are gaping, oozing, severely painful, offensive in smell or unusually hot, please contact your GP, midwife or local maternity triage/assessment unit.

Caesarean after care

Following a caesarean you may feel sore and swollen for a few days. To help with pain, regular pain relief is recommended in combination with early and gentle movement.

Your scar will take up to six weeks to heal, and to assist with healing you should:

• look out for any signs of infection such as severe pain, parting of the wound, redness, oozing of pus and bleeding
• bath or shower daily and clean your incision site gently with warm water and pat dry
• keep the scar dry and exposed to the air when possible
• wear loose, comfortable clothing and cotton underwear
• avoid lifting anything heavier than your baby.

Gentle activity such as a daily walk is recommended to prevent the formation of blood clots.

Blood loss (lochia)

Some bleeding after birth is normal – this is recorded in your notes as estimated blood loss (EBL). Vaginal bleeding after birth is referred to as lochia, which is a mix of blood and other products from inside the uterus. This can be quite heavy at first, requiring several sanitary pad changes a day. After the first week the lochia slows down and becomes pink/light brown in colour. This loss will normally disappear by four weeks post birth.

Any large clots, silky ‘membranes’, sudden heavy bleeding or an offensive smell may be a sign that something is wrong and should be discussed with your midwife or GP urgently.

After pains

Period type pains after the birth of your baby are normal and are caused by the contraction of your uterus as it returns to its pre-pregnancy size and tone. It is normal for these pains to feel stronger when you breastfeed your baby due to the effect of hormones released during a feed, causing the uterus to contract. Any severe after pains can be treated with paracetamol. Make sure you read the label, and speak to your local pharmacist if you are unsure about this medication.

Breasts

The milk that your breasts first produce is called colostrum, and this will be present in the breast from mid-way through your pregnancy. The colostrum helps protect your baby from allergies and disease. Around three days after birth, the colostrum changes and becomes mature milk – and this change may make your breasts feel heavy and tender. Engorgement can happen if your breasts become over full of milk. This can be relieved with frequent breastfeeding. If your breasts feel so full that your baby is unable to take the breast, hand expressing a little of your milk can help. You can contact your midwife, health visitor or breastfeeding support worker if you are worried about your breasts being engorged.

Visit our infant feeding support pages.

Infections

Infections following birth are rare; however some women may contract infections which require treatment with antibiotics. Infections may occur in perineal stitches, caesarean section wounds, the uterus, breasts or in urine.

Signs/symptoms:

• a high temperature (more than 37.5°C)
• feeling unusually hot or cold/shivery
• feeling unusually lethargic and sleepy
• flu-like aches and pains in the body.

If your stitches or wound are infected you may notice pus, an offensive smell or an unusual amount of pain or tenderness in the area. You may also notice the skin is red and hot to touch.

An infection in the uterus may cause symptoms of excessive vaginal bleeding, passing of clots and offensive smelling blood loss. You may also note severe pain and/or heat on touching the lower abdomen.

If breasts become infected (known as mastitis) they may appear red, swollen and be painful/hot to touch. You may notice a burning sensation during feeds.

Urinary infections: symptoms include the increased need to pass urine or pain on passing urine.

If you are worried please speak to your midwife or GP urgently, or attend your local maternity triage/assessment unit.