June 4, 2019

Reviewed by Kimberly Langdon M.D.

Most of the advice on recovering from childbirth assumes an “average” birth, which can be frustrating for everyone whose experience doesn’t match this standard (which is most people, btw). For example, most advice assumes an uncomplicated vaginal birth, when roughly a third of US births are via cesarean. Also, a common “complication” of birth is tearing, so we’re going to talk about how a perineal tear or episiotomy might affect your recovery.

First, let’s be clear about what that even means. During a vaginal birth, tearing is very common (occurring in 53-79% of vaginal births), and it usually happens around the perineum, which is the area between the vagina and the anus. Perineal tears are classified by severity from 1st degree to 4th, with 1st being the most superficial (just the skin tears around the vagina tears) and 4th being a complete tear from vagina to anus, including pelvic floor muscles, and a whole lot of ouch.

I can confirm postpartum life is 90% better when you don't rip to your butthole. Baby boy: 1 point. Luna: 0

— christine teigen (@chrissyteigen) May 20, 2018

Luckily, most tears are 1st or 2nd degree, which don’t usually require a procedure to fix, as 3rd and 4th-degree tears might. How fast you heal will definitely depend on how bad you tore, but everyone recovers differently. If you’re not sure if you tore (hey, there was a lot going on) or how badly, just ask your OB or midwife. Sometimes they gloss over this info, but it really helps to know so that you can manage your expectations for recovery.

Related: What to expect when you have a 2nd degree tear

Sometimes, you don’t tear naturally, but your perineum is cut by your OB during childbirth, which is called an episiotomy. Routine episiotomies are not recommended anymore, but episiotomies are still performed in some circumstances (around 12% of the time), for example if the delivery needs to be hurried up because the baby’s heart rate drops. If you have a forceps- or vacuum-assisted birth, you probably had an episiotomy. If you’re not sure if you had an episiotomy, again ask your OB or midwife. Usually, episiotomies end up healing like a 1st or 2nd-degree tear, but occasionally they will be more involved, like a 3rd or 4th-degree tear.

If your tear was 1st or 2nd degree, most likely you were stitched right up after delivery with local anesthesia. If it was 3rd or 4th degree, you will also be repaired immediately but it is a bit more extensive to repair the area. Either way, it’s going to be sore for at least a week, and potentially much longer depending on the severity. The actual incision should heal within 4-6 weeks (your doc will check on this at your postpartum check-up) and the stitches dissolve on their own.

Some things you can do to help with the pain and healing process include:

• Ice. In the hospital, they might have ice packs for you to keep in your underwear. At home, padsicles are a favorite way to reduce pain and swelling (here’s how to DIY).
• Witch hazel pads. You can buy pre-soaked pads (like Tucks brand) which help with pain, swelling, and reduce the chance of infection.
• Rest. The amount of rest vs. activity that’s right for you is going to depend on how severe your tear was, but pay attention to how you feel and don’t push it. Start slow by walking to your mailbox, and seeing how that feels before going farther.
• Sitz baths. A sitz bath is a small tub that you fill with water (you can add epsom salts or fancy sitz bath soaks), place on top of a toilet, and soak your perineum in for 10-15 mins. You can also do them in the bathtub if you prefer.
• Pain meds. Ibuprofen (like Advil) and acetaminophen (like Tylenol) are generally safe for breastfeeding and can reduce pain and swelling.
• Stool softeners. Oh man, that first post-baby poo can be terrifying. The last thing you want to do is pop your stitches straining on the toilet, so stool softeners, along with plenty of water and fiber, are your friends.
• Peri bottle. This is just a bottle that you fill with water to squirt yourself clean after going to the bathroom. Pat dry and avoid wiping until you’re healed. They usually give you one at the hospital, but there are fancier ones like the one from Fridababy.

buying myself a push present pic.twitter.com/LmONcG9GHD

— christine teigen (@chrissyteigen) April 20, 2016

After your incision is healed, you still may have some longer-term recovery. Tearing may involve trauma to your pelvic floor, so some physical therapy may be needed to address symptoms like pain, discomfort, or leaking. It should be routine for anyone with an extensive tear or episiotomy to be evaluated by a pelvic floor physical therapist (it is standard in some parts of the world, like France). Tearing, in general, is shown to have a higher risk of pelvic organ prolapse, when your pelvic organs start to fall out of place. Some studies have shown that episiotomies and 3rd & 4th degree tears lead to a higher chance of fecal incontinence, which is when you have trouble holding in bowel movements. And episiotomies have been shown to be correlated with painful sex, especially in the early postpartum months. All of these issues can be treated by pelvic floor physical therapy.

Also, traumatic birth may have a higher correlation with perinatal mood and anxiety disorders (PMADs), so check in with yourself and get help if you need it. For those that had a 4th-degree tear, there’s a private Facebook support group, and a blog featuring stories. Talking about it can really help, and there are professionals that specialize in birth trauma. If you need help finding someone, let us know.

Related: 7 Postpartum Depression Myths Debunked

Whew, I know this one is intense, but there is some good news. The odds of tearing are higher for first-time moms, so if you’re planning to have another kiddo, your chance of tearing again goes down. But also, if this happened to you, you’re in good company, even if people don’t always talk about it.

Sources:

https://www.uofmhealth.org/health-library/zx3823

https://journals.lww.com/greenjournal/Fulltext/2016/07000/Practice_Bulletin_No__165__Prevention_and.46.aspx

Kimberly Langdon M.D. is a retired University-trained obstetrician/gynecologist with 19-years of clinical experience. She graduated from The Ohio State University College of Medicine and then completed her OB/GYN residency program at The Ohio State University Medical Center. Recently, she founded a medical device start-up company that focuses on non-drug treatment for common maladies.