Always contact Labour Line if:
Your stitches are becoming more painful.
Your tummy is feeling painful.
You notice a smelly discharge.
The skin is red and/or swollen in the stitches and surrounding area. This can be difficult to check yourself. Using a mirror can help if you are alone. Someone who is close to you may be able to check this for you.
You feel unwell or have a raised temperature.
Contact Labour Line if you are concerned as these symptoms can be signs of infection.
0300 369 0388
It is common to experience a tear/bruising to your perineum (the area between your vagina and rectum) when you have your baby.
Tears vary in size and depth. They can be inside the vagina, on the labia, or on the perineum. They are assessed by looking at your perineum, assessing how much blood loss there is and doing a gentle vaginal examination. This will be done by your midwife or obstetrician after your baby is born and the placenta has been delivered. You will also be offered a rectal examination to check there is no damage to your bowel.
These examinations are offered even if there is no obvious tear, as damage may not always be visible. Your consent will always be obtained before any procedure.
Tears can be:
First degree: superficial tear to the skin of the perineum
Second degree: a tear involving skin and muscle
Third degree: a tear involving the muscles around the rectum
Fourth degree: a tear involving the rectum itself
Labial grazes and tears
You may experience one or more grazes or tears to the labia (vulva). These can often be left to heal naturally, depending on their size, position and if they are bleeding. Your midwife will advise you on this, and how to take care of the injury.
Stitching of tears and episiotomy
Not all tears require stitches – it will depend on your personal circumstances. You will be advised to have stitches to repair an episiotomy, tears that involve the muscle layer, those that are bleeding, or if the alignment of the tear needs adjusting.
Dissolvable stitches are used so that you do not need to have them removed. These can take up to six weeks to dissolve, and you should speak to your midwife if you are having any problems or pain associated with your stitches.
3rd and 4th degree tears are repaired by a senior obstetrician/specialist in theatre with a spinal anaesthetic.
Caring for your wounds and stitches
Keep the area clean and dry. Shower daily and keep a separate towel for your perineum. Try to avoid soaps and gels with strong scents.
Change your pads regularly, about every 4 hours. Always wash your hands before and after changing your pad.
If it stings when you pass urine, pouring a jug of warm water over the area while you pee can help. Keep your own jug separate for this.
Sitting on the toilet backwards can ease stinging caused by urine passing over the injury (it sounds strange but it can really help!).
Putting feet on a small foot stool to alter the angle of the rectum can be helpful in protecting the pelvic floor when emptying the bowel.
Apply ice packs for 10 minutes every 4 hours if the area painful. A few frozen peas in a plastic bag covered in a tea towel is soothing when at home. Place directly onto the perineum. Again, use a clean, separate tea towel. You can get ice burns if the pack is left on for longer than 10 minutes, so do be careful when using ice packs.
Changing your baby’s nappy on a high surface will avoid you bending and stretching too much, reducing the pressure on your stitches.
Stitches can feel sore and painful for the first week or so. Paracetamol can be useful (make sure you check the packaging as the dosage can vary). If you find this isn’t enough pain relief, talk to your Midwife or GP as some medications are not advised if breastfeeding.
Sometimes stitches will become loose. You might find a piece of thread or a knot (beige looking) in your underwear. Don’t worry, just let your midwife or maternity support worker know when they visit you. If you develop heavy fresh bleeding or your pain increases after you lose a thread, contact Labour Line on 0300 3690388 for advice.
Avoid constipation by increasing the fibre in your diet and drinking plenty of water. Taking medicine (stool softeners or laxatives) to help you go to the toilet can help if you are struggling. Talk to your Midwife for advice on this. If you have had a 3rd or 4th degree tear, you will be advised to take medicine regularly for a few weeks to keep your bowel movements soft.
Having your bowels open for the first time after having your baby can be worrying, so holding a clean pad on your stitches while you gently push will help.
Start doing pelvic floor exercises as soon as you feel comfortable. This will help the muscles in your perineum to heal and your body return to normal. It’s good to get into the habit of doing them at specific times so that you don’t forget (e.g. at traffic lights, while boiling the kettle, when sitting down etc.). Read more about pelvic floor exercises.
Your team midwife will ask to examine your stitches when competing your postnatal checks. This is to check that you are healing and haven’t got an infection or any swellings, such as a haematoma (collection of blood) which could need treatment. She will always ask for your consent before examining you. You always have the right to decline examinations. We understand that checking your stitches is very personal, and the midwife will make it as private and comfortable as she can for you. If you feel anxious about these examinations, talk to your midwife about how you are feeling so that they can reassure you.