No one ever told me how scared I’d feel thinking about what happens to my vagina during birth! Just kidding. This is one of the top concerns for first-time parents as they think through what it means to give birth.
As a midwife and mom myself, I promise you this cringe worthy topic isn’t as bad as it seems! And here’s why - vaginal tissue is similar to the tissue in your mouth, as you know, it heals very quickly. However, right after giving birth, your vagina is going to be sore and need time to heal. Here are a few ways to prevent tearing, reduce pain, and heal quickly!
Reduce the risk of tearing with perineal massage:
Start perineal massage around 34 weeks pregnant.
Practice daily for 1-5 minutes to gently stretch the perineum, the tissue between the vagina and anus, to prevent tearing during childbirth. You can practice perineal massage on your own or have your partner help.
Wash hands, trim nails, get into a comfortable position, lying down or standing/squatting in the shower. Use a warm compress during the massage to increase circulation and flexibility of tissue.
Use a massage gel (see our product playlist for ideas!).
Reach your hands in front of you or behind you to begin the massage. You can massage with one hand or both.
Insert both thumbs (or thumb and index finger from the same hand) about an inch inside the vagina (up to the first knuckle), rest your palms against the inside of your leg.
Gently press down with your thumbs or fingers toward the anus, and then pull them apart from each other and out to the sides. Hold this stretched position a few times, consciously relax your muscles in this region. You might feel a slight burning or stretching sensation.
Step by step guide to healing your vagina:
Immediately after delivery, use an ice pack to reduce bruising and swelling to your vagina and promote healing early.
Switch the ice pack every 30 minutes.
Ask your nurse for ice packs to take home with you or buy a reusable ice pad online. See our postpartum essentials product playlist!
Take a bath or shower a few hours after delivery, so you feel refreshed!
Be aware of dizziness in a warm shower! Have someone near you to help if you feel lightheaded.
Gently pat your vagina dry when you do a shower for the first time after delivery.
Use a sitz bath three to four times a day for the first 2-4 weeks. Sit in it for 10-20 minutes for best results to heal a sore vagina or hemorrhoids.
Don’t add soap to your sitz bath as it can dry out or irritate already sensitive skin.
Add herbs to make your sitz bath more soothing. You can add witch hazel, make an herb bath, or purchase premade sitz bath herbs. See our postpartum essentials product playlist for safe and healing herbs!
You can store your sitz bath in the shower/tub or in a plastic bag.
Rinse and clean your sitz bath after each use. You can clean it with traditional cleaners, like bleach, or create an antiseptic cleaning solution by mixing 1/2 cup organic white distilled vinegar or lemon with 1/4 cup baking soda into 1/2 gallon 2 liters of water.
If you don’t like the sitz bath, you can take a regular bath instead.
Wear pads or incontinence underwear
Change pads every four to six hours.
If bulky pads feel uncomfortable, try incontinence underwear!
Always pat the perineal area dry from the front to the back after washing to avoid introducing germs from the rectum into the vaginal area.
Numb it up!
Apply witch hazel, Dermoplast spray, and stool softeners to reduce pain and also irritation to the perineum.
Use witch hazel wipes and dermoplast spray every 2-4 hours as needed. Use these products right before or after you pee to reduce stinging.
Take a stool softener once or twice a day for the first week.
Spray it down:
Use a peri-bottle for 1-2 weeks, or longer if needed, when urinating.
Fill the peri-bottle with warm water or a healing herb mix. Then, squeeze the bottle in the direction of your urethra and vagina. Spray while you urinate to reduce both pain and irritation.
Ice packs to reduce swelling and provide pain relief.
You can make a ‘padsicle’ at home: Take a dry pad, soak it in witch hazel or an herb mix, and place in the freezer. To prevent water from leaking, wear incontinence underwear or the hospital mesh panties while the padiscle is in place. Wear for 20-30 minutes or until you feel numb.
Fill a condom with ice for a no-leak solution!
Purchase reusable ice packs.
Take over the counter pain-relieving medications, like Acetaminophen or Ibuprofen.
Most over the counter pain medications are safe to take while breastfeeding. Check out the LactMed app for more information on breastfeeding and medications. Always talk to your provider about options that are safe for you.
If you have a 3rd or 4th-degree tear, talk to your OB provider about prescription pain medication to use the first few weeks postpartum.
Don’t stand or sit for long periods. Alternate positions to reduce pressure on your perineum.
Brace your perineum! To (discreetly) support your perineum try:
Sitting off to your side with legs tucked underneath your butt.
Cover your lap with a pillow while you use your hand to support your perineum.
Place a rolled towel underneath you while sitting for natural support.
Reflexively and openly hold your vagina when you laugh or cough because (ouch!) you can’t help it, and that’s ok!
When feeding your baby, sit on:
A donut seat cushion.
A breastfeeding cushion: use it as a seat (if you’re not using it for baby!) like you would the donut seat cushion.
Two towels- roll them and place them next to each other for a boost.
Lie down to reduce the pain. Try feeding in the side-lying position.
Lie down to rest for 20–40 minutes every hour for the first two to four days to reduce pressure on the perineum so the stitches can heal. Lie in a position that’s comfortable for you. However, you might consider lying on your side with one pillow between your legs, one behind your back, and two under your head for a supported and comfortable position.
Keep your poop soft:
Eat a high fiber diet + drinking 2L of water/day. To do this easily, place three tablespoons (or more) of chia seeds in a 2L water bottle. Add fruit for extra flavor.
Take a stool softener 1-2 times a day.
How to poop:
Do not strain when pooping.
Sit with your bottom to the back of the toilet seat, legs apart, up on toes (or feet flat on a footstool)
Keep a straight back and lean forward with your stomach and pelvic floor muscles relaxed.
Keep breathing! Don’t hold your breath.
Have a support person with you when you poop for the first time. Having someone with you makes the moment less scary and even a little funny.
Support is everything:
Support the perineum with your hand while emptying your bowels, laughing, coughing, or sneezing.
If you are prone to constipation, use bulking or softening agents up to six weeks after repair. Discuss this with your OB provider first.
Avoid pelvic floor strengthening exercises for six weeks after the birth of your baby to prevent straining the wound.
After six weeks:
Work with a pelvic floor physical therapist to learn gentle pelvic floor exercises, to improve circulation and also decrease both swelling and pain.
Practice Kegels several times during the day.
Tighten your pelvic floor muscles by squeezing around the birth canal, vagina, and butt all at once, lifting up and towards your pubic bone ('squeeze and lift!'). Hold each contraction for 2-3 seconds and then release and relax - you feel a definite 'letting go' of the muscles.
Repeat ('squeeze and lift!') and relax, resting for about 5 seconds between each contraction.
Repeat this as many times as you can, up to a maximum of 8-10 squeezes.
Work the core:
Try pelvic tilts, belly breathing, and yoga to work both your core and pelvic floor.
Contact your OB/CNM if you:
Have not had a bowel movement in 48 hours
Feel like you have an infection (fever, worsening pain, body aches, pain with urination)
Bad smelling lochia (the normal discharge from the uterus after childbirth).
1st-degree tear: superficial tear, may or may not require stitches.
2nd-degree tear: tear of the skin and muscle, stitches are usually needed; it can take two months to feel comfortable again.
3rd-degree tear: is a tear through the muscles, and the muscle layer that surrounds the anal canal, requires stitches; it can take two months or longer to heal. It’s recommended to have pelvic floor therapy to heal the muscles in your vagina.
4th-degree tear: goes through the anal sphincter into the anal canal or rectum. Only 2% of the population experience a 3rd or 4th-degree tear! It’s recommended to have pelvic floor therapy to heal muscles.
Periurethral: a tear near the urethra, may or may not require stitches; might have pain or irritation when urinating.
An episiotomy is a cut made into your perineum to enlarge your vaginal opening. An episiotomy involves the same muscle and tissue as a 2nd-degree tear. However, some episiotomies can extend further. Episiotomies are not routinely done.