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Care of Perineal and Cesarean Section Wounds

Most women want a normal delivery with an intact perineum, but unfortunately, this may not always be possible and most women will have an injury to care for in the postpartum period.

Perineal injuries are either a tear or an episiotomy. During the second stage of labor, the perineum must stretch to allow the baby to be born. A tear usually occurs during delivery from the widest diameter of the baby’s head or the baby’s shoulders. A tear normally extends from the vagina down to the anal region and heals very quickly. Although rare, the tear can extend into the anus, which is more complicated and requires extra care. An episiotomy is a surgical cut in the perineum to facilitate vaginal delivery of the baby, which may be normal, by forceps or vacuum extraction. The tear or episiotomy must be sutured to facilitate recovery and hopefully return it to its pre-pregnancy state.

Care of perineal wounds

During the first postpartum days, the perineum will be bruised, swollen and painful. You may find it painful to walk or sit, so it is best to lie down as much as possible for the first few days. Sometimes, when you urinate, you may feel a stinging pain on the wound. To reduce this effect, pour cool water on the area while you urinate so that the water will dilute the stinging effects of the urine.

To help reduce the swelling and for the wound to heal quickly, the best treatment is to soak the perineum in cool salt water for 5-10 minutes once or twice daily until the wound heals. Hot water will increase blood flow to the area, which can make it more painful later.

During the healing process, the tissues will shrink causing the wound to become tight and uncomfortable. Sometimes the sutures (stitches) can become hard and stick into the flesh, which can be very painful. If you feel any uncontrollable pain, you should return to your obstetrician, who can remove some stitches to relieve the pain.

Keep the area as clean and dry as possible by changing your sanitary pad regularly. It is better to use sanitary towels with loops, because these can provide some counter pressure on the wound thus making it less painful.

Do not use air rings. It provides relief when you sit, but it can restrict blood flow to the area if used for too long, which can delay healing from the episiotomy. It is better to sit on a soft cushion.

Please do not use feminine sprays or powder as they can interfere with the healing process.

Caesarean section is an operation by which the baby is delivered through a cut in the lower abdominal and uterine walls. Usually, the cut is in the lower segment of the uterus at the bikini line.

Care of the wound department

At first, the wound may be painful especially when you move or cough. This is due to internal pressure on the wound. Placing a hand firmly on the wound when you cough or move will counteract this pressure and reduce the pain. The pain is also due to tissue trauma, so it may be necessary to take some painkillers. Keep the wound dry until any stitches are removed (usually about 7 days) so no bathing is allowed. Use a cotton ball soaked in salt water to soak and remove the scabs. Salt water also aids healing and reduces itching as the wound heals. Do not lift heavy objects for at least 6-8 weeks after delivery.

Care tips for both types of injuries

o If possible, try not to bathe the baby yourself until the wound has healed properly.

o To help the wounds heal quickly, do not eat ginger for the first 10 days.

o Take extra vitamin C.

o Do not walk too much especially up and down stairs as your injury needs “rest” to heal.

o After 2 weeks, massage the wound with vitamin E oil to prevent keloid formation.

o Do not worry if the wound feels itchy even after many weeks or months.

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