Care for birth injuries

Many vaginal births do not result in soft tissue tears of the perineum; some women experience only minor abrasions, which do not require stitches. If stitches are required after the birth, or if a caesarean section was performed, it is useful to be aware of the basic guidelines for optimal healing.

The risk of birth injuries can be reduced by taking care of yourself before the birth. It is advisable to treat any common vaginal infections – characterised by recurrent discharge and vaginal discomfort – in good time, as tissues fighting off an infection tend to be more fragile. Repeated, gentle massage of the perineum with your fingers, using non-irritating lubricants, will help improve the elasticity of the soft tissues. We’d be happy to discuss the use of the Aniball device with you at our antenatal clinics. 

During labour itself, we offer perineal warming in the shower or with herbal steam. We aim for a gentle, controlled delivery of the baby’s head whilst protecting the perineum. We do not perform episiotomies routinely or preventively. We opt for it only in clearly indicated cases, after explaining the reasons to the mother, such as foetal distress before the head is delivered with the need to speed up labour, or when there are clear signs of a high risk of severe perineal injury. After the baby is born, the obstetrician will examine the perineum, assess the extent of any injury and determine the need for treatment. Suturing is carried out using absorbable sutures, always under local anaesthesia; nitrous oxide inhalation may also be used. 

In the first few hours after the birth, it is both comfortable and advisable to cool the injury gently through a cloth. Careful hygiene is key to the ongoing care of birth injuries. During the first few weeks of the postnatal period, we recommend showering after each visit to the toilet; longer sitz baths are only suitable once the area has fully healed. If you experience understandable hesitation regarding your first bowel movement after giving birth, Lactulose syrup or glycerine suppositories may help; please do not delay going to the toilet. Breathable pads labelled ‘postnatal’ or ‘suitable after gynaecological surgery’, mesh knickers and loose-fitting cotton clothing will help keep the healing area dry. It is certainly not wrong to touch the wound for hygiene purposes or to check the healing process visually. If you have any concerns regarding healing, please do not hesitate to contact us. 

The caesarean section scar is usually closed with an absorbable suture hidden beneath the skin, roughly in the area of the underwear waistband. On the day of the operation, the wound is covered with a sterile dressing; during your hospital stay, it is then treated once a day with a thin film of iodine antiseptic. Once the dressing has been removed, you can shower over the scar, touch it, and keep it dry and clean. 

For more detailed care of perineal tears, we are also sharing an infographic by physiotherapist Marika Bajerová, with her permission: