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The perineum may be sore, swollen, and bruised from the birth. Women might have stitches in the perineum if they had a tear or an episiotomy. The stitches usually dissolve around two to four weeks, and the tissues heal over six weeks. It is normal for women to find small pieces of the sutures on their pads or in their underwear as the stitches dissolve.

Women may find relief from perineal pain and swelling by:

Applying ice packs to the perineal area for the first 24 hours. Ice packs and cold compresses should be removed after 10 – 20 minutes and reapplied every hour as needed.
Ice packs should be wrapped in a towel or facecloth and not applied directly to the skin.
Women can use cold compresses, a bag of ice or frozen veggies, or a frozen, water-soaked maxi pad or baby diaper to place in their underwear.
Resting as much as possible.
Letting the perineum air-dry while resting.
Using a pillow or an inflatable ring when sitting. Inflatable rings are available at most drugstores.
Soaking the perineal area in warm water a few times a day and after bowel movements. A sitz bath filled with a few inches of water and placed on the toilet seat is convenient. Sitz baths can be purchased at the drug store or home health store. If a woman is using her bathtub for perineal soaks, she should have it cleaned first and ensure that someone is present to help her in and out of the tub for the first few times.
Taking OTC pain medications recommended by her health care provider.

Pain that is not improving, or stitches that are opening or oozing are situations where the women should contact her health care provider.

Perineal hygiene

It is important to keep the perineal and anal area clean by always wiping carefully from the front to the back after urinating or having a bowel movement. Women can use a squeeze bottle with warm water to clean the vulva and perineum. Wipes or hemorrhoid pads can be gentler than toilet paper. Using soft, undyed, unscented toilet paper is preferable.

Having a sitz bath can help provide hygiene after having a bowel movement.

Additional Information

Care of the incision

Women who have had a caesarean birth will be given instructions as to whether they need their stitches or staples removed. Stitch or staple removal is usually done a few days after the caesarean birth either at the hospital, in the health care provider’s office, or during a midwife home visit. Some women will have dissolvable stitches that do not require removal.

The incision may have small pieces of tape on it which can be removed in the shower after a few days.

The incision should be left to air dry and not covered with a dressing unless instructed to do so.

Any redness, swelling, opening or gaping of the incision or discharge from the incision should be reported to the health care provider. Tissues take about six weeks to heal from any surgery.

Pain management

Women who have had a caesarean birth will be discharged from the hospital with pain relief instructions and often a prescription for pain medication. It is important for women to take their medication as needed since controlling their pain makes them more comfortable moving around and caring for themselves and their babies. It can be normal for some women to feel numbness around their incisions for a period of days to months

The breasts undergo a number of changes in the postpartum period whether the woman plans to breastfeed or not. Additional Information

Lactogenesis

Lactogenesis 1 is the initial secretion of colostrum; Lactogenesis 2 occurs two to four days after the birth with the copious secretion of breastmilk. Lactogenesis 2 is often referred to as the “milk coming in,” and is a time when many women experience discomfort as the breasts can become quite full and swollen. Breast fullness can last a couple of days and will diminish as the milk production becomes more regulated to the infant’s needs. Since the baby can have a growth spurt about every three weeks or so, mothers can expect to experience breast fullness due to the increase in milk production at these times.

Fullness/engorgement

Normal breast fullness that improves with infant feeding is not the same as breast engorgement. Engorgement is a pathological condition in which the breasts become hot, swollen, hard, and very painful.

The following strategies can help relieve breast fullness and prevent breast engorgement in the first few days:

Support mothers to identify and respond to feeding cues soon after birth.
Encourage frequent feedings, at least eight times in 24 hours to establish a good milk supply.
Avoid giving any supplemental feedings unless there is a medical need for them.
Ensure the baby is feeding well.
Encourage skin-to-skin care.

If breasts become so full or swollen that it is difficult to latch the baby:

Prior to feeds, massage, or manually express the breasts to help the milk to flow. Manually express the breast to soften the areola to make it easier for the baby to latch, especially if the breasts are full. Warm compresses applied to the breasts before massage is comforting and can improve milk flow.
Ensure the infant is well-latched and feeding well. The mother should hear the infant frequently swallowing during the feed.
Encourage women to offer both breasts at each feeding. If the baby does not feed on the second side, the mother can manually express for a few minutes to make it more comfortable.
Encourage mothers to wear a supportive bra that is not too tight.
Apply ice packs or cold compresses after feeds to help to reduce any swelling and/or pain.
Offer support and advise mothers to seek help if things are not improving with the engorgement or infant feeding. The most important thing is to feed the baby. Mothers can express their milk and feed it to their babies with a small cup, spoon, or bottle if necessary.
If the mother develops signs of mastitis, which includes localized or generalized breast pain, redness, heat, red streaking in the breast, along with fever and flu‐like symptoms, she should seek medical help immediately.

Women may also experience nipple tenderness with breastfeeding, and it is important for the breastfeeding mother to have reliable breastfeeding resources and assistance. This may include their family physicians or midwives, a breastfeeding clinic, in-home assistance through the Public Health Department, or through a peer support group such as La Leche League. Please see the Breastfeeding file for more information about engorgment.

Mothers who are not breastfeeding

Lactogenesis2 will start to occur regardless of a woman’s intention to breastfeed or not. There are some simple interventions to offer women who choose not to breastfeed to increase their comfort level. In the past, medications and herbal remedies were used to attempt to “dry up the milk” but these have not proven to be effective. Physicians and midwives do not prescribe any medications to stop Lactogenesis.

Women may find it helpful to do the following:

Wear a supportive but non-stretchy bra.
Apply ice packs or cold compresses to breasts frequently.
Avoid the application of hot packs or hot compresses as this encourages swelling and more discomfort.
Take pain medication as recommended.
Express small amounts of milk to relieve the discomfort associated with engorgement. Expressing small amounts of milk should only be done for a few minutes.
Be patient as it takes a few days to a few weeks for the milk to dry up.

Ontario Midwives Handouts

Before Your First Visit / About Midwifery

Prenatal Genetic Screening

Health During Pregnancy

Choice of Birthplace

Mental Health

Prenatal Education Classes and Doula Information

Labour and Delivery

Pregnancy Resources and Testing Information

Body Changes after Baby

The Postpartum Period and Newborn Care

Perineal Care After Baby

After your C-Section

Breast Changes