Postpartum Healing: Perineal Care & Episiotomy Care

Remember, your body goes through many physical changes postpartum

while it is returning to its pre-pregnant state. Here are some things to ease
your mind and discomfort.
Lochia
One of the most noticeable changes you should see is a discharge, called
lochia, that usually lasts about 3 weeks. Lochia is the lining of the uterus that
is shed after giving birth and is a normal part of the healing process. It
bleeds the heaviest right after birth and slowly decreases over the next 3 or
4 days. Hemorrhage can occur if the uterus isnt shrinking right away. If you
have bleeding that soaks a pad in 15 minutes or less, call your doctor
immediately. The normal stages are:
1. Lochia rubra first 2 to 3 days after delivery
the lochia is mostly blood
the blood looks bright red
the blood flow can be heavy to moderate
you may see small blood clots
2. Lochia serosa starts about day 4 and lasts until day 10
the color changes to pink or pinkish-brown
the flow is much less
blood clots or bright red blood during this time may be signs of a problem.
3. Lochia alba from about day 10 until day 21
the color is light yellow to a cream color
the flow has almost stopped and does not smell
the presence of clots, a bad smell, or bright red blood may be signs of a
problem.
It is important to know that the color should always turn from red to pink to
white as the amount of discharge gets less and less. If you see a red flow
after the flow has turned pink or white, call your doctor right away.
Perineal Swelling and Soreness
You will also have some swelling and soreness in the perineum due to
pressure and stretching during birth. However, this area will be more
sensitive if you have stitches from an episiotomy or tears. The discomfort
from your stitches usually last about 5 or 6 days.

During the first 24 hours after delivery, swelling can be kept down by
applying ice to the area. After the first 24 hours apply dry or moist heat for
20 minutes, 3-4 times a day. Heat increases circulation to the area, reduces
swelling, and speeds healing.
Perineal Care: After urinating and while still sitting on the toilet, squirt warm
tap water over the outside of the perineum, beginning at the front and
moving toward the back. Do not squirt water up into the vagina. Pat the
area dry from front to back with toilet paper. Once done, gently wipe the
entire area from front to back with witch hazel pads. Use a clean piece of
toilet paper or witch hazel pad for each wipe.
Sitz Bath: Wash your feet and legs and rinse out the bath tub. Put a clean
towel in the bottom of the tub and add 4 to 5 inches of warm water. NO
SOAP or BUBBLE BATH. Sit in the tub on the towel for 15 to 20 minutes. If
the water starts getting cool, then let some water out and add new warm
water. When you finish, stand up slowly so you wont get dizzy.
Hemorrhoids
Hemorrhoids are swollen veins of the rectum. Hemorrhoids can be caused by
pressure from your babys head or your pushing during the final stage of
labor.
Try applying ice for 20 minutes every 4 hours to relieve pain, shrink
hemorrhoids, and speed return of normal bowel function. Dont put ice
directly on your skin. Put the ice in a plastic bag and then wrap it in a towel.
Sitting in a bathtub of warm water or sitz bath for no longer than 20 minutes,
or using cold witch hazel pads can reduce minor discomfort and itching.
Eating foods high in fiber (fruit, whole grains and raw vegetables) and
drinking plenty of fluids (6 to 8 glasses a day) can also prevent hard stools
that can irritate your hemorrhoids. Your doctor may also prescribe you a stool
softener (Colace) to make stool easier to pass without straining. If you are
breastfeeding, taking a stool softener may cause loose stools in your baby,
too. Holding a pad of toilet paper against your stitches during a bowel
movement also helps relieve pain from the stitches.
References
Lowdermilk, D. L., Perry, S. E, Cashion, K., & Alden, K. R. (2012). Maternity &
womens health care (10th ed.). St. Louis, MO: Elsevier Mosby. pp. 478-479,
483, 491, 493.

Perry, S. E., Hockenberry, M. J., Lowdermilk, D. L., & Wilson, D. (2010).

Maternal child nursing care (4th ed.). Maryland Heights, MO: Mosby Elsevier.
p. 525.
Pillitteri, A. P. (2007). Maternal & child health nursing: Care of the
childbearing & childrearing family. Philadelphia, PA: Lippincott Williams &
Wilkins. pp. 634-636.