Though episiotomies are growing more rare, stitches to repair tears or episiotomies in the vagina and perineum are a common occurrence for mothers who deliver their babies vaginally. Not all moms tear but enough do that every mom would do well to be informed about stitch care ahead of needing the information.

Cold

Since the entire perineal area will be swollen and sore after birth, applying cold to the area is a smart thing to do. Women who deliver in hospitals will probably have access to frozen pads they can slip into their pants for the first day or two after delivery. Homebirthers can make their own frozen pads, with or without soothing and astringent herbs, by soaking a couple of pads in water, placing them in a zip bag and tossing them into the freezer until needed. An herbalist can recommend a combination of herbs to add to the water, if so desired, that can promote healing and pain relief.

Keep It Clean

Keeping the stitches clean is the most important thing a woman should do. After birth, mums are given what’s called a “Peri Bottle” to clean themselves after using the toilet. This squeezable bottle is filled with warm water that is then squirted over the whole vaginal-perineal-anal area. It’s like a low-tech bidet. Mums should take it home from the hospital and use it on the toilet and in the shower instead of toilet paper or cloths.
Mum can also have at Sitz bath. This peculiar contraption is a molded plastic pan that sits in the toilet. A water bag is filled with very warm water and Epsom salts and is hooked to the pan through a thin plastic tube. The tube is positioned in such a way that when the water is allowed to flow freely, to create a small and gentle fountain that bathes the perineum. Hang the bag of water at head height or better to let gravity force the water down and through the tube.

A Sitz bath is cheap, re-usable and available at most pharmacies. You may even be given one in the hospital. Epsom salts are also inexpensive and should last a long time. Of course, Epsom salts are not required when using the Sitz bath. A woman could use an herbal soak such as this one or plain water, if she preferred.

The bath cleanses mum’s bottom without putting any pressure on the tissues or stitches. Mum can have a Sitz bath every few hours if it brings her relief. When she is finished, she can pat the area dry with a towel or a paper towel – toilet paper is likely to be too delicate to hold up to a wet bottom and make break apart and stick – but remember to dispose of paper towels in the waste basket.

Epsom salts can also be added to a bath in a tub. Many people find a soak in Epsom salts to be soothing. Mum will have all the benefits of the Sitz bath combined with the relaxation of a full body bath. Herbals can be helpful in the bathtub, too.

Pain Relief

Pain relief will probably be a woman’s main focus in caring for her stitches. The doctor or midwife will generally recommend an oral analgesic like Acetaminophen or Ibuprofen. If pain is severe, a woman may be prescribed something stronger. If a mum wants to take something that wasn’t prescribed, she should call the midwife or OB first and get their OK; new mothers need to be extra careful in case any drugs or herbs ingested are contra-indicated for nursing or other medications and herbals.

One trick to help soothe the area around the stitches is to put a Tucks pad onto the menstrual pad. Intended originally for hemorrhoids sufferers, these towelettes will promote a cooling sensation on the perineum.

If it hurts to urinate, mum can use her peri bottle to pour running warm water over her vagina while she uses the toilet. Alternately, she can pee in the shower while directing the water across her lower half.

Keep It Dry

The stitches should be kept as dry as possible. With Lochia flowing for a few weeks after birth, this is a challenge and a woman certainly doesn’t want to be forever patting or rubbing with a cloth. One trick to drying the perineum is to use a hair dryer. Mum’s can spend a few minutes after a bath or shower with the hair dryer on medium. She can even use a hair dryer after going to the toilet.

Cautions

Some postpartum women have trouble having a bowel movement. This can be due to constipation or it can be because a woman is afraid she will rip her stitches or cause herself pain. To help make sure bowel movements are soft and easy to pass, women should increase their fibre intake in the days after birth.

New mothers should eat plenty of whole grains, fruits and vegetables. If they are particularly afflicted, they can increase the amount of flax and fibre in their diet, introduce prunes, and prune juice. In addition, anyone deliberately increasing the amount of fibre in their diet should dramatically increase the amount of water they drink. Extra fibre without extra water will only cause more constipation and more pain.
The stitches will dissolve on their own. They don’t dissolve evenly, however. A woman may suddenly feel like there is a tiny thorn sticking into her bottom. This is probably just a thread, partly dissolved, touching the very sensitive skin of the perineum or vagina.

If at any time a woman experiences itching, burning or discharge not associated with her Lochia, she should contact her caregiver immediately. While it is rare, some tears and incisions can become infected. Another sign of infection that should be checked out immediately by a midwife or a doctor is fever. Fever is the body’s reaction to infection, so take even mild fever seriously in the first weeks after giving birth.
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