Why birth injuries are so common
During birth, tissues must stretch a great deal in a short time. Added to this are pressure, friction and sometimes instruments or a rapid labour. This explains why abrasions, tears or swelling around the vagina, labia and perineum are common.
It is important to put this into context: common does not automatically mean harmless, but it is also not necessarily dramatic. Key factors are depth, bleeding, the course of pain and whether important structures such as the anal sphincter are involved.
Types of birth injuries
Several injuries can occur at the same time. The terms sound similar, but they feel different and are treated differently.
Abrasions and small tears
Abrasions are superficial injuries to the mucous membrane or skin. They often burn when urinating and can sting when sitting or walking. Most heal quickly if the area is kept clean and not further irritated.
Perineal tear
A perineal tear affects the tissue between the vaginal opening and the anus. Minor tears involve skin and superficial layers. Deeper tears can include muscle. In severe tears, structures around the anal sphincter are affected and follow-up care is particularly important. A clear overview with typical healing timelines is available from a family planning information portal. Familienplanung: Injuries from childbirth
Episiotomy
An episiotomy is a deliberate surgical cut that may be used in certain situations. The principles of healing are similar to those for a tear, but swelling and a feeling of pulling can be pronounced at first. There are clear recommendations for care and warning signs, for example from the NHS. NHS: Episiotomy and perineal tears
Haematoma
A haematoma is a collection of blood in the tissue. It can be small and feel like a bruise that is tight. Sometimes it becomes larger and causes severe pressure pain, a tense feeling or difficulty sitting. It should then be checked promptly.
Tears of the labia, vaginal wall or cervix
Tears of the labia and vaginal wall can burn intensely because the area is very sensitive. Cervical tears are less common but can be relevant if there is abnormal bleeding. These injuries are usually examined after birth and sutured if necessary.
Sutures, stitches and swelling: what is typical
Many injuries are sutured immediately after birth. Absorbable sutures are commonly used. In the first days swelling, a feeling of pressure and wound pain are frequent, often worse when sitting than when lying down.
Typical course: the first 48 to 72 hours are the most intense. After that it should gradually improve. Tugging at the suture, a foreign-body sensation or slight burning can still be noticeable for weeks, especially with longer periods of activity.
How to recognise normal healing
- Pain and swelling generally decrease over days
- You can sit or walk a little better from day to day
- The postpartum bleeding (lochia) does not have a strong odour and gradually lessens
- The wound feels tender, but is not becoming increasingly hot or markedly red
Assessing healing realistically
Tissue heals in phases. First the wound edges close, then stabilizing connective tissue is formed. That is why it may feel clearly better after a few days, but can pull again with too much strain.
Superficial abrasions often settle within a few days. For a perineal tear or episiotomy, healing is frequently a process over weeks. For higher-grade tears, follow-up checks and possibly specialised care are important. For severe tears there are detailed recommendations in clinical guidelines; for example, professional bodies such as the Society of Obstetricians and Gynaecologists of Canada (SOGC) or other national organisations provide guidance. AWMF: Management of third- and fourth-degree perineal tears after vaginal birth
Practical care in the postpartum period
Good care is primarily gentle. The goals are to avoid irritation, ensure hygiene and manage pain so you can move.
Hygiene without over-care
- Lukewarm water for rinsing after toileting can reduce burning
- Then pat gently dry, do not rub
- Change pads frequently and use breathable underwear
- Avoid aggressive wash lotions or frequent disinfecting
Sitting, lying down, cooling
- Side-lying often relieves pressure better than sitting flat
- Short cooling periods can reduce swelling—always use a protective layer and take breaks
- When sitting, soft cushions or changing position frequently help more than a rigid protective posture
Bowel movements and perineal pressure
Many people are afraid of the first bowel movement. That is understandable, but straining usually makes it worse. Drinking enough, eating fibre-rich foods and taking time are often the most important measures. If you have severe constipation or were given specific instructions because of a higher-grade tear, follow the plan from your care team.
Pain, burning, numbness: what might be behind them
Wound pain is to be expected. Burning with urination often fits with abrasions or irritated mucous membrane. A dull pressure pain can come from swelling or a haematoma.
Numbness or altered sensation can occur after stretching and swelling. The important factor is the course. If new numbness appears, spreads or you have difficulty controlling urine, gas or stool, it should be assessed promptly.
Scar, sex and intimacy
Many people feel physically capable again early on, but the genital area can still be sensitive. That is normal. Scar tissue can be drier, less elastic and sensitive to touch at first.
- Do not wait for a fixed date; rather wait for a stable, low‑pain course
- Start slowly and stop if you feel sharp pain or notice bleeding
- Vaginal dryness is common; lubricant can be helpful
- If intercourse is not possible for weeks or anxiety becomes overwhelming, seeking help is appropriate
Warning signs: when to act quickly
The key criterion is a clear deterioration. If things are noticeably getting worse instead of better, an earlier check is warranted.
Seek assessment without delay
- Suture pain increases markedly instead of decreasing
- Foul-smelling discharge or pronounced redness and swelling around the wound
- Fever, shivering or a marked feeling of being unwell
- The wound is heavily oozing, bleeding persistently or appears to have opened
- Severe pressure pain or a tense swelling consistent with a haematoma
Seek immediate help
- Heavy bleeding with signs of circulatory compromise
- Rapidly increasing, very severe pain with large swelling
- New inability to control urine, gas or stool
Typical signs of a possible infection include increasing pain, foul-smelling discharge and red or swollen skin around a cut or tear. NHS: Warning signs after an episiotomy or tear
If the course does not match how you feel
Sometimes the wound may be medically acceptable, but you continue to have pain, burning or strong uncertainty. This is not a luxury problem. Even without an acute emergency, an assessment can help clarify causes and identify sensible steps.
Structured follow-up is particularly important after severe perineal tears because symptoms such as pain, pressure or continence problems can be specifically treated. Care and follow-up for severe tears are described in detail in clinical guidance, for example in recommendations from professional organisations such as the RCOG. RCOG: Third and fourth degree perineal tears, management
Conclusion
Birth injuries are common, and most heal well. Expect a process over weeks rather than just a few days. Gentle care, good pain management and watching for warning signs are usually more helpful than rigid rest or over‑care. If your recovery worries you or clearly gets worse, early assessment is the quickest route back to reassurance.
