Why birth injuries are so common
Tissue has to stretch a lot in a short time during birth. Added to that are pressure, friction and sometimes instruments or a rapid delivery. 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. What matters are the depth, bleeding, pain over time and whether important structures such as the anal sphincter area 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 sting when you pass urine and can pull when sitting or walking. They usually heal quickly if the area is kept clean and not repeatedly irritated.
Perineal tear
A perineal tear affects the tissue between the vaginal opening and the anus. Minor tears mostly 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 times is available from patient information services. Patient information on birth injuries
Episiotomy
An episiotomy is a deliberate surgical cut made in certain situations. The principles of healing are similar to those for a tear, but swelling and a feeling of tension can be pronounced at first. There is clear guidance on care and warning signs, for example from the NHS. NHS: Episiotomy and perineal tears
Haematoma
A haematoma is bleeding into the tissue. It can be small and feel like a bruise under tension. Sometimes it grows larger and causes severe pressure pain, a tense feeling or difficulty sitting. In that case it should be examined 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 rarer but can be relevant when there is notable bleeding. These injuries are usually examined and sutured after birth 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 get better. A pulling sensation on the suture, a foreign-body feeling or mild stinging can still be noticeable for weeks, especially with prolonged 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
- Postnatal discharge (lochia) does not smell unusual and gradually decreases
- The wound feels tender but is not increasingly hot or markedly red
Assessing healing realistically
Tissue heals in phases. First the wound edges close, then stabilising connective tissue is formed. Therefore it may be much better after a few days, but excessive strain can make it pull again.
Superficial abrasions often settle within a few days. Healing after a perineal tear or episiotomy is often a process over weeks. For higher‑grade tears, follow-up checks and, where necessary, specialised care are important. Detailed recommendations for severe tears are available in clinical guidance. Guidance on management of third- and fourth-degree perineal tears
Practical care in the postnatal period
Good care is above all gentle. The aim is to avoid irritation, maintain hygiene and treat pain so you can move.
Hygiene without overdoing it
- Lukewarm water to rinse after using the toilet can reduce stinging
- Pat dry gently afterwards, do not rub
- Change pads frequently and wear breathable underwear
- Avoid harsh wash lotions or frequent disinfecting
Sitting, lying, cooling
- Side-lying often relieves more than flat sitting
- Short cooling periods can reduce swelling, always with a protective layer and breaks
- When sitting, soft supports or changing position often helps more than rigid protective postures
Bowel movements and perineal pressure
Many worry about the first bowel movement. That is understandable, but straining usually makes things 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 for a higher‑grade tear, follow your care team's plan.
Pain, stinging, numbness: possible causes
Wound pain is to be expected. Stinging when passing urine often fits with abrasions or irritated mucosa. A dull pressure pain can come from swelling or a haematoma.
Numbness or altered sensation can occur after stretching and swelling. The course is important. If new numbness appears, spreads or you notice problems controlling urine, wind or stool, this should be assessed promptly.
Scar, sex and intimacy
Many feel able earlier but are still sensitive in the genital area. That is normal. Scar tissue can initially be drier, less elastic and sensitive to touch.
- Do not wait for a specific date; look for a steady, low‑pain recovery instead
- Start slowly and stop if you feel sharp pain or bleeding
- Dryness is common; lubricants can be helpful
- If intercourse is not possible for weeks or fear dominates, seeking support is reasonable
Warning signs: when to act quickly
The key criterion is a clear deterioration. If things get noticeably worse instead of better, it is worth getting checked sooner rather than later.
Have assessed promptly
- Suture pain increases markedly instead of decreasing
- Foul-smelling discharge or notable redness and swelling at the wound site
- Fever, chills or a marked feeling of being unwell
- The wound leaks a lot, bleeds continuously or appears to have opened
- Severe pressure pain or a tense swelling indicative of a haematoma
Seek immediate help
- Heavy bleeding with circulatory problems
- Rapidly increasing, very severe pain with large swelling
- New onset problems holding urine, wind or stool
Typical signs of a possible infection include increasing pain, foul-smelling discharge and red or swollen skin around the cut or tear. NHS: Warning signs after episiotomy or tear
If the recovery doesn’t match how you feel
Sometimes the wound may be medically fine, but you still have pain, stinging or major uncertainty. This is not a trivial issue. Even without an acute emergency, a check-up can help clarify causes and find sensible steps.
Structured follow-up is especially important after severe perineal tears, because problems such as pain, pressure or continence issues can be managed specifically. Care and follow-up for severe tears are described in detail in clinical guidelines, for example in the recommendations of 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 attention to warning signs are usually more helpful than rigid protection or over-treatment. If the course worries you or clearly gets worse, early assessment is the fastest route back to reassurance.
