Why birth injuries are so common
During birth, tissue must stretch a great deal in a short time. Added to this 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.
Context is important: common does not automatically mean harmless, but it is not always dramatic. Key factors are depth, bleeding, the course of pain and whether important structures such as the anal sphincter area are affected.
Types of birth injuries
Several injuries can occur at the same time. The terms may sound similar, feel different and are treated differently.
Abrasions and small tears
Abrasions are superficial injuries to the mucosa or skin. They often sting when you pass urine and can pull when sitting or walking. They usually heal quickly if the area stays clean and is 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 involve muscle. In severe tears structures around the anal sphincter are affected and follow-up care is especially important. A clear overview with typical healing timeframes is available from family planning information portals. Family Planning: Birth injuries
Episiotomy
An episiotomy is a deliberate surgical cut used in certain situations. The healing principles are similar to those for a tear, but swelling and a feeling of tension can be marked at first. There are clear recommendations on care and warning signs, for example in NHS guidance. NHS: Episiotomy and perineal tears
Haematoma
A haematoma is bleeding into the tissue. It can be small and feel like a bruise with tightness. Sometimes it becomes larger and causes severe pressure pain, a tense feeling or difficulty sitting. In those cases it should be checked promptly.
Tears of the labia, vaginal wall or cervix
Tears of the labia and vaginal wall can sting intensely because the area is very sensitive. Cervical tears are less common but can be relevant with significant 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. Frequently absorbable stitches are used. In the first days swelling, a feeling of pressure and wound pain are common, often worse when sitting than when lying down.
Typical pattern: the first 48 to 72 hours are the most intense. After that it should gradually improve. A pulling sensation at the suture, a foreign-body feeling or mild stinging can be noticeable for weeks, especially with prolonged strain.
How to recognise normal healing
- Pain and swelling generally decrease over days
- You can sit or walk a bit better from day to day
- Lochia does not have an unusual smell and gradually decreases
- The wound feels tender but not increasingly warm or markedly red
Assessing healing realistically
Tissue heals in phases. First the wound edges close, then stabilising connective tissue is formed. That is why it may feel much better after a few days, but excessive strain can cause renewed pulling.
Superficial abrasions often calm down within a few days. Healing from a perineal tear or an episiotomy is often a process over weeks. For higher‑grade tears follow-up checks and possibly specialised care are important. Detailed recommendations for severe tears are included in clinical guidelines. Guideline: Management of third- and fourth-degree perineal tears after vaginal birth
Practical care during the postpartum period
Good care is above all gentle. The aim is to avoid irritation, ensure hygiene and treat pain so you can move.
Hygiene without overdoing it
- Wiping with lukewarm water after toilet use can reduce stinging
- Then pat gently dry, do not rub
- Change pads frequently and use breathable underwear
- Avoid harsh cleansing lotions or frequent disinfecting
Sitting, lying down, cooling
- Lying on your side often relieves pressure better than flat sitting
- Short cooling periods can reduce swelling, always with a protective layer and breaks
- When sitting, soft cushions or changing position often help more than rigid protective postures
Bowel movements and perineal pressure
Many people fear the first bowel movement. That is understandable, but straining usually makes it worse. Drinking enough fluids, eating fibre‑rich food and taking time is often the most important part. If you have severe constipation or specific advice after a higher‑grade tear, follow your treatment team’s plan.
Pain, stinging, numbness: possible causes
Wound pain is to be expected. Stinging when urinating often corresponds to 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 have problems controlling urine, gas or stool, it should be assessed promptly.
Scar, sex and intimacy
Many feel capable earlier, but the genital area can still be sensitive. That is normal. Scar tissue may be drier, less elastic and tender at first.
- Do not wait for a fixed date; wait for a stable, low‑pain course
- Start slowly and stop if you have sharp pain or bleeding
- Dryness is common; a lubricant can be helpful
- If intercourse is not possible for weeks or anxiety dominates, seeking help is reasonable
Warning signs: when to act quickly
The most important criterion is a clear deterioration. If things get noticeably worse instead of better, an earlier check is worthwhile.
Seek assessment promptly
- Suture pain increases markedly instead of decreasing
- Foul smelling discharge or noticeable redness and swelling in the wound area
- Fever, chills or pronounced malaise
- The wound is draining heavily, bleeding persistently or appears to have opened
- Severe pressure pain or a tense swelling consistent with a haematoma
Seek immediate help
- Heavy bleeding with circulatory symptoms
- Rapidly increasing, very severe pain with large swelling
- New problems holding 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 episiotomy or tear
When the course does not match how you feel
Sometimes the wound may be medically acceptable, but you still have pain, stinging or marked insecurity. This is not a luxury issue. Even without an acute emergency, a check can help to clarify causes and find useful 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 professional guidance. Professional guidance: Management of third- and fourth-degree perineal tears
Conclusion
Birth injuries are common, and most heal well. Expect a process over weeks rather than a few days. Gentle care, appropriate pain management and attention to warning signs are usually more helpful than strict immobilisation or overcare. If the course worries you or clearly worsens, early assessment is the quickest route back to reassurance.
