Why birth injuries are so common
During birth, tissue must stretch a lot in a short time. Added to that are pressure, friction, and sometimes instruments or a rapid labor. This explains why abrasions, tears, or swelling around the vagina, labia, and perineum are common.
What matters is assessment: common does not equal harmless, but it is also not automatically dramatic. Key factors are depth, bleeding, pain over time, and whether important structures such as the anal sphincter area are involved.
Types of birth injuries
Multiple 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 urinating and can pull when sitting or walking. Usually they 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 usually involve skin and superficial layers. Deeper tears can involve muscle. Severe tears affect structures around the anal sphincter and require particularly careful follow-up. A clear overview with typical healing times is available on the Family Planning information portal. Family Planning: Birth injuries
Episiotomy
An episiotomy is a deliberate incision that may be used in certain situations. Healing principles are similar to those for a tear, but swelling and a feeling of tension can be pronounced at first. There are clear recommendations on care and warning signs, for example from the NHS. NHS: Episiotomy and perineal tears
Hematoma
A hematoma is bleeding into the tissue. It can be small and feel like a bruised tension. Sometimes it enlarges and causes severe pressure pain, a firm sensation, or problems sitting. In that case 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 if bleeding is notable. These injuries are typically examined after birth and sutured if needed.
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 common, 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. Pulling sensation at the suture, a foreign-body feeling, or mild stinging can still be felt for weeks, especially with prolonged strain.
How to recognize normal healing
- Pain and swelling decrease overall over days
- You can sit or walk a bit better day by day
- Postpartum discharge (lochia) does not have a strong foul odor and gradually decreases
- The wound feels tender but does not become increasingly hot or deeply red
Realistic expectations for healing
Tissue heals in phases. First the wound edges close, then stabilizing connective tissue is built. Therefore, it may be noticeably better after a few days, but too much strain can cause increased pulling again.
Superficial abrasions often calm down within a few days. For a perineal tear or episiotomy the process commonly takes weeks. For higher-degree tears follow-up checks and, if necessary, specialized care are important. Detailed recommendations for severe perineal tears are available in clinical guidelines. Guideline: Management of third- and fourth-degree perineal tears
Practical care during the postpartum period
Good care is primarily gentle. The goal is to avoid irritation, maintain hygiene, and treat pain so you can move comfortably.
Hygiene without overcare
- Lukewarm water for rinsing after toileting can reduce stinging
- Then pat dry gently, do not rub
- Change pads frequently, wear breathable underwear
- Avoid harsh cleansing lotions or frequent disinfecting
Sitting, lying down, and cooling
- Side-lying often relieves more than flat sitting
- Short cooling periods can reduce swelling; always use a protective layer and take breaks
- Soft cushions or changing position often help more than keeping a rigid protective posture
Bowel movements and pressure on the perineum
Many fear the first bowel movement. That is understandable, but straining usually makes it worse. Drinking enough, eating enough fiber, and taking time are often the most important measures. If you have severe constipation or special instructions because of a higher-degree tear, follow your care team's plan.
Pain, burning, numbness: possible causes
Wound pain is to be expected. Burning when urinating often matches abrasions or irritated mucosa. A dull pressure pain can come from swelling or a hematoma.
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 evaluated promptly.
Scar, sex, and intimacy
Many feel physically able again early, but the genital area may still be sensitive. This is normal. Scar tissue can be drier, less elastic, and more sensitive to touch at first.
- Don't wait for a fixed date; wait for a stable, low-pain course
- 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 anxiety dominates, seeking help is appropriate
Warning signs: when to act quickly
The main criterion is clear deterioration. If things become noticeably worse instead of better, an earlier checkup is advisable.
Seek timely evaluation
- Suture pain increases significantly instead of decreasing
- Foul-smelling discharge or noticeable redness and swelling around the wound
- Fever, chills, or pronounced malaise
- The wound is oozing heavily, bleeding continuously, or appears to have opened
- Severe pressure pain or a tense swelling suggestive of a hematoma
Seek immediate care
- Heavy bleeding with circulatory problems
- Rapidly increasing, severe pain with large swelling
- New onset of 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 perineal tear
If the course does not match how you feel
Sometimes the wound may be medically fine, but you continue to have pain, burning, or strong anxiety. That is not a trivial issue. Even without an acute emergency, a check can help categorize causes and find useful steps.
Structured follow-up is especially important after severe perineal tears, because symptoms such as pain, pressure, or control problems can be treated specifically. Care and follow-up for severe tears are described in detail in guidelines, for example those from 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, adequate pain management, and attention to warning signs are usually more helpful than strict immobilization or overcleaning. If the course worries you or clearly worsens, early evaluation is the fastest route back to reassurance.
