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But Seriously: The Real Deal on Perineal Care

By Jen Wittes

Last week I joked about a doula’s tendency to use certain words:  placenta, lochia, and nipple come to mind.  My big confession was a particular fondness for discussion of the perineum, or the area between the vaginal opening and the anus.  Perfectly benign word for coffee chat and parent teacher conferences, right?  Maybe not, however, as I am a postpartum doula who constantly preaches preparedness for expectant moms looking toward a new life with newborn, I thought it might be a good idea to follow up the humor post with real, helpful information on caring for your perineum postpartum.

So.  What exactly happens to your perineum during childbirth that might require care, instruction, and attention to the perineum?  Well, for one, this is the area that most often tears and requires sutures.  This is the area that is manually compromised during an episiotomy.  Of course we can’t forget hemorrhoids.  Even without overt tearing or trauma, the perineum is often swollen and bruised after childbirth—after a C section as well—in part from the weight and pressure that comes with the last days of pregnancy.

What can you do to encourage comfort and recovery of this intimate area during the most tender of times?  Here are a few simple suggestions and items you might want to have on hand for the first few days after birth:

1.  Ice Packs  Your hospital care provide or your home/birth center midwife will likely supply you with a few handy crack-to-cool instant cold packs, but you can also make them yourself by wetting and freezing large maxi pads.  Crucial for swelling and tenderness and extremely relieving.

2.  Arnica  This homeopathic minimizes bruising and soreness.  Postpartum it is best taken orally in pellet form.  Although available in a topical ointment, you want to make sure there are no other ingredients that might irritate broken skin.

3.  Sitz bath  All hail the Sitz bath!  The basic definition is lukewarm water about 2-3 inches deep, only wetting the legs and hips.  This can be done with an actual mini basin you can order online, or simply in your own clean bath tub with shallow water.

4.  Herbs  Most commonly used in the Sitz bath—comfrey, lavender, and calendula are the most common.  Simple chamomile tea bags from the grocery store are also comforting in the bath.  Make a tea from these soothing, anti-inflammatory herbs in which to soak the maxi-pads you will freeze for the ice packs.

5.  Gentle Cleansing  Of course it is important to keep the area clean, especially after repair, however harsh soaps and vigorous scrubbing can of course irritate the area further.  Use your peri bottle (which the hospital or midwife will supply or remind you to supply) religiously.  Blotting with apple cider vinegar is also a good option.

6.  Rest  Birth is a big deal!  Take it easy and let yourself heal.

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