Pat Thomas looks at non-pharmaceutical treatments for healing cuts and tears after birth

Look at any magazine picture of a new mum and her baby and you could be forgiven for thinking that after the birth, all the pain and discomfort are over. After all you’ve done the hard part; everything from here on in should be plain sailing, right?

Wrong. Your back may hurt, you may have a headache and perhaps worst of all your perineum (the area between you vagina and anus) may be bruised, cut or torn. Perineal pain is common in a large number of women whether or not they’ve torn or had an episiotomy. The degree of discomfort can vary from a vague throbbing or discomfort, to achiness and stabbing pains.

When you are like this, basic movements like walking, sitting or going to the toilet can be horribly uncomfortable and sex almost impossible (perish the thought).

In spite of the fact that this is a widespread problem there is surprisingly little research on how best to deal with it. Doctors and midwives rely mostly on prescriptions for modern painkillers or numbing sprays combined with simple old-fashioned remedies such as Epsom salt baths and bags of frozen peas.

There are, however, a number of things you can do to aid the healing process.

• Try witchhazel – still a favourite among midwives and herbalists. Witchhazel is soothing and cooling and has a mild anti-inflammatory effect on the skin. You can apply it directly to the perineum or try soaking a face cloth in cold water, wringing it out thoroughly, and then putting witchhazel on the cloth before applying to the perineum.
• Essential oils have their uses post-natally as well. One famous research study published in the Journal of Advanced Nursing, found that women who added essential oil of lavender to their baths for 10 days post-natally experienced much less perineal pain than those who used either a synthetic or placebo oil.
• If you have to be on the move then the Femme Pad (available form Asda, £12) is a gel pad that fits in your panties like a sanitary towel. Keep it in the fridge before you put it on and it can be used to soothe and cool the perineum. This device is a high tech twist on that old standby, the bag of frozen peas. While not the most glamorous solution, frozen peas can be very soothing if your stitches feel hot and inflamed.

• Most post-natal wards have what are known as ‘valley cushions’ to help relieve the pain resulting from tears and episiotomies. They inflate to just the right level of support to help you sit comfortably. You can’t buy them for yourself yet but you can hire them from the National Childbirth Trust at a charge of £10.50 for five days. For further details call the NCT on 020 8992-8637.
• Try either a cold or warm sitz bath. This is a shallow bath – the water should only be deep enough to come up to your perineum (3 or 4 inches). While you might think that warm baths are the most soothing on the perineum, one study several years ago in the Journal of Obstetric, Gynaecologic & Neonatal Nursing found that while both cold and warm baths could deliver some degree of relief, cold baths were the quickest and most effective. If you like you can put some witchhazel or a handful of baking soda in the bath to enhance the effect.
• Herbalists recommend a warm decoction of oak and comfrey barks to which you can add either marigold or lavender flowers. If the damage to your perineum is quite deep and you are concerned about infection, add a tablespoon of slippery elm and golden seal powders to the mix. Brew these ingredients to make a strong ‘tea’, strain off the liquid and add to either a warm or tepid sitz bath. You can also use this mixture in a bidet or, just as effectively, in a large washing up bowl. Use it to soak your perineum 20-30 minutes twice daily (or if you have had sutures only once daily).

However, in 1999 a large study in Canada, published in the American Journal of Obstetrics and Gynaecology, found that perineal massage was an effective way of avoiding tears and cuts. In it, one group of women were instructed to massage, or have their partners massage, their perineums every day from 34 or 35 weeks. These women were compared to another group who did not use perineal massage. The result was that significantly more women in the massage group had intact perineums after birth.

In this study the women used almond oil, but really any nourishing oil such as a combination of wheatgerm or avocado mixed with jojoba can encourage suppleness in the skin. For a practical guide see perineal massage.

You might also consider:

• Talking to your midwife, before birth, about the hospital’s policy on performing episiotomies. Studies show that many of these are done unnecessarily.
• Birth in different places and with different kinds of caregivers can have a significant effect on whether or not you tear or are cut. For instance, a 1999 study at the Royal Bournemouth Hospital found that women booked for midwifery care had fewer episiotomies than those booked for consultant care.
• Earlier this year a study of water births at a Swiss hospital confirmed what several other studies have shown: women who labour and/or give birth in water suffer fewer tears and episiotomies. This was also the finding of a study in July 2000 at Homerton Hospital in London. Another study by the Swiss team found that using what they called ‘alternative birth methods’ such as water, but also standing or being in a supported squat, brought the episiotomy rate in their hospital down from 80 per cent to just 15 per cent.

Perhaps the most important thing, however, is to be patient with yourself and with the healing process. For the majority of women, time, with a little help from natural remedies, really is the best healer.