Around 85% of vaginal births involve some perineal trauma. Here's what the degrees mean, what actually helps recovery, and when to ask for more support.
Around 85% of women who give birth vaginally experience some degree of perineal trauma — either a tear or an episiotomy. First and second degree tears (the most common) heal well and most women recover fully within a few weeks.
First degree: affects only the skin. Often needs no stitches.
Second degree: extends into the muscle. Stitched in the delivery suite, usually under local anaesthetic.
Third and fourth degree: extend to the anal sphincter or rectum. Less common (around 3%), require repair in theatre, and need specialist follow-up.
Knowing the grading system before birth helps you understand what you're being told immediately afterwards — when it can be hard to take in information.
Pain relief: Paracetamol and ibuprofen together are more effective than either alone. Ibuprofen also reduces inflammation. Take them regularly in the first few days rather than waiting until pain peaks. A cooling pad or frozen maternity pad (briefly frozen) provides short-term relief — never apply ice directly to the skin.
Keeping the area clean: Use a peri bottle (a squirt bottle with warm water) after using the toilet rather than wiping. Pat dry rather than rubbing. Change maternity pads every 2–4 hours.
Sitting: A ring cushion is not recommended — it puts pressure on the wound edges. Lying down or sitting on a flat surface is actually better for healing.
The fear of passing a bowel movement after perineal trauma is almost universal — and almost always worse in anticipation than in practice. Stitches will not tear from a normal bowel movement. The skin is designed to stretch.
What actually helps: drink plenty of water, eat plenty of fibre, and ask your midwife for a stool softener if you haven't been offered one (lactulose or docusate are commonly prescribed and are safe while breastfeeding). Don't delay going when you feel the urge — holding on leads to harder stools which make it worse.
Some discomfort for the first 1–2 weeks is normal. The following are not normal and need prompt attention:
• Increasing pain after the first few days (healing should gradually improve, not worsen)
• Significant swelling, redness, or heat around the wound
• An unpleasant smell from the wound
• Stitches coming apart before the wound has healed
• Incontinence of wind or faeces (can indicate a 3rd/4th degree tear that was missed or hasn't healed well)
Contact your midwife, health visitor, or GP if any of these apply. Don't wait until a scheduled appointment.
Dissolvable stitches typically disappear within 2–4 weeks. The wound healing underneath takes longer. Most women feel significantly better at 6 weeks — but full internal healing of muscle tissue can take several months.
Two things consistently under-discussed: pelvic floor recovery (which should start gently as soon as pain allows — ask your midwife for guidance on modified pelvic floor exercises in the early weeks), and returning to sex (the 6-week check does not mean you are physically ready — some women aren't comfortable for several months, which is completely normal). If sex remains painful after 3–4 months, it's worth mentioning to your GP — pelvic health physiotherapy is very effective for this.