Every expectant mother probably hopes for a complication-free birth. Injuries are rarely discussed in connection with the big day. However, injuries to the intimate area during a vaginal birth are not unusual—but they’re usually not as bad as you might imagine. In this article, you’ll learn which birth injuries can occur, whether they can be avoided, and what you can do to support the healing process.

1. What birth injuries are there?

During a vaginal birth, various injuries can occur throughout the entire birth area, including the perineum, vagina, labia, clitoris, internal pelvic muscles, sphincter, and cervix.

Most women feel a slight after childbirth. Healing sensation at the vagina and perineum, as this area is particularly stretched and stressed during childbirth. The reason for the wound sensation is tiny fiber tears , which can occur due to the intense stretching of the sensitive tissue. Many women hardly notice the abrasions, while others feel them similar to severe muscle soreness.

Bruises ( hematomas ) can also occur in the vaginal area: When the tissue is significantly stretched during childbirth, blood vessels can be damaged. Blood then leaks into the surrounding tissue, causing swelling and a bruise to form. Not all hematomas are visible after birth; they often show up as mild pain when sitting, walking, or going to the bathroom.

Even if it may sound uncomfortable at first, both minor tears and bruises usually heal on their own within a few days after birth.

Apart from these minor injuries that most women experience after a vaginal birth, tear injuries can occur throughout the entire birth area. The most well-known (and most feared) is probably the perineal tear. But don’t worry: Only very few women experience a severe perineal tear; most of the time, it involves minor injuries that heal without complications.

2. What is the difference between a perineal tear and an episiotomy?

The perineum is the connecting bridge between the vagina and the anus, consisting of skin, muscles, subcutaneous fat, and connective tissue. During a vaginal birth, this delicate tissue is continuously stressed and stretched by the pressure of the baby’s head. When your baby’s head and shoulders emerge, the perineum may stretch so much that it tears. Depending on the severity and extent of the tear, injuries are classified into four severity levels .

1. Degree

• Superficial tears of the vaginal and/or perineal skin

• Depending on the size, the tears are closed with a small stitch under local anesthesia or heal on their own

• Wound healing generally proceeds without complications

2. Degree

• In addition to skin tears, superficial perineal muscle injuries occur

• Injuries are stitched under local anesthesia

• Wound healing generally proceeds without complications

3rd degree

• Partial or complete tearing of the sphincter

• Injuries are usually stitched under local anesthesia, and in rare cases under general anesthesia

4. Degree

• Injuries to the sphincter muscle and tearing of the intestinal mucosa

• Injuries are stitched, usually under general anesthesia and by a general surgeon

• May, in exceptional cases, lead to subsequent complications such as infections, fecal incontinence, or pain during intercourse

When people talk about perineal damage , they are usually referring to first- or second-degree injuries . More severe birth injuries—especially a fourth-degree perineal tear—occur only in very rare cases.

An episiotomy ( episiotomy ) is also considered a birth injury. In this procedure, the perineum is cut during childbirth—usually during a pushing contraction—typically to the right side past the anus, in order to avoid uncontrolled tearing of the tissue and thus a fourth-degree perineal tear, as well as tearing of the intestinal mucosa . Additionally, a controlled episiotomy toward the end of labor can help speed up the birth process . Even if many women don’t feel the cut itself during childbirth, they often find the healing process after an episiotomy more uncomfortable than after a tear. Not only for this reason is the procedure controversial today: Some experts argue that an episiotomy does not reduce the likelihood of perineal and vaginal tears and is often avoidable. Although the number of episiotomies has decreased significantly in recent years, there are certain situations in which a targeted cut may be necessary. For example, if the birth needs to proceed quickly because the baby’s care can no longer be adequately ensured, an episiotomy can be sensible, depending on the situation.

3. Can I prevent birth injuries?

Not every vaginal delivery results in birth injuries. Factors such as the baby’s weight, position, and head circumference, the speed of delivery, and the height and elasticity of the perineum all influence whether the sensitive intimate area sustains injuries. The likelihood of birth injuries also decreases with the number of vaginal births a woman has already had.

Even before birth, you can prepare your perineum with a perineal massage for the strain and stress, and try to prevent a perineal tear . While perineal massage does not guarantee that birth injuries will be avoided, it can help make the tissue more supple. It also helps many expectant mothers prepare for birth and approach it with more calm. You can find everything about the massage and a detailed guide in our article „ Damp massage for childbirth preparation ".

Even during birth, there are a few things you can do to reduce the likelihood of injuries. For example, your birthing position plays an important role: In the “classic” birth position—lying on your back with bent legs—the strain on the perineum is highest. In the hands-and-knees position or lying on your side, the pressure on the perineum is somewhat lower, and the likelihood of tears in the sensitive tissue decreases. It’s best to discuss with your midwife which posture is most advantageous in each situation. She may also guide you during labor to change positions periodically. Depending on the progress of the birth and the position of your baby’s head, your midwife can best assess which position is currently most suitable for you and your baby.

Birth injuries most often occur in the final phase of labor, the so-called pushing phase. During this phase, when the baby’s head stretches the perineum the most, your midwife can your support the perineum from the outside to slightly slow the pressure of the head. Additionally, she will guide you to consciously use contractions for pushing . This prevents your perineum from being unnecessarily strained by constant pushing. Even if you can hardly wait to finally bring your baby into the world, it can be very helpful to pause briefly between contractions—or even breathe through them. This allows the perineal tissue to stretch gradually and can reduce tissue tears.

Your gynecologist or midwife will monitor your perineum during the birth process and will do everything possible to minimize the risk of injury.

4. How are birth injuries treated?

After birth, your gynecologist or midwife will examine the birth area for possible injuries and decide whether wound care is necessary. For abrasions and minor, superficial tears, stitches are usually not required, as they heal on their own within a few days. However, in cases of bleeding or if the wound edges are not perfectly aligned, stitches may be beneficial even for small tears to support healing. If stitches are needed, they are typically done immediately after birth, usually in the delivery room and under anesthesia—you probably won’t notice much of it, as you’ll be holding your baby for the first time at the same time.

Your midwife or gynecologist will also continue to monitor the birth injuries regularly during the postpartum period to ensure the healing process is progressing well.

5. Do I have to expect pain after birth injuries?

Even if you only sustained minor injuries during birth, they can be uncomfortable or even painful in the first few days. Since every woman experiences these injuries differently, it’s difficult to make precise statements. If you find the pain very uncomfortable, discuss with your doctor or midwife whether taking painkillers is advisable and which ones you can take. If you have persistent pain, swelling, bleeding, or other abnormalities, you should definitely inform your doctor. These symptoms could be due to a wound-healing issue or an infection that needs treatment.

Many women with birth injuries worry about the first bowel movement after childbirth. By maintaining a high-fiber diet (fiber is found, for example, in flaxseeds or dried fruit) and drinking enough fluids, you help keep your stool soft and, hopefully, avoid difficulties. The stitches should not be affected by going to the toilet.

6. How can I support the healing process?

If your injuries were stitched after birth, the stitches usually dissolve within 10 to 14 days. However, it can take several weeks for a birth injury to fully heal. The healing process is very individual and depends on the type and severity of the injuries. Still, there are a few things you can do to support healing:

• Keep the wound clean and dry

  Rinse the wound several times a day with warm water and then gently pat it dry. Many women do this when using the toilet. Simply use a measuring cup with lukewarm water, letting the water run along your intimate area between your legs while urinating. This not only improves hygiene but also dilutes the urine, so urination hurts less in the first few days.

  You should also change your pad regularly—depending on the intensity of the lochia —every few hours to help prevent infections from spreading in the moist, warm environment. Letting air reach the wound from time to time can also support healing. For example, you can lie on your stomach without underwear now and then (don’t forget a protective sheet).

• Minimize strain

  To allow injuries to heal undisturbed, try to put as little strain as possible on the entire birth area. That means: If you take the postpartum period seriously, stay lying down as much as possible and walk, sit, or stand as little as you can. When sitting, choose a position that puts minimal strain on the area, and avoid sitting cross-legged and similar positions to prevent overstretching the wound. A soft pillow or a special sitting ring can help protect the wound area.

  When breastfeeding your baby, some positions are better suited than others to protect your perineum and pelvic floor. In our article “ The ABCs of Breastfeeding Positions ” you will learn how to position your baby immediately after birth without putting too much strain on the still-sensitive birth area.

• Cooling and care

  In the first days, your perineum may still feel uncomfortable. You can gently cool it to provide relief and help reduce swelling. To do this, you can soak some pads in nourishing oil and freeze them. Then place the frozen pads on your perineum several times a day, for as long as it feels comfortable.

  You can also care for the stressed perineum with sitz baths, starting around the fourth or fifth day after birth. There are special bidet attachments for this, but a clean bowl or a plastic bag stretched over the toilet bowl will also work. Make sure the water temperature does not exceed 37°C and that the sitz bath does not last longer than 15 minutes. If you like, you can add an anti-inflammatory supplement from the pharmacy or a small amount of essential oil, such as lavender or chamomile, to the sitz bath. If you prefer not to take a sitz bath, there are also special regeneration sprays for perineal care after birth. It’s best to ask your midwife which product she can recommend.

7. What are possible consequences of birth injuries?

Even if birth injuries can be uncomfortable in the first few days, they usually heal well with proper aftercare and don’t leave long-term scars. However, some women may have to deal with longer-term effects. In rare cases, infections in the wound area can occur and require medical treatment. Give your body enough rest and time for undisturbed wound healing. This also includes not rushing into postnatal sex: While sexual intercourse is generally possible during lochia, you should definitely use a condom due to the increased risk of infection and to avoid an unintended pregnancy. Our midwife Sissi recommends waiting six weeks after birth before having sex for the first time. If significant scarring occurs, you may initially find intercourse uncomfortable. Take it slowly and give yourself the time you need to truly feel ready.

In cases of severe birth injuries where the sphincter has been damaged, temporary (fecal) incontinence may occur. However, muscle function usually normalizes within a few months.

Every birth leaves traces—in a figurative sense, and sometimes in a literal one, too. Even if you want to avoid birth injuries as much as possible, try not to let the thought of them unsettle you. Instead, approach birth as calmly as you can. Your midwife has plenty of experience with these injuries and will be there to answer your questions and support you with practical tools. And holding your little explorer in your arms will make up for the pain—so it will soon be forgotten.