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How to Heal Your Scars After An Episiotomy or Tear During Childbirth

Childbirth is one of the most wonderful abilities we have been given. It's a time of joy, excitement, magic and wonder. But if you suffer a vaginal tear while giving birth, or if it becomes necessary for you to have an episiotomy, then that miracle can come at a physical cost.

In this article we'll look at exactly what happens when you're given an episiotomy or experience a tear during childbirth, why it happens, how to avoid tearing or needing an episiotomy and how to heal the scars afterwards.

What is an Episiotomy?

An episiotomy is a small cut deliberately made by the doctor or midwife during childbirth to widen the vagina so that the baby can pass through the vagina more easily. There are two types of episiotomy:

Midline - the cut is made straight from the rear opening of the vagina back towards the anus. This type will heal more easily but poses a greater risk of extending to the anus and causing more damage.

Mediolateral - the cut is made diagonally from the rear of the vagina opening towards the right or left of the anus. This sort of episiotomy is the safest bet against damage to the anus but can cause more pain and be more difficult to repair.

Episiotomies were once made routinely by medical staff in the belief that they would prevent more damaging tears, would heal more quickly than a tear and would be better for the pelvic floor in the long run. However, modern research has found that this isn't the case.

In the UK women are now only given an episiotomy when it's considered necessary by medical staff.

An episiotomy cut goes through skin and muscle and will be repaired after you give birth using dissolvable stitches. You will be given a local anaesthetic to numb the area so you don't feel any pain during the repair. However, you will normally experience some discomfort for two or three weeks once the numbness wears off. It generally takes about a month for your episiotomy to heal.

When is an Episiotomy Necessary?

Although episiotomies are no longer performed as standard during childbirth, they are still a recommended option in certain circumstances, such as:

Your baby is suffering from foetal distress and needs to be delivered quickly
Your baby's shoulder is tucked behind your pelvic bone (a condition called shoulder dystocia)
You need mechanical assistance to give birth, for example with the use of forceps or a vacuum

What is a Vaginal Tear?

Tearing during childbirth is extremely common and most will require stitches. Tears generally happen in the perineum, which is the tissue between the vagina and the anus. They are caused when the baby is pushed out.

The NHS reports that up to 90% of first-time mothers who give birth vaginally will experience some sort of tear or episiotomy.

Vaginal tears are ranked by degree of severity; a second-degree tear is similar to an episiotomy and a fourth-degree tear affects the anal sphincter muscle and can potentially cause bowel incontinence.

How to Reduce the Risk of Tearing or Episiotomy

The skin and muscles of the perineum are designed to stretch during childbirth, but it can happen very slowly. For that reason, it can still be damaged by the baby being born more quickly than your tissues have time to stretch to accommodate.

Try these techniques to reduce the risk of a vaginal tear or episiotomy:

Performing perineal massage last few weeks of your pregnancy, from 34 weeks. In research, the greatest benefit was seen in women who massaged their perineum every day.
Pelvic floor muscle exercises, in combination with perineal massage, can also reduce the risk.

Visit your women's health physiotherapist for a Pregnancy MOT to set you up for your best birth experience. Amongst other benefits, you'll learn how to practice these techniques correctly to achieve the optimum results in preparation for your big day.

Coping After an Episiotomy or Vaginal Tear

Once you have your new baby you'll want to focus on what’s most important to you – that they are safe and well. But it’s also necessary to consider your own wellbeing and do what you can to make yourself feel physically and mentally well.

It will take a few weeks for your episiotomy or tear to heal fully, and you can get advice from your midwife or other healthcare provider for ways to deal with pain, toileting, keeping your incision clean and looking out for infection.

Scar tissue around the area where you have had an episiotomy or suffered a tear can become quite tight and painful and may become attached to the layers of skin around it. It might be raised and itchy or causing discomfort during urination, bowel movements and intercourse as well as during general activity.

Perineal massage can also help to mobilise your scar and improve unpleasant symptoms.

Postnatal Perineal Scar Tissue Massage

You can begin postnatal perineal scar massage after you've had your GP postnatal check up at around 6 weeks postpartum. Once your GP has confirmed that your stitches have healed and there is no sign of infection, massage will help to reduce the scar tissue, soften it and ease any tightness or discomfort.

This is the ideal time for a Mummy MOT with a women's health physio so that you can learn how to massage the area properly as well as have a more thorough general check to ensure your body is healing as it should in every way.

Your therapist can help you to understand your body and overcome any fears you may have about touching your scar. Believe it or not, leaving your scars alone is actually the worst thing you can do!

You may be experiencing some redness, heat and swelling in the area, but as long as your GP postnatal check has been done and you’ve been given the all-clear, it’s ok to continue.

How to Massage Your Perineum

Always begin by washing your hands to prevent the transfer of any germs or infection, and have a hypoallergenic, water based lubricant available. You should start externally around the scar, carefully working your way towards the cut or tear site. You can repeat the action internally as well if you have scar tissue or discomfort there too.

Follow these simple steps to massage your perineum scar following childbirth:

Apply lubricant to the opening and your thumb.
Start externally. Apply pressure with your thumb or fingers and firmly massage into the scar, along the line of it, across it and in circles over the scar.
For internal stitches, make yourself comfortable with your legs gently open. Insert your thumb into the entrance of your vagina about 2.5 to 4cm so the pad of your thumb is facing down towards the anus. Gently press down and hold for 30-60 seconds while you concentrate on relaxing your perineum.
Move your thumb a little to the left and repeat.
Move your thumb to the right of your starting point and repeat.
Press firmly with your thumb on the back of the vaginal opening and move your thumbs up and out then back again in firm ‘u’ shapes over the scar tissue.

When you perform this massage, it shouldn't hurt, although you might feel pressure at first. This should improve over time as the massage starts to take effect.

Remember that in the vast majority of cases the scars will heal over time, and the pain won’t last forever. But to help get you there quicker, visit a women's health physiotherapist.

For more information about managing your scar from an episiotomy or vaginal tear, call Magdalena on 07877 017 936 or drop PelviCare an email. Alternatively, you can book an appointment online.

PelviCare Women's Health Physiotherapy is located in Greenwich, London, serving women across South London, East London, Essex, Kent and beyond.