Attention Readers: I am presenting this from a medical standpoint, not necessarily one from a midwife's standpoint. However, I will try to include information and links that may assist with presenting the pros and cons of this controversial procedure. Most midwives I know, including myself, take great pride in our very, very, low episiotomy rates and our ability to assist the mother in giving birth over an intact perineum with few, if any, tears or abrasions. If repairs are necessary, we also take extreme care in making sure that any repairs are performed properly, expertly matching tissues with appropriate tissues, providing sterile techniques to prevent infections, and careful instructions on postpartum care. Even first time mothers are fully capable of birthing their babies without this procedure when allowed enough time and support by a competent birth support provider.

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BASIC INFORMATION

DEFINITION

An episiotomy is an incision at the exterior of the vaginal opening to create enlargement.

Obstetricians used to cut episiotomies routinely to speed delivery and to prevent the vagina from tearing, particularly during the first vaginal delivery. Many experts believed that the "clean" incision of an episiotomy would heal more easily than a spontaneous tear. But a great many studies over the last 20 years of so have disproved this theory. Most experts no agree that the procedure should not be done routinely.

Research has shown that women with spontaneous tears generally recover in the same time and often with fewer complications than those with episiotomies. Women who have episiotomies tend to lose ore blood at the time of delivery, have more pain during recovery, and have to wait longer before they have sex without discomfort.

Women who get episiotomies are more likely to end up with serious tears through the anal sphincter or even all the way through the rectum (known as third- or fourth-degree lacerations, respectively) than those who deliver without being cut. These serious tears result in more perineal pain after the birth, require a significantly longer recovery period, and are more likely to affect the strength of the pelvic floor muscles. And tears that disrupt the anal sphincter increase the risk of anal incontinence - trouble controlling bowel movements or gas.

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REASONS FOR PROCEDURE

This procedure is usually performed during childbirth, just before the widest diameter of the baby's head passes through the outlet of the birth canal. This allows easier passage of the baby's head to reduce the potential damage to the mother's vagina, bladder and rectum (however, studies have shown otherwise... this is a medical surgical procedure that has been greatly over-used and over-abused. Midwives have shown that most women can give birth, vaginally, without tearing or needing to have an episiotomy).

This procedure also helps expedite delivery in the case of forceps or vacuum use when there is maternal exhaustion or fetal distress when the baby's heart rate shows that he/she is not tolerating the last minutes of labor well and needs to be born as quickly as possible.

Some practitioners will perform an episiotomy when they feel the baby's head is large or may not be molding enough to pass through the vaginal opening or if they feel they need a little extra room to manipulate the baby to get him/her to come out.

Some practitioners will use this procedure if the woman's tissue is starting to bleed or looks like it's about to tear in multiple places as the baby's head begins to crown. The idea here is that being cut in one place is better than tearing in more than one place. However, a few shallow tears may still be preferable to an episiotomy, so your health care provider or midwife will have to make a judgment call.

AVOIDING AN EPISIOTOMY

Talk to your health care provider or midwife early in your prenatal care about your feelings regarding the procedure. Ask him/her how often and under what conditions he/she would perform an episiotomy, and how she might help you to avoid tearing during the delivery. If you are in a group practice, make sure you discuss your concerns with other practitioners in the practice, in case you end up with someone else at your delivery besides your own health care provider. Studies show that, as a group, midwives tend to do far fewer episiotomies than do other health care providers, especially obstetricians, which seem to have the highest rate of surgical intervention.

Perineal Massage: Start doing perineal massage about 5 to 6 weeks before your expected delivery date. A few studies show that perineal massage may make it less likely that you will tear or need an episiotomy. Your midwife should be able to tell you how to do proper perineal massage for the best benefits.

MoonDragon's Pregnancy Information: Episiotomies - What You Should Know

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SUTURE OR NOT TO SUTURE

Determination of whether to suture or not is the next consideration. Some situations have been mentioned as things that should NOT be sutured: labia tears close to the urinary meatus or clitoris, skid marks which are like scrapes. Beyond this, assessment and decisions to suture or not to suture need to be made. The woman has the right to say if she does not want to be sutured, but she will also be depending on the experience of the midwife to help her make that decision. Some things which would make the decision to suture more likely might be:

• The woman wants them.


• The laceration is ragged and does not close together when legs are placed together.


• The laceration is extensive, externally or internally.


• The woman needs more than 2 stitches to close the laceration.


• A new laceration probably needs sutures for best healing.

Some things which might help decisions against sutures might be:

• The woman does not want them.


• The laceration edges are straight and close together well when legs are closed.


• The laceration is shallow and not extensive.


• The laceration is along an old episiotomy scar (where it will probably be very straight and close well).


• She needs less than 2 stitches to close her up.


• She has been closed up during a former birth in what turned out to be an uncomfortable way (that infamous "extra stitch" commonly given by male physicians for the pleasure of the woman's husband), in such cases healing is often better with no sutures at all, as long as the damage is not extensive. (Ask the woman.)

Ultimately, the midwife and the woman must come to a decision based upon the midwife's knowledge and the woman's desires.

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RISK

None expected. However, further tearing may occur beyond the incision which may involve more extensive repair.

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DESCRIPTION OF PROCEDURE

An incision is made in the perineum just before the widest part of the baby's head is to be delivered. The size of the incision depends on how large an opening is required for the baby's head to pass through safely.

An injection of local anesthetic may or may not be given prior to the procedure. Sometimes, if your perineum is already numb and thinned out from the pressure of your baby's head, she may be able to do the episiotomy without pain medication. This is sometimes called a pressure episiotomy.

The incision is usually made using surgical scissors to make the small cut. The surgical scissors preferred have a blunt end on one side (this side goes into the vagina) to prevent injury to the vaginal tissue and the baby's head during insertion and cutting.

The baby and placenta are delivered.

After the baby and placenta are delivered, you may get another shot of local anesthesia to be sure you are completely numb before your health care provider or midwife stitches up the cut. Note: if the cut is very small, requiring only a few superficial sutures, local anesthetic may not be necessary and may actually be a hindrance since it can cause tissue swelling and allergic reactions in the mother. The repair of a superficial cut or tear without anesthetic feels like a little "pinch" and can be done. I have had it done on myself and I have repaired a few incisions/tears without using anesthetic. - MoonDragon Midwife

The surgical area is repaired with sutures that will be absorbed by the body. The skill of the practitioner or midwife doing the repair is important. All tissues need to be matched, aligned and repair done properly using sterile technique.

MoonDragon's Suturing Equipment & Supplies

MoonDragon's Pre-suturing Preparation

MoonDragon's Procedures: Administering Anesthesia

MoonDragon's Suturing Information - Episiotomy Repair

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EXPECTED OUTCOME

Expect complete healing without complications. Allow about 6 weeks for recovery from childbirth.

If you have had an episiotomy (or tear), you will have stitches in a very tender area and you will need some time to heal. Your stitches will disintegrate (absorbable sutures usually made from chromic catgut) during the first weeks after delivery and will not need to be removed by your practitioner. Some women feel little pain within a week or two, while other have discomfort for a month or more, particularly if they have a third or fourth degree laceration.

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POSSIBLE COMPLICATIONS

Excessive bleeding.

Surgical-wound infection.

Inadvertent injury to sphincter or rectum.

May lead to increased risk of vaginal and/or rectal injury.

Incomplete healing usually caused by poor surgical repair.

Pain of perineum continues after healing.

Inability to resume sexual intercourse after healing. May be caused when the vaginal opening has been sutured too tight or too small for penile penetration.

Possible tearing risks along old scar tissue during later childbirth.

Incontinence of bowel from improper anal sphincter repair.

TREATMENT

GENERAL MEASURES

Bathe and shower as usual. You may wash the incision gently with mild unscented soap.

Take warm baths several times a day as long as you experience discomfort. A warm sitz bath may help relieve discomfort. Comfrey leaf may be added to the sitz bath to help in healing. See Rules For Wound Care below for more information and recommendations.

Use ice packs made of gauze soaked in ice-cold Witch Hazel to ease discomfort during the 24 hours after delivery will ease the discomfort and prevent or reduce swelling.

WITCH HAZEL PRODUCTS Mountain Rose Herbs: Witch Hazel, Bulk Organic Herbs Kalyx: Witch Hazel Astringent, Humphreys, 16 fl. oz. Kalyx: Witch Hazel Astringent, Certified Organic, Humphreys, 8 fl. oz. Kalyx: Witch Hazel Astringent Cleansing Pads, Humphreys, 60 Count Kalyx: Witch Hazel Extract, Starwest Botanicals, 16 fl. oz.. Kalyx: Witch Hazel Extract , Health & Herbs, 2 fl. oz. Kalyx: Witch Hazel Salve, WiseWays Herbals, 1 oz. Kalyx: Witch Hazel With Aloe Vera Astringent Pads, Thayers, Medicated, 60 Count HerbsPro: Witch Hazel Astringent, Humphreys Homeopathic Remedies, 16 oz. HerbsPro: Witch Hazel Astringent, Original, Thayers, 11.5 fl. oz. HerbsPro: Hazelet Witch Hazel Pads, Dickinson Brands, 60 Count HerbsPro: Witch Hazel Pads, Medicated, Thayers, 60 Pads TakeHerb: Witch Hazel Extract, Health Herbs, Stop External & Internal Bleeding, 2 fl. oz. TakeHerb: Witch Hazel Leaf Powder, Wildcrafted, Starwest Botanicals, 1 lb TakeHerb: Witch Hazel Leaf, Cut & Sifted, Wildcrafted, Starwest Botanicals, 1 lb TakeHerb: Witch Hazel Extract, Starwest Botanicals, 16 oz.

COMFREY PRODUCTS Mountain Rose Herbs: Comfrey, Bulk Organic Herbs Kalyx: Herbal Savvy Comfrey-Aloe Salve, Country Comfort, 1 oz. Kalyx: Herbal Savvy Comfrey-Aloe Salve, Country Comfort, 2 oz. Kalyx: Comfrey Oil, Organic, WiseWays Herbals, 4 oz. Kalyx: Comfrey Leaf Powder, Certified Organic, Starwest Botanicals, 1 lb. House of Nutrition: Comfrey Salve, Gaia, 4 oz. House of Nutrition: Comfrey Ointment, Dr. Christopher, 2 oz. House of Nutrition: Herbal Savvy Comfrey Aloe Vera, Country Comfort, 2 oz. TakeHerb: Comfrey Care Herbal Salve, Planetary Herbals, 2 oz. TakeHerb: Comfrey Ointment, Dr. Christopher's Original Formulas, 2 oz. TakeHerb: Comfrey Leaf Powder, Starwest Botanicals, 1 lb TakeHerb: Comfrey Leaf, Cut & Sifted, Starwest Botanicals, 1 lb TakeHerb: Comfrey Oil, Organic, For Sprains, Bruises & Swellings, WiseWays Herbals, 4 oz.

RULES FOR WOUND CARE WITH OR WITHOUT SUTURES

If a woman does not get sutures and has torn, she needs to follow the same rules that someone who has had sutures does. These rules are as follows:

Stay in bed with legs together as much as possible for 2 weeks.

Keep legs together at all times.

Sit very gently when urinating or having a bowel movement.

Kegel exercises - 150 daily.

Drink plenty of prune juice, drink lots of water and juices, and avoid constipating foods. Include fiber, such as bran, in the diet. Constipation is not a desired situation while the perineum is healing. I would describe the first bowel movement under the best of conditions as "passing a roll of barbed wire". Keep the stool as loose as possible to prevent straining.

Do not strain on the toilet. Not only is this painful, but it puts undesired pressure on the healing perineum.

Place an ice pack on the perineum for 1 hour to reduce swelling. Make sure you have a barrier between the ice pack and skin tissue. You do not want to freeze the tissue. A wash cloth, hand towel or thick layer of gauze will work.

Use comfrey tea pericare after urination (washing the perineal area with a comfrey tea and apply comfrey tea soaked 4x4 gauze pad compresses to the perineal area to soothe injury. Urine may cause a stinging sensation in sensitive perineal tissues. Pouring warm water over the perineum while urinating will help prevent stinging and helps to wash away the urine at the same time. Blot dry with gauze pads (do not flush, put in a trash barrel instead). Do not rub or wipe perineal area. This may open tissues that are repairing.

Apply herbal ointment (such as Comfrey - see products below) to the area GENTLY. Warm comfrey infusion sitz baths can ease a sore bottom and promote healing. Drink Comfrey Leaf tea (to promote healing) - This can be added to Red Raspberry leaf tea to help with flavor. Red Raspberry leaf is a good woman's herb for pregnancy and postpartum.

COMFREY LEAF & ROOT SALVES Mountain Rose Herbs: Comfrey Leaf & Root, Certified Organic, 4 oz. to 1 lb. Bulk Herbs Mountain Rose Herbs: Comfrey-St. John's Wort Compound Salve Kalyx: Herbal Savvy Comfrey-Aloe Salve, Country Comfort, 1 oz. Kalyx: Herbal Savvy Comfrey-Aloe Salve, Country Comfort, 2 oz. Kalyx: All Heal Salve, Wise Ways Herbals, 2 oz. Kalyx: Calendula -Comfrey Skin Dressing, Turtle Island, 1 oz. Kalyx: Chickweed Salve (With Comfrey), Satterfield Naturals, 6 Tins, 4 oz. House of Nutrition: Comfrey Salve, Gaia, 4 oz. House of Nutrition: Comfrey Ointment, Dr. Christopher, 2 oz. House of Nutrition: Herbal Savvy Comfrey Aloe Vera, Country Comfort, 2 oz. TakeHerb: Comfrey Care Herbal Salve, Planetary Herbals, 2 oz. TakeHerb: Comfrey Ointment, Dr. Christopher's Original Formulas, 2 oz. MoonDragon's Health Therapy: Herbal Ointments - Healing Wound Salve Recipes

Take the following supplements every day for at least two weeks:

ZINC (300 mg) Kalyx: Zinc, TwinLab, 30 mg, 100 Caps Kalyx: Zinc, TwinLab, 50 mg, 180 Caps Kalyx: Zinc & Echinacea, Quantum, 48 Cherry Flavored Lozenges HerbsPro: Zinc Orotate, NCI (Dr. Hans Nieper), 60 mg, 200 Tabs HerbsPro: Zinc High Potency, Thompson Nutritional Products, 50 mg, 60 Tabs HerbsPro: Zinc Plus, Olympian Labs, 30 mg, 100 Caps HerbsPro: Opti L-Zinc, Now Foods, 30 mg, 100 Caps HerbsPro: Zinc Lozenges, FoodScience of Vermont, 23 mg, 60 Lozenges HerbsPro: Ultimate Zinc - C, NOW Foods, 100 Lozenges HerbsPro: Zinc Gluconate, NOW Foods, 50 mg, 100 Tabs TakeHerb: Wellness Zinc Lozenges With Vitamin C (Zinc Ascorbate), Source Naturals, 23 mg / 30 mg, 120 Tabs TakeHerb: Wellness Zinc Throat Spray, Source Naturals, 2 oz. TakeHerb: Zinc Plus, Olympian Labs, 30 mg, 100 Caps TakeHerb: OptiZinc, Zinc Monomethionine Complex, Source Naturals, 240 Tabs VITAMIN B-COMPLEX Kalyx: Super Vitamin B-Complex With B-12, Schiff, 120 Caps Kalyx: Vitamin B-Complex, Schiff, 50 mg, 100 Tabs Kalyx: Vitamin B-Complex, Schiff, From Whole Rice, 50 mg, 100 Softgels Kalyx: Complete B-Complex, Rainbow Light, 180 Tabs Kalyx: Stress B-Complex, TwinLab, 100 Caps Kalyx: Vitamin B-100 Complex, Thompson, 60 Tabs HerbsPro: Liquid B-Complex With Vitamin B-12, NOW Foods, 8 oz. HerbsPro: Platinum Vitamin-B Complex, Nature's Answer, 16 oz. HerbsPro: Liquid Yeast B Complex, TwinLab, 16 fl. oz. HerbsPro: Coenzymate B Complex, Sublingual Orange, Source Naturals, 120 Tabs HerbsPro: Coenzymate B Complex, Sublingual Peppermint, Source Naturals, 120 Tabs HerbsPro: Stress B-Complex, TwinLab, 250 Caps HerbsPro: Super B Complex, Herbal Liquid, TwinLab, 8 fl. oz. HerbsPro: Super B Complex, Regular Liquid Formula, 8 fl. oz. HerbsPro: B Complex Liquid, World Organics, 16 fl. oz. HerbsPro: Maxi B-50 Complex, Maxi-Health Research, 100 Caps HerbsPro: Coenzymate B Complex, Sublingual Orange, Source Naturals, 60 Tabs Kalyx: B-Complex Gummy Vitamins, Be Calm Strawberry For Adults, Nutrition Now, 70 Gummy Chewables TakeHerb: Liquid B Complex, B Vitamins With Energy Herbs, Tropical Oasis, 16 oz. TakeHerb: Super B-Complex Regular Liquid, TwinLab, 8 oz. TakeHerb: Liquid Yeast B-Complex, TwinLab, 16 oz. TakeHerb: Ultra B Liquid, World Organics, In Raisin Juice, 16 oz. TakeHerb: Liquid B-Complex, With Vitamin C, Strawberry Flavor, Lifetime, 16 oz. VITAMIN B-6 PRODUCTS Kalyx: Vitamin B-6, Thompson, 100 mg, 60 Tabs TakeHerb: Vitamin B-6, Nature's Way, 100 mg, 100 Caps TakeHerb: Vitamin B-6, NOW Foods, 100 mg, 250 Caps TakeHerb: Vitamin B-6, NOW Foods, 50 mg, 100 Tabs VITAMIN B-12 PRODUCTS TakeHerb: Vitamin B-Complex B-12 Sublingual Liquid, Good'n Natural, Promotes Energy Metabolism, 2 oz. TakeHerb: Vitamin B-12 Liquid B-Complex, NOW Foods, 2 oz. TakeHerb: Vitamin B-12 Liquid B-Complex, NOW Foods, 8 oz. TakeHerb: Sublingual Liquid B-12 With B-Complex, 2000 mcg, Solgar, 2 oz. TakeHerb: Vegan Sublingual B-12, Deva Nutrition, 90 Tabs TakeHerb: Ultra Vitamin B-12, NOW Foods, 4 fl. oz. VITAMIN E (400 IU) Mountain Rose Herbs: Vitamin E Oil, Mixed Tocopherols, GMO Free, Kosher Certified, 7500 IU per oz., 2 oz. to 1 gallon Kalyx: Vitamin E One Grand, Thompson Nutritional, 1000 IU, 30 Softgels HerbsPro: Vitamin E, Country Life, 100 IU, 100 Softgels HerbsPro: Vitamin E, Country Life, 200 IU, 100 Softgels HerbsPro: Vitamin E, Country Life, 400 IU, 180 Softgels HerbsPro: Vitamin E, Country Life, Dry, 400 IU, 100 Tabs HerbsPro: Vitamin E, Country Life, 1000 IU, 120 Softgels HerbsPro: Vitamin E Complex, Country Life, 1000 IU, 120 Softgels HerbsPro: Natural Vitamin E, Healthy Origins, 1000 IU, 120 Softgels House of Nutrition: Vitamin E, BlueBonnet, 1000 IU, 250 Softgels TakeHerb: Natural Vitamin E Oil, Good'n Natural, 30000 IU, 2.5 oz. TakeHerb: Vitamin E, Good'n Natural, 1000 IU, 100 Softgels TakeHerb: Vitamin E, D-Alpha Tocopherol Acetate, NOW Foods, 600 IU, 100 Softgels TakeHerb: Natural Dry Vitamin E, Country Life, 400 IU, 100 Tabs TakeHerb: Vitamin E, Dry, 100% Natural, TwinLab, 400 IU, 100 Caps TakeHerb: Vitamin E, D-Alpha Tocopherol, Source Naturals, 400 IU, 250 Softgels TakeHerb: Vitamin E, Mixed Alpha Tocopherol, Solgar, 400 IU, 100 Softgels TakeHerb: Vitamin E, Natural With Mixed Tocopherols, Enzymatic Therapy, 400 IU, 100 Softgels TakeHerb: Vitamin E, D-Alpha Tocopherol, Source Naturals, 200 IU, 250 Softgels TakeHerb: Vitamin E, Mixed Tocopherols, Solgar, 200 IU, 250 Softgels TakeHerb: Vitamin E, Dry Alpha Tocopherol, Solgar, 200 IU, 100 VCaps TakeHerb: Vitamin E, D-Alpha Tocopherol Acetate, Natural, 21st Century, 200 IU, 110 Softgels TakeHerb: Vitamin E, Mixed Tocopherols, Solgar, 100 IU, 250 Softgels CALCIUM (500 mg - To Relieve Pain) Kalyx: Calcium With Vitamin D, TwinLab, 1000 mg / 400 IU, 120 Tabs Kalyx: Calcium Citrate Powder, Frontier Natural, 1 lb. Kalyx: Calcium Complex, Calcium & Magnesium, All One, 1000 mg / 500 mg, 8.5 oz. HerbsPro: Calcium Plus Liquid, French Vanilla, Buried Treasure Products, 16 fl. oz. HerbsPro: Calcium Plus Liquid, Blueberry, Buried Treasure Products, 16 fl. oz. HerbsPro: Calcium with Magnesium Chewable Wafers, Vanilla / Orange, Country Life, 1000 mg / 500 mg, 120 Wafers HerbsPro: Calcium Magnesium Complex Powder, All-One Nutri-Tech, 1000 mg / 500 mg, 8.5 oz. HerbsPro: Calcium Magnesium Liquid, Mint Flavor, Enzymatic Therapy, 16 oz. HerbsPro: Yummi Bears Vegetarian Calcium With Vitamin D, Hero Nutritional Products, 90 Bears HerbsPro: Calcium Soft Chews, Chocolate, Nutrition Now, 500 mg, 75 Chews HerbsPro: Calcium Soft Chews, Fruit Flavor, Nutrition Now, 500 mg, 75 Chews HerbsPro: Just An Ounce Liquid Calcium & Magnesium, Almond Flavor, Trimedica, 16 oz. HerbsPro: Calm Plus Calcium, Raspberry-Lemon, Peter Gillhams Natural Vitality, 8 oz. TakeHerb: Bone Strength Take Care, New Chapter, 120 Tabs TakeHerb: Liquid Coral Calcium Complex, Natural Calcium, Dynamic Health Labs, 32 fl. oz. TakeHerb: Osteo Rx, Bone Health & Density, Hi-Tech Pharmaceuticals, 120 Tabs TakeHerb: Calcium, Liquid Health, 32 fl. oz. TakeHerb: Calcium Citrate Chew, TwinLab, 1000 mg, 60 Wafers TakeHerb: Total Soy Calcium Shake, Vanilla, Naturade, 1000 mg, 17.3 oz. TakeHerb: Super Calcium-Magnesium With Vitamin D & Boron, Schiff, 1200 mg / 400 mg / 400 IU / 3 mg, 90 Softgels TakeHerb: Super Calcium With Vitamin D, Schiff, 1200 mg / 400 IU, 120 Softgels TakeHerb: Calcium Citrate With Magnesium, TwinLab, 300 mg / 150 mg, 250 Caps TakeHerb: Coral Calcium Complete Liquid, Buried Treasure, 32 fl. oz. TakeHerb: Coral Calcium Powder, Source Naturals, 8 oz.

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RELATED LINKS

MoonDragon's Pregnancy Information: Postpartum Care - Perineum

MoonDragon's Health Therapy: Sitz Bath Therapy

MoonDragon's ObGyn Womens Health Information: Hemorrhoids

MoonDragon's ObGyn Womens Health Information: Incontinence, Urge

MoonDragon's ObGyn Womens Health Information: Incontinence, Stress

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MEDICATION

You may use non-prescription drugs, such as acetaminophen or ibuprofen for minor pain.

Stool softener laxative (or lots of prune juice! A much safer and tastier remedy) to prevent constipation if needed.

Antibiotics, if required to fight infection.

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ACTIVITY

Follow your midwife's or health care provider's advice on resuming, or beginning, a postpartum exercise program.

Resume driving 10 days after the birth.

Resume sexual relations as directed by your midwife or health care provider or when a follow-up postpartum examination determines that healing is completed (usually 3 to 6 weeks).

SEXUAL ACTIVITY AFTER AN EPISIOTOMY

Your perineum should be completely healed around four to six weeks after delivery, so if your caregiver gives the okay and you are up to it, you can try having sex then. You might feel some initial tenderness and tightness.

Try having a glass of wine, taking a warm bath, and leaving plenty of time for foreplay. You might prefer to be on top so that you can control the degree of penetration, or you may find that lying on your side is most comfortable.

Relaxing as much as possible and using a good water-soluble lubricant will help make sex more comfortable. This may be especially helpful if you're breastfeeding, because lactation lowers your estrogen levels, which reduces the amount of lubrication your vagina can produce. Many women continue to use a lubricant during sex until they stop nursing.

MoonDragon's Pregnancy Information: Postpartum Care - Elimination

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DIET

Eating a high fiber diet will help prevent constipation which is common after childbirth. Increase your fluid intake as you increase your fiber intake.

MoonDragon's Pregnancy Information: Postpartum Care - Elimination

MoonDragon's ObGyn Womens Health Information: Constipation

MoonDragon's Nutrition Information: Fiber Diet

MoonDragon's Nutrition Information: Nutrition Index



NOTIFY YOUR MIDWIFE OR HEALTH CARE PROVIDER IF...

Pain, swelling, redness, drainage or bleeding increases in the surgical area.

You develop signs of infections: general ill feeling and fever, headache, muscle aches, dizziness.

You experience nausea, vomiting, constipation or abdominal swelling.

New, unexplained symptoms develop. Drugs used in treatment may produce side effects.

Pass uncontrolled urine through the vagina.

Pass gas (flatus) or stool from the vagina.

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MoonDragon's Pregnancy Information: Episiotomies - What You Should Know

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POSTPARTUM CARE INFORMATION

Postpartum Care: Index

Postpartum Care: Weight

Postpartum Care: Diet

Postpartum Care: Bowel Movements & Urination

Postpartum Care: Bathing

Postpartum Care: Breasts & Breastfeeding

Postpartum Care: Perineal Care

Postpartum Care: Vaginal Bleeding (Lochia) & Menstruation

Postpartum Care: Exercise & Back Care

Postpartum Care: Sexual Intercourse

Postpartum Care: Contraception

POSTPARTUM VISITS

PostPartum Visit: Day One

PostPartum Visit: Day Three

PostPartum Visit: Day Seven

PostPartum Visit: 4 to 6 Week Visit

POSTPARTUM CONCERNS

Baby Care & Concerns

Fatigue & Exhaustion

Postpartum Depression (The "Baby Blues")

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