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Ronnie Falcao, LM MS, a homebirth midwife in Mountain View, CA
Campaign for the passage of California AB1306
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Special page for California physicians and birth practitioners to join in support
Cream™ - Natural soothing cream for the perineum – for use before and
Also as a result of its anti-inflammatory effect, bromelain has been
found to dramatically reduce postoperative swelling in controlled human
research. Double blind research has found bromelain effective in reducing
swelling, bruising, and pain for women having minor surgery after giving
birth (episiotomy). [from MotherNature.com's
For the severe tearing, I have a tea bag sort of thing that has powdered
comfrey and plantain in it. My clients really like it for their soreness.
I can't say as it works for severe tearing but why not test it. Also I
have a recipe for something called People paste, or (Goose Poops). These
can be put just inside where the most soreness is felt and left to do their
job. Not all day or anything but for an hour or so. Then it can be changed.
This is a real good paste for anything, scrapes, bruises etc. Inside and
out. There are only 3 ingredients, equal parts of all 3 powdered, slippery
elm, golden seal and myrrh. This is the base and now for vaginal tears
you can add comfrey and plantain if wanted. Now you can add clover powder
if strong pain relief is needed. You can mix these herbs with honey, molasses,
aloe vera, water, etc. You want the mixture a little on the med. dry side
so it will stay in a form. Make a big tear drop shape. These can be inserted
just slightly or as much as the lady feels comfortable with. At least it
should be in contact with the damaged tissues. I forgot all about these
as I have only been using them for the past 6 months and haven't had to
use them enough to have it right on the top of my head. I have been using
the tea bag things for a few years and I have had ladies ask for more.
Regarding the "tea bag sort of thing": I have found that unbleached
coffee filters work really well for this. You can put the herbs in it and
staple or glue it together. I make them up in bulk and carry them in my
postpartum visit bag.
Do you mean unbleached paper coffee filters? Do you make a tea or infusion
then, or put these directly on the perineum?
I do both! I pour boiling water over the (single cup size paper) coffee
filter in a small bowl. Let it steep for 10 min. or so and then, after
checking for temp, apply it directly on the perineum. I put the leftover
tea water from the bowl in the mom's peri bottle. I do this at the first
day visit usually and then leave a few for the mom to use if they want
to (and have time). Mom's usually love it!
You can use the unbleached coffee filters if you want. You do like you are going to make a tea, hot water etc. Put the bag in the hot water just long enough till you see the herbs leak into the water. Then press out the excess water not to much though and carefully separate the labia and set bag on sore tissues or perineum. Leave on till cold dip very fast in to the hot water and turn over the bag and use the other side do the same to the tissues. Can be repeated with same tea bag 3 times on each side.
Can't remember someone else said about stapling and carrying in post
partum bag. the only thing about the staples they might rust and/or poke
tender tissues. If they rust that wouldn't be very hygienic. Mine are sealed
or fused together. I have someone make them. Hope this is clearer.
You can sew these up, too. By hand or by machine. That way you wont
have metal staples or chemicals from glue on the perineum. I use cheesecloth
fabric to make these, but coffee filters would sure be easier.
Yes, you can boil the fresh leaves and use them for compresses - however,
the large old leaves will have those little spines on the back. Rub the
leaves a lot to break the spines or wrap them in paper towels, or something
similar to keep the spines from causing further irritation.
Here's something I have each of my clients make up at about 37 weeks for sore bottoms (whether they tear or not).
First make up a strong pot of comfrey tea. Bring aprox. 2 quarts of water to a boil, remove from heat then throw in clean fresh comfrey leafs. (about 8-10 large leaves or if not available, about 1/2 to 1 ounce of dried leaves). Let steep overnight or at least 4 or 5 hours.
Then take 4 to 6 large sized sanitary napkins (not the super absorbent b/c they usually contain chemicals - though all store-bought ones probably have dioxins) and cut them in half so you have 8-12 shorter ones. Cover a shallow baking pan or cookie sheet w/sides with foil and lay the pads out. Pour the tea over each pad, soaking well, then put them in the freezer. After they are frozen cover each with plastic wrap (so they don't stick together) and stack them in a container (or not) and keep frozen till birth.
After the birth remove the plastic wrap and cover a pad with a clean sterile wash cloth or several layers of sterile gauze. This feels great on the perineum, aids swelling and the comfrey (which contains allantoin) aids healing. This can go on right away and again after stitches. They can be worn for the next few days. Your regular sanitary pad helps hold it in place, of course change it after about 45 mins to an hour as it gets soggy.
Favorite bath or sitz bath herbs are comfrey (you can get fresh during
summer), uva ursi (helps prevent infection), and rosemary (also fresh if
you can, smells great too).
I usually order the herb baths from Cascade; however, I found this "formula" in a magazine or journal. Forgot to write down source so I don't know where I read it. Anyway, here it is:
Most of the birth supply houses or birth herbal suppliers carry some kind of sitz herbs or perineal healing salves. mamasoaks.com specializes in organic herbal baths to reduce soreness and swelling of the perineum.
The herbs I use for perineal compresses are the same herbs I use for
the herbal bath. We start the tea for the bath while mom is in labor and
then use some for the birth and the rest for the bath. They include comfrey,
rosemary, shepherd's purse, uva ursi, garlic and salt.
Grated ginger steeped in the crockpot water is to increase blood circulation
to the area the compress is applied to, thereby aiding in stretching. If
we don't get around to using the crockpot water, we might drink it for
"perking up" (but not the mom as it can increase bleeding).
We have the parents grate about 1/2 cup, put it in a clean piece of
stocking and freeze. When labor starts, put frozen gingerroot in crock
pot or sauce pan.
The best recovery I've had of my own stitches are the times I used a
fresh comfrey tea as wash. I'd just keep a squirt bottle of lukewarm comfrey
tea in the bathroom and my healing time was drastically reduced. I've also
offered this suggestion to others and they have reported good results.
Salt on a wound? On a mucous membrane?
yes! I'm surprised you've never heard of this. Soaking wounds in salt water is the oldest medical treatment in history and still one of the most effective and most commonly used around the world.
salt is mildly antiseptic. Salt water promotes healing. Salt water is
actually soothing to open-tissues. You want the salt solution to
be about equal to "the salty taste of blood" -- about a teaspoon tablespoon
from Gloria Lemay in "Tricks of the Trade" Midwifery Today, Spring, 2009
Putting cold packs on the perineum is something we learned in Western medicine that should now be discarded in practice. Chinese medicine says "never put cold against a new mother or baby" and I have had great success with putting heat on bruised, scraped or torn perineums right after birth. Even thought the tissues feel "hot" after birth, hot compresses give instant relief.
Also, discomfort and swollen tissues can be caused by wearing commercial pads with "extra absorbency" chemicals. After three or four days, the postpartum woman is well advised to stop wearing store-bought pads and switch to cotton reusable pads, cloth diapers or folded face cloths for the remaining days of lochia.
[Ed. Women birthing in warm birthing tubs have the benefit of warmth
on the perineum both before and after birth. The warmth before the
birth is like a huge hot compress, which seems to help the tissues stretch
nicely. The water pressure reduces swelling during labor and birth,
and the warmth after the birth seems to feel very comfortable.]
My experience has always been that if there is edema in the tissues,
the cold will help the fluid redistribute back into the general circulation
over the first 24 hours. Then during the second 48 hours, the warmth will
bring healing fluids to the area and promote the further repair.
The only exception to this is if the woman has varicosities in the vulva
and vaginal area, and then we use cold packs during pushing (instead of
warm compresses) and for the following 48 hours and not warm sitz baths,
to keep the fluid from accumulating in the vulvar tissues and causing further
I have heard that warmth is best for healing as it brings blood
to the area, and I know that in many; traditional cultures post partum
women are not allowed anything cold at all and are kept in very warm rooms.
I prefer heat and strongly recommend it.
I offer moms their choice of heat or cold, and often let them try warmth first. I've never yet had a woman who decided she preferred cold after she'd tried warmth.
I think there is more pain relief, less swelling and faster reduction
of swelling, and faster healing of any tears.
For the moms who birth in the birthing tub and stay in it for about
10-20 minutes afterwards, there is very little perineal swelling, and they
often don't want any cold.
What do you use for a hot pack postpartum? A hot water bottle?
Usually the same hotpacks which we've been using during crowning. (well, same water anyway. They need to be clean!)
Sometimes we put ginger and comfrey in the water and that's even better than plain water.
It's really easy to do --- any cloth, washcloth, diaper -- will work for a hot compress.
Someone said that women go "Ahhhh, that feels good" when they get an
icepack, but I'll bet if you try a warmpack you'll hear the same thing!
Maybe a longer "Ahhhhhhhhhh".
I think that the warmth actually "prevents" swelling, not just reduces
it. I've been pretty impressed with it anyway.
Start her on stool softeners right away, and then encourage LOTS and
LOTS of fibrous fruit juices, water and more stool softeners. I also
like vitamin C as a mild laxative and its immune-supportive effect.
Remind her not to "push" when moving her bowels, and avoid iron supplements
that could be constipating.
Make sure she has a Fleets enema in case she needs one for a painful
I tell moms with a repair to take a pad of toilet paper and hold it
over the repair - counterpressure. It makes them less fearful that
they are pushing hard enough to rip out the sutures.
"Raw honey is a great remedy for first-degree [perineal] tears. Honey's
thick consistency forms a barrier defending the wound from outside infections.
The moistness allows skin cells to grow without creating a scar, even if
a scab has already formed. Meanwhile, the sugars extract dirt and moisture
from the wound, which helps prevent bacteria from growing, while the acidity
of honey also slows or prevents the growth of many bacteria. An enzyme
that bees add to honey reacts with the wound's fluids and breaks down into
hydrogen peroxide, a disinfectant. Honey also acts as an anti-inflammatory
and pain killer and prevents bandages from sticking to wounds. Laboratory
studies have shown that honey has significant antibacterial qualities.
Significant clinical observations have demonstrated the effectiveness of
honey as a wound healing agent. Glucose converted into hyaluronic acid
at the wound surface forms an extracellular matrix that encourages wound
healing. Honey is also considered antimicrobial." [Excerpted from "Herbs
for Postpartum Perineum Care: Part I,"The Birthkit, Issue 46]
TEA TREE OIL...essential oil antifungal, antibiotic, antiviral promotes healing of tissue, reduces risk of infection bonus...relieves itching!
absolutely fantastic results with vaginal yeast, pimples, sores, bug bites, itching sites of any kind...applied neat in all but mucous membrane and large wound applications (have, out of desperation, personally applied neat vaginally/orally on myself :-}). When used on abraded vaginal tissue can cause a stinging/tingling sensation that myself and others report as fleetingly strong but welcome. The spray formula below brings cooling relief immediately in even strong candida overgrowth vaginally...just made up a new batch last evening to treat vaginal candida overgrowth of my own.
formula: 3 drops of tea tree oil (essential oil only!), 1 cup DISTILLED water, put in mister bottle and spray away
DISCLAIMER: have not yet had the need to use this with nursing newborns
or cracked nipples...adapt to your situation as you see reasonable. (maybe
try cutting TT to 1 drop per cup water and use on breasts between nursing??).....keep
us posted, please
I've been reading the "honey" mail and thought I'd add my two cents
worth. I've worked in hospitals and nursing homes over the past 23 years
and have seen the sugar and or honey use for sores, bedsores (decubitus
ulcers) over the years. Just thought I'd tell the theory behind it's use.
The sugar supposedly feed the bacteria which caused the destruction of
the dead tissue and exposed "healthy" fresh tissue. The betadine was used
to kill off the unwanted more harmful bacteria or "germs". I saw this used
until about 1987 or so and saw some dramatic wounds get better. Don't know
if it was the sugar or not. I wouldn't use this with diabetic persons because
there glucose blood levels are already potentially high sugar levels.
This honey thing sounds great, because I know that honey has some great
antibacterial properties. BUT in my wound care seminar this week, we were
discussing the fact that diabetics take a long time to heal. One reason
given for that was the high blood sugar that diabetics have.
Hmmm.. but isn't it more a matter of the diabetic not being able to
USE that sugar (since they lack insulin, or the insulin they have is no
Impaired circulation is certainly a large part of the problem with diabetic
healing. But an important thing to remember about bacterial growth and
sugar (think back, way back, to high school biology experiments
with molasses and water...) is that bacteria and fungus feed on sugar,
but can only thrive within a relatively narrow range of sugar- to-substrate
concentration. In other words, very low concentrations of sugar provide
insufficient nutrition and very high concentrations of sugar inhibit growth
of bacteria. They like their sugar levels juuust right.
I was surprised to find that honey doesn't stick to the pad the way
you'd expect it to. It stays moist and soft and almost a bit slippery,
forming a layer on top of the skin.
See also: Vulvodynia / Vulvar
Vestibulitis / Pelvic Pain
I had a severe dermatitis vulvar/vestibular dermatitis after giving birth to my first child in 1974. We determined that part of the problem was an allergic reaction to 1) the betadine used for every vaginal exam in labor (my labia actually swelled shut at one point) and 2) the carrier for the topical anesthetic spray (I had previously had a similar reaction to Solarcaine spray used for sunburn!).
I do not recommend Dermoplast for that specific reason. Epifoam is actually more soothing, if one wants an allopathic remedy.
Also - what suture material did the doc use? I have seen some pretty nasty allergic reactions to both chromic and to vicryl....has she tried PO benadryl?
Estrogen cream may be helpful, too.
Some of my clients have found the OB pads to be very irritating, especially
the standard ones that might have been bleached with dioxin. Some
have found great relief by switching to NatraCare pads.
If you had an episiotomy, you can do gentle perineal massage about 10-14
days after the birth. This will help to prevent the formation of
Before resuming regular sexual activity, some women like to prepare
the vaginal tissues through gentle perineal massage: put the thumb inside
the vagina and put gentle pressure in the shape of a half moon from back
to front or front to back. Don't do anything that causes pain!
I'm wondering if any of you have had a problem similar to this.
What did you do? How long did it take you to heal? Are there
breastfeeding-safe foods or herbs that I can consume that would accelerate
the healing process? Other advice or support you can offer?
I had a similar problem I had "a small epis" .....( that is what
she said I needed after about 15 min of pushing.....but that is another
story ) anyway.... sex was uncomfortable right up until my son was 10 months
old, I thought this was all a normal part of birth. what
helped was astro glide. then one day it was like magic it stopped hurting,
I thought to my self wow it took ten months. personally I wouldn't
mess with injections unless sex was unbearable.
This happened to me when my baby was born. At the time, I could
not find anyone who had gone through what I was going through (even in
a new moms group) and I felt alone, like there was something wrong with
me. No other new moms I talked to about this had any idea what I
was talking about. It took a little over a year until it "didn't
hurt" anymore. I saw my OB who recommended steroid injections but
one of the problems with that would be injections "down there" (no thanks!),
and also, it just builds scar tissue faster and potentially more of it.
It "might" have helped heal faster but it would have been painful.
I cannot remember the medical definition of what I had but it was basically
a hypersensitivity to touch, etc... When the tissue at the site of
the cut/tear starts to heal the nerves in that tissue re-generate.
Well, sometimes the nerves don't heal together right and that is where
the sensitivity to pain/touch comes from. Some women that experience
this actually cannot wear underwear, pants, wash themselves, or even sit
down! It can last anywhere from a few months to a few years.
It is the same thing that happens to women that have had c-sections and
have scar tissue problems at the site of the incision. I saw two
doctors about this and my primary care physician actually knew more about
it than my OB did and was able to help me more and feel more comfortable
about it. He was great about it! :) After talking to someone
at the office I work at they recommended I go and see a pelvic floor physical
therapist. I actually went to see a specialized PT. She did
some work with me and within a couple of months or so I was "healed" to
the point of no more pain. It did take over a year to somewhat heal
and it took almost two years before I got a pap again. One thing
that honestly helps and what the therapist was telling me is to do perineal
massage and kegels. (Done at a certain frequency and pressure.)
Ironically, but those are two of the things that the PT had me doing daily.
If anyone you know has this or has had this let them know that they are
not alone and that there is a light at the end of the tunnel. It
will get better, with the right care/treatment and thinking.
I have a recommendation regarding slow-healing perineal tears.
Medical qigong therapy would probably help. I do a lot of work dealing
with neurological issues as chi emission activates neural transmission.
Medical qigong therapy is holistic so also can help to release emotions
held in the tissues. As the energetic bodywork is non-touch, with
the client fully clothed, it would be quite appropriate for this kind of
chronic health issue.
6 weeks is usually mentioned because that's when the postpartum checkup is usually scheduled. For women who've had episiotomy wounds or significant suturing of tears, it makes sense to make sure they're well healed before being subjected to the stress of intercourse.
A woman who wants to have this checked sooner than six weeks could schedule an appointment earlier. (Six weeks is chosen as the timing for the last normal postpartum checkup because the uterus has usually completed its return to a nonpregnant state by then. If you schedule your appointment earlier than six weeks, you might be advised to schedule another appointment to check the uterus.)
The cervical os is generally closed to infection by 3 weeks postpartum and has resumed its nonpregnant state by 4 weeks postpartum. For a woman with an intact perineum, her decision to resume intercourse after 4 weeks can be safely based on desire and comfort.
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