When you’re pregnant, everyone has advice—what to eat, what not to eat, how to sit, how to breathe. There’s a lot of talk about preparing for birth. But what about what happens after? When your baby is finally here, your body feels stitched and sore, and suddenly, all that noise disappears. Whether it was a small graze or a deeper tear, happened naturally or was part of a medical emergency, nobody prepares you for an episiotomy or perineal tear healing.
In fact, many women don’t even know that sometimes vaginal delivery can also leave you with a surgical cut or tear. Research shows that up to 9 in 10 new moms who gave birth vaginally will experience some form of perineal trauma.
While most heal well, the process can feel slow, sore, and surprisingly emotional. So if you’re wondering: “Is this normal?”, “Why does it still hurt?” or “How do I know if something’s wrong?” You’re in the right place.
Let’s walk through the healing process together.
First, what exactly is the perineum, a perineal tear and an episiotomy?
The perineum is the area between your vaginal opening and anus. During childbirth, this area stretches a lot. Sometimes, it stretches enough for a comfortable childbirth. Other times, it tears, or your healthcare provider makes a small cut (called an episiotomy) to help the baby come out safely.
For most people, these are minor and heal without long-term issues. For others, they can go deeper and involve muscles or even the anal sphincter (a ring of muscle that controls bowel movements). Either way, they’re a common part of vaginal birth. But just because they’re common doesn’t mean they’re easy to recover from. They deserve attention, care and time, just like any other injury.
But wait…doesn’t stitches from a tear or cut mean I had a C-section?
This is one of the most common confusions. But no, perineal tears and episiotomies are not the same as a C-section. C-sections involve a surgical cut in the abdomen and uterus to deliver the baby. The pain and recovery are focused on the lower belly area.
Perineal tears and episiotomies, on the other hand, happen during vaginal delivery and affect the skin, tissue, and muscle around your vaginal opening and perineum.
What does an episiotomy or perineal tear healing look like?
The healing time and the kind of care you’ll need really depend on how much the area was stretched or torn during birth. Here’s a breakdown of what you can expect, based on the type of tear.
First-Degree Tear: A Small Surface Wound
A first-degree tear is the most minor type of perineal trauma. It involves just the surface of the skin around the vaginal opening, without affecting the deeper muscles. You may not even need stitches for this kind of tear, but that doesn’t mean you won’t feel it. The area can still feel sore, raw, or stingy, especially when you pee. Some people describe it as a sunburn-like sensation, particularly in the first week after birth.
The good news is that these tears usually heal quite quickly. Within a week or two, you might start to notice the pain easing. By week three, many people feel almost completely back to normal.
However, if the soreness increases, if there’s a bad smell, or if you see swelling that doesn’t settle, it’s a good idea to check in with your doctor, just to be safe.
Second-Degree Tear: When the Muscle is Involved
Second-degree tears are deeper. They affect not just the skin, but the underlying muscles of the perineum (the ones that support your pelvic floor and vaginal tissues). These tears almost always need stitches, which are usually done soon after delivery with local anaesthesia.
In the first few days, it’s common to feel a heavy ache, a sharp sting while peeing, and a general feeling of bruising or swelling in the area. Sitting can be uncomfortable, and many new moms find themselves shifting positions constantly to try to relieve the pressure.
By the end of the second or third week, the stitches begin to dissolve, and a tight, itchy feeling might replace the initial pain, which is usually a sign that things are healing. Lochia (post-birth bleeding) adds to the mix. We recommend new mums rely on soft yet absorbent maternity pads, like Nua’s Maternity Pads, for some comfort through it all.
If you start to feel worsening pain, increased bleeding or see pus-like discharge, it could mean something needs medical attention. A warm, throbbing feeling or extreme trouble going to the bathroom even after the initial 3 weeks, are also signs to check in with your doctor.
Third-Degree Tear: Deeper Tear Involving the Anal Sphincter
A third-degree tear is more serious. This type of tear extends from the vaginal tissue through the perineal muscle and into the anal sphincter. It’s not very common. As per studies, only around 7% of women have a third-degree tear. It usually happens in assisted births with forceps or in cases where the baby is larger than average.
These tears are always repaired in the hospital, often in an operating room, soon after birth. The recovery takes longer and needs a bit more care. In the first few weeks, you might feel sore near your anus, have trouble sitting for long, or feel nervous about going to the bathroom. Some people also notice they can’t hold in gas as easily or feel a sudden urge to poop.
Over time, things usually improve. But if you continue to have trouble with bowel control even after 6-8 weeks, your doctor might recommend pelvic floor physiotherapy (exercises that strengthen the muscles around your vagina, bladder, and rectum).
If you feel increasing pain near your rectum, lose full control over your bowel movements, or feel like something’s bulging or pulling down there, don’t wait and speak to your doctor. The same goes if you notice a bad smell, fever, or swelling near your stitches.
Fourth-Degree Tear: The Deepest Kind
Fourth-degree tears are the most severe form of perineal trauma. As per research, they’re seen in less than 1% of cases. They go through the vaginal tissues, the perineal muscles, both layers of the anal sphincter, and into the rectal lining. These happen in complicated births or when intervention is needed quickly. Like third-degree tears, they’re repaired surgically and require careful aftercare.
You may feel ongoing soreness, difficulty with bowel control or a pulling sensation near the scar for several weeks or even months. Many people feel grief, confusion, or even shock after experiencing such a tear. That’s completely normal. This is a big deal and it’s okay to say that out loud.
If anything feels off, if pain persists, if you feel pressure in your pelvic floor or if you struggle emotionally, please reach out for support. You deserve it. And most importantly, go at your own pace. You don’t owe anyone, not even yourself, a deadline to heal (more on that here).
Episiotomy: A Surgical Cut Made During Birth
Unlike a tear that happens on its own during birth, an episiotomy is a small cut made intentionally by your doctor in the perineum to help the baby come out safely. It’s usually done in situations where things are moving fast or if the baby needs help getting out quickly, like when their heart rate suddenly drops. The idea is to control the direction of the cut, rather than risk an uneven tear.
But even though it’s done for a good reason, the healing can catch you off guard. In the first few days, the area can feel sore, tight, and bruised. Sitting might make you wince, walking can feel like a shuffle, and going to the toilet? Let’s just say you’ll probably take a deep breath first. This is all normal. The stitches used to close the cut usually dissolve on their own by 4 to 6 weeks, but the tenderness might stick around a little longer.
And if you’re breastfeeding, vaginal dryness might add to the discomfort. You might not feel ready for sex for a while, and that’s completely normal. However, if you notice that the skin around the stitches feels hard, shiny or overly stretched, or if there’s yellowish discharge, persistent bleeding or a sudden increase in pain when moving, it’s best to get checked.
You’re Healing More Than Just a Wound
Emotionally, some people begin to reflect on their birth experience more deeply during this phase as the newborn chaos starts to settle. As per research, this is especially true if you were unprepared for emergency interventions like an episiotomy.
If you find yourself feeling low, disconnected, or having flashbacks, it might be birth trauma or even postnatal PTSD. But please know you’re not alone. There’s a lot of support out there for new mums like you. Just ask your doctor and they’ll connect you to the right counsellor.
The truth is that healing from a perineal tear or episiotomy isn’t just about closing a cut. It’s about restoring trust in your body. It’s about recovering not just as a mother, but as a person, and you deserve every ounce of care along the way.
