Degrees of severity and healing times

• 1^st-degree tear: The least severe tears involve just skin and tissue in the perineum, and they may not even need stitches. If stitches are required, they can typically be done in the delivery room. Healing usually takes several weeks.
• 2^nd-degree tear: These tears involve both skin and muscle, and they may go deeper into the vagina. Stitches are likely required and can typically be done in the delivery room. Healing time is usually 3-4 weeks. 
• 3^rd-degree tear: These tears extend into the muscle known as your anal sphincter. Stitches are needed and may have to be done in an operating room. Healing time is usually 4-6 weeks, with antibiotics sometimes prescribed to prevent an infection. 
• 4^th-degree tear: These tears extend into your anal sphincter as well as the mucous membrane lining your rectum. Often, they have to be repaired in an operating room with stitches or more complex procedures. Healing time is usually 4-6 weeks or more, with antibiotics sometimes prescribed to prevent an infection.

What you can do to ease the pain

Some of the most common recommendations include:

• Applying chilled witch-hazel pads to the perineal area
• Using an ice pack or cold gel pack for 10-20 minutes at a time 
• Taking a nonprescription pain reliever like ibuprofen or acetaminophen
• Sitting on a pillow or padded ring to reduce discomfort while seated
• Trying a side-lying breastfeeding position to avoid putting pressure on the perineal area
• Soaking in a sitz bath once your provider has given the green-light for postpartum baths
• Taking a stool softener or laxative to prevent constipation, if recommended by your provider
• Using a numbing spray or cream to lessen the pain, if recommended by your provider
• Abstaining from sex until your provider confirms that you’re completely healed
• Avoiding the use of tampons and menstrual cups until you’re completely healed
• Filling a squeeze bottle with warm water to rinse your perineum while urinating
• Patting yourself dry after urinating or showering to avoid irritating the wound 
• Letting others do the heavy lifting until you’re completely healed

When to seek care immediately

Should your perineal pain get worse (instead of improving) or become disabling, it could indicate that you’ve developed an infection at the site of your perineal tear or episiotomy. Other signs of infection may include increased swelling, redness, pus/discharge, and fever. Contact your healthcare provider right away if you have any of these symptoms. 

Reviewed by the Ovia Health Clinical Team

Sources:

• “Postpartum Pain Management” American College of Obstetrics and Gynecology  ACOG. August 2022. https://www.acog.org/womens-health/faqs/postpartum-pain-management
• “What is postpartum perineal pain?” WebMD. WebMD. April 08, 2022. https://www.webmd.com/baby/what-is-postpartum-perineal-pain
• “Labor and delivery, postpartum care” Mayo Clinic. Mayo Clinic. October 26, 2023. https://www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/in-depth/vaginal-tears/art-20546855

You may experience some numbness, itchiness, or soreness around your incision site as you recover. This is a normal part of the healing process. You may also notice some inflammation around the wound, which should gradually disappear over time.

If you notice blood, discolored fluid, or pus, call your healthcare provider right away. Try to keep the area dry and clean to promote healing and comfort.

You may notice some clear fluid seeping out of the wound at first, but blood or pus (usually yellow or green) may be a sign of an infection or problem with the healing process. You may notice these symptoms within a few days of your surgery or several weeks after giving birth, so keep a watchful eye. If you notice anything abnormal, speak to your healthcare provider.

Afterpains are the strongest around days two and three postpartum, and may last for up to ten days. This pain could be mild, moderate, or severe– everyone is different. To help manage the pain, you can use a heating pad or take medication according to your healthcare provider’s instructions.

Your C-section incision may also be sore for the first few days or weeks, and it may swell a bit due to water retention. A tender uterus is very common after giving birth, but it could also be a symptom of postpartum endometritis, an infection in the uterus. Symptoms usually begin soon after birth and include lower abdominal pain, fever, bleeding, chills, and foul-smelling discharge. You’re at a much higher risk for postpartum endometritis if you had a C-section. Oral antibiotics can treat it within a few days, so if you notice odd symptoms or your pain is severe, talk to your doctor.

Afterpains are the strongest around days two and three postpartum, and may last for up to ten days. This pain could be mild, moderate, or severe– everyone is different. You may also have some soreness and pain around your vagina and episiotomy or perineal tears, if you had any.

To help manage the pain, use a heating pad or NSAIDs like ibuprofen or aspirin. If your pain is severe or you’re struggling to manage, it might be a good time to reach out to your healthcare provider.

Similar to your menstrual period, lochia begins as a dark or bright-red flow before tapering off to a brown or pinkish discharge, and then later becomes a white or cream color. The first several days after giving birth are usually the heaviest, and you might see some small clots.

During the postpartum period, nothing should be inserted into your vagina, so you will need to use pads or period underwear during this time. It is normal to have postpartum bleeding and discharge for several weeks after birth. It should taper off gradually until it is gone.

If you pass a clot the size of the palm of your hand or larger, or if you are bleeding heavily enough to fill a pad in an hour, you should call your provider or seek more urgent care.

• Age 35 or older
• Previous pregnancy or delivery problems
• Chronic conditions like high blood pressure

Signs of Postpartum Complications

Let’s review some of the signs and symptoms of postpartum complications. If you have any of these symptoms, contact your provider or seek emergency care immediately.

• Severe pain: Pain in your stomach or pelvic area that does not improve with medication can be a sign of complications such as infections or excessive bleeding.
• Heavy bleeding: Soaking through one or more pads in an hour, passing clots larger than the size of an egg, or passing tissue could be a sign of a postpartum hemorrhage.
• Signs of an infection, which may include:
  • A fever over 100.4°F
  • Chills
  • Foul-smelling vaginal discharge
  • Painful, red areas on the breasts (a sign of mastitis)
  • Drainage, redness and swelling, or C-section site pain
• Leg pain and swelling: Increased swelling, redness, and leg pain can signal deep vein thrombosis (DVT), which requires emergency care.
• Shortness of breath or chest pain could signal a pulmonary embolism (a blood clot in the lungs), which requires immediate emergency care.
• High blood pressure: A reading of 140/90 mm Hg or higher is considered high blood pressure and can signal postpartum preeclampsia.
• Persistent headaches: Intense, constant headaches and vision changes may also be caused by postpartum preeclampsia.

Prioritizing your postpartum care

Your postpartum recovery is a critical part of your overall health and wellbeing. Attending postpartum visits is a significant step in the healing process. New guidelines recommend seeing your OB/GYN within three weeks of giving birth. Contact your provider before your three-week checkup if you have any concerns or symptoms, especially if you had any problems during pregnancy or delivery. Getting help early can help prevent other health issues. Check out our article on the latest guidelines for postpartum care to learn more!

Share your postpartum recovery plan

Ask trusted family and friends to help watch for warning signs you might miss. Create a postpartum recovery plan and share it with people you trust so they can help if needed. Include as part of this plan an emergency plan that includes:

1. Key details about your pregnancy and birth
2. Your healthcare providers’ names and contact information
3. Dates of upcoming checkups
4. Nearest hospital and urgent care locations and contact details

Be your own advocate

You are your health’s first line of defense. Listen to your body and talk to your provider if something feels wrong or if you’re unsure about any symptoms. Being your own health advocate can help you stay on top of your postpartum care and ensure you heal and recover.

Reviewed by the Ovia Health Care Team

Sources:

• Signs and Symptoms of Urgent Maternal Warnings, Center for Disease Control, CDC, May 15, 2024 https://www.cdc.gov/hearher/maternal-warning-signs/index.html

Diastasis recti usually develops in the third trimester due to increased pressure on the abdominal wall but isn’t noticeable until after giving birth. For most people, this “ab gap” heals within eight weeks of delivery, but about 40% of those who develop diastasis recti still have it six months after childbirth. 

Risk factors for this common postpartum condition include being over 35, having multiple pregnancies (especially back-to-back), having multiple babies (twins, triplets, or more), having a large baby, being extremely petite, and delivering your baby vaginally.  

Signs and symptoms of diastasis recti

Because your abdomen is stretched during pregnancy, you may not notice the signs and symptoms of diastasis recti until the postpartum period. They can include:

• A visible bulge or “pooch” in your midsection
• A softness or jelly-like feeling around your belly button
• “Coning” or “doming” of the midsection when you contract your abs
• Difficulty lifting objects or performing everyday tasks
• Urine leakage when you sneeze, laugh, or cough
• Pain in your lower back, pelvis, or hips
• Abdominal weakness 
• Pain during sex
• Poor posture 
• Constipation

It’s important to note that diastasis recti isn’t painful in and of itself—meaning there is no pain at the site of your “ab gap”—but you may feel pain in other areas such as your lower back, pelvis, or hips due to the weakness in your core. It can also make intercourse painful as a side effect. 

With diastasis recti, there is a gap between the muscles, but connective tissue still covers the abdominal wall. A hernia is a similar condition that sometimes happens with or without diastasis recti. In the case of a hernia, there is a gap in the connective tissue as well, but a hole also develops. When this hole forms, abdominal organs, like your bowel or intestines, can push through that hole, causing a bulge. A hernia can be painful and can sometimes cause serious complications if not treated, so it’s important to have your healthcare team evaluate any belly bulge.

Getting diagnosed and treated

To diagnose diastasis recti, your healthcare provider may start by examining your abdomen with their hands. A gap in your muscles wider than two or three fingers is considered diastasis recti. From there, they may use an ultrasound, measuring tape, or caliper to get a more accurate measurement. 

Depending on the size and severity, your provider may prescribe exercises to perform at home and certain things to avoid doing to promote healing. They may also refer you to a physical therapist who can guide you in safely engaging the deep abdominal muscles with slow, controlled movements. 

What activities should be avoided? They include:

• Lifting anything heavier than your baby
• Crunches, sit-ups, planks, and push-ups
• Downward dog and other yoga poses
• Scissors, double leg lifts, and other Pilates moves
• Sitting straight up to get out of bed (instead, roll onto your side and push with your arms)
• Any activities or movements that push your abs outward

The good news is that when you avoid the things that make diastasis recti worse and do the recommended exercises that make it better, your prognosis for healing may be completely positive.  

Not sure what to do?

If you suspect you may have diastasis recti, make an appointment with your healthcare provider or plan to bring it up during an existing postpartum appointment. It’s one of the key factors your provider typically evaluates when deciding whether to clear you for exercise. 

Reviewed by the Ovia Health Clinical Team

Sources:

• Cleveland Clinic Staff. “Diastasis Recti.” Cleveland Clinic. February 08, 2022. https://my.clevelandclinic.org/health/diseases/22346-diastasis-recti
• National Library of Medicine, NCBI, Stat Pearls. “Diastasis Recti Rehabilitation.” Last updated August 8, 2023. https://www.ncbi.nlm.nih.gov/books/NBK573063/#:~:text=Introduction-,Diastasis%20recti%20is%20an%20increased%20distance%20between%20the%20rectus%20abdominis,distance%20between%20the%20rectus%20muscles.

This chronic pain condition can be caused by the awkward, repetitive hand positions involved in holding and caring for your newborn. It can make performing basic parenting tasks challenging, from bathing to feeding.  

Other symptoms and factors

De Quervain’s tendonitis is marked by inflammation in the tendon that runs down your forearm, through your wrist, and all the way to your thumb. As a result, it can also cause:

• Swelling or tenderness near the base of your thumb
• Pain that radiates out to your thumb or forearm
• Popping or snapping sounds when moving your thumb
• A stop-and-go sensation when moving your thumb
• Difficulty moving your thumb while grasping or pinching

In addition to parents of infants, this condition can occur in those who have jobs or hobbies involving repetitive hand/wrist/thumb movements, pregnant people (due to fluid retention), and those with inflammatory arthritis or a wrist or tendon injury. 

Getting diagnosed and treated

De Quervain’s tendonitis is typically confirmed with a simple evaluation. X-rays or other imaging tests aren’t generally needed to make a diagnosis. To start, your healthcare provider may check to see if you feel pain when pressure is applied to the thumb side of your wrist. 

Another way to diagnose it is called a Finkelstein test, in which you bend your thumb across your palm, bring your fingers down over your thumb, and then bend your wrist toward your little finger. If this causes pain on the thumb side of your wrist, you may have de Quervain’s tendonitis. 

Once diagnosed, treatment may involve a combination of home remedies, lifestyle changes, and medical interventions, such as:

• Taking non-prescription anti-inflammatory medications, such as ibuprofen or using anti-inflammatory gel (diclofenac)
•  Applying ice to reduce pain and swelling
• Wearing a brace or splint to help immobilize and rest your tendons
• Avoiding repetitive hand/wrist/thumb movements that cause pain and swelling
• Seeing a physical therapist or occupational therapist to learn exercises or modifications
• Getting corticosteroid injections directly into the tendon to decrease inflammation
• Pursuing outpatient surgery to release pressure on the tendon in more serious cases

Reviewed by the Ovia Health Clinical Team

Sources:

• Mayo Clinic Staff. “De Quervain tenosynovitis.” Mayo Clinic. August 4, 2022. https://www.mayoclinic.org/diseases-conditions/de-quervain-tenosynovitis/symptoms-causes/syc-20371332
• Hospital for Special Surgery Staff. “De Quervain’s Syndrome.” HSS. Accessed July 2024. https://www.hss.edu/condition-list_de-quervain-syndrome.asp

For more on lower back pain, see our full postpartum back pain article.

Pelvic girdle pain (PGP) in your hips

PGP is the most common type of hip pain that occurs during pregnancy. It can often be felt in the front and back of your pelvis, radiating to your hip or thigh. After you give birth, PGP may persist for a few months or, in some cases, even longer. 

Symptoms of PGP can also include:

• Constant tightness or pain in the pelvis
• Pain that worsens with exercise/activity
• Pain that is deep in your pubic area
• Pain that moves into your lower back
• A clicking sound in your hip joint (or feeling it catch)

Once PGP is diagnosed through various tests—such as a posterior pelvic pain provocation test, which can help distinguish it from lower back pain, your healthcare provider will help you explore a range of treatment options. They may include:

• Bed rest
• A pelvic brace
• Pain relief injections
• Physical therapy
• Occupational therapy
• Acupuncture
• Surgery (for severe cases)

Lower extremity nerve injuries 

An estimated 1% of births result in postpartum nerve damage in the lower body. In many cases, the culprit is a compression injury in the spine that occurs during delivery. Symptoms include lower extremity pain, weakness, numbness/tingling, and bowel/bladder dysfunction. 

Risk factors for sustaining nerve damage during childbirth include a prolonged second stage of labor, an assisted delivery involving forceps or other instruments, being short in height, and giving birth for the first time. On the other hand, frequent repositioning during the pushing phase may reduce the risk. 

Talk to your healthcare provider if you’re experiencing lower extremity pain and suspect you may have a nerve injury. Depending on the severity, your provider may refer you to a pelvic rehabilitation specialist or suggest other treatment options. 

When to seek care immediately

Another cause of postpartum pain in the leg—especially in the thigh, lower leg or calf—is a clotting condition known as deep vein thrombosis (DVT). Because this type of deep clot can travel to the lungs and become life-threatening, you should be seen right away if you have symptoms of DVT. 

See our full article on DVT to learn more about the symptoms, which, in addition to pain, can include swelling, redness, warmth, or tenderness in your leg. 

Reviewed by the Ovia Health Clinical Team

Sources:

Tanner H. Pelvic Rehab Report. “Postpartum Neuropathies of the Lower Extremity”. Accessed August 26, 2024. https://hermanwallace.com/blog/postpartum-neuropathies-of-the-lower-extremity.