Taylor Rackey, CPM Candidate 

Midwifery Practice Documents 

Revised April 23rd, 2020 
 
Care for the Perineum 
Even though very many birthing parents will have no broken tissue trauma, all will 
experience stretching and some bruising or swelling to some degree.  
 
Keeping the perineum dry: 
● Moist wounds heal best, so it is not necessary for the perineum to be kept 
as dry as possible at all times. 
● Pat the area dry with a towel, or use a hair dryer for a few minutes on the 
area avoiding direct contact with the skin 
 
Perineal Comfort Measures 
 
Heat and the postpartum period 
● Chinese medicine says that birth causes a rapid reduction of the body’s 
internal heat 
○ It is said that this is due to the Ming men (life gate fire) being opened 
by the birth. 
○ The Chinese believe the Ming men to be the basis of all strength. 
● This energy center is located between the kidneys, extends down the lower 
back and abdomen and from two fingerbreadths below the navel to the 
pubic bone. 
○ The kidney energy governs sexuality, reproduction, growth, and 
decline. 
● The Chinese feel that applying cold encourages this internal cold and may 
create long-term complications such as weakening of the back or kidneys. 
○ Therefore, ice should only be used in cases of extreme swelling or 
hematoma formation. 
○ Offer heat packs and heat-producing fluids, such as ginger tea and 
hot packs applied to the perineum to balance rapid heat loss.  
 
Herbal Sitz Bath  
● An herbal bath helps to soothe, heal, and cleanse the vaginal area. It also 
helps to dry the baby’s cord stump.  
○ Choose herbs (½ oz. each) that encourage healing and have 
anti-inflammatory properties  
■ Calendula 
■ Comfrey 
■ Lavender 
■ Marshmallow root 
■ Plantain leaf 
■ Sage leaf 
Taylor Rackey, CPM Candidate 
Midwifery Practice Documents 
Revised April 23rd, 2020 
 
■ Uva ursi 
■ Shepherd's purse 
■ Witch hazel bark 
○ Prepare the herbs as an infusion; steeping the ingredients (not 
boiled or simmered) for (6-8hrs).  
■ Fill a pot ¾ full with water, and boil. 
■ Remove the boiling water from heat, and then add ½ oz. of 
each herb.  
■ Cover the pot and let it steep, this makes a medicinal strength 
infusion for use. 
○ Fill the bath with water no hotter than 100° F if you plan to put the 
baby in the bath as well. 
○ Strain the infusion with a colander 
○ Add epsom salt directly to the bath at this time 
○ Add infusion to the bathtub, as wished and enjoy once or twice daily 
for the first few days postpartum 
 
Hot Packs 
● Hot, moist herbal packs that are placed directly against the perineum can 
help to stimulate circulation. 
○ This will carry away local anesthetic and swelling 
○ Promotes oxygenation and enhances healing 
 
Ice Packs 
● If swelling is extremely, ice application can help to aid the perineal area. 
● Ice therapy should not be applied for longer than 24hrs, except in the 
event of a hematoma that is enlarging. 
● Can be made be using a combination of witch hazel, aloe vera, and healing 
herbs that are placed on a postpartum pad and put in the freezer 
● Hot ginger tea and warm blankets can help to offset the chilling effect of 
ice 
 
Relief of Postpartum Pain 
● Afterease tincture - aids in postpartum uterine cramping 
○ https://www.wishgardenherbs.com/herbal-remedies/Afterease-After-
Birth-Pains-3 
● Internal and external homeopathic Arnica 
● Herbal relaxants and sedatives such as Skullcap, St. John’s Wort, and 
Valerian tincture; up to a half a dropper full before bedtime. 
● Both Ibuprofen (600-800mg every 6-8hrs) or Tylenol (500mg every 4hrs) are 
appropriate for postpartum pain 
Taylor Rackey, CPM Candidate 
Midwifery Practice Documents 
Revised April 23rd, 2020 
 
○ May take both; take 500mg of Tylenol ​and​ take 800mg Ibuprofen 
every 8hrs. 
 
Postpartum Nutrition 
● Continue to eat protein-filled, wholesome and nourishing foods 
○ Increase protein intake more than pregnancy 
● 500mg Vitamin C and bioflavonoids daily and Vitamin E (1,200 IU daily) can 
be taken to help slow the lochial (postpartum bleeding) discharge and 
encourage healing. 
● Zinc (15-25mg daily) can also be taken to promote healing 
○ Take after meals to avoid nausea 
● Magnesium to encourage regular bowels to prevent straining (Natural 
VItality CALM supplement) 
 
Postpartum pads and Underwear 
● Do not use tampons or menstrual cups during the immediate postpartum 
period (first 6wks) 
● The more air that reaches the perineal area, the better! 
● Change sanitary pads often; research the use of organic pads, or cloth 
pads 
 
Toileting 
● It is normal to go 24-36hrs without a bowel movement after birth 
● Continue to use a peri-bottle during urination to avoid burning  
● Pat dry, moving from from to back 
 
Catheterization 
● Those who had a catheter during labor or postpartum are prone to the 
development of a UTI 
○ Take 3,000mg Vitamin C with bioflavonoids daily 
○ Uva ursi lead or mullein infusion (1-2 cups daily for the first few days 
postpartum) can help decrease this risk 
 
Bedrest in the postpartum period 
● Many indigenous cultures consider postpartum bedrest to be an honored 
practice. Honoring this time allows the birthing parent to recover with 
undisturbed contact and be relieved of normal daily duties around the 
household. 
○ For approximately 6 weeks or 40 days, the birthing parent is cared 
for, so that they can care for their baby. 
Taylor Rackey, CPM Candidate 
Midwifery Practice Documents 
Revised April 23rd, 2020 
 
● In today’s culture, there is often a fast-paced hurry to recover in the 
postpartum period and get back to normal routines and tendencies. 
○ It is recommended to spend the first 2 weeks in bed, only getting up 
to use the restroom or shower/bathe and eat meals. 
○ The next 2 weeks should be spent “near the bed,” and the final 2 
weeks are spent “around the bed.” 
Hemorrhoids 
● Ensure adequate hydration and nutrition as previously mentioned, in 
addition to use of a magnesium supplement (Natural Vitality - CALM) 
● Witch hazel, or Tucks Pads can help to alleviate discomfort and size with 
astringent properties 
● External hemorrhoids can be gently placed back inside the anus with a bit 
of water-based lube or Vitamin E oil and a gloved finger 
 
Unsutured Tears 
● In addition to all the previous suggestions, it is best to keep the legs 
together and minimize contact with abrasive clothing for at least 2 weeks 
postpartum. 
○ This includes no sitting with legs apart, no pants, no underwear, 
sanitary pads, going up/down stairs, swinging legs over beds or 
in/out of cars. 
 
Resuming Sexual Activity  
● Even when no tearing or laceration has occurred, the perineum and 
surrounding tissues need adequate time to heal and return to their 
nonpregnant state, but it will never be the same. 
○ The structure of the vagina may have had a “landscape change,” but 
will still function with the same integrity as before. 
● If you are breast/chestfeeding your baby, it means that someone wants 
you touching and feeding them a significant amount of the time. For many 
individuals, it may be overwhelming for their partner to want something 
else from them as well. 
● Hormonal changes and the lack of sleep may also influence sexual desire, 
or lack of. 
● It is important to communicate feelings with your partner, and have the 
desire to resume sexual intimacy. 
● Remember, breast/chest feeding and hormones cause extreme dryness of 
all other mucus membranes --- a water-based lube will be your best friend. 
● Get creative! Not all intimacy requires penetration of the vagina. 
● It is best to wait until all bleeding has subsided, and there is no discomfort 
or pain in the vagina. Typically this may be around 6 weeks postpartum.