From the Research
After vaginal delivery with repair of a tear, bleeding typically lasts about 4-6 weeks, though the heaviest bleeding occurs in the first 1-2 weeks. Initially, the discharge (lochia) is bright red and may contain small clots, gradually changing to pink or brown, and finally to yellowish-white before stopping completely. The amount of bleeding varies among women, but generally decreases over time. You should use heavy-duty sanitary pads rather than tampons during this time to reduce infection risk. Contact your healthcare provider if you experience heavy bleeding that soaks through a pad within an hour, pass large clots (bigger than a quarter), notice foul-smelling discharge, or develop fever, as these could indicate complications like infection or retained placental tissue. The bleeding occurs as your uterus heals and returns to its pre-pregnancy size, a process called involution. The repaired tear itself may cause some localized bleeding initially but typically heals within 1-2 weeks with proper care, including keeping the area clean and following your provider's specific wound care instructions.
Key Points to Consider
- The use of tranexamic acid (TXA) has been shown to reduce the incidence of postpartum hemorrhage (PPH) and is recommended by the World Health Organization as part of the standard comprehensive PPH treatment package 1, 2, 3.
- A study published in 2022 found that early administration of TXA (within 3 hours of postpartum hemorrhage diagnosis) is a cost-effective strategy for reducing maternal morbidity and mortality from PPH in the United States 3.
- Another study published in 2021 discussed the care for perineal tears in vaginal delivery, including the use of cold gel pad therapy and treatment with natural oil on perineal wounds to reduce perineal pain and promote wound healing 4.
- It is essential to follow your healthcare provider's instructions for wound care and to monitor for signs of complications, such as infection or retained placental tissue.
Recommendations for Care
- Use heavy-duty sanitary pads rather than tampons to reduce infection risk.
- Keep the perineal area clean and follow your provider's specific wound care instructions.
- Monitor for signs of complications, such as heavy bleeding, foul-smelling discharge, or fever.
- Consider the use of cold gel pad therapy or treatment with natural oil on perineal wounds to reduce perineal pain and promote wound healing, as discussed in the study published in 2021 4.