Editor’s note: This article first appeared in The Birthkit, Issue 46, Summer 2005.
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What Is Classified as Perineal Injury?
Episiotomies and tears during childbirth can leave behind sore areas and dyspareunia. In the US, 35 out of every 100 women who give birth have an episiotomy.(1) Perineal trauma in the form of tearing can include the following:
- First degree: involving fourchette, hymen, labia, skin, vaginal mucosa
- Second degree: involving pelvic floor, perineal muscle, vaginal muscle
- Third degree: involving anal sphincter, rectovaginal septum
- Fourth degree: complete disruption of internal and external anal sphincter and mucosa
First-degree tears will probably heal well without stitching. Practitioners often use seaweed, suture glues and suture tape instead.
Sitz baths, compresses and use of a peri bottle incorporating the herbs listed below are very effective for first-degree perineal tears and bruising.
Hydrotherapy utilizes external hot and cold applications of water to manipulate the quantity of blood flow through a given tissue. Adequate blood flow brings oxygen, nutrients and red and white blood cells to target tissues, so warm and cool sitz baths and peri bottle applications to the affected area will also be very beneficial.
Arnica (Arnica montana) used topically is a very effective remedy for bruising. I suggest using it in an infused oil blend. This can be used on perineal muscles and leg muscles if they are sore. Arnica in an infused oil form should not be used directly on the opening or any broken skin. It should not be taken internally unless in a homeopathic remedy.
Plantain (Plantago off.) has vulnerary, demulcent, anti-inflammatory, astringent and anti-microbial properties. Plantain can be incorporated into a sitz bath, compress, poultice or infused oil.
Calendula (Calendula off.) has anti-inflammatory, astringent, vulnerary and anti-microbial properties. This will assist with wound healing by softening the skin and reducing inflammation. Its healing power appears to be based in part on the presence of terpenes. A triterpene glycoside called calendulozide B exerts a marked sedative and anti-ulcerous action. Calendula can be applied in a sitz bath, infused oil and compress.
Lavender (Lavandula off.) is well known for its pain relieving properties and for keeping infection at bay. Lavender can be applied as a compress and sitz bath.
Chickweed (Stellaria media) has vulnerary, emollient actions. Chickweed is commonly used as an external remedy for cuts, wounds and, especially, itching and irritation. High in vitamin C and bioflavonoids, it assists in reducing scarring. Chickweed can be applied as a sitz bath, compress, poultice and infused oil.
Raw honey is a great remedy for first-degree 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.(2) Significant clinical observations have demonstrated the effectiveness of honey as a wound healing agent.(3) Glucose converted into hyaluronic acid at the wound surface forms an extracellular matrix that encourages wound healing; honey is also considered antimicrobial.
Aloe vera applied topically fresh from the plant has superior wound healing abilities. Allantoin, a substance in aloe vera, has been considered a cell proliferant, an epithelial stimulant and a chemical debrider. (The authors of some studies have claimed that aloe vera delays wound healing, but these results are debated.)(4) It has been shown that aloe vera increases collagen content and degree of collagen cross-linkage within the wound. Studies showed that collagen increased 93% with topical aloe vera treatment and 67% with oral treatment, compared to controls.(5) Because aloe vera has a high water content, allow the area to dry after application. If using a prepared aloe formula, the presence of preservatives may cause stinging.
How to Use the Herbs
Soak the perineal area in a basin of water with three cups of tea added to an additional six to 10 cups of clean water. Use cold water if there is inflammation or swelling. Once that has subsided, experiment with warmer water until you are comfortable. Some women find that very warm water helps promote blood flow to the area and offers relief, whereas others find the reverse to be true. For each cup of tea you will need one tablespoon dried herbs.
A plastic squirt bottle that can be used to irrigate and cleanse the perineal area can greatly reduce stinging if used during urination and, afterward, to clean the area. Dilute the tea by one half with clean water and fill the bottle. This can also be used to relieve discomfort by squeezing over the area.
A compress is made by soaking a piece of clean cloth (such as linen, cotton or gauze) in a decoction or infusion and applying it as hot as can be tolerated to the affected area. When the compress has cooled, it can be soaked again in the reheated liquid and reapplied until the condition has been relieved. Compresses can also be applied cold. For postpartum care the compress should be a cold or cool one.
A poultice is similar to a compress except that plant parts are used rather than liquid extraction. Crush fresh plant parts. Heat them in a pot over boiling water or mix them with a small amount of boiling water. Apply the pulp directly to the skin, as hot as can be tolerated, holding it in place with a gauze bandage. When using dried herb, first powder it and make a paste with one tablespoon of powdered herb and a little boiling water or hot organic cider vinegar. If the paste is likely to irritate the skin, apply it between two layers of cloth.
Infusions are made from the more fragile parts of the plant. Pour boiling water over the plant matter and allow it to infuse from 20 minutes to overnight. For infusions and decoctions, use one tablespoon dried herb or two tablespoons fresh herb per cup of water.
This is the method used to get the healing constituents from more tenacious plant material such as bark, root or nuts. Simmer the herb gently in water for 20 minutes. For pre-blended roots and leaves, decoction is the preferred method of preparation.
Infused Herbal Oil
To make herbal oil I suggest using the simplers method. The oil of choice is olive, but a high-quality sunflower or apricot kernel oil will do.
Fill a jar halfway with the selected herb. I suggest starting with a small jar. Make sure the herb and the jar are dry. If the herb is fresh, allow it to wilt in the sun or overnight to release excess water that can contribute to mold in the oil. If recycling old food jars, scrub and sterilize the jar. Scrubbing and running through a dishwasher will do the trick.
Add oil to a depth of 1–2 inches over the herb and infuse:
Sun infusion—Place the jar in the sun during the day for two weeks. Then strain the oil through cheesecloth. Repeat, for really potent oil. This is great for making colorful oils like rosehip, St. John’s wort, etc.
Crock pot infusion—Place oil and herb in jar as above and place in a crock pot three-quarters full of water. Simmer for four hours. Keep an eye on the water, so it does not boil out. After the four hours, strain and bottle in clean, dry jars. The same can be done with a roasting pan in the oven. You can also use a double boiler.
- Maternity Center Association. 2004. “How Can I Prevent Pelvic Floor Problems When Giving Birth?” Maternity Wise. http://maternitywise.org/mw/topics/pelvic-floor/index.html. Accessed Feb 25, 2005.
- Allen, K.L., et al. 2000. The Potential for Using Honey to Treat Wounds Infected with MRSA and VRE. Paper presented at FirstWorld Wound Healing Congress, 10–13 Sep, Melbourne, Australia. http://bio.waikato.ac.nz/pdfs/honeyresearch/potential.pdf. Accessed Feb 28, 2005.
- Efem, S. 1988. Clinical Observations on the Wound Healing Properties of Honey. British J Surg 75(7): 679–81.
- American Academy of Family Physicians. 1991 Dec. Effect of Aloe Vera Gel on Wound Healing—Tips from Other Journals.
www.findarticles.com/p/articles/mi_m3225/is_n6_v44/ai_11875223. Accessed Feb 28, 2005.
Schmidt, J.M., and J.S. Greenspoon. 1991 Jul. Aloe Vera Dermal Wound Gel Is Associated with a Delay in Wound Healing. Obst Gyn 78: 115.
Blanchard, Elizabeth Joy. Aloe Vera: Understanding Its Proposed Mechanism of Action and Clinical Importance. “Curtin University of Technology.” www.podiatry.curtin.edu.au/encyclopedia/aloe_vera/. Accessed Mar 2, 2005.
- Houdijk, A.R., et al. 1998. Randomised Trial of Glutamine-Enriched Enteral Nutrition on Infectious Morbidity in Patients with Multiple Trauma. Lancet 352(9130): 772–76.