Finding a comfortable position with stitches is one of the less-talked-about parts of the first few weeks home.
If healing isn't progressing the way you expected, or you just want someone to talk it through with, it's worth checking in with your midwife rather than waiting for your six week check. Monique Maitland, a clinical midwife specialist and the voice behind The Middee Society, is a midwife we trust for grounded, judgement-free guidance on postpartum recovery.
According to Pregnancy, Birth and Baby, around 8 in 10 women who have a vaginal birth experience some degree of perineal tear. Stitches are common, and so is the question nobody quite prepares you for. How do you actually get comfortable enough to sleep. We've covered what sleep is actually like on the postnatal ward and in your first week home more broadly, this one is specifically about the stitches themselves.
What's Normal in the First Few Weeks
Perineal tears are graded first to fourth degree depending on depth. Pregnancy, Birth and Baby explains that most first and second degree tears are stitched in the birth room, while third and fourth degree tears need surgical repair. Soreness around the area for two to three weeks is considered normal, especially when walking or sitting. Skin stitches usually dissolve within about three weeks, and full healing can take six to eight weeks. Everyone heals at a slightly different pace, so having a tougher day after a good one isn't a sign anything has gone wrong, it's just how healing tends to go.
Easing Discomfort While You Heal
Alongside the day-to-day basics below, many women find a few simple comfort measures make the first week or two noticeably more manageable.
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A cold pack wrapped in a cloth and held against the area for short stretches can take the edge off soreness, particularly in the first day or two.
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If pain relief would help, your midwife, GP or pharmacist can talk you through what's appropriate while breastfeeding or otherwise, rather than guessing at what's safe to take.
Getting Comfortable at Night
Lying on your side where you can is the main recommendation from Pregnancy, Birth and Baby, along with resting as much as possible and avoiding positions or activities that put direct pressure on the area. Many women find that the hardest part isn't finding the position but holding it for a whole night without constantly readjusting.
This is where many mums find a Pregnancy Pillow helps in those early weeks too, not just during pregnancy. Having something solid along your back and between your knees means you're not relying on muscle tension to stay turned on your side, so you're less likely to half-roll onto the area in your sleep and wake up to find out the hard way.
During the Day
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Avoid constipation and straining where you can. Pregnancy, Birth and Baby recommends plenty of water and high-fibre food, and using a footstool or lifting your heels so your knees sit above your hips on the toilet.
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Lean forward slightly when passing urine. This keeps urine away from the tear, and drinking more water can dilute it and reduce stinging.
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Keep the area clean and dry. Shower daily and pat dry gently rather than rubbing.
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Our own guide on what to put in a postpartum care basket has a dedicated section on perineal care essentials, worth a look alongside this one.
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Change pads often, and start gentle pelvic floor exercises when you feel ready. Pregnancy, Birth and Baby says this can begin two to three days after birth.
If Your Tear Was More Significant
Third and fourth degree tears are a different recovery altogether. The Royal Women's Hospital advises lying down as much as possible in the first few days, aiming for an hour of rest each morning and afternoon through the first six weeks. An ice pack placed inside a pad for 20 to 30 minutes every few hours can help with swelling. Firm supportive underwear is also suggested. Follow-up with your hospital's perineal clinic matters here, even once you feel you've healed, since an ultrasound or physiotherapy review can pick up on things that aren't obvious day to day. It's worth asking at your discharge, or at your six week check, whether a perineal clinic review has actually been booked, since it's easy for this follow-up to get lost in the busyness of the first few weeks home.
When to Get It Checked
A postnatal check is usually scheduled around six weeks, but Pregnancy, Birth and Baby lists several reasons to contact your doctor or midwife sooner.
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A temperature, or an unusual smell or discharge from the area
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Swelling, redness or inflammation around the tear
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Pain that's still there after two to three weeks
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Trouble controlling your bowels or wind
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Painful sex, or a heavy, dragging feeling in the vagina
If you ever feel extremely unwell, or notice heavy or worsening bleeding, seek urgent care, call triple zero (000) or go to your nearest emergency department.
Frequently Asked Questions
What's the best sleeping position with stitches?
Side sleeping is the main recommendation, with support to help you hold the position without putting direct pressure on the area.
How long does soreness from stitches usually last?
Soreness for two to three weeks is considered normal, particularly when walking or sitting. Full healing can take six to eight weeks.
Is it normal to still be sore after three weeks?
For most people it settles within two to three weeks. If pain is still there after that, it's worth mentioning to your doctor or midwife rather than waiting for your six week check.
What can I do about discomfort on the toilet?
Avoiding constipation helps a lot. Drink plenty of water, eat high-fibre food, and use a footstool so your knees sit above your hips. Leaning forward slightly when passing urine can also reduce stinging.
When should I be worried about a perineal tear not healing properly?
Contact your doctor or midwife for a temperature, unusual smell or discharge, swelling or redness, pain lasting beyond two to three weeks, trouble controlling bowels or wind, or painful sex. Seek urgent care for heavy bleeding or feeling extremely unwell.
Can I use a cold pack to help with the pain?
Many women find a cold pack held against the area helpful in the first day or two. It isn't a substitute for checking in with your midwife or GP if pain is significant or getting worse.
The information in this article is general in nature and intended as comfort support only. It is not medical advice. Always consult your midwife, GP, or a qualified healthcare provider for guidance specific to your situation.
