A Doula Diary guide to understanding, healing, and trusting your incredible body

One of the most common fears people have as they prepare for birth is the idea of tearing. The thought can stir up anxiety, Will it hurt? Will I heal? Will I be the same again?

Let’s ease those fears together with knowledge, care, and trust. Your body was made for this. And yes, it can stretch, it can tear, and it can heal beautifully.

First, Let’s Talk About Tearing

During vaginal birth, the perineum (the area between the vaginal opening and anus) stretches significantly. Sometimes, despite this incredible elasticity, a tear may occur especially in first time births.

But here’s the truth:

Tearing is common, and in most cases, it heals well. The vaginal and perineal tissues are rich in blood supply, which supports rapid healing.

There are different degrees of tears:

      •     First- and second-degree tears involve the skin and muscle around the vaginal opening. These are the most common and heal well with or without suturing.

      •     Third- and fourth-degree tears are deeper, involving the anal sphincter or rectal tissue. These require medical attention and longer healing.

What About Episiotomies?

An episiotomy is a surgical cut made in the perineum to enlarge the vaginal opening, typically performed when the baby needs to be born quickly or if there are concerns about tearing in an unpredictable pattern.

However, routine use of episiotomy is no longer recommended, because:

      •     Episiotomies can extend into deeper, more complex tears, such as third- or fourth-degree tears.

      •     Studies show that natural tears often heal better than surgical cuts, as they follow the body’s natural tissue planes and are often less deep.

      •     There is no strong evidence that episiotomies prevent tearing or pelvic floor trauma in low-risk births.

Informed consent matters. If an episiotomy is suggested, you always have the right to ask:

      •     Why is it being recommended now?

      •     Are there alternatives?

      •     What are the risks and benefits?

Designed to Stretch and Heal

The vagina and perineum are designed to stretch during childbirth. Tearing is not a sign of failure, it’s part of the natural process for many. And in many cases, the body heals quickly and fully.

My Experience: Healing Without Sutures

When I gave birth, I chose to heal a second-degree tear without suturing and I’m so glad I did. I experienced no complications and found the healing process to be comfortable and empowering. It was something I appreciated as part of our birth story, not having suturing allowed me to rest and recover without that additional intervention.

That said, this option is not right for everyone and it’s not a one-size-fits-all decision.

When to Suture and When You Might Wait

Many second degree and above tears are sutured after birth. But there are cases where suturing can be delayed or even declined, depending on:

      •     The depth and alignment of the tear

      •     Bleeding

      •     Your preferences and energy levels after birth

If you’ve laboured in water, it’s sometimes better to wait as waterlogged tissues are harder to suture effectively, and allowing some time for them to dry can result in a better outcome.

However, delayed suturing must be followed up with your local maternity unit. Most trusts recommend suturing as soon as possible, ideally within 6 hours, before tissue swelling or misalignment occurs.

Suturing is necessary when:

      •     Bleeding does not stop

      •     The tear is deep or jagged

      •     Tissue edges will not align naturally

      •     There is risk of infection or poor healing

Healing Support: Homeopathy, Herbs & Sitz Baths

You can do so much to support your healing naturally:

Sitz Baths

Use warm water and gentle herbs to soak the perineum:

      •     Calendula – antimicrobial and soothing

      •     Chamomile – anti-inflammatory

      •     Witch hazel – astringent and toning

      •     Lavender – calming and healing

Soak for 10–15 minutes, once or twice daily (I loved my sitz bath as not only was it beneficial for my healing, it was soothing and allowed me to have some me time.

Homeopathy

      •     Arnica – bruising, trauma, swelling

      •     Calendula – wound healing, infection prevention

      •     Staphysagria – healing after surgical interventions or deep emotional sensitivity

Padsicles

Soak maternity pads in a blend of witch hazel, aloe vera, and lavender hydrosol, freeze, and use in the early days for soothing relief.

Food for Healing

Healing from tears (or episiotomy) requires proper nourishment. Your body is rebuilding skin, muscle, and connective tissue. Focus on warm, soft meals that are easy to digest and comforting to eat.

Rest and Recovery

Your perineum is healing, but so is your whole body and spirit. Make time to:

      •     Lie down often, this reduces pressure and swelling

      •     Accept help and nourishment from others

      •     Use breathwork and gentle movement once you feel ready

Final Words from Doula Diary

Tearing can feel scary but it’s a common and natural part of many births. Whether you tear or not, whether you choose sutures or not, you deserve to feel informed and respected in your choices.

And remember, you are not broken. You are healing. You are whole. And your body is incredibly wise.

Reference point:

      •     WHO, RCOG, and NICE guidelines recommend restrictive rather than routine episiotomy use

      •     A Cochrane review (Carroli & Mignini, 2009) found that restrictive use reduces severe perineal trauma

      •     Research in BJOG (2005) and BMC Pregnancy & Childbirth (2016) supports spontaneous tears having better long-term outcomes in many cases