Herbs for Postpartum Perineum Care: Part One
by Demetria Clark

[Editor's note: This article first appeared in The Birthkit Issue 46, Summer 2005. See this issue for more tear treatment and methods of preparation. See See Herbs for Postpartum Perineum Care: Part Two for second-degree tear treatment and methods of preparation.]

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


[Photo by Heather Long]


First-degree tears will probably heal well without stitching. Practitioners often utilize 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.


[Photo by Jennifer Rosenberg]


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.

Demetria Clark is the director of Heart of Herbs, an herbal and aromatherapy school founded in 1998 in Vermont. Visit her Web site: www.heartofherbs.com Additionally, she is a labor support professional in hospital, high risk (preterm, disabilities, etc) and homebirth settings. She has a BA in Human Services and is a midwifery student in the MSM program at Midwives College of Utah and a midwifery apprentice. She is often found penning articles on the use of herbs, parents' empowerment, aromatherapy and a lot more, in between loving and being with her two sons and husband.


  1. 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.
  2. 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.
  3. Efem, S. 1988. Clinical Observations on the Wound Healing Properties of Honey. British J Surg 75(7): 679–81.
  4. 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.
  5. 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.

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