How common is heavy bleeding after birth in perineal tear?

A perineal tear affects the skin or deeper tissue between the vagina and anus. Blood from the tear is usually seen around the vaginal opening and may continue when the uterus feels firm. The depth and position of the tear influence bleeding, soreness and the need for repair.

Bleeding after birth can also come from inside the uterus, including the placental attachment site. For that reason, heavy bleeding after birth does not by itself identify a perineal tear. A clinician needs to examine the tear, check the uterus and consider the whole pattern of symptoms.

Tell the midwife or doctor immediately if bleeding is heavy, pain is increasing, stitches feel very tight or the wound seems to open. The team may inspect the perineum, check whether the uterus is firm and repair the tear when needed. They can also provide advice on pain relief, hygiene and preventing constipation while the tissue heals.

Use only medicines and wound-care products recommended for you. Keep the area clean and dry according to the discharge instructions, and report worsening swelling, pus, fever or increasing tenderness because these can suggest infection or a wound problem.

Seek emergency help for rapidly increasing bleeding, faintness, severe weakness, a racing heartbeat, severe pain, breathing difficulty or collapse. Contact your maternity team urgently for bleeding that does not ease, a large or worsening swelling near the tear, inability to pass urine, fever or a wound that is separating.

Where is the bleeding coming from, and does the tear need repair? How should I care for the wound at home? Which changes in pain, swelling, discharge or bleeding mean I should return immediately?