A hematoma occurs when blood collects in the tissues that stretch and open while your baby is being born, creating a painful, sometimes large lump or swollen spot in the perineal area. Hematomas are usually caused by the pressure of pushing your baby out, or by an imperfect stitching job in which the two sides of the skin are not completely closed together. Though the bleeding below the skin or mucus membranes usually stops on its own, the pooled blood can be prone to infection and can also lead to a longer healing period for the perineal area, so a hematoma should be reported to your healthcare provider immediately.
Many midwives swear by homeopathic Arnica for treatment of postpartum bruising, tissue trauma, and soreness. Arnica comes in pellet, gel, and cream form and can be found in many drugstores and health-food stores. Don't use cream or gel on broken skin, and be sure to get the homeopathic version of the pills, which are considered safe for nursing mothers.
If a hematoma becomes infected, it can cause the edges of a tear or episiotomy repair to pull apart from one another, and they may not be able to re-adhere. If this happens, you may have to return to the hospital for repair, and there can be significant blood loss and pain.
The use of forceps during birth; rough handling of your uterus, vaginal area, or perineum during labor, birth, or postpartum; or a mismanaged repair job can all increase the risk of hematomas. Again, the rules seem to be that the more gently you are treated during labor and birth, the better your postpartum recovery will be.
Your midwife or doctor will prescribe antibiotics and may also advise alternating hot and cold soaks. The heat will stimulate circulation, while the cold can decrease swelling and relieve pain. Your care provider may also recommend a rinse of warm water with a bit of antiseptic after using the toilet, and you'll want to gently and thoroughly pat your perineal area dry or allow it to air dry after each trip to the bathroom.