Right off the bat:
---Alternate warm with cold. Although the cold packs will reduce swelling you also want to encourage circulation, which is what a warm pack does. Start out with cold packs, but after the first hour or two (12 hours max) start alternating a warm chem pack, heated rice sock, or warm cloth with the cold pack.
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--for the cold/warm therapy, make an herbal tea (see sitz bath ideas below). Soak clean wash cloths or fabric menstrual pads in the herbal blend then freeze or place in a crock pot (depending on whether you want cold or hot). Use these instead of the "glove full of crushed ice" the hospital offers.
---Rock Rose and Star of Bethlehem are Bach Flower Remedies that address shock, trauma, and birth injury. Rescue Remedy is great for any birth, but start taking Star of Bethlehem and Rock Rose as soon as possible... even during suturing!
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--homeopathic arnica, 200c, taken orally every 15 minutes on the first day, then 3-4x a day. Again, safe to start during suturing.
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After the first few hours:
---sitz baths! At least twice a day for 15 minutes (though I found that a sitz bath before/after every bathroom visit was very helpful during the first weeks... and I even nursed while sitting on the toilet topper sitz bath). An herbal blend can be purchased or make your own. For example, epsom salt, sea salt, lavender, calendula, rosemary, comfrey, uva ursi, garlic, shepherd's purse, or ginger in any combo can be added to the hot water. One recipe (if you want a recipe) is:
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2 oz Comfrey  (there is some safety concern about Comfrey on injured skin, it can cause liver toxicity so while it has a good track record for tissue healing you may want to substitute a different herb. Personally I used chamomile instead of comfrey and left out the garlic LOL.)
1/2 cup sea salt
2 or 3 bulbs garlic
Put the herbs into an 8-qt pot filling with water 1/2 to 2/3 up the side. Bring to a boil, immediately reduce to simmer and set timer for 20 minutes. In meantime break garlic bulbs into cloves and peel. When timer dings, pour *tea* into another pot covered by strainer or colander. While drawing bath mash garlic (bottom of cast iron pan works great) and add sea salt and mashed garlic to tea.
---use some of the sitz bath "tea" in a peri bottle for bathroom visits
---"Sun you Bum": Use the sitz bath for 10-15 minutes. Then smear the healing tissue with topical aloe vera gel. Lay down on the bed so that your nekkid bum is sticking up, hopefully in a sun beam. Wait 5-10 minutes then get dressed or take another sitz bath.
---keep your legs together! Don't do things where the tissue is "pulled" against for a few weeks. Be careful getting into and out of cars, or walking up and down stairs, to make sure your legs stay together. When picking up your child make sure you don't squat! You'll only do it once (and then you'll NEVER forget to avoid squatting), but it can cause damage to the healing tissue as well as being darned uncomfortable so try to avoid that once.
---some mamas like those donut pillows, but a pillow or cushion made from memory foam may be better. Donut pillows allow the healing tissue to "sag" while the memory foam provides some support. If you do choose a donut pillow, try not to use it for more than a few weeks before moving to a more supportive pillow.
---along with topical aloe vera gel (look in a natural food store for the kind sold as a beverage, it's usually purer than the other brands) applied 1-2x a day to the healing tissue, try patting the healing tissue with honey (a little honey, dabbed on, then "tapped" so that the skin pulls a little with your finger tips) or smooshing on some plain (no added sugar) yogurt. You can leave them in place or rinse them off (rinse off or rinse in a sitz bath).
---Kegel! Kegel kegel kegel.
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In general:
---Add more protien to your diet. It takes protien to build new tissue and you're building tissue on top of dealing with a new baby, possibly older kiddos, the rest of the world, etc. So try eating whole foods, in season, with a bit more protien than you'd normally have.
---Take a prenatal multivitamin (with iron, you're building tissue after all and probably have some blood loss due to the tear). Add flax or cod liver oil. Take a probiotic or eat live culture yogurt (plain, without sugar).
---Belly Dance! It sounds odd, but the gentle stretching and increased blood flow to the pelvic area that comes from belly dance is a good healer. In addition, some people feel that genital trauma or birth injury can cause the body to "shut down" the pelvic area. Basically the body responds to the pain by isolating the area, but re-integration of the pelvic area isn't automatic. You need to encourage the body to re-integrate. Belly dance and gentle yoga (svaroopa or kundalini) that encourage focus and awareness of the pelvic muscles while stretching/enhancing blood flow encourages the body to heal on more than just the physical level.Â
---Tapping, kundalini yoga, chiropractic, acupuncture/acupressure or other energy work. Many traditions believe that there are "energy lines" in the human body. Alternate health therapies like acupuncture, reiki, and some chiropractic schools focus on these channels. Many traditions teach that the perineal area is the root chakra, or that lines of energy flow through this area. Tears damage the energy chanels and chakras as well as the physical tissue so spending some time restoring energy flow can help you heal completely.
---Check out books like Ending Female Pain, The Core Program, Lose the Mummy Tummy, and Beyond Kegels. The Core Program is designed to be done in 15 minutes a day and focuses on helping women create/maintain proper posture and joint stability. The Mummy Tummy book focuses on healing the diastasis that happens during pregnancy and includes detailed exercises for healing the pelvic floor. And the Ending Female Pain book just plain rocks for ANY woman!
