Six hours postpartum, patient complains of episiotomy site discomfort. Most appropriate action?

Six hours postpartum, patient complains of episiotomy site discomfort. Most appropriate action?

• A. Administering an intravenous (IV) opioid analgesic
• B. Applying an ice pack to the perineum
• C. Contacting the nurse-midwife or health care provider
• D. Assisting the woman in taking a warm sitz bath

Answer: (B)

Cold therapy to the perineum is the best first step for immediate postpartum episiotomy discomfort. An ice pack reduces swelling and provides rapid local analgesia by constricting blood vessels, which helps lessen edema and pain in the first hours after delivery. Use a clean cloth to wrap the pack and apply for about 10–20 minutes at a time, several times in the first 24 hours, to avoid skin injury. Warm sitz baths are more appropriate after the initial swelling has decreased or as advised by care providers, since heat can increase edema early on. An IV opioid analgesic is not the initial approach here due to risk of side effects and the availability of safe nonpharmacologic relief. If pain remains uncontrolled or new symptoms develop (signs of infection, heavy bleeding, increasing redness or drainage), involve the nurse-midwife or health care provider.

Cold therapy to the perineum is the best first step for immediate postpartum episiotomy discomfort. An ice pack reduces swelling and provides rapid local analgesia by constricting blood vessels, which helps lessen edema and pain in the first hours after delivery. Use a clean cloth to wrap the pack and apply for about 10–20 minutes at a time, several times in the first 24 hours, to avoid skin injury.

Warm sitz baths are more appropriate after the initial swelling has decreased or as advised by care providers, since heat can increase edema early on. An IV opioid analgesic is not the initial approach here due to risk of side effects and the availability of safe nonpharmacologic relief. If pain remains uncontrolled or new symptoms develop (signs of infection, heavy bleeding, increasing redness or drainage), involve the nurse-midwife or health care provider.