Herbs for Postpartum Perineum Care: Part Two

Editor’s note: This article first appeared in The Birthkit, Issue 47, Autumn 2005.
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See Herbs for Postpartum Perineum Care: Part One for first-degree tear treatment and methods of preparation.

Second-Degree Tears

Many of the second-degree remedies are good choices for first-degree tears also.

Gotu kola (Centella asiatica) has been documented in several scientific studies to aid wound healing.(1) One of the primary mechanisms of Centella appears to be the stimulation of type-1 collagen production.


Comfrey (Symphytum officinale) has anti-inflammatory properties that may decrease bruising when the herb is applied topically.(2) Comfrey is also widely used in traditional medicine as a topical application to help heal wounds. Comfrey may be used externally to speed wound healing and protect against incorrect development of scar tissue. Care should be taken with very deep wounds, however, as the external application of comfrey can lead to tissue formation over the wound before it is healed deeper down, possibly leading to abscesses. It may be used as a compress or poultice for external ulcers, wounds and fractures.(3)

Marshmallow (Althea oficinalis) has demulcent, emollient, anti-inflammatory properties—a good choice for wound healing. Mucilage, made up of large carbohydrate (sugar) molecules, is one of the active constituents in marshmallow. This smooth, slippery substance soothes and protects irritated mucous membranes.(4)

St. John’s wort (Hypericum perforatum) contains anti-inflammatory, astringent, vulnerary, nervine and anti-microbial properties, all of which are wonderful for topical application. St. John’s wort, although famous for depression in modern times, was first used as a topical herb for wound healing and was written about during the age of early Greek civilization as well as in the 1500s.

St. John’s wort

St. John’s wort infused oil is used for bruises, is anti-inflammatory and is often used by herbalists to speed healing of wounds and sores. Externally it is applied to bruises, sprains, burns, skin irritations or any laceration accompanied by severed nerve tissue. The German government allows such external St. John’s wort preparations to be labeled for the treatment of wounds, myalgias (muscular pain) and first-degree burns.(5) Its soothing, anti-inflammatory action eases burning and swelling and speeds the healing of perineal tears.

A number of studies of St. John’s wort extracts have demonstrated anti-bacterial and wound-healing activity. For instance, two widely prescribed Russian preparations of Hypericum, novoimanine and imanine, have been tested for treatment of Staphylococcus aureus infection in vivo and in vitro and have been found to be more effective than sulfanilamide.(6) St. John’s wort can be used as a compress, poultice, sitz bath and infused oil.

Witch hazel (Hamamelis virginiana) has astringent, anti-inflammatory properties. It is soothing and cooling and has a mild anti-inflammatory effect on the skin. You can apply it directly to the perineum or try soaking a cloth in cold water, wringing it out thoroughly and putting witch hazel on it before applying to the perineum. Witch hazel is also great for treating varicosities and vulvular bruising and for slowing bleeding. Witch hazel can be used as a compress or a sitz bath.

White oak bark (Quercus robur) has astringent, anti-inflammatory and antiseptic properties. It reduces irritation on the surface of tissues due to a form of numbing. A reduction in surface inflammation is one of the possible effects. A barrier against infection is created which is of great help in wounds and burns. Only a small amount of oak bark is needed in a sitz bath formula; too much can be irritating.

Horse chestnut (Aesculus hippocastanum) contains a compound called aescin that acts as an anti-inflammatory and reduces edema (swelling with fluid) following trauma.(7) Horse chestnut also has astringent properties. Because of the resin content, I would use an alcohol-based tincture. Add 2 teaspoons of tincture to 2–3 cups of warm water. The alcohol in the tincture would be sufficiently diluted so it shouldn’t be felt by the woman. Horse chestnut can also be used in a sitz bath or compress.

Horsetail (Equisetum arvense) can be used both internally and topically to decrease inflammation and promote wound healing.(8) It has astringent, diuretic and vulnerary properties. Horsetail also has high silica content, which is helpful in the production and repair of connective tissues and accelerates the healing of broken bones. It can be used as a compress and sitz bath.

Chaparral (Larrea tridentata) has been used topically to decrease inflammation and pain and to promote healing of minor wounds. For topical use, cloths can be soaked in oil preparations or tea of chaparral and applied several times a day (with heat if helpful) over the affected area. Chaparral is a well-known herbal antibiotic. Powdered chaparral can be applied directly to minor wounds after they have been properly cleansed.(9) It can be used as a compress, sitz bath and infused oil. Chaparral should not be used internally.

Using herbs in perineal repair not only promotes healing but gives the mother options and control over her healing process, further empowering her.


  • Wilmore, D.W. 2001. The Effect of Glutamine Supplementation in Patients Following Elective Surgery and Accidental Injury. J Nutr 131 (9 Suppl.): 2543S–49S; 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; Williams, J.Z., N. Abumrad and A. Barbul. 2002. Effect of a Specialized Amino Acid Mixture on Human Collagen Deposition. Ann Surg 236(3): 369–74; Suguna. L., P. Sivakumar and G. Chandrakasan. 1996. Effects of Centella asiatica Extract on Dermal Wound Healing in Rats. Indian J Exp Biol 34(12): 1208–11; Bosse, J.P., et al. 1979. Clinical Study of a New Antikeloid Agent. Ann Plast Surg 3(1): 13–21; Lawrence, J.C. 1967. The Morphological and Pharmacological Effects of Asiaticoside upon Skin In Vitro and In Vivo. Eur J Pharmacol 1(5): 414–24; Rosen, H., A. Blumenthal and J. McCallum. 1967. Effect of Asiaticoside on Wound Healing in the Rat. Proc Soc Exp Biol Med 125(1): 279–80.
  • Weiss, R. 1988. Herbal Medicine. Translated by A.R. Meuss and Beaconsfield, UK: Beaconsfield Publishers Ltd.
  • Brauchli, J., et al. 1982. Pyrrolizidine Alkaloids from Symphytum officinale L. and Their Percutaneous Absorption in Rats. Experientia 38(9): 1085–87.
  • Tomoda, M., et al. 1987. Hypoglycemic Activity of Twenty Plant Mucilages and Three Modified Products. Planta Med 53(1): 8–12; Blumenthal, M., et al. (eds). 1998. The Complete German Commission E Monographs—Therapeutic Guide to Herbal Medicines. Translated by S. Klein and R.S. Rister. Austin: American Botanical Council.
  • Foster, S. 1996. Herbs for Your Health. Loveland, Colorado: Interweave Press.
  • Hobbs, Christopher. 1996. St. John’s Wort (Hypericum Perforatum L.): A Review. HealthWorld Online. www.healthy.net/asp/templates/Article.asp?Id=915&action=print. Accessed Feb 28, 2005.
  • Guillaume, M., and F. Padioleau. 1994. Veinotonic Effect, Vascular Protection, Anti-inflammatory and Free Radical Scavenging Properties of Horse Chestnut Extract. Arzneimittelforschung 44(1): 25–35.
  • Blumenthal, M., et al. Op cit. 150–51.
  • Kay, M.A. 1996. Healing with Plants in the American and Mexican West. Tucson: University of Arizona Press, 178–81.

More on Herbs

  • Marshmallow, related to the hollyhock, is traditionally used by Native Americans to increase postpartum milk production.
  • Mother Food: Food and herbs that promote milk production and a mother’s health. 2004. Hilary Jacobson.

About Author: Demetria Clark

Demetria Clark is the Global Director of Birth Arts International (www.birtharts.com), Heart of Herbs Herbal School (www.heartofherbs.com) and a midwife assistant and doula living and working in Basel, Switzerland, and the tri-country region of Switzerland, Germany and France.

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