Postpartum Recovery: How Lactic Acid May Improve Episiotomy Healing

Childbirth is a powerful and life-changing experience, but it can also come with physical challenges. Whilst you can plan many aspects of labour and birth, it’s important to remember that things don’t always go exactly as expected.

Being mentally prepared for changes and knowing your options if your birth plan shifts from Plan A to Plan B (or C) can make a big difference. 

One intervention that a woman or birthing person may give consent to during vaginal birth is an episiotomy – a surgical cut made in the perineum, the area between the vagina and anus.

It’s usually done to make more space for the baby, especially if the birth needs to happen quickly or if instruments like forceps or a ventouse are being used (Box 1), and to reduce the risk of more severe or irregular perineal tearing, which can happen naturally during childbirth (Box 2). 

Regardless of the reason, the result is a wound that requires careful healing to avoid pain, infection or longer-term discomfort. 

Recovering from an episiotomy – or any perineal trauma – can be tough, particularly whilst caring for a newborn and adjusting to life as a family.

That’s why there’s growing interest in new ways to support healing and improve comfort after an episiotomy.

One promising area of research is the use of lactic acid in wound care. 

A systematic review, published in Healthcare (Basel), compared lactic acid with conventional treatments to assess its role in episiotomy wound healing. 

I spoke with the study’s first author, Dragoș Brezeanu, Specialist Doctor in Obstetrics and Gynaecology at Ovidius University, to learn more about the research and what it could mean for improving recovery after birth. 

Q: What challenges in episiotomy wound care led to this systematic review? And how do you think lactic acid might address some of those challenges? 

A: Episiotomy remains a common obstetric intervention in many parts of the world, yet optimal wound care practices remain inconsistently applied. Among the main challenges are delayed healing, pain, infection and scar-related sexual dysfunction. These outcomes not only affect immediate recovery but also postpartum quality of life.

Lactic acid, with its natural antimicrobial and pH-regulating properties, emerged as a promising adjunct for promoting faster, safer healing. Our review sought to critically examine and assess the available evidence around its clinical utility. 

Q. How did you address heterogeneity in the lactic acid formulations (gel, spray, solution) across included studies when evaluating the results? 

A: We recognised early on that formulation variability could impact outcomes. Whilst conducting the review, we stratified studies based on product type and application frequency and noted differences during subgroup analyses.

Due to limited data, a formal meta-regression wasn’t feasible, but we performed a qualitative comparison to acknowledge these differences whilst highlighting overall trends across formulations. 

Q: What criteria did you use to assess the quality and risk of bias of the included studies, and how did these assessments influence your conclusions? 

A: We used the Cochrane Risk of Bias Tool for randomised trials and the Newcastle-Ottawa Scale for observational studies. Studies with high risk of bias were clearly labelled, and their results were interpreted cautiously. These assessments were integral in weighting the strength of our conclusions and in identifying areas needing more robust future trials. 

Q: Were there any challenges in comparing studies with varying outcome measures (e.g., healing time, infection rates, pain scores), and how did you standardise these for meta-analysis? 

A: Absolutely. The variation in outcomes and assessment tools was a major challenge. Where possible, we converted measures to standardised mean differences (SMD) or calculated risk ratios for dichotomous outcomes.

For pain scores, for example, we relied on VAS normalisation. In some cases, meta-analysis wasn’t feasible, so we presented narrative synthesis instead. 
 

Q. What do you think are the key biological mechanisms by which lactic acid accelerates episiotomy wound healing? 

A: Lactic acid fosters a slightly acidic environment, which inhibits pathogen growth and supports native microbiota. Additionally, it promotes angiogenesis (the formation of new blood vessels), migration of keratinocytes (the primary type of cell found in the outermost layer of the skin) and activation of fibroblasts (cells that support and connect tissues).

These are all key steps in tissue regeneration. Its humectant effect also maintains an optimal level of moisture in the wound bed, further enhancing healing. 

Q: The review reports a 30% faster healing and 50% lower infection rates with lactic acid. How clinically significant are these improvements in real-world obstetric practice? 

A: These improvements are not only statistically significant but highly relevant for postpartum recovery. Faster healing reduces the risk of secondary complications and improves comfort, whilst lower infection rates reduce the need for antibiotics and subsequent healthcare burden.

For those people navigating new parenthood, such gains can translate into a smoother and more confident transition. 

Q: Were there any adverse effects or safety concerns related to lactic acid? 

A: Overall, the reviewed studies reported excellent tolerability. A few mild cases of local irritation were noted, especially in more concentrated formulations, but none required discontinuation. Importantly, no systemic side effects were reported, which supports its safety for external use in the postpartum context.