Postpartum problems in the downstairs department are pretty common after a natural birth, so how come no one really talks about them? From swelling to scar tissue, piles to painful perineums, Rebecca Howard Dennis reveals what you can expect from your lady bits after labour.
Brace yourself, ladies and gents – well, mostly ladies, but you blokes better not think you’ll be sheltered from the harsh realities of childbirth – as we present the truth about bringing your babe into the world and what it really does to a woman’s undercarriage. No sugar-coating, we promise; well, maybe just a sprinkling; after all, we don’t want to completely put you off the business of having babies…
In hindsight, many new mums report feeling less than prepared for the physical fallout – sorry, poor choice of words – of labour. While recovery from, and the risks associated with, a C-section are well-documented, mothers can often be unaware of the short- and long-term effects of a vaginal delivery. So why are we seemingly so ill-informed?
‘We spend a lot of time educating parents about labour and birth,’ explains midwife Alison Matti, ‘but not about what to expect in the immediate postnatal period – such as how much you bleed, what medications you need and how often you feed your baby and so on. If women were aware of these things it might take away some of the fear associated with the postnatal ward, allow women to know what to ask for and when to be worried, when to ask for help and when it is Ok to be independent.’ With that in mind, here are some of the most common symptoms and side effects to prepare for after giving birth.
‘Most women anticipate bleeding, but it can be pretty heavy after delivery and some are surprised by that,’ explains Dr Shannon Clark, associate professor in the Division of Maternal-Foetal Medicine at the University of Texas. Known as lochia, this post-birth discharge is a mixture of blood, mucus and uterine tissue. The amount differs from woman to woman and can last anywhere from two to six weeks.
The first flow will be bright red and may contain clots, but this should taper off to a pink and then white discharge after a couple of weeks. If you are becoming more active it may become redder again; take this as your body’s way of warning you to slow down.
If you get a fresh blood loss, this may be your period restarting, but always contact a health professional if you are worried.
Tip: Stock up on maternity pads, rather than regular sanitary towels, and don’t be tempted to use tampons until after your six-week check up (they can introduce infection in your healing uterus).
Bruising and tenderness
Bruising and grazing of your cervix and vagina is inevitable following a natural birth – the result of all the squeezing and stretching necessary to push your baby out. As a guide, expect some discomfort anywhere from three to five weeks and don’t be surprised if you find it hard to sneeze, cough or even sit down for the first fortnight.
Tip: We know homeopathy is a Marmite topic, but many midwives and doulas swear by its ability to help reduce bruising and speed recovery after labour. If it gets your vote, consider taking Arnica at the start of labour and just before delivery. For more information and dosage visit www.britishhomeopathic.org
After labour, and depending on the amount of time spent pushing, it’s not unusual for your labia to swell to triple their normal size. You can expect this kind of post-birth trauma to subside after a few days, but be sure to mention it to your health visitor if you still have swelling and soreness after a fortnight.
Tip: Don’t be tempted to use ice packs – they will have no effect as your labia are swollen with excess fluid. Be patient and they should deflate on their own.
As well as the obvious post-labour pains, you can expect to feel some mild contractions every time you breastfeed. This is because it releases the hormone oxytocin, which also helps your uterus to contract back down to its pre-pregnancy size. The discomfort is usually most intense in the first few days, after which it can feel like bad period pain before finally subsiding after six to eight weeks.
Tip: It’s quite normal for these nursing-linked-contractions to make your lochia redder again during the first couple of weeks after birth.
The strain of labour can mean that even women who escaped the inconvenience of haemorrhoids during pregnancy may suffer from them after birth. They should disappear without treatment, but always tell your GP if they become troublesome. ;
Tip Try to eat a fibre-rich diet and be sure to get plenty of fluids to help alleviate constipation (see below).
Pregnancy hormones, as well as pain medication, can slow down your gastrointestinal system making constipation more likely. Then postnatal pain and piles can make it tempting to ‘hold on’. Trust us; don’t. It will only make matters worse and those number twos much harder to pass.
Tip Ask you GP for a stool softener and swap starchy white carbs for wholewheat options that should help to get things moving.
In many ways the mystery of childbirth has never been less mysterious. Fly-on-the-wall documentaries have brought the labour ward and delivery suite into our living rooms, yet discussing what happens in the postnatal period still remains something of a taboo. Or as one mum stated in the relative anonymity of an online chatroom, ‘Talking about how childbirth has changed my nether regions is important and necessary, but hardly a subject I’d feel comfortable broaching with other mums at the school gates.’
And yet, what do we really expect? Childbirth is one of nature’s most wondrous but biologically brutal feats, demanding vaginal muscles and other tissue to stretch and force something the size of a cantaloupe melon out of an opening that is normally the size of a carrot. Not only that, a contracting uterus is capable of exerting over 60 pounds of force per square inch during labour. It’s unsurprising, then, that this kind of physical stress and exertion can result in a variety of both short-lived and often longer-lasting problems. Because forewarned really is forearmed, here’s what you need to know about the more serious effects of labour on your no-longer-very-private parts.
According to the British Journal of Gynaecology (BJOG), 85 per cent of women will experience some form of tear during their first vaginal birth. Ouch! Of these first time mums, 50% will need stitches to help them heal, with nearly four per cent sustaining third- and fourth-degree tears (see Tears: Your Guide). In England, the number of reports of severe tears tripled between 2000 and 2012 (to 5.9 per cent) with the rise being put down to both a better rate of diagnosis and a link to women having heavier babies, later in life.
Tears typically occur in the second stage of labour, when the baby’s head descends into the vagina and on to the perineum (the area between the vagina and anus). The perineal skin must stretch over the baby’s head. As the baby’s head begins to crown (be delivered), the labia and vaginal opening start to bulge and stretch around the head, but if the skin of the perineum has not stretched sufficiently it can tear
Risk factors for tearing include:
• A first vaginal birth.
• An assisted birth using forceps
• A large baby
• An induced labour
• Second stage of labour lasting longer than expected.
Asian mums are reported to have a higher risk of tearing (although the reason has not yet been studies), as do mothers delivering babies in the back-to-back position (when the baby’s spine faces your back rather than your stomach).
A severe bruise sustained during delivery that causes a lot of swelling – so much so that it may be necessary to have it drained. Usually caused by your baby’s head passing through the vaginal opening but sometimes the result of a forceps or ventouse birth. Healing usually takes six to eight weeks.
It’s quite normal to experience some numbness down below as your body recovers from birth (especially after an assisted birth) and any postnatal intervention such as stitches. While disconcerting, rest assured that sensation should start to return after a few weeks. If you have still have a lack of sensation discuss it at your six-week check and consider asking for a referral to a pelvic physiotherapist.
Often scar tissue as the result of postnatal repairs can cause discomfort. For some women this means a pulling sensation leaving them feeling as though the muscles in their groin and upper legs are too tight. Often something as simple as vaginal and perineal massage can make all the difference. Ask your doctor to recommend a specialised physical therapist who can teach you to locate and manipulate intimate scar tissue, massaging it to make it more mobile.
Often delivery stetches the pelvic muscles that control the bladder and bowel. In the short term, the resulting bruising and swelling can make going to the toilet painful and difficult to control. This kind of stress incontinence affects about a third of all mums and usually resolves itself in a few weeks. ‘It’s often only a tiny amount of urine that you leak, usually when you laugh or sneeze,’ explains Dr Marwood.
Strengthening your pelvic floor will speed up recovery, but if you are still experiencing problems with control after three months, make an appointment with your GP or health visitor. There are many treatment that can help, including physiotherapy; The Birth Trauma Association (birthtraumaassociation.org.uk – don’t be frightened by the name) has lots of fantastic, practical and emotional advice for anyone suffering with bladder and bowel issues.
Sometimes the pressure of pushing and giving birth can cause prolapse, when one or more of your pelvic organs (the womb, bladder or rectum) can drop down, or prolapse, into your vagina. ‘It’s not that common and happens to around ten per cent of women,’ says Dr Marwood. ‘It can feel heavy and may even see a bulge in your vagina. If the prolapse is pushing on your bladder you may find you need the toilet far more frequently.’
This is definitely something to discuss at your six-week check-up, when general pelvic pain and swelling should have subsided, and your doctor can advise on targeted treatment. This can range from physio and yoga to electrode therapy designed to help tone and tighten the muscles, or even surgery if deemed necessary. For independent advice or a second opinion, seek out a local specialist gynaecologist or pelvic clinic that offers prolapse recovery programmes. Try pelvicpain.org.uk for nationwide listings.