Note from BellyBelly: While we don’t agree with using the term ‘broken’ when it comes to vaginas, this is the wording used by the blogger and media everywhere.
A recent post from a mum blogger has gone viral. She wrote about how she struggled to have sex after a vaginal birth.
Zoe George, who blogs at The Subtle Mummy, has revealed how her first baby’s birth was difficult, and has left her vagina ‘broken’.
In a bid to raise awareness of the difficulties new mums can face in the bedroom, Zoe George has told how scared she was about having sex with her husband six months after the birth.
“I was petrified. I have been bungee jumping before and the thought of having sex again scared me more”.
Sadly, Zoe’s story is all too familiar. Two weeks past her due date, she was induced. After enduring intense induction contractions for eight hours, she opted for an epidural. Eventually her son was born, with forceps, and in the process she experienced vaginal tearing.
The tearing was serious enough to require stitching. But that was just the beginning of Zoe’s ‘nightmare’.
The stitching was ‘botched’, and the scar tissue that formed afterwards caused a great deal of pain when she tried to have sex.
Twelve months after her baby’s birth, her gynaecologist gave her the news. She could either have more surgery, or bear the pain during sex until she conceived again, and then “hope the next baby tears the same spot so that it can be re-stitched more carefully”.
In the process, Zoe also experienced a condition called vaginismus. This is when the muscles in the pelvic floor essentially become locked in spasms. The sensation ranges from uncomfortable to painful.
We can’t judge this situation, as we weren’t there – and certainly not in Zoe George’s position.
But what’s so sad about this case is that we know how to avoid injury to women in labour. We also know there are better ways to treat women so they don’t end up in these situations – enduring unnecessary pain and trauma in the months and years after the birth.
So how do you avoid damage to your vagina during birth? Here are 6 ways:
#1: Avoid Induction Unless Medically Necessary
Leading health experts, such as the World Health Organization, agree that induction of labour should occur only when medically indicated. Medical reasons for being induced are those involving a risk to either mother or baby if pregnancy continues.
Being past 40 weeks isn’t in itself a medical condition. The American College of Obstetricians and Gynecologists (ACOG) states being past 42 weeks is ‘overdue’, but acknowledges: “Health risks for the baby and mother increase if a pregnancy is prolonged. The more prolonged the pregnancy, the greater the risks. But problems occur in only a small portion of post-term pregnancies. Most women who give birth after the due date have healthy newborns”.
Inducing a baby who isn’t ready to be born can lead to induction failure. A slow induction means more interventions: once the induction is under way, there is no turning back.
This increases the chance of women experiencing trauma to their pelvic floor – whether through the use of instruments (forceps, vacuum, or episiotomy) or from forceful pushing.
You can read more about this in 8 Reasons To Say No To Labour Induction.
#2: Avoid Epidurals Whenever Possible
The epidural is the most common form of pain relief used during labour; about half of all women opt for one.
Not all women who are induced have an epidural, but many do. Induction contractions are powerful and intense, and the artificial oxytocin that’s used overrides the body’s normal response to pain. As a result, the woman’s body doesn’t produce natural endorphins to help her cope with the pain of contractions, so she might need extra pain relief.
Even if you aren’t induced and decide to have an epidural, there are a few ways this common pain relief can contribute to your vagina being broken. Epidurals confine you to a bed. In almost all situations, once you have an epidural placed, you will be lying on your back, or semi-lying on your side, for as long as your labour takes (this, of course, depends on whether or not you decide to let the epidural wear off before the actual birth).
Lying or semi-reclining has a big disadvantage when it’s time to give birth. Your baby isn’t afforded as much room to get into a good position for birth. Your pelvis is unable to flex and move apart as your baby descends, which can lead to complications such as failure to progress, malpositioning, and fetal distress.
If these situations occur, you might need assistance to give birth to your baby. Forceps and vacuum births are common with epidurals, and increase the risk of pelvic floor damage.
#3: Breathe, Don’t Push
This might sound a little crazy but when you’ve got what feels like a bowling ball coming out of your body, it’s better to let it come out gently, rather than force it out. You will feel like you need to push your baby out as quickly as possible, probably pushing out a few curse words, too, as your midwife or partner reminds you to ‘breathe through the contractions’.
But you will thank them later. The area between your vagina and anus, called the perineum, stretches quite a lot during the last stages of birth. These tissues have to accommodate your baby’s head, and they will manage it, if you give them time.
During the second stage, your baby’s head will move through the cervix and into the vagina. The perineal tissues start to fan out and stretch, a little at a time. By allowing this time, you will avoid forcing the muscles and tissue to open, which reduces the chance of tearing.
Breathing is also a way of making sure your baby is getting plenty of oxygen. During contractions, there is a temporary lack of oxygen as the umbilical cord is squeezed. This is normal, and the midwife will check your baby’s heart rate each time, to make sure it picks up after the contraction is finished. If you are breathing during the contraction, rather than holding your breath and forcefully pushing, then oxygen will be readily available to your baby when the contraction ends.
If there is a lack of oxygen, over time your baby might feel uncomfortable and signal distress, in the form of heart rate irregularities. Your care provider might then want your baby to be born quickly, either with assistance from instruments or via c-section.
#4: Have The Right Kind Of Support
Avoiding many of the things that cause pelvic floor damage is often about making the right choices. Think about where you will give birth, and who will support you. This means doing some research, and making decisions early in pregnancy, so on the day of the birth you aren’t left wondering whether you’re going to make it through labour intact.
Care in obstetric settings increases the risk of interventions. Interventions lead to women experiencing pelvic floor trauma. Inductions, epidurals, augmentation of labour, restrictions on movement… all of these factors are more common in a hospital with obstetric staff.
If you focus on having support from care providers who understand and support an undisturbed labour, you will greatly reduce the chance of having interventions or restrictions that can contribute to a broken vagina.
Midwifery-led models of care, for example, focus on supporting women to choose to give birth in the positions they feel most comfortable in.
They also use techniques such as warm compresses on the perineal area. Warm compresses have been shown to reduce pain during birth, and in the following days. The heat provides relief, allowing women to relax the pelvic floor muscles. This reduces tearing and swelling during birth, which means the post partum healing is faster and less painful.
If you have a tear that requires stitching, how this is done can affect how you heal. The type of material used, the technique used to carry out the stitching (continuous thread is better than separately tied stitches), and the skill of the care provider can determine the level of pain and the way the wounds heal.
Find out How To Choose A Care Provider.
#5: Have Post Natal Support
Most women go home from hospital with a brand new baby, a sore vagina, and not really much idea of how to take care of either.
A newborn seems like an innocent little bundle, but there are so many moments when a new mother wonders what she was thinking. Breastfeeding is ‘natural’ but it’s a learned skill and many women don’t have an easy time of it. They also battle through sore nipples, all-night feeding sessions, and bouts of newborn crying.
To make things even more challenging, your bits aren’t going to feel too fantastic for a while. How sore your vagina is after giving birth, and how long the soreness lasts depends on the individual. Generally, women who have a spontaneous, normal, and drug-free birth will feel pretty good after a week or so.
Even so, there is a certain amount of swelling – both inside and out – that needs to subside. Rest is important, not just for your vagina’s sake but for your whole body. You just helped a human being out of you. Now it’s time to give your body a chance to recuperate. Let someone else hang out the washing and feed the dog. You can lie on the couch and soak in your newborn baby, and allow your bits to take a break.
Pelvic floor exercises in the first days after birth can help to increase blood flow to the area. This will reduce swelling. Some women like to use cold packs or sitz baths on the area. A popular homeopathic remedy for post birth swelling and bruising is Arnica, which can be found in health food stores or even pharmacies.
You can read more in 6 Ways To Heal Your Perineum After Giving Birth.
#6: Don’t Ignore Painful Sex After Birth
You’ll probably be advised to avoid having sex for about six weeks after having your baby, regardless of whether you have a vaginal or c-section birth. This allows time for your body to recover, and for post birth bleeding to stop, and lowers the risk of infection.
Women can experience painful sex after birth regardless of whether their babies were born vaginally or via c-section. In fact, research published in BJOG: An International Journal Of Obstetrics and Gynaecology showed women who had given birth via c-section were twice as likely to experience painful sex for up to 18 months after birth, compared with women who had spontaneous vaginal births.
The problem with painful sex after birth is no-one wants to talk about it. Many women are too tired or too scared even to think about having sex for some time. It’s enough to have to deal with a newborn and all the things that go along with that – like sore, leaking boobs, and feeling overwhelmed and ‘touched out’.
Feeling discomfort during sex might be related to other things – anxiety, how you view your postpartum body, or not having much of a libido. But sometimes there’s pain related to muscles and nerves being affected by pregnancy and birth, poorly repaired tears, or even scar tissue.
It can take some time for discomfort to settle, but ongoing pain shouldn’t be ignored. It isn’t necessary to suffer in silence or ‘put up with’ painful sex after birth.
If your care provider doesn’t take your concerns seriously, seek a second opinion. A specialist in pelvic floor disorders, such as a women’s health physiotherapist, can help you to understand what is contributing to the pain and how to treat it.