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Childbirth Recovery
by Jennifer Wider, M.D.

Recovery from Vaginal Delivery

Recovery time from a vaginal delivery is usually shorter than the recovery time from a Cesarean section. But sometimes it can take a while, especially if you've experienced any lacerations or tears.

The perineum, or the region between the vagina and rectum, is vulnerable to tearing during delivery. Some studies show that women are more likely to tear during their first vaginal delivery, probably because this is the first time the area has been stretched to that degree. But whether it's your first or your tenth, delivery technique can make a huge difference. One study revealed that if normal, spontaneous vaginal deliveries are unrushed and occur in a controlled setting with a nurse, doctor, or midwife guiding the pushing process, there is a lower risk of obstetrical trauma. Many health experts recommend perineal massage in the weeks prior to delivery as a way to lower the chances of tearing. Unfortunately, some women experience tears despite their own best efforts and the efforts of their health care professional.

Tears and Lacerations
Tears and lacerations vary in severity and are classified accordingly:

  • First-degree tears are surface tears that involve the skin of the perineum and the vaginal connective tissue, usually near the vaginal opening. No muscles are involved. Healing time for first-degree tears is rapid, and women usually experience little discomfort. Stitches may or may not be required.

  • Second-degree tears are deeper tears that involve the skin, connective tissue, and underlying muscles. Second-degree tears almost always require stitches, and healing time can vary. Most often, the stitches will dissolve on their own. Some women report feeling fine in a matter of weeks, others complain of experiencing pain for longer periods of time.

  • Third-degree tears are more severe and involve the skin, connective tissue, and the external anal sphincter muscle, the muscle that you can squeeze to stop yourself from going to the bathroom.

  • Fourth-degree tears are the most severe and can involve a tear through both the internal and external anal sphincter muscles and lining of the bowel. These tears often result in the loss of anal sphincter control, as well as fecal urgency and/or incontinence.
While third- and fourth-degree perineal tears are not common, they can happen to anyone. There are a few risk factors which may increase the chances:
  • Larger babies
  • Occiput posterior deliveries (baby is sunny-side up, or delivered faceup, instead of facedown)
  • Nulliparity (delivery of first babies)
  • Extended second stage of labor, or if the pushing stage lasts longer than an hour
  • Midline episiotomies -- unfortunately, some women end up tearing further than the controlled incision
  • Forceps delivery
Third- and fourth-degree lacerations can be extremely painful and may interfere with all sorts of activities, including intercourse, for quite some time after delivery. Many women find going to the bathroom, especially having a bowel movement, a huge challenge. One woman with a third-degree tear told me that having bowel movements after her delivery was worse than the actual delivery itself.

The pain can persist for months after the baby arrives. A thorough follow-up is very important, so make sure that you see your health care professional several times after the delivery. Your doctor should examine the area and make sure the anorectal area is functioning properly. For many women, the pain and discomfort will subside within a few months and normal activities, including sex, can be resumed.

Some moms experience uncontrollable gas and/or fecal incontinence down the line. These problems should be brought to the attention of your physician immediately. In some cases, additional treatment may be necessary.

Episiotomies
An episiotomy is a controlled surgical incision made in the perineal area (between the vagina and rectum), prior to the delivery. In the past, the episiotomy was used routinely in order to lower the risk of vaginal tears during deliveries. But because newer studies have shown that these routine episiotomies have no real benefit for the mother, and may actually worsen the outcome and prolong healing time, episiotomies are becoming less common. In fact, several studies reveal that more severe lacerations were associated with the occurrence of an episiotomy.

Despite the new research about episiotomies, some women still get them. And it's certainly true that in some cases, an episiotomy may be necessary, especially if the baby presents in an unusual position or is overly large; it may also be necessary if the doctor needs to speed up the delivery for health or medical reasons pertaining to the mom and/or the baby.

Recovery from an episiotomy is a lot like the recovery from a tear; it all depends on the extent of the cut or laceration. For most women, the pain and tenderness will subside significantly in one to two months. If a woman experiences a serious tear in addition to the surgical incision, recovery time may be prolonged.

Recovery from C-section Delivery

The recovery from a Cesarean section, or the delivery of a baby through an abdominal incision, varies from woman to woman. In general, recovery time tends to be longer than the time it takes to recover from a normal, vaginal delivery, unless, of course, a severe tear or laceration is involved.

Right off the bat, the incision site will most likely be sore, although some women report that their incision feels numb and tingly. The pain will gradually subside and the numbness should lessen as well (although I've spoken to a few women who never fully regained total sensation in that area). Many women also complain of itchiness around the scar during the healing process. If the itchiness becomes intolerable, speak with your health care provider for options. Some doctors will recommend soothing creams, but others do not, so it's important to get his/her opinion.

Some women who have had a C-section complain of cramps caused by the buildup of gas in the abdomen after surgery. Walking around or light exercise can help. This will usually go away within the first few days post-surgery, but it can linger, especially if you are not moving at all. Speak with your health care professional if it becomes a problem.

Don't be shocked by the way the incision looks! For many women, seeing a dark red scar on the abdomen can be upsetting. But remember, it fades with time (and will likely look a whole lot better in six to eight weeks) and most doctors make the incision low enough that your pubic hair will eventually cover it.

Certain activities may be difficult right after a C-section; even coughing, sneezing, and laughing can be uncomfortable. Lifting anything heavy is out of the question, and it will be a while before you can have sex again. You also may need to wait to drive a car, especially if you experience pain buckling your seat belt or getting in and out of the car. Getting up and moving are important parts of the healing process, but you shouldn't expect to run a marathon.

Here's a good piece of advice: Don't overdo it! Oftentimes, women don't seem to realize that they have just had major abdominal surgery and they feel frustrated that they are unable to move around freely or lift heavy things. One woman I spoke to complained that the stairs in her house posed a major challenge. Another woman was upset that she was in too much pain to be able to cook for her older child. It normally takes an average of six to eight weeks to recover completely from a Cesarean, and for some women it can take several months.

Here are a few more tips to help speed your recovery from a C-section:
  • Accept help. As simple as it sounds, it can make a world of difference. Many women are used to doing everything themselves. But this is not the time to be superwoman. Husbands, siblings, parents, friends, and even in-laws make great helpers. If they offer, take them up on it!

  • Take it nice and slowly. Many women feel okay by that six-to-eight-week mark, but if you're not among them, don't do anything that makes you uncomfortable. Overexerting yourself can actually prolong the healing process.

  • Don't neglect your bowels. If you're taking pain medications, be aware that certain types can cause constipation, which in itself can become a serious problem. Make sure that your bowel movements are regular, and if this starts to become an issue, speak with your health care provider. Stool softeners and laxatives might be necessary.

  • Accept the mess. With tons of foot traffic through your home and visits from your extended family, your house may get messy. But you're recovering, so leave it. This is a great opportunity to ask your mother-in-law to help clean up. Even if the mess causes you stress, it's better to leave it for someone else to handle than for you to overexert yourself. Believe me, there will be many messes in the future you can dirty your hands with!
The above is an excerpt from the book The New Mom's Survival Guide by Jennifer Wider, M.D.
Published by Bantam Books; June 2008; $15.00US/$17.00CAN; 978-0-553-80503-1
Copyright 2008 Jennifer Wider, M.D.

About the Author:
Jennifer Wider, MD, is a doctor, author, and radio personality who specializes in women's health issues. She is the medical advisor to the Society for Women's Health Research in Washington, D.C. Dr. Wider is a regular contributor to Cosmopolitan magazine and hosts a weekly segment on Cosmo Radio for Sirius Satellite. She has appeared as a health expert on The Today Show, CBS News, Good Day NY, Fox News, and a variety of cable channels. She lives with her physician husband, and their daughter and son, in Fairfield County, Connecticut.

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