Vaginal birth. It’s the most natural thing in the world, right? Women do it every day. The idea of giving birth conjures up images of red-faced, grunting women, legs askew, pushing with every bit of might they can muster. There’s a reason why it’s called labor. It’s hard!
Fear about the process is also natural. Ask a woman what she fears the most about vaginal birth and chances are she’ll say it’s the pain. Whether choosing to go drug free or getting an epidural, there will be some measure of pain – it’s guaranteed. Then there’s another fear, one discussed less freely.
Just what does all that pushing, squeezing, and stretching do to your vagina anyway?
Maybe you’ve heard a horror story or two, or have been consoled by a friend or family member that assured you everything went right back into place. Maybe the thought of actual damage hasn’t crossed your mind at all. Well, get ready for the ugly truth.
“A woman’s bottom is going to be different after a vaginal birth” says Dr. Edward Wolanski, an OB/GYN practicing in Charlottesville, Virginia. “How much it will change depends on the size of the baby, the delivery, the nature of the woman’s tissues; it’s different for everyone, but there will be some change.”
Before we get to the details, let’s be clear – the female body is spectacularly designed and does an amazing job recovering from childbirth. Not all women will experience serious lasting trauma or changes. However, some will experience the following:
It’s not what you’re thinking. Skid marks are abrasions or minor tears either on the interior or the exterior of the vaginal opening. Internal abrasions are generally caused by the baby’s movement through the birth canal or tools used to assist in labor. External abrasions are the result of overly stretched (but not torn) skin. These marks generally heal quickly and eventually fade, though some may leave lasting reminders.
A relatively common occurrence, tears are measured in degrees ranging from one to four. A one degree tear involves only the skin immediately around the vaginal opening (most common), while a fourth degree tear reaches all the way to the anus (less common). Treatments range from stitches to surgical repair. Scarring is likely, but may fade depending on the location and severity of the tear. Keep in mind that tears are not always symmetrical, and may leave you with what some refer to as a “crooked smile”.
The intentional cutting of the perineal tissue, this procedure was once routine since it was believed to help speed delivery and prevent tearing. However, studies have shown that episiotomies may actually cause more damage due to the increased likelihood of further tearing. It makes sense: a piece of cloth is easier to rip if it’s already been cut a bit. For this reason, episiotomies are no longer recommended as routine though many doctors still perform them. Sometimes the benefits can outweigh the risks. Expect scarring and potentially painful scar tissue to remain for some time.
The pelvic muscles become stretched during pregnancy and labor sometimes resulting in a feeling of slackness (much like the stretching of your abdominal muscles left you with a loose “jelly belly” at first). Decreased bladder or fecal control may result in some instances. The good news is, for most women pelvic floor weakness is temporary and muscle tone can be improved with exercises called “Kegels”. Biofeedback and physical therapy can help in the identification and strengthening of these muscles when needed.
The organs of the pelvis rely on your muscles and ligaments for support. When the ligaments become so stretched they can no longer hold the organs in place, you have what is known as prolapse. There are several kinds of prolapse, which may occur simultaneously or on their own. The bladder, urethra, uterus, bowel, and rectum may push against the vaginal wall causing bulging and even protrusion from the vagina. A device called a pessary can be inserted for support in some cases. When this and other treatments fail to provide relief or necessary support, surgery is your best option.
So there you have it. It’s not pretty, but all of it is possible.
Before you schedule that c-section though, keep in mind that plenty of women give birth vaginally without any complications or lasting physical damage. However, the number of elective c-sections being performed has increased dramatically in the last decade. Many women cite the fear of pain, the unpredictability, and the potential for complications like those listed above as reasons for doing so.
While Dr. Wolanski does perform the occasional elective c-section for a healthy woman at full term, he cautions against women thinking it’s the easy way out.
“A c-section is not going to be pain-free. The recovery is going to be much longer than from an uncomplicated vaginal birth and babies are prone to respiratory problems if the c-section is performed too early. It’s still a major surgery,” said Dr. Wolanski, adding, “Ideally, vaginal birth is the way to go.”
Some studies, like that by the National Institutes of Health in 2006, find vaginal birth and c-section have very separate but nearly equal risk of complication, while others argue the opposite is true. Research is ongoing as to whether or not one method of delivery is truly safer and less complicated in the long run.
Either way, this fact remains the same: it’s not just your life that changes after giving birth – your body likely will too.
Tia O’Neill is a freelance writer in Virginia and Florida.
