After 20 odd years in the birthing circles, I've found that most pregnant women will wonder at some point, out loud or internally:
- How the heck will my baby fit through my vagina?
- What damage will be done to me in the process?
These concerns are so normal.
In fact, tearing during childbirth is one of the top fears for most pregnant women (along with pooing in labour).
As a doula I've had the privilege of seeing all sorts.
10 pound babies leaving no trace, 7 pound babies with a 2nd degree tear, 8 pound babies being born only after an episiotomy and 9 pound babies leaving a labial graze only. And everything in between!
Interestingly - and also alarmingly - the rate of perineal damage during childbirth birth has increased over the past 100-200 years.
Some data suggests 95% of women in the 1800s came through childbirth tear-free! These days this statistic is only around 25%!
Some reasons for this discrepancy may be that; 19th century women were younger at time of giving birth, they had many babies close together, they also gave birth in upright positions, and they received less medical interventions such as forceps, vacuum and episiotomy.
Historically, providing protection and comfort to the perineum were key priorities for midwives. Most of whom traditionally practised under the 'social' model of care, compared to the 'surgical' model.
This model came about with advent of the Man-Midwife in the 17th and 18th century.
The perineum became an area to be 'pathologised' and eventually it became a site for routine surgical intervention, with the widespread use of episiotomy.
This 'surgical' model of care also saw women move from upright positions to supine (on back) birth positions. The vulva/perineum were also routinely prepared as a 'surgical site' with shaving and elaborate aseptic procedures.
Thankfully in the last 30 years in much of the developed world, there has been a re-emergence of care aimed at preserving and protecting the perineum!
The stats for Australian women:
- 25-27% experience no tearing at all
- 23-25% have a very minor vaginal tear or graze that often does not require stitches, healing on its own
- 26% have a perineal tear that may need to be stitched
- 20% will receive a surgical cut to the perineum called an episiotomy
- 2% endure the most severe form of perineal tearing during birth, involving the vagina, perineum and sometimes the anus (ie. 3rd and 4th degree tear). These require more extensive care.
Bottom line (pun intended): You have about a 75% chance of coming through birth with some degree of tear or graze.
Given this, I've listed all my tips to help ensure speedy healing to your amazing, life-bearing lady bits!
My Top Tips for Healing After Birth
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The first week matters. Get your healing off to a great start straight away. What you do - and don't do - in this first week after birth matters. It can be the difference between getting an infection and/or ongoing dramas, or getting things sorted once and for all.
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Do more warm, than cool. Yes, anything cool will feel REALLY nice on the hot and swollen area by numbing it and bringing the swelling down, but just don't over do it.
It's best to alternate between cooling applications (ice packs, cooled herbal compresses, padsicles and warming applications (warm compresses, sitz/herb baths). As these encourage circulation to the area which brings all the healing magic with it. More on herbs below.
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Change your maternity pads regularly to help keep the area clean to support healing.
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Move like 'a lady', meaning it helps to keep your knees close together when getting in/out/rolling over in bed or getting in/out of a car - think of how the Royal Princess' do this to avoid flashing their knickers to the paps. These conscious movements can help prevent micro tissue tears as healing is underway.
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Avoid long periods of sitting or standing. This includes sitting up in your hospital bed, home bed or sitting on the couch. Sitting anywhere basically. As it increases the pressure on the area and the swelling will persist. Same goes for standing. You'll know you've over done it when your peri gets super achey by the afternoon. Another excuse to lie down and heal!
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Fall in love with side-lying (AKA napping, sleeping, dozing) and/or side-feeding baby. This is an easy way to take that pressure off your achey nether regions.
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Avoid the donut cushions. The theory is nice but they increase the pressure to the area and provide little support for sutured tissues. Side-lie instead.
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Keep the area clean but avoid over-washing the area with soaps/body washes. Remember your vagina is self-cleansing.
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Prepare for toilet visits. Use a peri wash bottle (pictured) over the toilet to take the sting out of urine touching tender tissues. These are also great instead of harsh toilet paper! But if you do use loo paper, always wipe from front to back - this message has never been so important, especially if you have an open wound.
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Have your caregivers check how you're healing and that no infection is beginning. Especially if you sense things aren't feeling - or smelling - right. You should be getting better gradually, not stalling or regressing.
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Ask a postpartum/women's physio which pelvic floor exercises you can begin with - and which to avoid - specific to your situation.
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Throw a hand down there to support your peri while coughing, sneezing, laughing or even while emptying your bowels (using a warm, moist handtowel can be nice here).
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Food is medicine. Nourish yourself from the inside with (hopefully) all those nutritious meals you stockpiled in your freezer whilst pregnant. Otherwise call on your postpartum support team to drop off meals to your door. Foods to support your body's healing include warming soups and stews, rich in protein, collagen/glycine and fats and made with bone-in meats (particularly slow cooked), poultry with skin and/or bone broth.
Collagen/glycine-rich bone broth based meals are wonderful for postpartum recovery. Glycine is an amino acid found in animal protein that stimulates collagen production. It supports the involution (shrinking) of the uterus, wound healing at the placenta site and any perineal tears, or episiotomy or caesarean incisions. It also helps with connective tissue remodelling and supports the skin as it gains its elasticity.
Other amino acids that support wound closure are arginine (found in nuts, seeds, animal protein) and glutamine (found in eggs, animal proteins, some protein powders). Glutamine stimulates connective tissue growth, and its also lost during any tissue injury.
Fruits, vegetables and wholefoods rich in Vitamins C, D, E, zinc and iron will also help by providing the building blocks for tissue repair whilst supporting immune function so infection doesn't set in.
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Take your supplements. Continue on your prenatal multivitamins and also consider adding in some 'wound healing' supplement/s. As mentioned, Vitamins C, D, E, zinc and iron are also essential for the synthesis of collagen. Consider a natural form of vitamin C over the ascorbic acid varieties.
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Stay hydrated and up your fibre. This keeps your bowels happy and keeps the need to strain on the loo to a minimum. Seek help if you haven't done a poo in 48 hours. You may need a form of stool softener if you've been on pain meds - as these can often bind you up. Although helpful, try to keep their use to short term only and let your fluid intake and diet do the rest.
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Take Ural sachets to alkalise your urine, reducing the sting on sensitive tissues.
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Tilt your pelvis when pooing by using a small step to rest your feet on. This helps the bowel open easier and takes the pressure off the peri area.
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Take probiotics. Especially if you have IV antibiotics during labour (and/or a caesarean). These help keep body's microbiome - and healing powers - on point.
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Engage your postnatal support team. More rest = faster healing. Simple and a non-negotiable.
- Take pain relief, if required but try avoid the constipating varieties.
Using Herbs for Healing
Used for centuries - and still going strong - herbs have a well deserved place in postpartum care.
Obviously I'll mention those you can find within The Mamawise Store, but even if you 'DIY' your own versions ensure you use quality ingredients for the best results.
The herbs required are those with astringent, antiseptic, anti-inflammatory and vulnerary (wound healing) properties.
And remember, alcohol-free solutions all the way cause no mama needs that!
Of the Mamawise varieties, some are ready to go as is whilst some have a variety of uses.
Most of them can be used together (ie. at different times throughout the day) or following one another depending on your needs.
Here's a quick run down.
If you like convenience and hands off healing, this may be for you.
This wins hands down for convenience and no-prep as its all ready to go.
It packs easily into your hospital bag and if your postnatal room has a small bar fridge (bonus) you can keep in here for extra cooling relief.
Use multiple times a day, and especially after toilet use. Begin on the day of the birth and continue for as long as required in those early days/weeks.
Tip: Keep any leftover for skin irritations; sunburn, heat fuelled nappy rash, grazes or burns!
A padsicle is a maternity/sanitary pad thats had soothing ingredients spread onto the pad's inner surface.
For convenience these pads are typically prepped prior to birth and then frozen. They're used like any maternity pad in those early days after birth. But they come with the bonus of providing direct, cooling relief at the same time!
Padsicles help reduce swelling, cleanse the area and provide sweet relief to those tender areas after giving birth.
If you’re looking for a convenient, all-in-one gel to prep your postpartum padsicles - this is it! No need to hunt around for all those single ingredients that you're unlikely to use up.
If you like options and multi-use, these may be for you. They are essentially very large tea bags, packed and sealed with potent healing herbs and salts.
They're perfect for a mess-free, deep herbal bath or a shallow sitz bath.
They can also be used as a direct warm or cool compress to the vulva/peri areas.
You can also use the herbal liquid to fill a peri wash bottle. Simply pour this liquid over the sensitive areas whilst on the toilet. It will dilutes the urine to take the sting out.
My final word...
There are many factors that contribute to the likelihood of experiencing vaginal/perineal/labial trauma from giving birth (another blog coming on this!)
The good news is that vaginas are extremely forgiving!
For the overwhelming majority of us, they are built to birth our babies. Over and over.
Even if we come through birth needing to heal afterward, with the right support we can do so quickly and hassle-free. So much so, we can't resist going back and doing it all again!
Happy birthing and happy healing,
Kristin x
Naturopath & Doula
Founder of The Mamawise Store