By Malinda Wright
Childbirth is no picnic: 85% of women who deliver vaginally experience perineal trauma and a third of those women in the USA and UK require stitches.2 The thought of having another baby after having gone through a traumatic birth can be daunting, to say the least. Returning to sex can also seem like a feat, especially when pain is involved. Pain with sexual intercourse, medically known as dyspareunia, and pain in the perineum, are common experiences for postpartum women.1 According to Kettle C et al, up to 10% of women will have continued perineal pain at 3-18 months after delivery, up to 25% will have dyspareunia or urinary problems, and up to 10% will experience fecal incontinence.2 The severity and duration of the pain correlates with the severity of the tear.3 None of this is meant to scare you, but the statistics are significant: this is why all postpartum women need pelvic floor physical therapy. And for those of you who have had a traumatic birth and are contemplating another baby, but are scared to go through delivery again, here’s a great story to give you hope!
You may remember Sarah from a blog post I wrote last year. She is one of the 85% of women who experienced perineal trauma and one of the 25% who had dyspareunia. Sarah had a traumatic birth and sustained a significant perineal tear. Here’s a recap of her birth story.
Sarah reports she delivered her baby vaginally in lithotomy position (on her back with her feet in the stirrups, like in the movies). She felt a strong urge to push and started to bear-down. The nurse asked her stop and wait for the doctor. Twenty minutes later the doctor arrived. Sarah reports she pushed once and the baby arrived fast. She sustained a 3rd degree tear along the perineum, meaning that she tore from the perineal muscles down to her anal sphincter. Sarah stated she attempted intercourse once, sometime later, but stopped due to severe pain. During her evaluation with me, she described her pain as “like having razors” along the entrance of her vagina. She reported a “hard nodule” right at the entrance, which was painful during sex. Sarah had been unable to participate in sex due to this pain, and had felt discouraged about her plan to have multiple children. She had confided in her friend about her pain and her friend had encouraged her to seek pelvic physical therapy.
Cases like Sarah’s are all too common. Fortunately, Sarah initiated pelvic floor physical therapy, and was able to overcome the pain and discomfort. Within 11 treatments, she was able to return to sexual intercourse without any discomfort. In 2016, Sarah became pregnant with her second baby. We were all very excited about the news! She emailed me that she was concerned she would have a second traumatic birth. Her fears were understandable but I’m very glad she contacted me. I asked her to come in so that I could re-assess her and give her some helpful tools for the birthing process. The scar tissue from the 3rd degree tear with her first baby continued to no longer bother her – in fact, it looked good. Her pelvic floor and pelvic alignment was all within normal limits. To set her up on the right path for success with her second delivery, we went over the following; perineal massage, breathing techniques for pushing, different positions to deliver in, and things to discuss with her doctor, such as her birth plan.
Earlier this year, Sarah contacted me to let me know she had a successful birth. She reported that while she did sustain a 1st degree tear, it felt significantly different from her first delivery and she was quite pleased. She didn’t have the pain that she had with the first baby. Sarah had a follow-up visit with me at six weeks postpartum. Her 1st degree tear had healed and she had no pain or discomfort during the exam. She also reported that she had no pain with sexual intercourse, and that she felt confident that she could go through another delivery if she wanted to.
So, don’t let statistics and pain scare you. With the right treatment, you can overcome traumatic births and set yourself up for an easier path with the next birth.
- Barrett G et al. Women’s sexual health after childbirth. BJOG 2000, 107 (2), pp. 186-195.
- Kettle, C and Tohill S. Perineal care. BMJ Clin Evid. 2008; 2008: 1401. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2907946/
- Leeman L and Rogers R. Sex after childbirth. ACOG 2012, 119 (3), pp 647-655.