birth injury

Sex After Birth...Is it Normal to Hurt?

Okay ladies, let's talk about sex. Not just sex, but sex after having a baby. You've just labored, pushed and birthed a baby either vaginally or cesarean and your body is forever changed.

So now you have to reacquaint yourself to your new body...."Hello mama body, how are you feeling today? Tired? Sore?"

No wonder the thought of having sex for most of us is the last activity we'd chose to do with our new body.

So why is sex after baby painful?

Statistics range from 9 out of 10 women experiencing pain the first time after birth, falling to one quarter of women suffering long-term painful sex. Other studies find 45% of women experience pain during sex after birth

Nearly one in ten women who had an episiotomy, tear or other forms of intervention during childbirth suffer from painful post-birth sex – that’s over 35,000 women a year!

Here are the tops reasons sex is painful after baby:

  1. Shy about our new bodies
  2. Breastfeeding
  3. Hormones & the thyroid
  4. Scarring
  5. Injured pelvic floor muscles

For many women the changes that occur to our bodies make us self conscious of how we look...stretch marks, soft tummies, wider vagina. Even though a women's body is beautiful after having a baby, many of us just aren't comfortable with these changes.

Breastfeeding changes the natural mucosal lining of the vagina and reduces the lubricant produced by the body when aroused.  This in combination with unbalanced estrogen levels from the body readjusting from pregnancy can cause the vagina to feel dry....leading to major friction during sex.

These on top of being sleep deprived and focusing 24/7 on a new baby can really reduce the sex drive we may once had.

Scarring occurs in tissue when it has been cut or torn.  So for those who tore during delivery, had an episiotomy or a cesarean the risk of painful sex is increased.  Why is this...because when scar tissue is less flexible or elastic than the surrounding tissue.  This becomes even more apparent when the scar does not heal properly and creates more scar tissue than necessary or binds down neighboring muscle.  So then when you go to stretch the scar it doesn't want to give and creates a pain response.

No matter how you delivered, your pelvic floor has been forever changed from pregnancy.  The weight it supported during pregnancy, the strain it felt during labor and the stretch it went through during delivery all play a role. "I had a c-section" you may say.  You're pelvic floor can still be affected depending on if you pushed before your transition to the c-section.  If you had a scheduled cesarian your risks are more linked to scarring, hormones, and past history of pelvic floor dysfunction.

This does not mean you can avoid painful sex by having a c-section!  There are more risks that come along with having major surgery, so please let this decision be medically based.  That is a whole different post...I have worked with many moms who never delivered vaginally but had horrific pain during sex.

So what can you do about it now?

First listen to your body...if it is painful, slow down, adjust your position, or just stop.  You don't want your body to associate pain with sex..this creates muscle guarding and increased anxiety....which are easily avoidable.

Then try some lubricant. Natural oils like coconut and olive oil can help boost the bodies natural moisture, but if you go with store bought always go with water based.  If you have sensitive skin, you may want to stick with organic brands like Sliquid.

Massage, massage, massage!!!

So think of yourself as an athlete returning to your sport after an injury.  [Not that I consider birthing an injury...it is a natural process for the female body] but bare with me.  An athlete with ice, heat, get a targeted massage, do targeted exercises for the injured area.  These help the body heal!  So why wouldn't you help your body heal by using targeted massage and exercises?

Take out that coconut or olive oil and gently massage your perineum (that tissue between the vagina and anus), especially if you have a scar.  If you have a c-section scar gently massage it and the surrounding tissue.

*Always wait for the scar to be fully closed before doing any massage*

Stretches and targeted pelvic floor awareness exercises helps your muscles find their groove again.  Because of the strain and stretch these tissues experience they loose some of their natural function to contract and may end of tightening up or weakening.

Reacquanting yourself to this area with breathing exercises to synchronize your diaphragms and create a new muscle memory will help bring back the sexual function of the pelvic floor.

Be aware though that KEGELS should not be done if you have tight pelvic floor muscles...this will only lead to more tension and more pain.

My best advice is to assessed by a women's health physical therapist who is trained in postnatal and pelvic floor care.  That way you will know exactly what your body needs!! No point in guessing when there are experts who can help!

Too many moms I have worked with waited months and even years experiencing pain with sex.  Don't wait, soreness and tenderness is totally normal the first few times you try.  But persistent, sharp, stabbing, burning, (I could go on here) is not!

Do yourself and your partner a favor and mention it the next time you see your provider. Or better yet find a local women's health PT near you..did I mention NH is a direct access state, so you can see a PT without a referral.  How cool is that!

Remember the only sensations you should be feeling during sex are pleasurable ones!

What You Were Not Told About Birth: Part 1

So I can't tell you how many times I have been chatting with a client and she says

Why didn't they [meaning her OB or midwife] tell me that?

And I can never really give a good answer, because I don't know why providers don't inform expecting moms what may or will happen to her body after birth.

To me, this should be common practice, so that moms can make the best decisions while preparing for birth and recovery. If we are unaware of what to expect how can we prepare?

This creates more of a reactionary mindset, which is typically more defensive.  Rather than a proactive mindset, which is typically more offensive.

So I've decided to delve into the issues that aren't brought up. The changes, birth injuries and short and long term problems that arise from pregnancy and birth.

To begin, I want to talk about a podcast I listened to this morning on the way to work.  It was called Risky Birth-ness from The Longest Shortest Time.

It was brought to my attention by a past client, who thought I'd enjoy the topic, being about the risks of vaginal births.

In the episode the host, Hillary interviews Kiera Butler who wrote What the Expect: Why aren't we talking about the surprising number of women injured by childbirth?  for the magazine Mother Jones.

[You may subscribe to the magazine for free here]

After downloading the podcast I couldn't wait to listen to it!!

I am such an advocate for women who experience childbirth injuries so I was excited to hear what Kiera had to say.

So I was shocked to feel less than satisfied by the conversation. Which you can listen to here.

Hillary and Kiera spoke some specific birth traumas that can occur from vaginal birth and how the prevalence of birth traumas are on the rise.  How Doctors are required by law to inform women the risks of  C-section but aren't required to discuss the risks of vaginal birth.

They also discussed certain interventions that may occur during vaginal birth, such as epidural, vacuum, episiotomy, and how the risks of these interventions are not addressed. And how vaginal birth can leads to short term and long term injury. Kiera went into a little more detail around these, stating short term injury is tearing or episiotomy and long term can be prolapse and stress incontinence. [I will go into more detail to these later].

But to me, this episode sounds almost like an anti-vaginal birth discussion until the very end.  I do not believe that was the intent; however I feel there was information lacking about the comparison in risks between C-section and vaginal, not just stating there are risks with C-section as well because it is major surgery.

Here's my insight on the risks of vaginal birth - 

Vaginal birth is the most natural way to deliver; however there are circumstances that can reduce a woman's ability to birth vaginally, so in those cases C-section is necessary.

Just because vaginal birth is the most natural doesn't mean there are no risks to your body.

There needs to be more education upfront about how to birth, including positioning, respecting the bodies innate pushing reflex. This includes the providers involved doing every effort to use these practices rather than the default lying on the back and telling moms to push.

Providers need to have more training on the muscular on the pelvis or to at least have it become standard practice to have expecting moms see a physical therapist trained in pelvic floor and prenatal care.  This gives expecting moms the best opportunity to bring awareness to the proper muscles that are the most involved or injured during birth, regardless of method.

Even though the risk of stress incontinence and prolapse is twice as likely for those women who have vaginal births compared to C-section and may lead to surgery in the long run. These are still risks of C-section in addition to other complications like abdominal pain, back pain, painful sex...

Medical interventions should be the last resort based on an individual basis, because there are other risks that are involved, such as epidural migraines, lack of body awareness to feel a natural push (which can lead to tearing), trauma to infant from vacuum or forceps, etc.

Hospitals and birthing centers need to be more open about it being the woman's decision for birth method and the experience she is looking for. Meaning she should not feel pressured or shamed into either method, but treated with respect.

Care does not end after birth. There needs to be more education around recovery, what to expect, what could happen and how to be proactive. I like how Kiera brought up recovery in France includes PT! [I have to listen to the podcast about pelvic floor PT].

And never, I mean never, tell a mom "At least you have a healthy baby" when she expresses a discontent with the birth experience because it diminishes her feelings.

Each birth experience is different because each woman is different, so every women should have the opportunity to be able to make an informed decision about that experience, without feeling pressured by society, medical community, friends, family or other moms. The only way we can make informed decisions is by being educated by those who have the information.  If birth trauma is not discussed, normalized or dismissed, then woman won't know to ask. So providers need to be the first to bring it up. Especially since, pregnancy books don't talk about birth trauma.

After listening to this podcast I was worried I was over reacting, but was pleasantly reassured by other's comments that I was not the only one who felt that this episode left me wanting more.  As one woman pointed out in the comments - there was nothing said about vaginal injuries being linked to the birth environment, including medical professionals you've never met, machines, IV, other sounds, etc, which may affect the moms mindset around birth. As I mentioned in another post, when a mom feels uncomfortable with a situation during labor the body responses by slowing or stalling progression. This can lead to intervention and possible injury.  So I'm glad someone brought this up in the comments.  That yes, there can be birth trauma and injury but what percentage of this trauma was caused by or within less than desirable environments.

I know I may stir up some conversation about this topic and I'd love to hear from you.  Tell me about your birth experiences. That is the only way we can learn from each other and figure out the best way to educate other woman about the birthing process.

Look for part 2 of this series as I get more in depth with some of the issues brought up in the podcast like stress incontinence, pain, prolapse and more.