It’s ridiculous how many expectations and conventions exist around childbirth and parenting. But over the course of writing two books about this time of life, I’ve come to appreciate that there are some things you simply cannot anticipate: things people don’t talk about, sometimes because they are sad, sometimes uncomfortable, sometimes just plain weird. I think we should talk about them—and, more than that, we should use data to really understand them. (I’m an economist; I love data). Acknowledging the data can often relieve a lot of the pressure on parents, either by reflecting experiences that feel isolating in the moment or by presenting us with a greater range of choices than we might have thought we had. In that spirit, I have a series in Slate this week about how data helps illuminate childbirth and parenting’s most underdiscussed topics.
When I was in graduate school, many years before I contemplated having children of my own, a close friend had a baby. A week or so after she was born, I went to their house to bring a gift. The truth is probably not this extreme, but I recall my friend opening the door and, as I stood there in the foyer, announcing that she had a fourth-degree vaginal tear stretching from her vagina all the way to the anus. At that moment, I wasn’t sure if I should suggest we take a seat.
Before I had children, I had the vague sense that there must be some trauma associated with birth. But I had certainly never contemplated the details. To say the news of my friend’s fourth-degree vaginal tear was a surprise was an understatement. Part of the reason for the surprise was that I wasn’t yet at that life stage, but the other part is that—minus a few helpful friends—women simply do not talk much about the recovery from childbirth.
There are a lot of baby books (I just wrote one) that aim to tell you what will happen with your baby. And there are a lot of pregnancy books (I also wrote one) that detail what happens to you while you are pregnant. But the literature is oddly lacking in discussions of what happens, physically, to the mom after the baby arrives. Before the baby, you’re a vessel to be cherished and protected. After the baby, you’re a lactation-oriented baby accessory.
This omission is problematic, since it fails to inform women about what to expect after they’re expecting. Physical recovery from childbirth is not always straightforward, and even in the best of circumstances, it’s messy.
If you’ve had a caesarean, your doctor will stitch up the incision and dress the wound. This is typically a straightforward process, and similar from woman to woman. With a vaginal birth, there is more variation, largely due to differences in the degree of vaginal tearing. This tearing most frequently involves the perineum—the area between the vagina and anus—but you can also have tearing in the direction of the clitoris.
The degree varies widely from woman to woman. Some women do not tear at all (although most women do a bit, at least with their first baby). In the case of the perineum, the degree of tearing is ranked from first- to fourth-degree. A first-degree laceration is minor tearing, which heals well on its own with no stitches. Second-degree means there is more involvement of the perineal muscles, but the tear doesn’t extend to the anus. Third- and fourth- degree tears extend all the way from the vagina to the anus but differ in how deep they go, with fourth-degree tears extending into the rectum. Third- and fourth-degree tears must be repaired with stitches, which will dissolve on their own after a few weeks.
Most tears are on the minor side, but approximately 1 to 5 percent of women will have more serious third- and fourth-degree tears. More severe tearing is more common with instrument-assisted delivery (that is, delivery with either forceps or a vacuum), more common for first babies, and more common if the baby is very large.
You may wonder what you can do to prevent this. The answer is not much, although there is some evidence that warm compresses on the perineum during the pushing stage of labor can prevent very severe tears. One note is that vaginal trauma is much more common if a doctor performs an episiotomy—making a cut in the vagina to help the baby come out. Although these used to be very common, they are no longer part of routine practice and are strongly discouraged by most medical experts.
Let’s assume, like the rest of us, you have some vaginal tearing. Among your first concerns is likely to be: Isn’t it going to hurt to pee and poop? The answer is yes, at least to some extent. Even if you had a very “easy” experience, your vagina will still be kind of banged up, and you’ll feel some stinging when you pee. It’s worse if you are dehydrated, which makes the urine more concentrated. At many hospitals, they’ll give you a squeeze bottle of water, the idea being that you spray water on yourself while you pee so the urine is diluted and not as painful. This works OK, although—here’s a pro tip—definitely make sure you do not use extremely cold water.
With pooping, it again depends on how traumatic your birth experience was. Or in the case of a C-section, as with any abdominal surgery, it is a question of how long your abdomen takes to “wake up” from anesthetizing drugs. It is common to give women stool softeners or laxatives to improve the first post-birth bowel movement. It may be a couple of days before you actually have that first bowel movement, which gives you a bit of healing time. And it may not be as bad as you fear.
Now it’s been a couple of weeks, you are back home, and you may start to wonder: When will things go back to normal? Ever? With a vaginal birth, there are significant lingering physical consequences for your vagina. As one medical description puts it, “After birth, the vagina will be capacious.”
Things will just not be quite the way they were before. You may still have stitches; the whole area will be painful and just kind of … off. It is not the vagina you are familiar with. It does heal, but it takes time, and for most women, things don’t quite go back to the way they were before birth. This doesn’t necessarily mean worse—just different. And a return to normalcy takes months, not weeks. You grew a baby for 40 weeks; give yourself a break on getting back.
Postpartum physical health is a challenge (as is mental health, which is equally important, but that’s for another essay). And it’s made more challenging by the fact that it can be hard to share the truth. You have a new baby—shouldn’t you be happy and feeling great? When people ask how you are, everyone wants to hear, “The baby is great! We’re so thrilled!” Not “I’m dealing with third-degree tearing and a lingering fear that my vagina will never be the same.” The fact that these things are not talked about makes many of us feel like we are the only ones dealing with them or we should just get over it. This simply isn’t true. I’m not suggesting we all start tweeting the details of our vaginal healing—although I have no problem with that—but the more we talk about this, the more we do a service to other women, and ourselves, too.
Cribsheet: A Data-Driven Guide to Better, More Relaxed Parenting, From Birth to Preschool
By Emily Oster. Penguin Press.
Adapted from Cribsheet: A Data-Driven Guide to Better, More Relaxed Parenting, From Birth to Preschool by Emily Oster. By arrangement of Penguin Press, part of the Penguin Random House company. Copyright (c) 2019 by Emily Oster.
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