When I was eight months pregnant, a friend told me: “Don’t worry, it all goes back to normal down there in about a month.” I didn’t really know what she meant, but I filed away the information. A few weeks later, following childbirth, I felt like my body had been through a beautiful though shocking experience, and those words of reassurance stayed with me as I navigated pain, postpartum bleeding, and other physical symptoms.
If you’re pregnant, you likely expect a period of physical recovery for your vagina following childbirth. Yet, the details can be hazy. Issues like postpartum bleeding or swelling will resolve in a few weeks, as my friend promised. But there are also things that can last, including postpartum incontinence and painful sex. To take away some of the mystery, let’s review what really happens down there after childbirth.
PAIN AND SWELLING
The average newborn is about 7.5 pounds. As you can imagine, it hurts to push out something that weighs about the same as a gallon of water. You might also need stitches if you tear or have an episiotomy, aka a surgical incision to the vaginal wall made by the doctor during delivery. The realities of vaginal delivery lead to discomfort and swelling right after.
Dr. Heather Rupe, an OB-GYN and WebMD contributor, told me that pain and swelling should be 90 percent resolved in the first two weeks, while the last 10 percent usually takes another month. In order to keep the recovery process going smoothly, she recommends postpartum ice packs and warm water (sitz) baths when you get home. It’s also crucial not to overdo it physically in the first two weeks of healing.
Samsarah Morgan, a doula with Doulas By the Bay and executive director of Oakland Better Birth Foundation, explained that working with a doula can also help mitigate injuries by encouraging gentle pushing techniques and as few medical interventions as possible.
“In hospitals, they tend to give you a cold compress. If they don’t you should ask,” Morgan noted, adding that herbs like witch hazel can help when you get home, too. Many moms I’ve talked to swear by witch hazel pads you can find on Amazon or at a drugstore. Line them up in your underwear for immediate relief.
Tearing or surgical cuts during childbirth can result in stitches, as mentioned above. These wounds can range from a first-degree tear, which is just skin deep and typically heals naturally, to fourth-degree tears, which include the anus and rectum. Second-degree or higher tears are typically repaired with stitches. Your doctor may prescribe pain medication depending on how serious the injury is and should give specific direction on how to care for it. Sometimes warm baths are recommended, while other times they’re not. It is typical to be directed to clean the area with a spray bottle and also wipe or pat front to back when you go to the bathroom. Ask your doctor for details on what to expect and how to care for your specific situation.
If you have stitches, it’s crucial to take it easy: “If you are too active initially you can damage your stitches and this causes the vagina not to heal properly,” Dr. Rupe said. In two weeks, you should see things heal pretty well. Expect some itching and for the stitches to fall out themselves.
In addition to birthing a baby, a woman delivers the placenta. Once it is detached from the uterus, there is an open wound in the body that has to heal. The result is bleeding that will be heavier for two to three weeks and last from six to eight weeks. “The blood shouldn’t be as thick or red as menstrual blood beyond the first 24 hours,” Morgan explained, adding: “If you’re resting well and eating well it should taper off in two weeks.” During this time, you’ll want to use pads, and not tampons.
Morgan explained that consideration of this open wound is often why many cultures encourage women to stay in for 40 days following childbirth. “We’re lucky if we can get American women to rest for two weeks,” she pointed out, “but they need to rest.”
Hemorrhoids are swollen veins in your rectum and anus and are a common side-effect of labor and delivery. As with other swelling, witch hazel pads, cold compresses, and warm baths can help alleviate the discomfort.
Typically before you leave the hospital, the nurses will check on whether you’ve managed to have a bowel movement. The culprit of constipation could be both physical and mental. Pain medications can stop you up, as can the fear that going to the bathroom will be painful. Do your best to eat fiber and relax.
POSTPARTUM URINARY INCONTINENCE
One in three new moms experiences urinary stress incontinence, meaning they pee their pants a bit when they cough, sneeze, exercise, laugh, or have sex. “I encourage them to do their Kegels and give themselves some time,” Dr. Rupe explained. She said it can take about three months for your pelvic floor to recover from childbirth and for the bladder leakage to stop. “If women are still having issues at three months postpartum, I recommend pelvic physical therapy.”
Pelvic floor physical therapy is hands on. A physical therapist will use their fingers in the vagina to help work the muscle and often get good results. While you consider options to address postpartum incontinence, bladder pads can also keep you dry.
Postpartum hormonal changes can cause significant vaginal dryness. This is especially true if you’re exclusively breastfeeding. Estrogen helps to keep our vagina lubricated, but those hormone levels drop significantly when you’re nursing. The phenomenon is similar to what happens during menopause. Keep in mind that it mostly impacts penetrative sex, so other fun is still on the table.
“I encourage women to use adequate lubrication,” Dr. Rupe told me. If lubrication isn’t enough, she said topical vaginal hormonal creams effectively relieve the symptoms. While you’ll want to talk to your doctor about using hormone creams, Dr. Rupe said they are safe to use while breastfeeding because there is minimal systemic absorption.
WHAT IF YOU HAVE A C-SECTION?
“You should not have vaginal pain after a c-section unless you have one after pushing for several hours,” Dr. Rupe explained. If you did have to push, then you might have swelling and achy pressure for a week. Symptoms like postpartum incontinence or hemorrhoids are also a possibility if you pushed. Because the placenta wound does need to heal regardless of how you give birth, you can still expect bleeding. While bleeding associated with vaginal delivery can last six to eight weeks, bleeding from a c-section should be a little shorter, for about four to six weeks. And if you’re breastfeeding, you might still experience painful sex.
Childbirth is an amazing physical feat, and your body is going to feel the aftermath. Most of the symptoms should subside by your six-week checkup with your doctor, which is the perfect time to discuss those that haven’t.