Common Questions Answered

There are a number of issues that can arise after giving birth.  If you are uncertain about a symptom please reach out to your health care provider but here are a few key issues that you should see your doctor:

This is a difficult question to answer as it varies significantly from person to person.  Depending on what kind of birth you have will determine a lot about your recovery.

This is not just about Vaginal Birth vs C-Section but also about the kind of pregnancy & birth you had. Some examples include:

• A straight forward pregnancy vs a complicated one that could include prolonged bed rest
• Did the birth go smoothly and to plan?
• Was the birth premature?
• Did you feel prepared for what happened during the birth?
• Was it complicated – ie a bad tear / a traumatic emergency c-section/ baby complications.

To make it easier we will take an average timeline that most women follow.

For most women who have had a straightforward pregnancy in which they kept active and an uncomplicated vaginal birth with a smaller tear (grade I/II) and/or episiotomy or a planned or uncomplicated C Section with no postpartum complications; we can generally say that by 6 weeks they are able to start returning to more intense activities. It is important to note that the individual has to be accounted for, so we always strongly recommend seeing a pelvic floor physiotherapist to assess you and determine whether you are safe to resume all of your normal activities.

Unless you are a miraculous human being without doubt you will have a degree of soreness and inflammation down below after a vaginal birth and possibly soreness around the tummy are too.  Depending on the mechanics of how the birth followed you may have pain in your pelvis, low back or around your pubic bone too.  Going to the toilet may be a very uncomfortable time in the early stages.  Here are some simple ways to help relieve any soreness and inflammation in the first several days after giving birth.

The first and most obvious is to take what ever pain medication has been prescribed by your doctor for the level of pain you have. This varies between people and your Doctor will advise and prescribe what you need.

Another very effective pain relief tool during the early stages of recovery is ice. There are different options for its application. The one many women prefer is the frozen sanitary towel. Take clean water, soak a large sanitary towel in it and freeze it. Ideally we advise using the sanitary towel for about 15 minutes or until it is melted and no longer giving relief. (No longer advised as can become warm and moist increasing chances of infection). Then gently dry the area by gently patting with a towel, then lying on the towel with no underwear for about 10 minutes.  This is a gravity offloaded position as well as allowing the area to dry out which is also an important healing component.

For the first couple of weeks post birth gravity is not your friend. If you sit directly onto your vulva most women find it too painful so an easy way around this is to sit in a way that doesn’t place any direct contact onto the vulva. Either by sitting in a side seated or on one bottom sitting. Using a towel rolled up from the ends to allow space for the vulva. Or using a donut cushion (can buy inflatable donut rings as pic from Amazon).

When sitting on either the towel or rolled up cushion we advise not to sit for too long as gravity will cause pooling of liquid in and around the vulva causing more discomfort. Where possible especially in the first week spend more time lying down rather than sitting down, as the swelling and bruising subside so will it become easier to sit for longer periods and directly onto the vulva itself.

While we do not want to over exert a very fatigued and (depending on whether you have torn or had an episiotomy) damaged pelvic floor; using the muscles can be like a pump action which gently pushes out the fluids gathered.  Gentle pelvic floor squeezes where you try to “stop passing wind” and then relax. You can aim to try repeat this 3-5 times several times through the day.

We do not advise practicing these pelvic floor contractions without a check from a Womans Health physio first if you have been told you had a Grade III or Grade IV tear or Prolapse during the Birth.

An episiotomy is a cut made through the perineum (area between vagina and anus). It is a procedure done during childbirth to make the area larger for the baby to pass through.

Like any wound it needs to be cared for to prevent infection. If however you feel or see any of the following signs seek medical help:

•  red, swollen skin or small pustules developing in or around the stitches
•  increased pain in the stitches
•  smelly discharge
•  you develop a fever

The episiotomy will likely bleed quite a lot initially but this should be stopped by the stitches and some pressure.  If you suddenly begin to bleed more or feel you may have burst the stitches seek medical treatment.  While a sudden increase in pain is not usual it is common to feel some pain and discomfort for the first 2-3 weeks. There are a few over the counter painkillers that are safe to be taken even while breastfeeding. Ask  your doctor or pharmacist about which would be best for you.

After giving birth if you are in a medical setting they will likely want to measure your first urine output. Urination may sting initially after giving birth as the urine passes over the wound. However this generally reduces quite quickly. Pouring clean warm water with a squirt bottle as you urinate may reduce this stinging sensation.

Some women find hovering over the toilet seat as opposed to sitting down can reduce the stinging sensation when urinating. While long term we do not recommend this position but rather a knees above hip position via the use of a stool/ potty squatty; for the first few days it can help.  When having a bowel movement this allows the a muscle in the pelvic floor (puborectalis) to relax which unkinks your bowel making it easier to pass out the stool.  Some find it helps when having a bowel movement to hold a clean pad gently pressed over the perineal wound for a bit of counter pressure.

Also advised to try and prevent Constipation by ensuring sufficient fluid and fiber intake.  Take care if you are using a fibre supplement as if not taken with sufficient fluid it can increase constipation. Some women will be given or may need a laxative or stool softener, discuss this with your healthcare provider.

Toilet tissue can come apart and get stuck in the wound or stitches, and is usually quite uncomfortable to use.   After urination or a bowel movement use a squirt bottle with clean warm water to clean instead of toilet paper.   After cleaning if you chose you can either air dry or use a clean towel to pat dry the area rather than wiping.  If you do choose to wipe with toilet paper then with bowel movement always wipe front to back to avoid any faecal matter getting in the wound.

After 24 hours post birth you can try the following to relieve discomfort, promote faster healing and ensure the area is as clean as possible.  Fill a bath tub or basin with 3-4 inches of clean warm water and sit in it for about 15-20 mins.  You can also add a little bit of epsom salt or baking soda to the water which can help with soothing.  In addition to cleaning the warm water increases blood flow to the perineal area which can promote faster healing as well as reduce itching, irritation and mild pain.

Another very effective pain relief tool during the early stages of recovery is ice. There are different options for its application. The one many women prefer is the frozen sanitary towel. Take clean water, soak a large sanitary towel in it and freeze it. Ideally we advise using the sanitary towel for about 15 minutes or until it is melted and no longer giving relief. (No longer advised as can become warm and moist increasing chances of infection). Then gently dry the area by gently patting with a towel, then lying on the towel with no underwear for about 10 minutes.  This is a gravity offloaded position as well as allowing the area to dry out which is also an important healing component.

Dissolvable stitches are most commonly used and generally break down in the first 2-4 weeks.  Depending on where you have given birth you may have a 6 week follow up where your healthcare provider will check that the stitches have dissolved and that the scar is healing well. Ideally you will see a Women’s Health physiotherapist at around 6-8 weeks after birth who will also check your perineum and your scar as part of the assessment. They will advise you on what you need to do to continue care if needed as well as any other postpartum issues you may be facing.

Occasionally some women may develop scar hypertrophy (excessive scar tissue formation); scar sensitivity (where the scar becomes overly sensitised to any touching) or the tissue around the scar becomes a bit tight which may cause discomfort or pain on penetration. All of these can be helped with different programs of desensitisation exercises as well as perineal massage and stretching if required.

See our section on Perineal Massage

Getting up from a reclining position after giving birth can be a greater challenge than initially imagined. When you are very newly postpartum you may still be recovering from pain and discomfort from both the vagina and pelvic floor region as well as various different musculoskeletal pains. We also want to limit and worsening of the Diastasis Recti (abdominal separation) so we try to avoid the sit directly up movement.

For some women the thought of exercising after birth is not even a consideration until much much later but for many women they can be very keen to return to exercise as soon as possible after giving birth.

After a “straight forward” vaginal birth with minimal to no tearing many women feel they are able to return to exercise sometimes as soon as a few days after birth. And while that may be a possibility for some, it is generally not recommended unless you have been assessed by a qualified and trained healthcare provider and given the all clear.

This is for a number of reasons but chiefly your body is trying to recover from the ordeal of giving birth as well as all the changes that occurred during pregnancy.  In the first weeks postpartum a vaginal birth your body is needing to recover from:

It is generally advised for women to wait for 4-6 weeks after giving birth to resume sexual activity. This gives the body a chance to heal and reduces risk of complication and infection. In this time your tear/episiotomy scars should heal, the lochia (postpartum discharge) should have stopped and your cervix should have closed. It is usually safest to get checked by your healthcare provider to get the go ahead to resume sexual activity.

While some women are keen to resume sexual intercourse as soon as possible, many women are anxious about having sex again. This can be especially true if they have had any injury to the vulva and or perineum during a vaginal or attempted vaginal delivery.

Once you’ve been cleared to resume sexual activity from your healthcare provider, you should only resume sexual activities when you are ready. Sex after giving birth should not be painful. The first few times may be uncomfortable but if it is very painful or persistently painful then you should seek medical advice. It is also common to not feel any desire for sexual activity initially this is due to a number of reasons including:

• hormonal changes – low oestrogen (vaginal dryness) & higher oxytocin (this hormone triggers feel good baby hormones but naturally suppresses your sex drive)
• fear – of pain, of how things will feel different, of how your partner/ you view your body
• fatigue – having a newborn is easily the most exhausting time in many people’s lives
• no time – finding time to be intimate with your partner can prove to be a real challenge when you are caring for a new born
• painful and leaking breasts – this can be quite common when you are breastfeeding

It needs to be highlighted than some women can get pregnant again as soon as 3 weeks after giving birth even if you are breastfeeding and your periods have not returned yet.  So if you do not wish to be pregnant again so soon you must use a contraception each time you engage in sexual activities.

Something that many women notice after giving birth is a change to the sensation or feeling of sexual intercourse. It is not always a bad change! Many women report increased pleasure and intensity of orgasms after giving birth. However in some cases some women report either a feeling of “difference”, lack of sensation, more room than before, heaviness or bulging in the vagina, pain on either touching or on penetration. This can be due to a number of reasons:

• change in the tone of your pelvic floor (hyper or hypotonicity)
• infection
• hormonal changes
• prolapse

This is a very important topic to understand. It is one that is commonly misconceived or misunderstood. There are 2 things that can happen to the Pelvic Floor after birth.  It can become high tone and overactive or be low tone and more lax.  The first thing to understand is what is muscle tone. Muscle tone can be described as the amount of tension in a muscle at rest which is very different from muscle strength – which is how much force a muscle can create in response to resistance.

Hypertonic muscles is where the tone in the muscle is too high.  When the tone in the pelvic floor is too high the muscles become tense and are unable to relax.  This can cause pain on penetration as well as other concerns such as urgency, constipation and pelvic pain. There can be a number of different reasons that people develop overactive pelvic floors and it can occur after giving birth.  Many people assume that after giving birth there will be a drop in tone but the opposite can happen.

Treatment for hypertonic pelvic floors usually requires a variety of treatments that can include breathing techniques with muscle relaxation and manual release of the muscles which can be done by a Women’s Health physio.  Desensitisation and Scar tissue of the perineum itself can help – see our ‘Perineal Massage’

Hypotonic Muscles is the opposite and can also be an issue after giving birth, where the tone of the muscle has reduced and now there is more laxity as well as decreased strength and possibly sensation on penetration.  In this case then we recommend seeing our Section on ‘Pelvic Floor Activation Exercises’ which will help to restrengthen these Pelvic Floor Muscles after birth.

If you are unsure which one you are experiencing then a Women’s health physio check would really benefit you where they can use ultrasound and feel for your pelvic floor tone and function.

It is important to rule out any source of infection. An infection for example, a urinary tract infection (UTI) or fungal infection can also affect the tissue of the vagina making penetrative sex very uncomfortable. Your healthcare provider will likely do some examinations to rule out any infection that would need to be treated first.  Signs of infection can include redness, bleeding, pain in and around the vagina or urethra, increase in discharge or foul smelling discharge, itching or increase in frequency of urination to name a few.

When you are breastfeeding the hormone oestrogen depletes significantly. This hormone plays an important role in both lubricating the vagina as well as tissue pliability so as this become low especially in women who are breastfeeding it can contribute to vaginal dryness as well as making the vaginal tissues thinner and more delicate. This not only contributes to discomfort during sex but can even make wiping or wearing tight clothes uncomfortable.

If you’re struggling with these feelings there are some simple at home remedies that can help such as keeping the tissues moisturised by applying a small amount of some food quality grade coconut oil, an over the counter vaginal moisturiser or chat to your GP or Ob/Gyn about whether you’d benefit from an oestrogen topical cream. Using a sitz bath again can help with painful or burning sensation.

When breastfeeding as well as lowering oestrogen levels, your body produces more oxytocin. This hormone makes you feel good and bonded to the baby but naturally suppresses your sexual drive. It can be thought of your body’s way of naturally trying to limit the chance of conception again. But this does not last forever and many women are relieved to hear there is a reason for this drop in libido.

If you are finding yourself quite dry down there then lubricants can help.  Try to avoid coloured, scented or flavoured lubricants as they can be irritants and can upset the natural pH balance in your vagina. Try different types until you find the one that works best for you. Remember silicone lubricants can affect the latex of some forms of contraception so take that into consideration.

Foreplay can be helpful by improving arousal, blood flow to the genitals and self lubrication.  Not for everyone but can be a good way to ease back into sex.  The first few times does not need to be about penetration but mutual enjoyment and connection which can be done with touching, cuddling, kissing, mutual masturbation, massage what ever feels good to you and your partner.

If you have used toys or aids previously you may wish to use the same ones or may prefer to try others. You can explore toys that stimulate in different ways, anything from penetrative toys to clitoral or anal based stimulators.

Aids such as the ohnut can help with controlling depth of penetration. Sometimes when women struggle with pelvic floor muscles that are hypertonic or “too tight” a set of dilators or a pelvic floor wand can help release some of the tightness and tension.

Foreplay can be helpful by improving arousal, blood flow to the genitals and self lubrication.  Not for everyone but can be a good way to ease back into sex.  The first few times does not need to be about penetration but mutual enjoyment and connection which can be done with touching, cuddling, kissing, mutual masturbation, massage what ever feels good to you and your partner.

Different positions may be more comfortable/ enjoyable after giving birth depending on scar sensitivities, preference and your pelvic floor:

• Woman on top  for control of depth of penetration and speed
• Side to side (spooning) again allows for control of depth, speed and access to clitoral stimulation from both parties
• Woman lying flat on your stomach which can allow for easing into penetration without going too deep
• Instead of standard missionary you may try the Coital Alignment Technique (CAT) position for more clitoral stimulation and less depth of penetration
• Oral sex can be a great way to ease into sex with digital penetration as opposed to a penis or dildo.

Just like scar tissue anywhere on the body the scar tissue in and around the genitals and in the perineum can become overly sensitised (even light touch feels uncomfortable) or can develop constrictions around the scar tissue.  To prevent sensitivity increasing once the wound has healed it should be touched regularly ie when cleaning in the shower do not avoid touching your scar.

If however after a few months the sensitivity has not settle and is still tender, in these cases a program of scar desensitisation can be undertaken with generally very positive results. Like with any scar sensitivity work it starts with very gentle touching to desensitise the area. This can be done with fingers and or different objects and textures every day. It is done with increasing tension and pressure until the sensitivity to touch has gone.

Sometimes scar tissue or the area surrounding it can contract or develop into excessive scar tissue (hypertrophic or keloid scar). It can result in reduced elasticity as well as possibly reducing the size of the introitus (entrance to the vagina). Scar massage is meant to help with the mobility and elasticity around the area it does not always help with the excessive scar tissue formation.

See our ‘Perineum Massage‘ section to learn how to do perineal scar massage and desensitisation.

Breast feeding makes your breasts tender and leaky. For some women they can find leaking breasts embarrassing while others do not mind. During breast stimulation and orgasm you generally release oxytocin, the same hormone that triggers the let down reflex.  This can result in the breasts leaking or even spraying milk.

If you find this uncomfortable or embarrassing there are certain things to try, but the first and foremost thing should be to discuss this with your partner.

Other tips include:

• pump or nurse before sex to reduce the feeling of being too full
• wear a nursing bra or lingerie with nursing pad to help ease the feeling of heaviness and help absorb the leakage
• trying different positions to find which feels most comfortable – for example straddling your partner in a seated position with your breasts gently pressed against them for support