On Childbirth and Wound Healing

It’s somewhat arbitrary but the idea is based on the timeframe for any type of wound healing. Whether it’s a scrape from a bike accident, a cut from a piece of glass or an incision from a surgical procedure, the timeline for healing is about 6 weeks.

So let’s be clear about this reality of childbirth: whether the delivery is vaginal or by c-section, childbirth wounds a mother’s body. In ways that few parents are prepared for and few doctors provide guidance on.

The human body has an amazing capacity for adaptation when it comes to procreation. The pelvic floor muscles relax, the uterus contracts, the cervix dilates. Even the connective tissues that hold the pelvic bones together have the capacity to shift in order to allow a tiny human to exit the body that carried it through gestation.

But all that shifting isn’t without consequence. Tears during delivery are common. In some cases, tears can extend through the vaginal wall into the urethra or even into the rectum. These tears require surgical repair and can lead to problems with urinary continence and deification. Shifts that happen during childbirth can also stretch the pudental nerves which are the nerves that carry pleasure sensations during sex. It’s not uncommon for people to struggle with urinary incontinence after childbirth. In fact, nearly a third of women suffer with this embarrassing condition postpartum.

What about c-section delivery? It depends on the need for c-section. Some women never go through the pelvic changes related to labor because they have medical indications for elective cesarean section delivery. Many other women require c-section delivery because of complications during labor: fetal distress, maternal exhaustion, failure of the fetus to progress downward during labor, umbilical cord prolapse and a host of other maternal or fetal factors can lead a physician to conclude that urgent surgical intervention is the safest option.

Patients who require surgical delivery after labor end up having two wounds to recover from: pelvic floor damage and major abdominal surgery.

So how are new parents counseled in the wake of these injuries. In most cases, the advice of physicians is “Congratulations! See you for follow up in two to six weeks. Oh, and no sex for 6 weeks.”

As if women have any desire to be touched in a sexual way after all that stretching and tearing.

As a pediatrician, I see new parents far more in the first year of parenting than almost any other professional. When I practiced in an insurance-based clinical setting, I was limited to 10 minute patient appointment times. Which meant that I actually got about 5 minutes per patient if I wanted to have any hope of completing clinical documentation on time. In those 5 minutes, I was meant to cover everything related to my patient: the baby. Is baby eating? Breast or bottle feeding? Are they jaundiced? Are they peeing and pooping? Are they gaining weight? Where are they sleeping? What were the results of their newborn screen and is it time for a repeat blood test?

It wasn’t until I started my own housecall based practice that I realized how miserably we, as a medical community, fail in this aspect of maternal-child health. Now, with the benefit of time and without the burden of interference by insurance companies, I can spend up to an hour with families and their newborns.

Rather than whisking a naked screaming infant out of its mother’s arms and onto a cold scale, the first thing I do at newborn visits is ask how the mother is doing. How is her body feeling? How are her wounds healing? How is breastfeeding going and is she experiencing pain or frustration with it? How are her hormone fluxuations affecting her mental health? How are parents managing sleep, showering and the general exhaustion that comes with having this new, tiny stranger in their house?

Baby showers, mommy blogs and social media all offer excited, soft-focused content and expectations of new parenthood that very seldom match the difficult reality of the first 2 months of parenting. It’s time we begin to talk about and normalize the truth about what a major life transition that new parents face.

Incontinence is common. Breastfeeding is difficult for many people. Babies are loud, messy and unpredictable. Sexual activity drops off precipitously when young children come into the picture. Relationships between partners change in ways that they can’t possibly imagine. It will be months before parents (especially mothers) see a full 7-8 hours of uninterrupted sleep. All of this is normal. And wounds take time to heal. We should do a better job of preparing people for it.

** This post was authored by Dr. Amber Hull without the use of AI technology.**