Before delivery, concern about the baby’s welfare is the main priority, but it is sensible to think about how your body will be affected. The debate about rates of caesarean section will continue for ever, but what matters is you and your delivery. Data from Scandinavia has shown how protecting the perineum rather than “hands off” delivery, makes extensive trauma to mother tissues less likely.
Software for mothers to use during the pregnancy is becoming available which helps an individual mother assess whether she is at increased risk of long-term pelvic floor trauma.
Persistent bleeding after 6 weeks may be due to infection inside the uterus, with or without some placental tissue which is still in the uterus. Taking a culture swab and doing a pelvic scan together with blood tests to check for anaemia may be needed.
Stitches in the vagina with an episiotomy or from a tear should get less and less painful, and be healed within 2 weeks. Pain which goes on for weeks and or pain with intercourse may indicate the presence of vaginal granulation tissue. This is not a serious, and is easy to resolve as part of your consultation.
Poor control of urine/feeling numb in the perineum occur in the first week in many mothers and improves with time especially when combined with as much pelvic floor exercise as you can manage.
Granulation tissue can be treated during your consultation with local application of silver nitrate.
Finding time to do pelvic floor exercise is not easy when looking after a new baby, but the earlier you do it, the greater the benefit – think of the intensive exercise rehabilitation used by athletes with soft tissue injuries, and it makes sense.
In the short term, surgery rarely has a role. In the longer term, the whole pelvic floor function is taken into consideration.
Increased maternal age, leaking urine with coughing during pregnancy, large baby, forceps or ventouse delivery, and family history.
No, pregnancy alone increases the risk of pelvic floor problems later, but rarely are the problems bothersome enough to need any surgical intervention.