Episiotomies, which are incisions in the perineum (the area between the vagina and anus) to make more room for the baby, aren't routine anymore, says Bruce Shephard, M.D., an ob-gyn in Tampa. But some doctors still do them, especially if you've been pushing for several hours. If you don't get one, tears in the perineum may occur -- usually as the baby's head and shoulders pass through. Whether you're cut or you tear, expect stitches and discomfort around the wound.
How to treat it: The first week, use a squeeze bottle filled with warm water to rinse the area whenever you use the toilet. Pat -- don't wipe -- dry. Sitz baths can also help. Aim for three ten-minute soaks daily. To alleviate soreness, sit on an ice pack for ten minutes at a time. Medication such as ibuprofen can help too.
When to call the doctor: Discomfort should lessen a bit each day. If the perineum becomes more painful or is bleeding, call your doctor. Also check in if you notice discharge, a foul odor, redness, or stinging when you urinate -- all possible signs of an infection.
Long-term care: Most stitches heal with no side effects. Occasionally, women have scar tissue that causes numbness or pain during sex.
The weight of your baby and/or strenuous pushing can weaken pelvic-floor muscles, which support internal organs, says Kristene E. Whitmore, M.D., a clinical associate professor of urology at Drexel University, in Philadelphia. When this happens, the bladder, uterus, or bowel -- or all three -- can shift from their normal positions. The most common symptom of this is urinary incontinence. Another sign is a heaviness or bulge in the vagina or fecal bowel leakage.
How to treat it: Visit your ob-gyn, who may send you to a urogynecologist. Although most doctors suggest waiting up to six months to start aggressive treatment (which can include physical therapy, electrical stimulation, or drug or hormone therapy), some prolapses require immediate care. Either way, the first course of treatment is almost always Kegel exercises.
When to call the doctor: Phone if you feel something protruding from your vagina or if you have difficulty urinating or having bowel movements.
Long-term care: Fifty to 70 percent of women with mild prolapse who do Kegels heal after about six months.
Hemorrhoids are enlarged veins of the anus and rectum usually caused by pressure from constipation or from pushing during labor. You're at increased risk postpartum if you had them during your pregnancy, but they can happen to anyone, says Constance Bohon, M.D., an ob-gyn in Washington, D.C. How will you know you have one? Most women report discomfort around their rectum. Occasionally, the hemorrhoid is visible -- it looks like a pink pea is sticking out of your bottom.
How to treat them: Doctors may prescribe stool softeners and topical medications that have hydrocortisone to alleviate swelling. Most doctors suggest avoiding iron supplements, which can be constipating. It's also best to keep the area as clean and dry as possible.
When to call the doctor: Call if pain or itching becomes intense, or if the vein looks purple or large, which means it could have a clot in it.
Long-term care: The majority of hemorrhoids resolve on their own. Topical medications can speed recovery. Rarely, surgery is needed.
After delivery, you will bleed as the uterus contracts back to its original size. The bleeding shouldn't be a lot heavier than a normal period. But sometimes, a piece of the placenta is left inside, which can lead to heavy bleeding. "You can also bleed heavily if you do too much activity," Dr. Bohon says.
How to treat it: If you lie down and the bleeding subsides, that's a sign you've been overexerting yourself and should take it easy. But if rest doesn't help and your doctor suspects retained placenta -- part or all of your placenta is still inside -- you will need a dilation and curettage, or D&C, to clean out your uterus.
When to call the doctor: If you're soaking more than one pad an hour or passing clots that are as big as a lemon, you need medical attention.
Long-term care: You may be anemic and tired after blood loss, so your doctor may prescribe iron supplements and plenty of rest.
Copyright © 2005. Reprinted with permission from the January 2005 issue of Parents magazine.
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