For many women, just “getting through” labor and delivering the baby should be the end of birth-related pain, right?  Unfortunately, that’s not always the case.  From vaginal tears to breastfeeding (yes, that can sometimes be pretty miserable, too), for some women the delivery is only the beginning of their postpartum discomfort.

​So, what can hurt so much compared to labor and delivery?  According to ACOG (the American Congress of Obstetricians and Gynecologists), somewhere between 53-79% of women experience tearing during childbirth whereas their British counterparts estimate that number to be as high as 90%.  Either way, chances are good that moms having vaginal births will have some type of laceration.  Not only can the repair process be extra uncomfortable for moms without an epidural, but suture in such a sensitive area can definitely cause some discomfort for some time after delivery.  We also know that some amount of labial swelling is also normal after delivery, and this is especially true for women who push for a long period of time.  In some cases, we can even see extra separation of the pubic bone where it stretches to accommodate a baby's head (pubic symphysis diastasis).  As for breastfeeding, pain can happen from the latch process, cracked nipples with thrush, mastitis and even the uterine contractions associated with breastfeeding.  Breastfeeding causes release of oxytocin, the same hormone used to stimulate labor, and this can result in pretty significant uterine contractions for some moms.  Lastly, moms who need cesarean delivery are expected to have pain after their surgery, too.

Is there anything to do about all this fun stuff?  During suturing of a vaginal tear, moms who have an epidural are already a little ahead of the game, although we certainly do our best to help numb the area with lidocaine for those who don’t have an epidural.  That being said, even with an amount of lidocaine injections that would be drool-inducing in the mouth, it’s quite a challenge for us to effectively numb the vagina.  Ice packs can be a big help for some of the labial swelling after delivery.  Occasional sitz baths may also be beneficial for women with tears as can stool softeners to help prevent constipation and straining in the area of a vaginal repair.  Pubic symphysis diastasis may require physical therapy or even a walker for a brief time.  With breastfeeding, moms are encouraged to take advantage of the knowledge of a lactation consultant to ensure proper latching and nipple care.  Thrush and cracked nipples often respond well to topical treatment whereas mastitis generally requires antibiotics to resolve.  Regrettably, there’s not much we can do to suppress contractions when breastfeeding.  Tylenol and Ibuprofen are also helpful for pain following a vaginal delivery, although postoperative pain from a cesarean delivery is likely to require something stronger.

For many fortunate moms, pain from labor and delivery fades soon after their baby is born; however, for others, some amount of discomfort may persist a bit longer.  Collaborating with your provider is generally the best way to ensure a satisfactory healing process, so if you are having issues, be sure to let them know.  The sooner you feel better after delivery, the more time you can focus on loving that new baby 😊

Dr. Nick

Probably not a clinic day goes by that I’m not asked to move up someone’s due date.  Not to say all moms-to-be are naughty, but there may be a sense of “I’m so over this pregnancy,” especially as we enter the third trimester.  This question even comes up around the time of the 20-week ultrasound if the associated “due date” is sooner than has previously been assigned.  By this time, though, the due date should already be established and only changed in very rare circumstances.  Here’s why:

The most accurate dating we can use involves the day for either IVF or embryo transfer as this is a certain date.  In fact, we can even know the specific time of the procedure.  After IVF, the next most accurate criteria to use is a first trimester ultrasound (prior to 14 weeks) that shows a fetus with a heartbeat (one with just a sac and no fetus isn’t as accurate).  It is accurate to within 5-7 days.  As we move into the second trimester, ultrasound can vary as much as 2 weeks from the actual due date, and in the third trimester, we can variation from 21-30 days.  This can be a full month discrepant from when a patient is due!

If you think about it, this totally makes sense.  If asked to compare a bunch of 6 month olds to determine their age, you’d probably be within a few months of their actual age.  Looking at 6 year-olds, you might be within a year or two.  With 16 year-olds?  Good luck!  You’d probably be fortunate to be within 5 years for some of them.  For babies in-utero, the same holds true.  The earliest estimates of age are going to be the most accurate, so that’s what we go with.  The due date at each ultrasound is the average due date for a baby of that size.

So, even if your baby grows faster than average, that doesn’t mean we get to deliver early.  There are still developmental milestones for the brain and lungs and other parts of the body that we’d you’re your baby to reach before delivery.  To put it in perspective, you wouldn’t expect a 12 year-old to graduate high school just because he’s now 6 feet tall.  Whether the biggest kid in 6th grade or the smallest in 6th grade, they are still 6th graders.  They’re probably not quite ready for the college application process just yet 😊

Interestingly, I’ve yet to have a patient ask me to push back their due date.  No one’s ever said to me, “You know.  I just love being pregnant.  Do you think you could move my due date back a week or two?  Maybe a month?”  In fact, it’s more the opposite.  I can almost hear the nervousness of those whose baby is growing a little slower than average, and their thoughts seem to be going a little like this:  “Maybe Dr. Denson won’t notice my new due date is later than we thought.  If I don’t make eye contact and rush him through the report, then maybe I won’t have to stay pregnant any longer.”  Fortunately, for those moms (and the health of the doctors who would have to ask them to stay pregnant longer), pushing back the due date at that point would be like making a smart child stay in kindergarten because he or she is too short to go to first grade.

There you have it.  Earlier dating is best!  Once you’ve been assigned a due date after an ultrasound showing a fetus with a heartbeat, you can mark it on the calendar, and the countdown can begin!  So even though we can’t move up your due date, you don’t have to worry about us moving it back either 😊

​Dr. Nick