Minimizing Genital Tract Trauma and Related Pain Following Spontaneous Vaginal Birth

Leah L. Albers, CNM, DrPH; Noelle Borders, CNM, MSN


J Midwifery Womens Health. 2007;52(3):246-253. 

In This Article

Recovery After Childbirth

Aspects of intrapartum and immediate postpartum care, as reviewed above, affect perineal pain after childbirth. Although perineal pain tends to diminish in the weeks and months after birth,[3,4,9] continuing pain and related symptoms (e.g., bowel or urinary) may interfere with a woman's ability to care for her baby. Pain that persists may delay the resumption of sexual activity.[45] Therefore, avoiding trauma where possible and using optimal suturing techniques will improve the health of new mothers. Longer-term assessments of pelvic floor function, according to the degree of birth trauma experienced, are rare in the literature. Long-term pelvic floor strength has been measured in 3 studies using perineometers to assess squeeze tone of the levator muscle group.

Data from Klein et al.[46] compared measurements with a perineometer before birth and at 3 months after birth in women from 5 groups (N = 701): cesarean delivery, intact perinea, spontaneous tear, episiotomy, and third- or fourth-degree lacerations. At 3 months postpartum, women with cesareans or intact perinea (regardless of parity) had the strongest pelvic floors, followed by women with spontaneous tears, then episiotomies, and finally third- or fourth-degree lacerations. First-time mothers who delivered vaginally without any lacerations had the strongest pelvic floors antenatally, suggesting that pelvic floor condition may partially determine perineal outcomes.

Fleming et al.[47] used a perineometer to assess 5 groups of women (N = 102) in late pregnancy, and at 6 weeks and 6 months postdelivery: those with intact perinea, cesarean delivery, first-degree perineal lacerations, second- or third-degree lacerations, and episiotomies. Women with instrumental deliveries or epidurals were excluded. At 6 months after birth, greater perineal strength was observed in women with intact perinea or cesarean deliveries, followed by women who sustained first-degree lacerations, then second- or third-degree lacerations, and lastly episiotomies. Women with no perineal trauma had the best pelvic floor muscle function at 6 months after birth. When trends from before to after the birth were examined, women with intact perinea or cesareans showed a gain in pelvic floor strength, but women with episiotomies had a net loss after birth.

Finally, Gordon and Logue[48] examined pelvic floor strength at 1 year after birth in 6 groups of women: those who had intact perinea, cesarean delivery, second-degree lacerations, episiotomies, forceps and episiotomies, and these authors included a comparison group of midwives who had never been pregnant. Fourteen women were assessed in each group (study, N = 84). Perineal muscle tone at 1 year postdelivery was unrelated to the degree of birth trauma, but was related to regular exercise following birth. Those women who performed pelvic floor exercises and engaged in regular, generalized exercise (walking, dancing, swimming, jogging, yoga, etc.) had better overall muscle tone, including pelvic floor strength.

Together, these studies provide data for 897 women, with the Fleming[47] and Gordon and Logue[48] studies using small, nonrepresentative samples of women. The data suggest that pelvic floor muscle tone in the 6 months after birth may be a function of the degree of trauma experienced with birth. Beyond 6 months, the degree of regular exercise (pelvic floor and generalized) may play an important role in pelvic floor recovery after childbirth. While further research is warranted to confirm these hypotheses, a dual approach of minimizing genital tract trauma and postdelivery pain, and encouraging postnatal exercise can be supported at this time.


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