Postpartum pain Is very common, and for good reason!
Many women experience some form of postpartum pain, whether its physical discomfort or weakness, or emotional difficulties in adapting to the challenges of taking care of a newborn child.
This is not in the least bit surprising. After all, having a baby is no small feat. A healthy baby is the reward for a process that is lengthy and at times extremely strenuous for the mom. Once the baby is born, we often forget that the mom is now recovering from the tremendous strain she and her body endured during pregnancy, labor, and delivery.
The postpartum period is a woman’s time to heal and recover her pre-pregnancy health and strength.
For many women, this period is relatively short and uneventful.
However, the postpartum period may be rocky and extended due to interventions during the birthing process, such as the use of an epidural anesthetic, the use of pitocin (a synthetic form of the natural hormone oxytocin, to restart labor), the use of forceps, a vacuum assisted (ventouse) vaginal delivery, an episiotomy, or the planned or unplanned cesarean section (c-section).
Moreover, a woman’s body goes through a lot of physical changes during pregnancy to support placental development and the implantation of the egg, to nourish a growing fetus, to hold the fetus securely within her womb, and to help the baby exit her body at the time of birth. These are monumental feats requiring hormonal and physical adjustments that can cause postpartum pain from which she needs to recover once the baby is born.
Although the interventions mentioned above can help, and may be life-saving indeed, they are associated with side effects or complications that can not only make the birthing process more difficult for both the mother and the baby, but leave the mother to deal with the aftermath in the form of postpartum pain.
The list of symptoms that come from interventions is long.
Epidural anesthesia requires the insertion of a catheter into the space between the outer covering of the spinal cord (the dura) and the vertebral canal in the lumbar region. It is well known that the anesthetic may slow down labor (or entirely stop/stall labor), necessitating the use of pitocin (synthetic oxytocin) to augment or restart labor.
If there’s difficulty placing the catheter in the epidural space, the woman has to endure several needle punctures into her lumbar spine, often resulting in postpartum pain in her lower back that may linger for days, weeks, or even months. If the needle punctures the dura (tough membrane covering the spinal cord), a spinal headache may ensue, caused by a leakage of the cerebrospinal fluid (CSF) into the epidural space.
Oxytocin versus pitocin. Mother Nature knows best.
While the body delivers natural oxytocin in a pulsatile fashion, adjusting the amount to the body’s needs during labor, pitocin is delivered via the catheter in a steady flow fashion. It is difficult to guess how much the body actually needs.
Consequently, the amount delivered is often too great, forcing rapid and forceful contractions of the uterus. This may greatly increase the trauma to the uterus and increase the chance of uterine bruising and rupture of the uterus with hemorrhaging.
Forceps and vacuum extraction (ventouse) assisted vaginal deliveries are relatively rare these days.
Forceps and ventouses are used in approximately 5% of births when the health of the mother or child is at risk. While sometimes necessary, these types of delivery devices may cause substantial tissue damage to the mom and the baby. Forceps delivery tends to cause more tissue damage to the mom, while vacuum extraction assisted delivery appears more harmful to the baby due to the suction forces on the baby’s scalp and scull bones.
Risks of forceps delivery to the mother include
- anemia from excessive blood loss during the procedure
- pain in the perineum postpartum (cuts and tears in the vaginal canal, vulva, or perineum)
- uterine rupture and hemorrhage
- weakening of the pelvic floor muscles, leading to uterine prolapse
- injury to the urethra and urethral opening
- difficulty urinating
- urinary and/or fecal incontinence that may be temporary or permanent
A vacuum extraction assisted delivery poses similar risks except for uterine rupture and hemorrhage.
Some symptoms may not show up for one to three years.
Episiotomies can really distort a woman’s perineum.
Episiotomies,, a cut into the perineal tissue between the vagina and the anus as the baby’s head crowns, have become relatively rare in the U.S.. This is no minor procedure, as the blade cuts through the vaginal wall and the tissues of the perineum.
Potential complications to the mother include:
- postpartum pain in the perineum
- scar tissue in the vaginal wall and perineum
- difficulty and pain with bowel movements, possibly leading to hemorrhoids and anal fistulas
- fecal incontinence, leaky stool, urgency with bowel movements
- painful intercourse along the scar
Cesarean sections have become very common in the U.S.
They comprise approximately a third of all deliveries now, while only 4-5% in the early 1970’s. Much of this increase is due to non-emergency (elective), scheduled C-sections. The price for the convenience of scheduling a delivery, or to avoid the strains and pains of a vaginal delivery may indeed be very high.
Risks of a cesarean section to the mother include:
- death three times the rate of a vaginal delivery
- endometritis due to injury or infection of the lining of the uterus (pain, foul smelling discharge, fever)
- infection of the incision site
- injury to the bladder or other organs nearby
- blood clots especially in the legs or pelvis
- increased risks of complications during subsequent deliveries, such as bleeding, uterine rupture, and problems with the placenta during the pregnancy, delivery, and afterbirth (expelling the intact placenta).
Adhesions after surgery are all too common.
Like any surgery, a cesarean section often results in internal adhesions between the pelvic and abdominal organs. Adhesions are formed when connective tissue (fascia) becomes distorted by injuries such as accidental cuts, tears, and surgical incisions, causing inflammation and tissue changes.
The recovery period may take up to 6 months following a cesarean section, during which time the mother is discouraged from athletic activities such as running, lifting weights, and other strenuous exercise or household duties, including lifting weights of 10 lbs or more. Compare that with the average recovery of six to eight weeks for an uncomplicated vaginal birth.
The birthing process always causes some form of injury.
There will be some loss of blood and tissue damage no matter what the mode of delivery. The postpartum period is vital for the mom to recover from these injuries and to recover her strength and vitality.
The process of healing involves inflammation in the form of heat, swelling (edema), pain, and weakness of muscles involved in the birthing process. If the labor and delivery was relatively uncomplicated, the tissues will heal and return to good health. However, cuts, tears, and bruising caused by the use of forceps, vacuum extraction devices, or forced contractions with the help of pitocin require more time to heal.
Moreover they may result in connective tissue distortion and changes in the form of adhesions, scars or fistulas, as well as injury to the urinary tract, bladder, or other abdominal organs (in the case of a c-section).
The fistulas are the result of injured tissue that won’t heal, leaving an opening that connects with adjacent tissue or organs. These connections are communicating channels that allow fluid to pass between these two tissues, and infections to spread into adjacent tissues.
Craniosacral therapy during the post partum period.
Craniosacral therapy gently assists the body to restore tissue health and to minimize tissue distortion in the form of scars, adhesions, or fistulas.
Even without intervention, women often suffer from lingering postpartum pain in the neck, shoulders, the back, sacrum, or tailbone (coccyx), due to the toll that pregnancy takes on a woman’s spine due to the baby’s weight gain, especially in the last trimester.
Craniosacral therapy helps the body to release the tension that has accumulated in the muscles along the spine, helping the mother to regain her ease of movement and strength.
Craniosacral therapy also helps to improve blood, lymph, and energy flow, thus supporting and helping to speed up the healing process from postpartum pain.