Speaking from personal experience, pregnancy is one of the most amazing experiences a woman can have. The thought of growing another human inside of you is absolutely mind boggling -- almost as mind boggling as the first time you feel the baby moving. (Come on, admit it, the movie Alien crossed your mind when it happened).
From other people touching your belly and confidently telling you the gender of your baby to being told what foods to eat to bring on labor, pregnant women are given a TON of (mostly unsolicited) advice. But I bet no one ever told you what to expect down there after you deliver the baby. Women just aren't given much insight into the fact that after delivery it's likely her vagina won't be the same...and that's normal.
BIG DISCLAIMER: I am not an ob-gyn, but I do have over 20 years' experience treating women's pelvic floor disorders that are often the result of vaginal delivery. I have treated thousands of women immediately post-partum and years later, and think I have some good information to share. For the record, by no means do I think women should stop having vaginal deliveries. I just think women need to be informed of what to expect down there after delivery. In fact, my colleagues interviewed women during their first pregnancy and asked what their birth plan was. As expected, most women planned on a vaginal delivery. Even after being told of the risks of vaginal delivery such as incontinence and pelvic organ prolapse, most women still planned on having a vaginal delivery, but they were extremely appreciative of knowing what to expect after delivery.
What can you expect down there? Let's start immediately after delivery. Up to 34% of women report some degree of urinary incontinence in the first three months postpartum. Likely the same percent or higher number of women have some degree of pelvic organ prolapse (bladder or uterus "falling" into the vagina). How can incontinence and prolapse occur so often? An easy to understand analogy I often use with my patients: if I took a golf ball and forced it through your nose, you wouldn't be surprised if your nose didn't look or function properly for a while, if ever. What happens to your pelvic floor after delivery makes sense if you think about it this way. Women who don't know that incontinence and prolapse are common after delivery feel ashamed and abnormal since these conditions aren't openly discussed. I have had many women shed tears of relief in my office after hearing the words "this is normal."
Fortunately for most women, the vagina returns close to its pre-pregnancy state. If a woman's vagina/pelvic floor doesn't function the way it should, there are things she can do such as Kegel exercises. If she needs instruction and/or motivation, home biofeedback devices and pelvic floor physical therapy can be very helpful. There are also vaginal devices, such as a pessary, that can be used to provide support to the pelvic organs. While all of these things are great, sometimes they aren't effective. A woman shouldn't feel badly that she didn't do enough exercises or blame herself in any other way. When the baby comes through the vaginal canal, the ligaments that attach the pelvic floor muscles to the pelvic sidewalls can get stretched and torn. If there is excessive damage to the ligaments, pelvic muscle exercises aren't as effective because a woman is exercising muscles that aren't attached properly. In this case, surgery may be the best option.
Women are strong, resilient and can handle the truth which is why I think we need to tell women what to expect down there after delivery.