By Lovetti Lafua
Nurse • Midwife • Biologist • Maternal Health Advocate • Human Optimization Researcher

There is a question I have been thinking about for a very long time.

Why do we spend so much time preparing women for birth, but so little time preparing them for what happens to their bodies afterwards?

Think about it.

A woman can spend months learning about contractions.

She learns how to breathe.

She learns about birth positions.

She reads about pain relief.

She packs her hospital bag.

She chooses her birth preferences.

She might attend antenatal classes, speak to her midwife, read books and watch videos.

She prepares for the big day.

But how many women are taught what happens when the big day is over?

Who explains what it can feel like to sit down after a significant perineal tear?

Who talks to her about pelvic floor recovery?

Who tells her what to do if she starts leaking urine?

Who explains that sex may be painful for a while and that persistent pain deserves attention?

Who tells her what pelvic pressure or a vaginal bulge could mean?

And who tells her that needing help with her recovery doesn’t mean her body has failed?

These are questions I believe we need to ask much more openly.

And they are exactly why this is something I teach in my own birth education and TTC work click on the link

The history tells us something important

What makes this conversation even more interesting is that none of this is new.

We have been studying the female pelvis and childbirth for generations.

In 1892, J. Clarence Webster published Researches in Female Pelvic Anatomy, contributing to the understanding of female pelvic anatomy.

In 1948, Helen Heardman’s A Way to Natural Childbirth* was published, followed by her work on relaxation and exercises for natural childbirth.

And by 1974, Obstetrics Illustrated, by Garrey, Govan, Hodge and Callander, was already part of the established obstetric literature.

The anatomy was being studied.

The mechanics of birth were being discussed.

Women were being taught about preparation for childbirth.

And yet, here we are generations later, with women still saying:

Nobody told me this could happen.

That sentence should make us stop.

Because perhaps the problem isn’t that we don’t know.

Perhaps the problem is that we’re not consistently passing that knowledge on to women in a way they can actually use.

Let’s talk about the perineum

The perineum doesn’t get much attention in the typical pregnancy conversation.

Until suddenly it does.

During vaginal birth, the tissues of the perineum have to stretch dramatically to allow the baby’s head and body to pass.

Sometimes they stretch beautifully.

Sometimes there is a small tear.

Sometimes there is a deeper tear.

Sometimes an episiotomy is performed.

And occasionally, the injury extends into the anal sphincter.

RCOG reports that third or fourth degree tears occur in around 6% of first vaginal births and around 2% of subsequent vaginal births.

These aren’t just statistics.

Behind every statistic is a woman.

A woman who might be frightened to have her first bowel movement.

A woman who might struggle to sit comfortably.

A woman who might experience pain during sex.

A woman who might develop bowel-control problems.

A woman who might quietly wonder whether her body will ever feel normal again.

And that is why I believe women should hear about perineal injury before they give birth, rather than discovering everything afterwards.

Preparation doesn’t mean fear

This is something I feel strongly about in my classes.

Talking about possible birth injuries isn’t about frightening women.

Quite the opposite.

Knowledge can reduce fear because uncertainty is often more frightening than information.

I don’t want a woman to hear that she might tear and think, “I’m terrified.”

I want her to think:

Okay. I understand what that means. I know what questions to ask. I know there are things I can discuss with my maternity team. And I know what support exists if it happens.

For example, RCOG discusses antenatal perineal massage from around 35 weeks as one option that may reduce the risk of perineal trauma, particularly for women having their first vaginal birth.

Cochrane evidence also suggests that antenatal perineal massage can reduce some forms of perineal trauma and persistent perineal pain.

It doesn’t guarantee an intact perineum.

Nothing can.

But that’s not the point.

The point is that women should be given evidence-based information and allowed to make informed decisions about their own bodies.

What happens during the birth matters too

The second stage of labour isn’t simply about telling a woman to push.

Her tissues are stretching.

The baby’s head is descending.

Her pelvic floor is working.

Her position and the way the birth is supported can matter.

Evidence has explored techniques including warm compresses and perineal massage during the second stage of labour, with evidence suggesting these approaches may reduce some severe perineal injuries.

Again, there are no guarantees.

But shouldn’t women know these things?

Shouldn’t they be able to ask their midwife:

What do you normally do to support the perineum?

Can I use warm compresses?

What positions can I try?
What happens if I need an episiotomy?

These aren’t confrontational questions.

They’re informed questions.

And I want women to feel comfortable asking them.

Then the baby arrives and suddenly everything is about the baby

Of course it is.

Your baby has just been born.

Everyone is looking at the baby.

Checking the baby.

Feeding the baby.

Weighing the baby.

Photographing the baby.

And somewhere in all of that excitement, the mother can become almost invisible.

But she’s still there.

And her body has just done something enormous.

Maybe she has stitches.

Maybe she’s swollen.

Maybe she can’t sit comfortably.

Maybe she is frightened to use the toilet.

Maybe she feels pressure.

Maybe she’s leaking urine.

Maybe she doesn’t feel sexually comfortable.

Maybe something simply feels different.

And she might be told:

Give it time.

Sometimes time is exactly what the body needs.

But sometimes the body needs something else.

It needs assessment.

It needs explanation.

It needs rehabilitation.

This is where pelvic health care becomes so important

One of the things I want women to understand is that postpartum recovery isn’t simply about waiting for your body to heal.

Sometimes you need help learning how to use that body again.

Pelvic-health physiotherapy can be an important part of recovery for women experiencing pelvic-floor symptoms.

And women shouldn’t have to reach breaking point before they ask about it.

If you have ongoing pain, urinary or bowel problems, pelvic pressure, a vaginal bulge, painful sex or concerns about how your perineum has healed, talk to your healthcare professional.

NICE guidance specifically recommends assessment of postpartum physical problems, including perineal healing, pain and bladder and bowel function, and provides recommendations around pelvic-floor rehabilitation.

So when a woman says:

Something doesn’t feel right.

We should listen.

Because “normal after birth” needs to be used carefully

There is a phrase women hear all the time:

That’s normal after having a baby.

And sometimes it is.

But common and untreatable” are not the same thing.

A symptom can be common and still deserve treatment.

A problem can happen after childbirth and still not be something you have to simply tolerate.

If you are leaking urine every time you laugh, cough or exercise, that’s worth discussing.

If you’re avoiding sex because penetration hurts, that’s worth discussing.

If you feel heaviness or pressure in your pelvis, that’s worth discussing.

If you are frightened every time you need to open your bowels, that’s worth discussing.

Your baby being healthy does not mean you have to ignore your own health.

This is what I want women to learn in my birth classes

When I teach women, I don’t want the focus to be only on getting through labour.

I want women to understand their bodies before they enter the birth room.

I want them to understand their pelvic floor.

I want them to understand their perineum.

I want them to know what questions they can ask.

I want them to understand what recovery can involve.

I want them to recognise symptoms that deserve attention.

And I want them to feel confident enough to say:

This doesn’t feel right. I’d like someone to assess me.

Because sometimes the most important skill we can teach a woman isn’t how to cope with pain.

It’s how to advocate for herself.

And this isn’t only for women

If you’re a midwife, doula, nurse, doctor or obstetrician reading this, perhaps this is the question worth taking back to your practice:

How much time do we spend preparing women for birth compared with preparing them for recovery?

Do we explain what a tear can mean?

Do we explain the degree of injury?

Do we tell women what to watch for?

Do we ask about bowel and bladder function?

Do we ask about sexual pain?

Do we explain where pelvic-health support is available?

Do we ask the mother how she is doing or do we assume that because the baby is doing well, she is too?

And perhaps we need to ask that question even when everything went “normally.”

Because a normal birth can still be physically demanding.

And an uncomplicated birth can still require rehabilitation.

Think about the mother going home

This is the part I keep coming back to.

Imagine her.

She’s holding her newborn.

She’s exhausted.

She’s probably not sleeping.

She’s learning how to feed.

She’s recovering from pregnancy.

And perhaps she’s also recovering from stitches, swelling, pelvic floor trauma or a difficult birth.

Then she walks through her front door.

And the maternity unit is behind her.

Now what?

She has a newborn in her arms.

And a body that may need care too.

This is where preparation matters.

Because if she has been told beforehand what to expect, she is less likely to think:

Something is wrong with me.”

She can think:

I recognise this. I know what questions to ask. I know where to get help.”

That is empowerment.

This is why I teach it

This is what I want my birth classes to give women.

Not fear.

Not unrealistic promises.

Not a perfect birth plan that makes them feel like they have failed if birth doesn’t go according to plan.

I want to give women knowledge.

Knowledge about their anatomy.

Knowledge about birth.

Knowledge about the pelvic floor.

Knowledge about perineal protection.

Knowledge about recovery.

Knowledge about what they can ask their maternity team.

And, perhaps most importantly, the confidence to know that their wellbeing matters too.

Because preparing for birth shouldn’t end when the baby is born.

The birth is one day.

Recovery is a journey.

And women deserve to be prepared for both.

If you’d like to learn more about the way I teach , pregnancy, birth preparation and postpartum recovery, you can find my classes and resources here:

Feel free to click on this link and join us

And if you’re a woman preparing for birth, a midwife, doula, nurse, doctor or birth professional, I’d love you to ask yourself one question today:

Am I preparing women only for how to give birth or am I preparing them for how to live in their bodies afterwards?

Because perhaps that is the conversation we’ve been missing.