In 6 months time I will be squeezing a watermelon out of my vagina. I'm 6ft 2" and my husband is 6ft 5", this baby isn't going to be small. But that thought doesn't terrify me, it's all part and parcel of the whole being pregnant thing. In fact the birthing process fascinates me, I'm guessing that's my naivety, but I'm intrigued to discover how it all works: given the average baby's head is 11.4cm in diameter and the average vagina is 2.1cm - 3.5cm, you do the maths.
What I'm concerned about however is the long term damage that giving birth will cause to my vagina. I've tried to ignore the well-intended, 'heads up' birthing horror stories/advice from my well-meaning nearest and dearest, as best I can, and have instead focussed my attention on possible outcomes to my lady bits (post-birth). I reckon knowing what can go wrong is only half the battle, knowing what can be done to remedy it is the other half. Allow me to share my findings.
So what is supposed to happen to your vagina post-birth (if nothing goes wrong)?
As far as I can tell if you've been religiously doing your pelvic floor exercises (three times a day, every day), had your partner massage your perineum (to minimise the stinging when your baby's head crowns) and not pushed unnecessarily for too long during labour, oh and you're blessed with great genetics which means you're naturally super stretchy down there, you can expect to feel 'sore and uncomfortable immediately after delivery'. Expect a full recovery, albeit with a slightly looser vagina, in about six weeks.
What can happen to your vagina if things go slightly awry?
As a starter for ten:
-Episiotomy. Your perineum can tear (or be cut, also known as an episiotomy) to speed delivery (around 50% of first time mums will need to be stitched up).
-Incontinence. 40% of women will experience incontinence after birth.
-Prolapse. For 10% of women the combined pressure of pushing and giving birth can cause a prolapse (where one or more of your pelvic organs - be it your womb, bladder or rectum - can drop down into your vagina).
How to remedy these outcomes
The great news is that not one of these outcomes will permanently affect you. If you needed stitches your recovery time will be slightly longer than someone with just a bruised vagina, but you should heal up nicely, with no long term effects. There are simple and effective non-surgical solutions you can try to deal with a prolapse or incontinence before you have to explore surgical options, but those surgical options are there if required.
-Kegels. If you think having a strong pelvic floor is an urban myth, think again. The NHS have even developed an app to help you strengthen your pelvic hammock. Start squeezing now, it is never too late - like any muscle group, the more you work it, the stronger it becomes.
-Perineal massage. OK, I might have sounded facetious before, but this is a great way to start stretching the muscles between your vagina and perineum in anticipation of a small human passing between them. Just don't start the stretching any earlier than a month out and aim to massage at least once or twice a week.
-Urinary Incontinence. There are a plethora of non-surgical treatments to try prior to a surgical solution, but if that is the last option, there are at least a number of procedures that the surgeons can perform including: a sling procedure, a bladder neck suspension, prolapse surgery or an artificial urinary sphincter insertion.
-Prolapse. If non-surgical treatments fail to reduce or eliminate the prolapse, surgery can help. There are various options available depending on your type of prolapse and you will be given advice post-surgery for how to prevent any future prolapses.
-Vaginoplasty (vaginal reconstruction). This is a procedure to repair damage from childbirth, where the goal is to tighten both the vaginal opening and inner vaginal walls, it isn't for the faint hearted. It requires a general anaesthetic and 1-2 hours of surgery during which time the surgeon removes excess tissue and pulls the muscles together.
'Giving birth is a breeze' (said no one ever)
As far as I can tell, the best thing I can do is go into labour with an open mind, be adaptable, and push safe in the knowledge that if it does all go horribly wrong, my vagina won't have to resemble a car crash for life.