There are, however, small and less visible ways in which my body has changed with childbirth. My body will never feel or look the same. It took me a while to accept this. My body adjusted quickly, but the mind needed so much more attention and caring to learn to live with the new me. 

Tears and stitches

That final push motivated by my absolute want to avoid an episiotomy ended in tears and lacerations all over the vulva and perineum. Our midwife spent more than forty-five minutes to stitch me in the midst of constant post-partum bleeding, in what felt like longer and more uncomfortable than labour itself. I don’t know how bad it was in medical terms, I don’t remember anyone telling me the degree of the tears and I did not know about it to ask. I assume it can’t have been that bad. I did not really experience pain or much discomfort because of the stitches. The first two days post-birth I was in intensive care with a catheter on, so that must have helped a lot. I had a slight sensation of burning the first time I weed on my own, but that was all in terms of immediate bodily sensations. What I did feel was a sensation of heaviness, like carrying a piece of lead between my legs. Nevertheless, I did take daily twenty minutes sitz baths with Epsom salts, as recommended, for the first weeks. It helped me relax and disconnect (that is, until my husband came in asking how much longer, cause the baby was fussing :P). 

During the first weeks, the idea of the tears and stitches was mentally uncomfortable. I avoided looking down between my legs for weeks. Looking back, I must have been quite anxious. I attribute it to a feeling of having “damaged” my body, having rendered it different than before in a way I could not grasp, probably mixed with disappointment about having ended up tearing, against my hopes and efforts to avoid it. Given the situation of the baby and the way I pushed him out, tearing was probably unavoidable, and I am probably lucky it wasn’t worse. 

I kept asking my husband whether all looked fine. I asked the midwife to check at each one of our post-partum appointments. It felt itchy sometimes and my gynae prescribed a cream. I only used it a couple of times and the itchiness went away. A couple of weeks in, it started to feel a bit stingy and even a tiny bit painful at contact. When I finally took the courage to take a look at it, it turned out it was because of small pimples that have appeared all over the vulva. They cleared away quickly and it all went back to normal. Pimples continued to appear here and there on the vulva and perineum for the first few months, sometimes making it uncomfortable to sit down properly. They went away on their own. I didn’t speak to a doctor about the pimples, but I assume hormones must have had something to do with that. 

Every once in a while I can still feel a momentary tingling. I remember a gynae telling me she could only feel her episiotomies when the weather changed, kind of like my dad feeling discomfort in his knees because of his rheumatism. It’s something I can relate to now. Another thing, for at least a year after childbirth my vagina was very dry, so extra lubrication was needed during sex. It’s gotten better, but it still requires dedication to get things going :). 

Abdominal surgery scar

From a physical point of view, the pain went away fairly quickly. The four days I was in the hospital, I got painkillers through the drip. I was sent home with a bag full of painkillers, but I took four or five at most, during the first two days. By that point, it wasn’t pain anymore. I probably could have gone without the pills, but I did not want to feel any discomfort related to the surgery or the scar. 

For a very long time, the area around the scar felt numb. I could feel nothing around it. To a certain extent, it is still true, but it doesn’t feel foreign anymore. 

Mentally and emotionally, it was very challenging and it took me a while to accept I had an abdominal scar. I hated it so much, I didn’t look at it for days. I felt deeply frustrated and angry that it should be there at all. I had done everything I could to have a natural birth and I had had it and still…. For the first two weeks, the staples around the stitch would prick in some positions. Taking the staples out was uncomfortable, but not painful. The nurse who did it was extra careful and empathetic; her husband had had stitches removed in a very rough way and she was aware of the emotional effects. 

In time, the scar faded away. I used to look at it every once in a while, just to see how the fading was progressing. Looking at it still can bring up painful memories and feelings of helplessness and disappointment mostly, that this happened to me. When going to the beach and particularly when seeing mommies in bathing suits, I can’t stop but look below their tummy to see whether there’s a sign of a C-section scar. Whilst not visible, it is noticeable through a one piece swimming suit; it’s like a tiny ditch in the flesh and skin. 

Hip and lower back pain

I felt signs of discomfort in my hip and lower back (or maybe lower back irradiating down into my hip) around three months after birth. I was sitting down on the bed, resting my back on a pillow and had just finished breastfeeding. I didn’t know whether it was the pre-pregnancy hip pain that was coming back or whether maybe I had not paid enough attention to protecting my back during breastfeeding. At some point, I had my lower back checked by an orthopedist and a physiotherapist. There was nothing particularly wrong with it, but I did ten sessions of physiotherapy and kinetotherapy anyway and for some weeks, it went away. Then the pain came back.

I assumed my sleeping conditions bore the responsibility. We co-slept throughout the night with baby until he was 14-15 months. That meant sleeping on one side only for half the night or so and then switch sides and breast. There was also definite pain on the hip at the contact points with the bed. Yoga helped keep discomfort away, as long as I could keep up a regular practice. Ten minutes of gentle sun salutations in the morning at least three days a week did the trick. That, together with ensuring adequate support for my back whilst breastfeeding during the day. As soon as I let a few days pass without exercise, the pain came back. It is still the case today. Baby sleeping in his bed half of the night has helped over the past months, but I still spend at least half the night on one side, with my spine twisted.

On a few occasions over the past two years plus we managed to indulge in a massage treatment. It always felt so good afterwards. I felt like new for a short while, with all the tension in the back gone. Breastfeeding however makes back massages deeply uncomfortable. Lying on my tummy quickly became painful. I used to breastfeed immediately before having the massage and would constantly reposition my breasts when facing down. It was stressful, I kept waiting for the moment my breasts would start aching. And they always started with me face up, which gave enough time to the breasts to start filling up again. It got better with time, as the pace of breastfeeding slowed down and milk production decreased. 

Upper back pain

This one triggered in later, from holding and carrying baby around, once he became a bit heavier. An orthopedist told us upper back pain was absolutely common in new parents. He should know; he had an eight months old baby. It just occurred to me that now that baby is two and a bit and he asks only occasionally to be picked up and he can understand if I only hold him for short spans of time, this particular sensation has toned down. I can still feel it during yoga practice, oh those moments in extended child’s pose, but generally, this one is pretty much gone. Yeei!!!

Piles/Haemorrhoids

My buddies have stayed with me. I lost all hope that they would retreat on their own. I used all tricks and home remedies I heard of, but nothing worked. They are still alive, so I have to be very mindful about my transit and constipation. When I don’t, they grow a bit and then go back to their normal size.  

I have always had a lazy transit, but it is only since developing the piles that I have become much more aware of all the factors enabling a good transit and avoiding constipation. I have to pay attention that I eat properly and have a good fiber intake, drink enough water and exercise during the day. It is not always forthcoming and it takes a conscious effort still. I don’t always get it right, and for those times, I have at hand extra fiber to drink. Back during the first weeks post-partum it was more challenging. I was on iron supplements because of all the blood loss and that can cause constipation. I took a natural laxative to counter the effect of the supplements. 

My GP advised to live with my buddies as long as they didn’t create discomfort. Should I really want to get rid of them, he advised to only consider surgery once I was done having kids. 

It took me a long time to accept my very close buddies were here to stay. The first few days, when the stitches on the perineum were fresh and I could feel something with my touch, I was convinced somehow one of the piles had been stitched in. I was very anxious about it and asked the midwife to check every time. She calmly looked at them and told me everything was fine, that also the doctor had revised her stitching and all was in order. I was still hoping then they would go away and didn’t want anything to prevent that.  

My husband has been checking them regularly, their colour, number and size. According to him, they look healthy. And they haven’t multiplied :)). He keeps telling me it is not a big deal, not to think about them. It just feels foreign, to have bits of skin just hanging outside the anus. 

Rectum pressure 

For months and months after giving birth I felt pressure on my rectum, particularly when sitting down for long stretches (at the office or just home). I don’t know whether this was a consequence of constipation or piles or something else, my GP didn’t offer any real explanation, other than being something related to giving birth that should go away in time. I also did not keep a journal about it in relation to my transit and bowel movements, to observe a possible link. It certainly became unbearable on flights, especially when the baby was also sleeping in my arms. On more than one flight between South Africa and Europe my husband ended up walking up and down the airplane aisle with the baby in his arms most of the night. That was a dreadful experience. I still experience it occasionally, but it is much less rare and painful. And now I know better to stand up frequently and stretch when bound to a seat for longer periods of time. 

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Labour did not start as I had expected. Although I couldn’t tell what it is I was expecting, I was convinced I would recognise it when it started. I didn’t…. I gave birth on the first day of the 41st week, hours before our appointment for the sweeping of the membranes, something I was uncomfortable with, but our midwife had suggested as the first and less invasive way to accelerate labour… I remember conversations with friends via wapp the night before: no, no sign yet of the baby. I couldn’t even identify any Braxton-Hicks during late pregnancy, so it was all quiet. 

I woke up shortly after midnight to go to the loo. I had cramps and felt the need to empty my bowels. I thought I had an upset tummy, that I must have eaten something funky. In retrospect, it was similar to my pre-menstrual cramps, but I could only feel annoyed it interrupted my sleep. It went on like this twice per hour. Finally, my husband asked what was going on and suggested I tell our midwife. At that point, I was still only concerned about my sleep and thought it unnecessary to contact her in the middle of the night.  

I wrote to her at 3:02 am: “I’m having cramps that come and go (quite strong), strong pressure on pelvis and for the past two hours have continuously emptied my bowels, harder stool becoming softer and softer; slight sensation of nausea and cold shivers.. It’s quite uncomfortable and I’m having trouble relaxing and calming my breath during shivers; it also comes with some radiation of pain in my hips and lower back. And for the last two-three times, I noticed some vaginal excretion when wiping, brownish traces on the toilet paper, like early menstruation.” She said: “That’s good news; sounds like labour is on its way”. 

There was a sense of surprise and excitement. Didn’t know how this was going to unfold. She said getting rest was more important than anything else at that point, so I followed her advice. I got into the bathtub at home and started listening to my hypnobirthing tracks. My husband was running around the house; mom and baby’s luggage for the hospital had been ready for weeks, but my husband’s was not. He was to be in charge of feeding me healthy snacks and energising beverages, of having all the phones and tablets duly charged and to install the baby car seat. If all went well, we planned to come straight home afterwards. If we had to stay in the hospital, he was to stay with me, we had reserved a family room overnight. In between his running around, he was soothing me, timing my surges and communicating with the midwife. 

At 5:26, we had three series of contractions every 10 minutes. He told the midwife I was “looking good. The contractions last under 1 min and she is suffering; in between she is calm. The pain in the hip is continuous with spikes at contraction time”. That must have been the moment I got out of the bathtub; I needed to lie down. Our bathtub was rather on the smallish side. The only thing that comes back to me from those moments is the hip pain; it was intense. When surges came, however, I found it impossible to lie down, so I struggled to stand up and felt like going to the loo all over again. Somehow the hip pain felt stronger lying down. We gave ourselves 30 min to see whether I could manage it at home. In less than 10 minutes, my husband told the midwife we were getting ready to go to the hospital. We agreed to meet there at 6.30. Last message to the midwife just before we left home was about “little dark bleeding”. I have no recollection of that whatsoever, maybe I didn’t notice it, but my husband did. 

I don’t think I’ll ever forget the drive to the hospital. A 25-30 minutes drive with traffic, of which Pretoria had a lot at that hour on a Tuesday morning. First we had to get out of our residential jacaranda lined streets neighbourhood – with plenty of speed bumps. Uhhhh, how I felt those bumps, deep down inside me and down to my heels and toes. Didn’t matter how slow my husband was taking them… Tears were coming to my eyes every time. It took forever to get to the hospital; I had the impression all the streetlights had been on red and the traffic was not moving. I kept munching this thought in my head: “If the midwife tells me I am only 3 or 4 cm dilated….” and was getting worked up and emotional about it.  

We got to the hospital just before 7. Somehow I managed to walk down the ramp to the midwives unit. I had this funny sensation that I was holding something big and heavy between my legs that may just fall down if I took bigger steps. The labour room was lit up with candles and the bathtub was on and the big bed had clean sheets on. It felt welcoming and peaceful. There was no paperwork to be done, no conversations or explanations to be given. I laid down and the midwife did a quick check-up. I was fully dilated; I could go into the bathtub. What a relief! Had it not been the case, I might have been tempted to ask for some kind of pain management. I recall her kneeling down on one side of the bathtub, with gloves on and a couple of towels at hand, almost holding her arms out like waiting to catch the baby popping out. It felt reassuring; it wasn’t going to be long now. It was only the three of us in the room; there was a second midwife that until the very end took notes in a corner of the room. 

I kept on listening to my relaxation tracks. My husband sat down on the side of the bathtub, with his feet in the water. He held me, patted me and caressed my forehead and hair throughout. His presence was so comforting. It just felt easier expressing myself in my own language in those moments, most of the time anyway; he was doing the talking with the midwife over my head. 

I must have spent at least 1h30 min in the tub. That was the hardest part. It was not a constant pain; it came and it went in waves and there was enough time to catch a breath in between. And I was feeling it all in my hips and in my lower back. Somehow, it took me unprepared every time for my hypnobirthing “breathe baby out technique”. Consciously, at least, it didn’t feel like I was doing much in terms of helping my body bring baby out. I tried different positions in the bathtub and the midwife was letting me be, regularly checking the baby’s heart rate with a stick-like thing from a couple of centimeters distance. She also had a tiny sieve that she used to fish floating debris I was expelling with every contraction.  

At a certain point I remember her telling me my water had not broken and asking whether she could break them. I asked whether that would hurt (!!!! in hindsight, what a ridiculous thing :P). Seconds later I asked whether it was over. Yes, of course. 

I was not aware of the time; even so, I had expected it to be over more quickly. I was exhausted. Next thing I remember is the midwife telling me not to hold baby back, but let him come out; she told me I needed to start pushing then (instead of my gentle help it flow out approach). Apparently, they could see his head appearing and then withdrawing. My husband told me he was there, he could see him! I felt nervous and lost. I was not doing any such thing. 

At some point, in a very calm tone, the midwife told me the baby’s heart was getting tired; it was obvious the bathtub positions were not working and we needed to change. I was ok with getting out and asked for a birth stool; I found that it was the position in which I could best bear the hip pain. Ok. It must have been at that moment that she realised something was not right. 

I was not told this in the labour room, but my husband knew it. The baby was not progressing because he had the cord wrapped twice around his neck and one hand next to the ear. The midwife took one loop of the cord, but the second one was tight. The second midwife stepped in to help. In a matter of seconds I was told first that they would need to suck the baby out and immediately after that that was not an option anymore and that they would do an episiotomy. I laid down on the bed on one side and my husband held the upper feet up in the air. I could not bear being down on my back. I saw the midwife getting ready to open a kit of some sort for the incision and I thought “no way!” and pushed the hardest I had done until then. I felt a burning sensation for a moment. The baby came out and it felt good afterwards. 

It was 9:02 in the morning. About six hours after realising I was in labour, six intense hours that flew by. Eight hours and a half after the first signs of labour that I failed to recognise. 

My husband followed the baby across the room for the measurements. He was fine. First apgar score was 8; 10 after ten minutes. He was 3,27 kg and 51,5 cm. The midwife took the samples that we needed for the stem cells bank and the baby was put on my chest covered with a towel.  

He looked like a tiny grumpy old man; so very tiny, upset and all wrinkled. He was squeaking in a low tone, like a kitten. I was given a shot to accelerate the expulsion of the placenta – I was bleeding too much. After a very short while, baby was given to dad, who laid down next to me. He stayed on his dad’s bare chest, nuzzling and looking for the breast, poor baby, for more than an hour.  

I had torn in all kinds of different ways and the midwife needed to sew me. I laid on my back for what felt an eternity. It must have been 45 minutes at least. It felt uncomfortable; in my head it was all over and this was pure torment. The midwife kept saying she was almost done to reassure me; at one point I snapped at her that it was taking too long. It was a big tear, where the episiotomy should have been, and then many tiny zig-zag tears all over. At some point I was given suppositories and subsequently put on a drip. The uterus was not contracting; I was still bleeding too much and they were trying to make it stop.

When sewing was over, I wanted to go to the toilet. The midwife suggested to use a catheter and I insisted on going on my own feet to the toilet. It was a bad idea, but I could not be convinced. So I got up supported by her and my husband and directly plummeted unconscious on the floor  – in a puddle of blood, my husband later told me. When I got back to my senses, I was told the doctor was on her way to take me to the theatre; they had done all  things possible, but the bleeding wouldn’t stop. It felt like a defeat and scary. I’m certain my husband was also worried. But we were calm; the situation was out of our hands and we had to trust our medical team. Can’t remember whether I was sobbing, but I’d be surprised if I wasn’t. 

When the doctor arrived, she explained she needed to do a uterus evacuation; it turned out pieces of the placenta and membranes had stuck inside, causing the bleeding. There was no other alternative, but an intervention under general anaesthesia. As with any intervention, it involved risks and the most serious one was hysterectomy, but chances for that happening were minimal. It should be a quickie; in 30 min I would be out of the theatre, she said. 

I remember meeting and answering the anesthetist’s questions on the way to the theatre. A needle was put into my right hand and in a couple of seconds I was out. Next thing I remember was being transferred to ICU after the intervention. I felt heavenly; no sensation of pain, discomfort of any kind, anywhere in the body. My husband came over with the baby. It was so emotional seeing them together. I had all sorts of wires on me, so my husband was doing most of the holding, as baby was mostly asleep. His look was constantly going beyond me to the screens above me and he kept my mom informed of my blood pressure levels – lower than my generally lower ones. 

I stayed in the ICU two nights and a bit longer than two days. I got two rounds of blood transfusion and my iron levels were checked regularly. I was told I had lost around 2 l of blood in between the birth and intervention and I kept on bleeding, at least for the first day. I was monitored at all times. The night nurse took me for my first post-birth shower and stayed with me;  she probably knew what to expect. The moment she took the catheter out, a big puddle of blood rushed down on my legs onto the bathroom floor. I was shocked. She wasn’t impressed. I preferred to keep the catheter a little while longer; with the stitches burning a bit and a sensation of heaviness between my legs, I played it safe. I had huge pads between my legs and under me that nurses changed a couple of times a day with amazing speed and dexterity, just shuffling me around. 

My husband spent the day with me and the night in the family room we had reserved in the maternity ward. Baby was with me at all times. When I slept, the nurses were looking after him and only woke me up when he gave feeding cues. On the first day, the midwife, a paeds and another nurse from the baby clinic stopped by to check on me and the baby and start with the vaccinations. They also showed and helped me latch the baby to breast. The nurses in ICU kindly helped me latch baby every time.  

We spent the third night in the family ward, as I got extra iron through a drip, and the following day we went home. I felt weak and out of breath when going up the stairs of our house. When breastfeeding, I felt the cramps that accompany the contraction of the uterus and with them, a mild version of the back and hip pain during labour. 

We finally had all the time to be together, just the three of us. The midwife visited us at home for the first two weeks after birth. I still remember how she used a portable scale to weigh baby, much like the scale that is used at the market back home to weigh watermelons. Hilarious! Until my mom came over, more than a week later, my husband took care of us on his own. And he did it wonderfully. 

All things considered, I am happy with my birthing experience; the only thing I would change, if I could, is to allow the episiotomy to be performed, instead of getting torn all over. One doctor explained to me that it would have been a clean cut, easy to sew it would have avoided the other tiny tears. Which sounded reasonable enough for me. Plus, the driving force behind my resistance to it was the fear of pain (getting cut without any anaesthetic), ignoring that in that situation, I would have probably felt very little. I don’t regret not having opted for pain management; it was challenging and intense, but nothing that I could not bear. 

Should I have another child, I would look for a similar experience. Having my husband close to me throughout was the best thing. The calmness and gentleness of our midwife was just so amazing. Being in an environment that allowed the three of us to be together in the circumstances, that was not invasive and did not stress us about how we cared for the baby whilst in hospital, but instead enabling us to care for him, including breastfeeding related, helped us get a good start, my post-partum situation notwithstanding. 

It marked a first time for me in many respects: being put on a drip or going under general anaesthesia, going to theatre, having blood transfusion, spending time in ICU; having a catheter and being cared for as I was, as an adult. Still, in all likelihood, it was harder for my husband than for myself. I was unlucky; and I had further complications later on, but that is a separate story.

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