Pubic hair in labour: should it stay or should it go?

My friend and I were talking about pubic hair last week.  As you do. She really wanted to know what we think of the different “styles” that we see on women in labour.  She’s not the first to want to get the behind-the-scenes info, to know what midwives really think, to surreptitiously find out whether we talk amongst ourselves about what we’ve seen.  So we discussed it at length (no pun intended). I guess it’s a question a lot of women think about, but probably not the kind of question you’ll ask in an antenatal class in front of 20 other mums and dads.  Or maybe YOU would?  It’s certainly not a question I’ve ever been asked in an antenatal class but I can understand why women wonder about it.  You read about hair removal trends in the glossies, on Mumsnet, you see it on tv… You wonder what people do in real life, and what they really do with it before birth.  I’ve had self-conscious apologies from women in labour, commenting on how their bikini line isn’t as tidy as they’d like.  Maybe it’s something that’s never crossed your mind, but if it has, or you’re curious to know what we REALLY think, read on. By the way, I’m not going to use euphemisms, no foofs, fannies, lady gardens, front bottoms or the vague “down there”… My three year old daughter can use the word “vulva” so I’m presuming that adults can read a blog piece which uses the correct words.

razors

Let’s start with the science bit.  Does it matter from a medical point of view if the hair on your vulva is trimmed, shaved, waxed, or whether you have hair growing around your vagina?  Surprisingly, there wasn’t much information on this when I did a search.  When I search the medical databases, I usually start off pretty general and then narrow it down if necessary.  There was no narrowing down this time.  I started off by searching “pubic hair”.  The database search didn’t even recognise it as a subject.  So I tried “hair removal”, which worked. When I combined that with “pregnancy”, I got 16 results.  The best one of the lot was a Cochrane database review in 2014 which looked at only 3 trials done between 1922 and 2005 (so obviously not a huge field of research)1.  The three trials compared whether women had their pubic hair clipped or shaved in labour and whether they then went on to develop an infection or wound breakdown if they had a tear or a cut.  There was no significant difference in infection or wound breakdown rates in either group, although the level of evidence was low in all three trials.  Cochrane concluded that there was no evidence for shaving pubic hair in labour.  Unfortunately, there does not appear to be any studies which look at the difference in outcome between hair removal and leaving pubic hair intact in labour.  We know that outside of pregnancy, however, pubic hair removal can result in a complication in over half the women who do it (infections, boils, ingrown hair etc)2.  Since minor abrasions caused by shaving or waxing can potentially increase the risk of infection, it stands to reason that hair removal done very close to the time of delivery could also increase the risk of infection if there is any perineal trauma, so best to leave well alone.

But what if you need stitches?  Isn’t it easier to suture if there is no hair in the way?  Well, actually, no.  I think there have been very few times I have had to suture a tear and there wasn’t some hair present.  Quite frankly, if that’s what you get used to from the start, then it’s not a problem.  In other words, if your midwife or doctor is used to suturing around pubic hair, it’ll make no difference if it’s there or not if you do need stitches, so there isn’t any need on your part to remove hair “just in case” you need stitches.  Plus, the last thing you need is itchy regrowth right next to stiches!

What about if you need a caesarean section?  Well, the NICE Guideline Surgical site infections:  prevention and treatment states that it isn’t necessary to routinely remove hair from a surgical site, it doesn’t reduce wound infection; if it IS necessary to remove hair, clippers should be used rather than a razor, as using a razor can increase the risk of infection3.  Why would it be necessary to use clippers at all?  Well, a caesarean section is usually performed through a small incision along your bikini line, and at the end of the procedure an adhesive dressing is applied on top.  The only reason to use clippers is so that the dressing will stick properly to the skin4.  Part of the preparation for a caesarean section (whether an emergency or planned) is to check your bikini line and use clippers to take a strip (about an inch wide) away.  If you have recently tended to your bikini line, or you have sparse, short hair, it will probably be left alone.  Please don’t wax or shave within a couple of days of having a planned caesarean section though, as this will result in small tears and scrapes that might increase the risk of infection.

To summarise then, whether you have a vaginal birth or a caesarean section, there is no need to do any pre-birth work on your pubic hair just to be helpful to staff.

So… Is it “normal” for women to remove some or all of their pubic hair before giving birth?  Honestly… I’ve seen it all (or nothing, as the case may be).  Apparently around 87% of women in the USA remove some or all of their pubic hair.  We aren’t so well groomed.  I found it hard to get figures for the UK (and no figures for Ireland), but one newspaper article says about 50% of women in the UK don’t do anything at all with their pubic hair5. My overall impression is that the majority of women coming in to hospital to give birth have done very little (if anything) with their pubic hair.  I don’t know whether this is because it is a trend for the general female public in Northern Ireland, or whether it is specific to pregnancy, due to the sheer impracticality of removing your own pubic hair with a large bump in the way.  There is also a feeling that it’s ok to “let yourself go” a little in pregnancy, so this may have some influence on what women do too.

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What I found really interesting when I was writing this piece is that if you do a Google search, there are no shortage of blogs or articles on pubic hair, the removal of it, the feminist, sociological, psychological implications of whether it’s there or not, the impact that media and pornography has on whether women remove their pubic hair… Yet when I did a medical database search, I found very little at all in the medical journals, and the midwifery textbooks and journals don’t even seem to discuss it at all.

So what do I think this means?  Well, I think it means we (midwives and doctors) don’t really think about pubic hair.  We don’t really discuss it, or try to work out why you left it all there or took it all away. We assume it will be there, and it’s really not a problem or an issue. When you are in labour, your midwife won’t be thinking about your bikini line, she’ll be thinking about you and your baby, how you are progressing in labour, how you both are coping.  If your midwife does a vaginal examination, she’ll not notice whether you waxed or trimmed, she’ll be concentrating on her findings and what it means for your labour.  She almost certainly will be more interested in building a rapport with you and your birth partner, completing paperwork and supporting you in labour than wondering why you have a Brazilian, a Holywood, or are “au naturale”.  She’ll definitely find something more interesting to talk about in the tea room if she gets a break…

So bottom line (sorry, another pun), do what you want with your pubic hair before you give birth, do what makes you feel comfortable.  Unless it’s a rainbow stripe or an arrow pointing towards the exit, it’s unlikely to draw much attention.  I promise your midwife won’t give it a second thought.

References:

  1. http://www.cochrane.org/CD001236/PREG_routinely-shaving-women-in-the-area-around-the-vagina-on-admission-to-hospital-in-labour, accessed 13/05/2016
  2. http://www.ajog.org/article/S0002-9378(14)00065-9/pdf
  3. https://www.nice.org.uk/guidance/cg74
  4. http://www.cochrane.org/CD004122/WOUNDS_no-evidence-that-routine-preoperative-hair-removal-reduces-surgical-site-infection
  5. http://www.telegraph.co.uk/women/womens-life/10452327/Pubic-hair-is-back-ladies.-The-men-dont-care-and-the-women-cant-be-bothered.html

 

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Rebecca

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4 Comments

  • Oh my goodness. First I was shocked and then I laughed. I can’t believe that you needed to have a blog about this and that people worry about these things, it seems so unimportant…but well done for addressing what must be an important issue head on…thumbs up!

    • I guess as midwives, it isn’t really an issue to us. I’ve had lots of positive comments from mums who’ve read the blog though, so I guess it is something some women think about.

  • Thank you for this article! I have always shaved my bikini line. It just makes me feel good and I saw no reason to stop during my first pregnancy, but I did have stitches (which failed and had to heal openly) and oh my goodness the regrowth was very very uncomfortable.
    Now at 25 weeks with pregnancy no 2 and this is something I’ve started researching. I think I’ll probably let it grow to avoid the possible repeat of last time, and your article has really helped in terms of understanding that there’s no reason for the midwife to need to shave in order to suture. Thank you.

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