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Birth is the tearing down and rebuilding of a woman. She is tested physically, mentally, and spiritually. Even seemingly beautiful empowering births leave battle scars. Most women are prepared (or think they are) for the physical trials of parturition (except when birth does not go as planned). Few anticipate the emotional and spiritual demolition and reconstruction that commence during childbirth and are completed postpartum. The 4th trimester is a time for licking wounds and gaining footing in a new era of life. It is a seismic shift woman and women are not prepared for it.
There are steps to postpartum healing
Women need to be informed of the work that needs done after the climax of birth. The illusion of a happily ever after leaves so many mothers floundering when confronted with seemingly taboo feelings of depression, anxiety, brokenness, or discontent. These feelings are not uncommon and are not a reflection of a woman’s ability to mother nor is it a reflection of depth of her love for her baby.
Postpartum women need more education, more time, and more support. Our culture puts an enormous amount of stock in preparing for birth. We have classes, we make birth plans, we hire doulas and all of it is a mere flash in the our motherhood story. Yet, there is very little preparation made for postpartum beyond decorating a nursery and stocking it with diapers. Yet, postpartum is the beginning of our lives a mothers. It sets the tone for all that will come after.
The 3 Realms of Postpartum Healing
There are three realms of healing during the 4th trimester;
Neglecting any of the three can leave a woman feeling damaged by her birth experience or without sound footing as a mother. The focus of care needs to not be just be on the fundamentals of tending a new baby but teaching mothers self-care during the postpartum period and beyond.
Most people know enough to except some degree of physical healing after delivering a baby. Both vaginal and cesarean deliveries take their toll. I find our culture has a very insensitive, matter-of-fact perspective concerning self care after delivery. There tends to be a “suck it up” undertone that does little to encourage women to find space for healing. Whether the delivery was routine or had complications, most women will tell you they feel sore and battle worn after giving birth.
Women are bone tired. They are ravenous and utterly spent. Unfortunately, newborns do not care one bit. Babies require feeding and care from the moment they enter this world until you pack them up for college 18 years later. Often, I care for mothers in the hospital that are complaining of uncontrolled pain, raging headaches, and unrelenting nausea. Do you know what I tell them?
You need to take a nap. No shit folks. Women are exhausted. Exhausted from giving birth, blood loss, lack of sleep, and stress. Then instead of caring for themselves, women put on a brave face for visitors. I am all for visitors if they come to support mom. But too often, when the last visitor leaves, I am left with a mom at her wits end (and this is only day 2 of her postpartum journey). This does not build a strong foundation for families going home. During that first day, mom needs rest. Baby is going to be basically comatose during the first 24 hours. Take these advantage of your sleepy baby while the going is good. Because I promise, your baby will wake up and you will wish you had slept while you had the chance.
After having a vaginal delivery, your butt is going to hurt. The best way to describe perineal pain post delivery is that if feels like you are walking around with a baseball in your butt. There is a heavy weight and any pressure on it can be uncomfortable. Some women have pain with urinating if there is a urethral tear. Hemorrhoids can add insult to injury and in some cases can be VERY uncomfortable.
WHAT HAPPENED DOWN THERE?
Well, lets break it down. There are 4 main types of vaginal tears and they are broken down by degrees. First degree perineal tears are the most mild and 4th degree are the most invasive.
- First Degree– Least invasive. Tearing involves only perineal skin. May or may not require stitching.
- Second Degree– Most common level of tear. Involves perineal skin and some of the perineal musculature. May extend into the vagina. Requires some stitching.
- Third Degree– More invasive damage. Tearing extends into the musculature of the anus. More complicated repair and healing. More likely to have complications with painful intercourse or fecal incontinence.
- Fourth Degree– Severe tearing. Tearing extends all the way through the anus. Repair and healing often proves to be more complicated. May require pelvic floor physical therapy once healed to restore pelvic floor tone.
- Episiotomy– When provider cuts perineum instead of allowing natural tearing. Episiotomies are no longer routine but may be executed if provider deems medically necessary. Episiotomy repair is usually straightforward but can often be associated with longer perineal recovery.
HEALING THE PERINEUM
First line of treatment for all vaginal deliveries is ice. Ice helps reduce swelling and can aid in pain relief. Some mothers with will require pain mediation to help control their pain. Motrin or Tylenol are typically sufficient. Some third or fourth degree tears will require opiate pain relief during the first few days.
There are several topical treatments we can use to help your perineum. Tucks pads are commonly only thought to be useful for hemorrhoids (if you have hemorrhoids then you should definitely be using these) but they are also soothing for your sore healing perineum. Place a pad right against your stitches and change every time you change your pad.
Dermoplast can also be a lifesaver. Dermoplast is numbing benzocaine spray. It is pure bliss on a sore perineum. Spray every time you change your pads. FYI, it is also good for bug bites, burns, or itching. Keep your left over spray for family use (I used mine on my son’s bee sting the other day and it worked like a charm)!
After 24 hours of ice, we recommend warm sitz baths for healing. The heat brings blood flow back to your injured perineum aiding in healing and also feels quiet nice. Gerneally, we just tell you to use warm water in the hospital. But an herbal sitz bath can be a nice complement to this therapy.
Herbal sitz baths can help reduce swelling, promote healing and reduce infection risk. Lavender, Witch Hazel, Yarrow, and Chamomile are a couple of herbs that work really well. Check out this link at mommypotamus. She has a nice recipe and directions for making herbal bath.
Another lovely herbal option is making “padsicles”. A “padsicle” is a home made icepack that is infused with healing herbs to be used immediately after delivery. Generally, the hospital will supply you with icepack pads for the first 24 hours. These herbal infused pads have an extra punch of soothing healing goodness. Basically you make a concentrated tea with the same herbs used for the sitz bath. Using extra heavy maxi pads, pour about 1/2 a cup of your herbal tea evenly over the pad. Fold pad back up and place in freezer. Viola, magic herbal ice pack.
Be aware, these babies are VERY cold immediately out the freezer, give them 15 minutes to thaw before applying directly to skin. They are also not very absorbent because they have already absorbed the tea mixture. You will need pads under the ice pack to contain your vaginal bleeding.
TAKE IT EASY
Most women feel pretty good after the first week postpartum. Just a word to the wise, take it easy. Really. I tore my stitches playing on the floor with my toddler day 4 postpartum. Ugh, be better than me. When you are discharged home, there are general restrictions given to vaginal deliveries. While you may feel like you can handle more, remember your body needs this time. Be tender with yourself.
- No vigorous exercise- Walking is fine. Stairs are fine. Just don’t go to the gym and start pumping iron or training for your half marathon. At 6 weeks, you will have a follow up with your OBGYN/Midwife to clear you for exercise. Until then, no vigorous activity.
- No heavy lifting- You should not be lifting anything heavier than your baby. Lifting and straining can be harmful immediately postpartum. You can pop stitches or prolapse your uterus trying to be a hero… so don’t. If you have an older child that wants lifted up, encourage them to crawl into your lap instead of lifting.
- Nothing in the vagina- No sex, no tampons, no douching… leave your vagina alone. Most women don’t need to be told this twice. Your vagina and perineum are healing. Any undo strain can lengthen the healing process or cause injury. Also, you are more susceptible to infection postpartum because your cervix is not seal tight yet. Sex, tampons, and douching are infection risks.
- Watch your bleeding- If you start trying to do too much, your vaginal bleeding is likely to increase. This is a nice reminder from your body to ease of the accelerator a bit. If you are saturating more than a pad an hour or if you start passing large clots, call your provider.
Healing after a Cesarean Section
Recovery after a C-section is going to be longer than a vaginal delivery. You most likely will require a more intensive pain management regimen because you had surgery. My biggest piece of advice is to manage your pain well the first few days. If you get “behind your pain” it is more difficult to get control of it again with medication. I also recommend using some non-pharmacologic pain management remedies (like ice and a belly binder) to help manage pain and aid in healing.
Every hospital/doctor manages their c-section pain medication regimen differently. Most likely you will receive a scheduled IV pain medication for the first 24-48 hours. Stay on top of pain meds. Don’t let them get too off schedule. Most patients feel pretty good the first day because anesthesia has not totally worn off and they have not gotten out of bed yet. The incision needs ice for the first 24 hours. Ice helps reduce swelling and will decrease your pain.
The goal is to get all c-section patients out of bed by 12 hours. This often only involves getting up into a chair for a meal and then back to bed. The sooner your get moving the better your healing outcomes. Prolonged bed rest after surgery can increase risk of blood clots, respiratory infections, and delay healing. Day one postpartum, we try to get all moms showered and moving freely around the room again. At first, you can feel euphoric being up, showering, and free to move around.
Another common side effect of surgery is constipation. Women with c-sections are at increased risk because they had surgery, aren’t moving around, and often take opiate pain medication… all of the above can be constipating. Getting up and moving is one way we can combat constipation (along with take a stool softener such as Colace or Sennakot twice a day). Trust me, bearing down with an abdominal incision is not fun. Hydrate, walk, and drink some peppermint tea to stay ahead of the game.
By the afternoon, most moms are hitting a wall. I tell my patients that I expect them to feel some pain but I don’t want them rating their pain higher than a 4 out of 10. If they are much higher, we need to look closer at their pain management regimen and consider using a different approach. Some moms require a little opiate pain medication like Percocet to manage high pain levels.
One important and often overlooked element of healing from a c-section are deep breathing exercises. Deep diaphragmatic breathing expands your whole body during an inhale and contracts it during an exhale. Moving your body, especially all the layers of fascia (layers of tissue in your body) helps prevent restrictions from scar tissue formation. We want our body to heal as fluidly as possible to prevent torsion or pain from scarring. Spending a couple minutes everyday doing some deep healing breaths aids in reduce adhesions (when your fascia layers are bound together by scar tissue) and can be preventative for acquiring pneumonia, a common side surgical comorbidity.
I give belly binders to all my c-section moms. I honestly think every postpartum women could benefit from some kind of belly binder. After childbirth, all the organs that had to shift to make room for a growing baby have to find their way back in the body. This can leave women feeling vacant or “empty” immediately postpartum. Some women experience extreme gas pain. A belly binder gives a nice snug hug that can feel very comforting giving women a sense of “closing.”
Belly Binding has a long history all over the world but most notably in eastern and hispanic cultures. Many cultures practice a confinement period postpartum focusing on the healing and nurturing of the postpartum women. Belly Binding is often a integral part of this ritual. The reason belly binding is so widely practiced around the globe by a wide range of cultures is because it has distinct health benefits for postpartum women.
- Abdominal Support- Many women experience diastisis recti (the separation of the core abdominal muscles) during pregnancy. This is a natural phenomenon that allows a woman’s abdomen to make space for her growing fetus. Binding, gives support to your healing muscles allowing them to “close” and heal postpartum.
- Pelvis and Pelvic Floor Support- During pregnancy, your hips naturally widen to make room for baby and give space for delivery. The widening and pressure of baby puts a lot of strain on your pelvic floor. Belly Binding exerts gentle pressure on the hips to help them return to their pre-pregnancy state. While your pelvic floor doesn’t seem to be related to your core and pelvis, your whole body is a connected system. Your strained pelvic floor benefits as your core strengthens and your pelvis is supported.
- Lower Back Support- Just as the pelvic floor is connected to your core, so is your back. A weak core seen in women experiencing diastisis recti can contribute to lower back pain and weakness. Binding gives you back support while your body strengthens and heals.
- Decreased Postpartum Bleeding– The gentle pressure from belly binding can aid in uterine involution and decrease postpartum bleeding time.
- Improved circulation and swelling– Belly binding can improve blood circulation. The gentle pressure helps expel retained fluid from pregnancy.
TRADITION BELLY BINDING
Traditional belly binding is a generally completed using a piece of fabric that is wrapped around that abdomen from the hips to the breast. The traditional wrap takes more time and practice to execute, though they tend have more healing benefits than store bought Velcro wraps. These traditional binds should not be executed immediately postpartum for c-section patients because the incision needs to be open for healing. Start with a Velcro wrap for support when moving about. If you are looking for the full healing benefits of a traditional wrap, you can begin a week to 10 days postpartum.
BINDING AFTER A C-SECTION
When you have a c-section, belly binders can be extremely helpful. Immediately postpartum, that feeling of emptiness and a need support your belly “to hold everything in” can be especially strong. The pressure on your incision increases pain. An abdominal binder helps support the belly and incision. I wore a binder for the 6 weeks postpartum with my c-section baby. Then I used these fantastic c-section support underwear. They are a little less intense than a binder, but I still felt like I needed abdominal support as I became more active caring for my family.
All women will experience vaginal bleeding after delivery called lochia for 4-6 weeks postpartum. Women who have C-sections will also have vaginal bleeding though it is often less than vaginal deliveries. The first few days, bleeding will be heavier than most women experience during a menstrual period. Some small clots, quarter size or smaller are normal. Saturating more than a pad an hour or large clots are not normal. If you are in a hospital you should save clots or pads and call your nurse in to take a look. If you are at home, you should call your medical provider.
WHY DO WE BLEED POSTPARTUM
Bleeding postpartum is related to expelling all the products of conception. Blood, mucus, meconium, products of birth are all expelled. The uterus is also shedding an endometrial lining (similar to a menses) that was in place during pregnancy. The site where the placenta attaches to the uterus makes a wound when it separates. As this wound heals, dead tissue is sloughed off and expelled.
How should my bleeding look?
Bleeding after the first 3-4 days becomes more moderate and period like.
SIGNS OF ABNORMAL BLEEDING
Below are possible warning signs of abnormal bleeding or complications postpartum. I you are:
- Saturating more than a pad an hour
- Bleeding but it has stopped or slowed and then returns back heavy
- Passing clots bigger than 2″ in diameter
- Having fever or flu like symptoms
- Having severe abdominal pain (more than cramping)
- Getting dizzy or lightheaded when trying to stand. Fainting with standing.
If you are experiencing any of these symptoms, call your medical provider.
Sex is not the same
Many women struggle with physical healing and believe they must simply accept their postpartum body in it’s broken altered state. Painful sex, urinary incontinence, or trouble with bowl movements are not normal. Women think because they get the thumbs up at 6 weeks, the rest is par for the course. There is no education about pelvic floor disfunction and it’s effects on sex life. Most women are too embarrassed to ask detailed questions. Open conversation about what is normal and what needs further treatment should be the norm to assess if a consult to a pelvic floor physical therapist or scar tissue remediation specialist is needed.
Women need to be taught how to strength their pelvic floor BEFORE and AFTER childbirth. They need to be told why it is important. Nobody thinks, “Man, I can’t wait to get a beefy ripped pelvic floor.” Yet, nobody wants to pee a little (or a lot) after every sneeze for the rest of their life. Kegels are an important part of strengthening our pelvic floor but there are a variety of other accessory muscles that can be helpful to strengthen in preparation for birth. Did you know walking postpartum can help strengthen your pelvic floor?
Check out THIS AWESOME podcast from the Birth Kweens with their guest Colleen Flaherty. You can also check out her instagram account for lots of workout tips to strengthen your core. She outlines the importance of healthy movement pre-coneption, throughout pregnancy, and postpartum.
Breastfeeding is hard
Painful breastfeeding is another postpartum ailment commonly glossed over. Breastfeeding should NOT BE painful. Initially, some women will have tender nipples and experience some breakdown as they learn how to get a deep latch. CLICK HERE for TIPS FOR YOUR NIPS
If this does not resolve, mom and baby need to be evaluated by a lactation consultant. Actually, EVERY BREASTFEEDING MOTHER should be seen by a lactation consultant. No other healthcare provider is schooled in the arts of breastfeeding and milk supply. Painful breastfeeding can be as simple as a shallow latch or possible a undiagnosed tongue tie. Read here for a step by step guide to getting a deeper latch.
Misinformation is rampant and can potentially sabotage breastfeeding dyads before milk supply is established. Low supply, oversupply, painful latch, and unchecked fear that baby isn’t getting enough can feel like overwhelming problems when you are freshly postpartum. Check out my 10 Tips to Help you Breastfeed in the Hospital to get off to a good start! Then, schedule a postpartum lactation consult immediately.
ABNORMAL COMPLICATIONS FOR BREASTFEEDING
Your milk should start to come in around day 3-4. If you are not feeling any filling and believe you have not begun to transition from colostrum by day 5-6, you should contact a lactation consultant to discuss possible complications.
If your breast get red, painful spots, or you get flu-like symptoms with a fever, contact your medical provider and a lactation consultant. These could be signs of an infection call mastitis.
Make a Plan
In the past, family units were multigenerational. Grandparents were nearby or living in the same residence. There were other hands eager to make the work light while mom focused on breastfeeding and HEALING. Today, many new parents do not live near grandparents or they do not seek out the help. The expectation is that new parents should be able to figure it out … just like everyone else.
The hidden secret unbeknownst to these new mothers is this:
most women struggle postpartum, but very few talk about it.
It is important to give yourself time and space to adjust postpartum. Not only is your body healing, but you are evolving into a whole new expanded version of yourself. You are now a mother and all your preconceived notions of the world and its contracts are about to be challenged and shattered. It is a physically and mentally exhausting time. There is a phenomenal book called The Fourth Trimester by Kimberly Ann Johnson that details making a complete holistic plan for postpartum. It should be required reading for all pregnant/postpartum moms!
You Need Help
You need help. Needing help does not make you a failure, it makes you human. We are meant to be supported postpartum especially by other more experienced women. While your husband may have the absolute best intentions in the world, he has never given birth and breastfed an infant. His ability to relate and lend expertise is limited through no fault of his own. Make a plan to have support for both of you. An extra hour or two of sleep can be life changing during the fourth trimester. Many hands make the work light… or uh lighter???
The point is that it is normal to feel shaken to your core after having a baby. You don’t need to figure it out alone. You need physical help and you will need emotional support. Postpartum is a time of healing. Your goal is not to return to your pre-baby self but to morph into a new evolved version of yourself. They key is giving yourself space to heal physically, mentally, and spiritually before you feel whole again and are ready to move forward.
During pregnancy, women need to be making plans for postpartum support. Plan for grandma, a hired doula, or friend to come stay during the first few weeks home. It takes a village to raise kids. We need a cultural shift making it acceptable and desirable to ask for help postpartum. Women need the physical help, they need sleep relief, and they need community from other women.
Want to learn more about postpartum healing?
Want to Learn More About Postpartum?
Consider this fantastic course, Navigating Postpartum: An Essential Guide to the Mom’s 4th Trimester. This a comprehensive course that dives into every dynamic of the postpartum period. You will have free 24/7 access to all course content to work at your own pace and refer back to materials. The course has several awesome instructors (including YOURS TRULY) to walk you through:
- Support/Resources: Every section of the program includes resources, tips, recommendations and great reads.
- Physical: The changes and reactions to expect in your body, your body’s healing process, body image, diastasis recti, safe exercises, and nutrition.
- Mental/Emotional: Postpartum anxiety, baby blues, postpartum depression, Other postpartum moods are addressed.
- Sex & Relationships: We delve into mom guilt, wife guilt, dad guilt, trauma, survivor guilt, rainbow guilt, friend loss, communication in relationships. ⬅️ THIS IS MY SECTION
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If you are interested in learning more… Head over to NAVIGATING POSTPARTUM