Postpartum Recovery
Having a baby can be one of the most wonderful times in someone’s life. Maybe you were fortunate to experience the endorphin rush of that final push to finally get to meet your miracle face to face. Maybe you were completely numb from the waist down with a curtain separating you from your lower half while someone performed a c-section. Maybe it was an emergency surgery and you were completely put under, only to wake up to their glorious face. Everyone’s birth story is unique and beautiful or even sometimes scary. This blog will focus on complications from delivery, the postpartum period, and how to return to various activities (sex, exercise, etc.).I have been blessed with two healthy kiddos (see picture above) and two very different delivery stories. Olivia entered the world via a vaginal delivery with quite a bit of tearing (TMI…sorry, but also the reason I got into pelvic floor therapy), while Eli wound up breech (butt down instead of head down), pooping in utero (risk of infection goes up), and wound up with a different exit plan. Eli was born via c-section (good thing too, he was over 10 pounds). This gives me a unique perspective and the ability to sympathize with most of my patients. Whether you have given birth to 2 or 20 babies, or are pregnant for the first time, I hope you learn something from this blog.
Hormones
No matter how your baby entered the world, some parts of the postpartum recovery are very similar. After delivery, your hormones do a 180. Your estrogen and progesterone plummet (hello baby blues…more on actual postpartum depression soon). Your prolactin (responsible for breast milk production) and oxytocin (bonding hormone) increase. These hormonal shifts can lead to mood swings, hot flashes, anxiety, and EXTREME bouts of crying (just ask my husband or mom), just to name a few. No matter how your baby got here, fatigue is a VERY real hurdle every mama must juggle in the beginning. Sleep deprivation has it’s own set of side effects that differ for everyone.
Vaginal Delivery
According to the CDC, 69.1% of all deliveries occur vaginally. If you are like me, you were terrified of all the horror stories you hear about delivery. One of those very real fears was "tearing". Well... guess what? Olivia was only 6 pounds and 15 ounces, but I pushed like a mad woman and wound up with a grade 2, nearly grade 3 perineal laceration. Perineal tearing is fairly common during delivery. Your perineum is the skin between the vagina and rectum. Years ago episiotomies (surgically cutting the perineum) was standard practice. Thankfully this is no longer standard of practice, which has reduced the severity of tearing. There are 4 grades of tearing:
Grade 1: This is the most common and involves only the perineal skin
Grade 2: This tear involves the skin and some muscles of the pelvic floor. The anal sphincter is still intact.
Grade 3: This tear extends into the sphincter that surrounds the anus.
Grade 4: This tear is the most severe. It extends through the anal sphincter and into the mucous membrane that lines the rectum.
Many sources place the rate of third and fourth degree tears from 3-5% of all vaginal deliveries.
These tears sometimes require a repair with anesthesia in an operating room.
It is highly recommended that anyone with a third or fourth degree perineal laceration/tear get pelvic floor physical therapy once cleared from provider. Women frequently experience painful intercourse and even fecal incontinence. For those of you that are visual learners...What can cause someone to tear? A number of factors including:
Induced labor (check)
First baby (check)
Short pushing stage (double check)
Instrument-assisted delivery (forceps, vacuum, etc)
Shoulder dystocia (baby's shoulder getting stuck)
Large baby
Now everyone give your mom a hug. She's a badass and you owe her your life...literally.
Cesarean (C-section) Delivery
31.9% of U.S. births occur via c-section. The nerd in me really wanted to watch my own c-section. I was already terrified out of my mind and the wuss in me didn't want to pass out. A cesarean delivery, or c-section, is when the baby is delivered via cutting through the abdomen and into the uterus to retrieve the baby. C-sections require a longer hospitalization, since it is considered a major surgery. Lifting restrictions are often enforced after c-sections due to the pressure placed on the new incision. Providers typically do not want you to lift more than the weight of your baby for a couple of weeks to allow the incision to heal.
Helpful tips for c-section recovery:
Do not twist your trunk/spine while getting in and out of bed or chairs. To reduce pulling on your incision, use the “log roll” method and keep your back straight.
Stay on top of your pain by taking your medication around the clock. Surgical pain is so much harder to “catch” once you miss a couple of doses.
LET PEOPLE HELP YOU! Especially your partner when it comes to handing you the baby to nurse/feed.
Wear an abdominal binder. The compression feels AMAZING and helps reduce twisting.
The pain of getting in and out of bed or a chair that first week was often bad enough to take my breath away. Speaking of ways to reduce the pain in your incision... let's discuss body mechanics with a newborn.
Why does my neck/back/shoulder hurt so bad?
Body Mechanics
Taking care of a tiny human can take quite the toll on your body. Your ligaments are relaxed from pregnancy hormones, everything is sore from delivery, and to top it off, you are not getting ANY sleep... Yay motherhood. One thing you can take charge of is how you use your body to help take care of your new little one. Here are some helpful tips:
Bend your knees and not your back when lifting your baby
Alternate which arm you carry him/her in
Use a baby carrier if possible
Alternate which way they face when bottle feeding OR make sure to use different latch positions and different breasts if nursing
Alternate which end of the changing station their head is at when changing diapers
Hold the car seat as close to you as possible (like a laundry basket)…especially as they grow and get heavier
Some aches and pains are normal as your body adjusts. If you have a sharp pain/ache somewhere that just won’t get better, ask for a referral to a physical therapist.
When can I have sex again?
Return to Sexual Activity
Most providers advise that nothing should go in the vagina for at least 6 weeks after delivery, regardless of method (vaginal delivery vs. cesarean delivery). This includes intercourse, tampons, douching, etc. This is primarily due to the risk of infection, vaginal dryness, tissue healing, and postpartum discharge/bleeding. Not to mention, a lot of new moms are just not ready, or not in the mood, and that is A-OK! When you get the green light from your provider and are ready to go again, here are some things to help:
Use lubrication (especially if you are breastfeeding due to the low estrogen).
Side note: the lack of estrogen can also make urinary incontinence (leakage) worse while you are nursing
Use LOTS of foreplay to amp up desire and maximize natural lubrication
Ease into it (Especially if you had any vaginal tearing!)... for the love of everything...
Don’t force it. If intimacy is what you crave, there are other activities you could engage in that do not include penetrative intercourse. Go old school and stay on the outside of the vagina.
Some discomfort the first couple of attempts can be normal, especially if you had any vaginal tearing. If you wind up with a lot of pain, or are unable to engage in intercourse due to discomfort, ask for a referral to a pelvic floor physical therapist.
When can I try to lose the baby weight?
Return to Exercise
You just went through oh so many months of pregnancy where you limit a lot of your physical activity. You finally deliver the baby and want to start losing that baby weight. When can you start working out again? For the first couple of weeks, your focus should be on keeping your baby alive, eating, drinking (water…sorry), and sleeping. Your body needs time to heal and recover. In general,
Walking is ok…as long as you feel up to it and it doesn’t hurt. If the weather is nice, a walk outdoors can do wonders for you both physically and mentally.
Breathing: try to envision your rib cage as an umbrella. Take nice big breaths in and try to open that umbrella in all directions. This will engage your diaphragm, which will connect with your pelvic floor and help with any scar tissue.
Begin pelvic floor contractions, or kegels, once any vaginal tearing is healed.
For details on how to complete these, how many to do, etc., see a pelvic floor physical therapist
Gentle core activation (think tighten and relax).
Do NOT start with planks and crunches
If you see a "doming" in your abdomen when lifting your head up, you are NOT ready to begin any aggressive core strengthening. The doming means that your abdominals have not come back together yet (from being stretched out in pregnancy). Sometimes they do not come back together (called diastasic recti) and require physical therapy, or even surgery.
The best way to start is to take a nice big breath in (see above) engaging your diaphragm and then blow all of your air out through your mouth (like you are blowing out birthday candles). This will start gently activating those deep core muscles.
Wait for AT LEAST 12 weeks before resuming in more vigorous activity. Some research suggests even waiting up to 6 months before running due to the pressure it places on your pelvic floor. Returning to running too quickly could lead to pelvic organ prolapse. There is a protocol that is recommended to master before returning to running. Check out my blog for more details on return to running.
Everybody is different and every postpartum recovery is different. If you were super active during your pregnancy, you can probably return to exercise sooner. If your bleeding/discharge increases, then you may be doing too much too soon.
Listen to your body!
If anything hurts more than just an ache, see your healthcare provider to get checked out. We’ve covered physical recovery, but what about your mental health? This will be covered in my next blog, which will be posted soon.
