There is no denying it. Pregnancy, labor, and postpartum can feel overwhelming. There is so much to learn. There are so many emotions, changes and ways to prepare. During my pregnancy, I realized how many books and recommendations were given to me about pregnancy itself, but so little was discussed in terms of what to expect after the baby arrived. The postpartum phase often gets bypassed in terms of information and preparation; this is a huge disservice to women and mothers. Do we refrain from talking about the fourth trimester to expecting mothers in order to avoid scaring them? Motherhood can be messy, but knowledge is power! This is a crucial period when we are learning to care for a tiny human on top of trying to heal our bodies from birth. Whether or not your birth went exactly to plan, it is considered a trauma to the body and should be treated as such. We also can’t ignore the fact that women are currently going through these changes, often for the first time, in the middle of a pandemic. This means resources and time with their provider is even more limited.
We decided to compile a few tips to help you on the so-little-discussed journey of early postpartum. These are points we have learned from our pelvic health training, personal experience (thanks to Katie!), other midwives, doulas, and birth professionals. These are also topics which are rarely discussed with your traditional birth provider. Let’s dive in.
- Use your bleeding as a guide
In case you didn’t already know, you will bleed after delivering your baby. The length and duration varies from woman to woman. I personally bled for about a week, and have had patients who bled off and on for six weeks. It can be similar to a menstrual cycle, but it is important to use your bleeding as a guide in regards to your activity level. The best advice I received was from the pediatric nurse who checked on my daughter at 3 days old: she explained to me that if my bleeding was heavier from one day to the next, it could be a sign I was doing too much and could delay healing.
Girl, let me tell you, the very next day I bled significantly more from moving from my bed to the couch a couple times throughout the day. We had family come over who were excited to see the little munchkin, so I was rearranging my position and THAT was too much. A general recommendation which I found helpful was “5 days in the bed, 5 days around the bed, 5 days in the house.” This is obviously not feasible for everyone, but the idea here is to do as little as you can in the first couple of weeks outside of caring for your newborn and letting your body heal.
2. You can start LIGHT movement day ONE.
We will get to more about exercise when we talk about the 6 week check-up, but there is a misconception that we should not be doing ANYTHING in terms of rehabilitation until we are cleared from our doctor.
However, In the matter of a day, your center of gravity and posture has drastically shifted. Your diaphragm (breathing muscle) now has more space to descend. Whether you delivered vaginally or via C-section, your muscles have been lengthening or altered. We know in any rehabilitation that introducing light, pain-free movement improves outcomes and lets our brain know that movement is not a threat. This decreases the chance that muscles will tense and guard up, creating patterns which can be hard to break. A pelvic floor PT can help guide you, from day 1, to restore breathing patterns, assess posture and body mechanics for your new activities and promote healing of those tissues. Regardless of your doctors recommendations for rest, you are moving and breathing postpartum. Let’s do it safely and gradually.
Believe it or not, I started doing LIGHT core and pelvic floor contractions the very next day after my daughter was born. This was not necessarily intended to build strength, but rather to improve circulation and begin to work on the neuromuscular control of this system. This work was coordinated with my breath so it also feels very nice for the diaphragm. Best part, you can do it in any position, anywhere. If you want to try it for yourself, think about doing a light core and pelvic floor engagement or “draw in” as you breath out, focusing on full breaths in and out.
3. Breastfeeding helps contract your uterus back to its original size. And it hurts.
During pregnancy, the uterus capacity grows from 10mL to 5000 mL. Think about that for a second, a woman’s uterus grows 500% during pregnancy! Our bodies are amazing, ladies. What women are often not told, though, is the process involved in shrinking that uterus back down after birth. If you are breastfeeding or pumping, oxytocin will be released which will cause the contraction of the uterus. These feel like light labor contractions and are helping to expel any loose blood, clots, and are slowly changing the tone and size of the uterus. This process of uterine shrinking back to apple size vs watermelon size can take anywhere around 6 weeks if you are breastfeeding and 10 weeks if you are not breastfeeding. This is not to say you will feel pain for that long - often these contractions get better in about a week or two. Again, this information is meant to inform, rather than scare you. I was completely surprised that I had never heard of this until I was going through it.
As pelvic physical therapists, we are a part of the birth TEAM. Lactation consultants are also part of that team. Breastfeeding can be very rewarding, but also very challenging in the first couple weeks to months. If your wish is to breastfeed but you are having pain or unplanned issues, we are happy to help you find the right specialist for your concerns.
If you do not wish to breastfeed, you can also use techniques such as abdominal massage to help stimulate the contraction of the uterus. There is also anecdotal evidence of belly binding as a way to help the uterus shrink back down, although support of this was not found in the literature. These techniques are not meant to be comfortable, but it is important to allow full healing of the uterus post-birth.
4. The 6 week “all clear” should be taken with a grain of salt.
The 6 week check-up can be a confusing one: “How did I just magically get the green light to resume exercise and sex?” Tissues take 4-6 weeks to heal but we have to take a lot into consideration when assessing each individual - no two women or deliveries are the same! Was this your first birth? Third? Fifth? Did you tear or have an episiotomy? What have your symptoms been the last month? What kind of exercise did you enjoy pre-pregnancy? What kind of exercise, if any, did you do during pregnancy? Your doctor’s job is to make sure stitches have healed and that there is no infection in the pelvis; that doesn’t mean that return to sport or sex is instantaneous! Scar tissue from vaginal tearing or cesarean section can contribute to painful sex. Weakened or uncoordinated pelvic floor muscles can lead to urinary incontinence with jumping, running or sneezing.
Even with the best birth and staying fit your entire pregnancy, there are still things to consider when getting back to exercise.
- 1. If you are breastfeeding, you still have higher levels of relaxin in your system. Relaxin is a hormone present during pregnancy to allow the body to expand as the baby grows. Ligaments stretch and tissue becomes more elastic. That hormone is still present as long as you breastfeed, so it’s important to be aware of this when planning what type of exercise you want to return to.
- 2. Your body NEEDS you to start slow. Think of this time as a rebuilding and rehabilitation phase. You are setting the stage for the rest of your life in this postpartum body. It has the potential to be stronger than ever, but if there is too much load too early, you may set yourself up for injury down the line. That’s where we come in. A pelvic floor PT can guide you with appropriate exercise progression and help you return to the activities you love.
5. Find your tribe
In tribal culture around the world, there is a large focus on community and healing the new mother*. Members come together to ensure she can rest, nourish herself and that her family and home are cared for. It’s no secret that the immediate postpartum phase can be isolating, even more so during a global pandemic. In the current climate that is social distancing, nearby family may not be able to help as they normally would. Spouses working from home may be on-call throughout the day and many people are choosing to limit time spent outside to limit exposure to coronavirus. Times have certainly changed for the time being, but there is support available for moms IF you know where to look. Local mom groups on facebook can help you find moms in similar stages of life to talk with. A pelvic PT can also refer you to a perinatal psychologist if symptoms of postpartum depression or anxiety arise. Above all - now is a time to ask for help and to give yourself grace. You’re doing great, momma!
*Traditional Practices and Beliefs in Post-partum Care: Tribal Women in Maharashtra - Ranjit Kumar Dehury, Ashalata Pati, Parthsarathi Dehury, 2018
To greater community and self-love,
Dr. Katie & Dr. Carly