An ObGyn's Guide to Healing Your Postpartum Body
Sep 22, 2019
by Dr. Christine Sterling, M.D., FACOG
You know what I was definitely not expecting after having my baby…
To be surprised by how difficult the recovery from birth is. After 15 years of schooling and training to become a board-certified ObGyn, I thought I knew what it would be like. But there is nothing quite like experiencing it personally, to expand your expertise.
So here I am to prevent you from being surprised by your recovery. I want you to have the knowledge you need to heal.
You also may want to check-out my Ultimate Postpartum Kit Checklist (just enter your email and I’ll send it your way), so you have the stuff you need for a smooth recovery, in addition to the knowledge!
1. Nipple Care
Okay mommas, I hate to tell you this, but at the beginning, breastfeeding often hurts. For most, the pain gets better after a few weeks. It is important to get help early, especially if you are experiencing pain beyond the first 30 or so seconds of the latch. I can tell you from personal experience— do not wait to get help until your nipples are cracked and bleeding. The best nipple care is a proper latch, as shallow or off-center latches can cause nipple damage. Though I eventually switched to exclusive pumping due to nipple damage from latch issues, prior to that I alternated between Motherlove organic nipple cream and these hydrogel pads to soothe my nipples in between breastfeeding sessions.
And while we are on the subject of breastfeeding…
As wonderful as breast milk is for your baby, and it is remarkable stuff, you are more important than your breast milk. The number of women I’ve seen torn apart by their troubles with breastfeeding breaks my heart. The pressure placed on women, by themselves and by others, can be heavy. For one, we have an innate drive in us to feed our children. When we have trouble feeding our child, we feel it in our core. Compounding this issue, is the knowledge that “breast is best.” If we can’t provide breastmilk, then we feel aren’t doing the “best” for our babies. The guilt from this, even when it is out of your control, can be overwhelming. And the cherry on top is the idea that breastfeeding is a bonding experience to be enjoyed. So, yeah, there is a lot of pressure. Yes, breastmilk has a lot of advantages. Yes, it is an excellent way to bond with your baby. And yes, you can have a healthy baby and a strong bond without breastfeeding. Do your best. You can do no more.
2. Vaginal lacerations
Most of us experience some degree of tearing in and around our vagina during birth. Prior to leaving the hospital, it can be helpful to find out from your provider the location and severity of any lacerations, so you can have an idea of what to expect. Your provider may recommend Sitz baths. While you should always follow the specific recommendations of your provider, in general, Sitz baths are performed by placing warm water in a bathtub or a special container designed for this purpose, and sitting and soaking the affected area for approximately 15 minutes, 2 to 4 times daily. Some add herbs, salt, or other medications to the water. I had this Earth Mama Organic Herbal Bath at the ready for my postpartum recovery.
While you do not need to clean inside your vagina, you can keep your labia and any tearing between your vagina and anus clean with a small amount of mild, fragrance-free soap. Don’t be afraid to touch the area with clean hands, but you don’t need to scrub, and you can pat to dry.
For pain, over-the-counter pain medications such as acetaminophen and ibuprofen, are typically enough. Some prefer topical pain relief with cooling sprays and witch hazel pads (I prefer these organic pads that also have aloe in them). You can also take maxi-pads, add a small amount of water (or organic aloe vera juice), and place them in the freezer or refrigerator for some cooling relief.
Let’s talk about pooping…
The first poop after having a baby, vaginal or cesarean, can be an experience. Your pelvic and abdominal muscles are somewhat traumatized, and it can be hard for your body to remember how to push and relax at the same time. You don’t want your body straining to push out a hard, firm poop. If you have stitches, pushing against the repaired area can be scary and painful. If you’ve had a cesarean, you will soon realize how much you use your abdominal muscles, particularly when going to the bathroom. Do yourself a favor and drink plenty of water and eat fiber-rich foods. Your provider may even recommend taking a stool softener such as Colace. Ground flax seed is a great addition to smoothies, yogurt and oatmeal to pack in the fiber and omega-3 fatty acids that are so crucial for healing.
3. Belly birth (cesarean) incisions
Prior to leaving the hospital, you should receive detailed care instructions for your incision. In general, you want to keep the area clean and dry, though in most cases, it is okay to get the area wet. Some women feel most comfortable when wearing an abdominal binder, which most hospitals provide. Studies have not found abdominal binders improve healing, but they still provide some with a feeling of security and comfort. Even after my vaginal delivery, I felt most comfortable when wearing a binder. I got mine at the hospital, but if you didn’t receive one while admitted, this one is the closest I’ve found to those provided in the hospital.
Most women experience soreness along and around their incision, though some experience numbness and burning sensation on the skin. While the soreness and pain usually resolves over weeks, the numbness and burning can take longer. Some women are left with a little residual numbness.
Getting around for the first few weeks is certainly more difficult. You will find new ways to move that require less work from your abdominal muscles. Listen to your body. It is not unusual for your pain level to increase when you start moving more. If you are experiencing more pain, this may be a sign that you are doing too much. However, if your pain is increasing regardless of your activity level, or your incision is becoming red and inflamed, you should contact your doctor immediately.
There is also an emotional component to cesarean recovery, particularly when unplanned. If it was an emergency situation, you may have been afraid and overwhelmed. A debriefing with your Ob provider after an emergency delivery can be helpful. Because most ObGyns do emergency cesareans all the time, they may not realize how you felt. Don’t be afraid to ask questions and seek understanding once the emergency has passed.
Ugh. These lovely little protruding blood vessels can cause problems throughout pregnancy, but are often at their worst after delivery. The good news is that they often resolve with time. The bad news is that the over-the-counter treatments are just okay. Most importantly (again) with hemorrhoids is avoiding constipation. Sitz baths also help alleviate the pain. Feel free to try the OTC treatments, as they are all safe in breastfeeding. I wish I had a secret cure for this one, but, alas, I'm in the same boat with the rest of you.
5. Pelvic floor
Your pelvic floor is comprised of the muscles, shaped much like a bowl, that attach to your pelvic bones and keep your abdominal and pelvic organs from falling out of your body. In pregnancy and birth, these muscles can be damaged and strained. Fortunately, like other muscles in your body, they can be repaired. If you are recovering from a vaginal laceration or belly birth (cesarean), in general, it is best to wait at least 6-8 wks, once cleared by your Ob provider, to begin exercises to strengthen your pelvic floor. If you birthed without any lacerations, you can begin right away. The easiest way to strengthen your pelvic floor at home is Kegel exercises. Kegel exercises involve tightening the muscles around your vagina. If you’ve ever had to stop peeing mid-stream, say you forgot to lock the stall or for a clean-catch urine specimen, you have done a Kegel. In general, the instructions are to do 10 repetitions, 3 times a day. While Kegel exercises work, it can sometimes take months of consistent effort to see results. Don’t be discouraged. Some women will need the assistance of a pelvic physical therapist to aid with their recovery.
Unsure if you need to do Kegels? You probably do, even if you aren’t experiencing symptoms of pelvic floor dysfunction. Some of the symptoms of problems with your pelvic floor include leaking urine, feeling of a ball in your vagina, feeling something coming down or out of your vagina, and pain with intercourse. Everyone should discuss their pelvic floor health with their Ob provider at their postpartum appointment. Before attending this appointment, make sure to check out my Must Discuss Guide to the 6 week Postpartum Appointment (click on the link, enter your email and I’ll send it your way!)
6. Rectus Diastasis
During pregnancy, our abdominal muscles (known as the rectus abdominis) often separate slightly. Postpartum they should slowly come back together, meeting in the middle. Unfortunately, in some women these muscles don’t come back together. This is called Rectus Diastasis. An abdominal exam should be performed at your postpartum visit to check for a diastasis, but if you don’t receive this examination, don’t be afraid to ask. Untreated rectus diastasis can lead to chronic lower back pain in the future. The treatment for this separation often involves specialized exercises, sometimes done in coordination with a physical therapist.
Alright mommas, there you have it. I hope you found this guide useful. Please feel free to share it with your expecting friends and family! Knowing what to expect is half the battle. And if you didn’t earlier, make sure to grab my Ultimate Postpartum Kit Checklist (complete with Amazon links!)
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