Quite often when working with moms they have numerous questions regarding the early postpartum period: what to expect, how to stay comfortable while healing, how to fully heal their bodies and minimize lasting symptoms from pregnancy and delivery. I have found through my personal experience and with conversations with moms, there is a lack of communication on what moms can do to help ease discomfort in the early postpartum weeks. The vast majority of what moms are finding and learning are from blogs, Pinterest or their closets girlfriends that are moms. The majority of the information is NOT coming from their providers unfortunately. And after baby is born, most moms get little to no guidance for the first few weeks after delivery outside of “take it easy” and “sleep when baby sleeps.” Some moms get nothing after they leave the facility until their 6 week checkup. Part of this is because of mindset that the healing simply takes time – which it does…there’s no dispute on that fact.
General tissue healing takes approximately 12-16 weeks. And **NERD ALERT** did you know that it takes approximately 29 weeks for your abdominal organs to FULLY settle back to their normal position? Even then, sometimes the tissues that surround your abdominal organs (visceral and parietal peritoneum) can get stuck against each other like cellophane when it gets folded over on itself which can cause persistent pain, diastasis, prolapse and weakness (we’ll discuss this more in a future blog). However, there are things you can do to help facilitate healing, keep you more comfortable so that you can get back to the things you love quicker. This is my attempt to help eliminate the uncertainty with some of the most basic and most common issues a woman experiences in the early postpartum phase.
0 – 2 WEEKS AFTER DELIVERY
You did it! You have brought your bundle of joy Earthside and are now in the throes of figuring out motherhood. But let’s not forget about you. Your body went through a great deal of change and will take longer than you think to settle back to a new normal. The majority of changes in the healing postpartum phase occur within the first 6 months, with the first 6-10 weeks being the most rapid changes. The first TWO WEEKS can be overwhelming. Not just from a hormonal standpoint, but physically, digestively, emotionally and more. The following information will help you ease through these first couple weeks more comfortably by knowing how to address some of the most common issues.
THE FIRST POOP
Many women have read or heard the fears around the first poop. Let’s be honest, a lot just happened to this area, the bowels undergo a lot of stress and it’s a bit sensitive, especially if any of the tissues were stitched (whether abdomen or the vulva). The Bristol Stool Chart is a great guide to know what the range of stool types is. And yes, I ask EVERY SINGLE PATIENT about their poop – and quite frequently!! We discuss a whole new level of detail about poop in my clinic! Follow this link to see where you are on the Bristol Stool Chart. The goal, for most people, will be a Type 4. If you’re on the firmer side, which is most common after delivery, here are some things that you can do to help minimize the stress to these sensitive healing tissues as your first (sometimes first few) BMs pass on by.
1. Stool Softener OR Magnesium Citrate
You can use a stool softener (ie Colace or the generic of this) proactively to help prepare for that first movement and ensure that your stool is staying soft. After you birth a baby, whether vaginal or cesarean, there is a lot that goes on and affects the movement of the colon and rectum. Though you never know exactly when baby will be born (unless of course you have a scheduled cesarean), the last week or two you can start adding 1-2 capsules of the stool softener. I tend to base this off of what the woman’s norm for her bowel movements are in those final 4ish weeks. If they’re tending to be firmer and you’re struggling a bit more, go ahead and start with 2 capsules as the bottle tends to suggest. I recommend you take them at night so that they have time to be absorbed into the system and do their magic so that when you wake and are ready for that (ideally) morning movement, the stool is a bit softer.
Taking the stool softener for the first week or two postpartum can help the stool stay soft when the tissues are most sensitive. Depending on your “norm” you may benefit using it a bit longer. Check with your provider if you think you need to continue much beyond a few weeks after delivery.
Magnesium Citrate can be really helpful to help the stool stay soft and create movement in your system. My personal favorite recommendation is Natural Calm. What I like about Calm is that it is a powder and can be adjusted more easily to an individual’s need. It also is more gentle on your system. I suggest starting with the recommended dosage, again at night, and monitoring effects over the next few days. Sometimes adding an extra half or full dose in the morning can help if you’re really backed up. Even though magnesium citrate is relatively safe for people to use, I always suggest speaking to a pharmacist and or your maternal provider to ensure you don’t have any contraindications for taking a supplement. Also, keep in mind that the bowels are slow to change and can take 3-5 days, depending on the individual, to really make a change when taking supplements.
2. Drink Extra Water
When in doubt, add water! Though it is likely that you will be drinking a good amount of water if you are nursing, it can be easy to forget this when struggling with the mommy brain, being sleep deprived and trying to figure this newborn stuff out (again). A good rule of thumb and what I recommend is HALF OF YOUR BODY WEIGHT IN OUNCES PLUS an additional 32 ounces if you’re nursing. I know, my eyes start to float too when I hear that. Don’t shoot for perfection – do the best you can to sip on water frequently through the day (FYI…drinking small volumes steady through the day is better than taking in large volumes all at one time just to get in the total amount). Also, creating a habit of each time you sit down to nurse drink 6-8 oz of water. In short, if you see that your stool is firmer and harder to pass, increase your water intake!
3. Herbal Teas
There are many options of herbal teas that can help stimulate the bowels, but the most popular seems to be “Smooth Move” tea by Traditional Medicinals. Peppermint, ginger and chamomile teas may also help get things moving in your system as well.
4. Veggies, Veggies, Veggies!
We’ve all heard to increase our veggies and it’s true! They are SO good for us in a number of ways. For the majority of people this is an easy fix to help improve BMs. If you have a sensitivity to certain vegetables, you most likely know this and clearly should avoid that. If you want an added benefit to help your bowels along, I recommend increasing your vegetables in the morning specifically. The added fiber from vegetables will push the stool through the system and get things going. Another consideration from a naturopathic physician friend of mine is that if your body is over taxed energetically, it may be easier for your body to get nutrients from steamed vegetables versus fresh vegetables though fresh do tend to have a bit more of the natural fiber still present.
On that same note, it is actually quite important that we chew food. Seems like an obvious statement, so let me elaborate. More and more people are having smoothies or breakfast shakes these days. They can be packed with great nutrients and be great for you too. However, you’re missing one key piece to digestion when you go this route…CHEWING. Chewing actually creates a reflex in the large intestine that initiates the small wave-like movements (peristalsis) that helps push stool through our system and ultimately out the backdoor. If you bypass this by drinking your breakfast, it may impact your bowel movements. If this is your standard morning breakfast, great! Stick with it, just add a handful of carrots, almonds or something with fiber that you can chew slowly so get that jump start in your system. If you’re eating “solid foods” take an extra few chews with each bite and this again will help stimulate the bowels more. Our busy, fast paced life tends to be true of our eating habits too. Us Americans are great at inhaling food which doesn’t bode well for our digestion.
A question asked at a presentation I was at recently was “how much exactly do I need to chew?” Great question! And the presenter had a great response…if you think you would struggle to have it come up (because it wasn’t chewed up enough) then you need to chew more! 🙂
5. Breathing
Breathing is so important and quite effective. If someone tends to run on the constipated side, 90%+ of the time, they admit they will strain more often than not. I want people to be really familiar with how to do a good diaphragmatic breath. This should have equal expansion in the chest, ribs and belly. The ribs are key to getting the diaphragm to move which will cause the abdominal and pelvic organs to shift southward and the pelvic floor muscles to relax. So the phrase I like to use is INHALE YOUR POOP OUT. Yes, you read that correctly. Silly as it sounds, remember that when you inhale your pelvic floor muscles open and soften which is necessary for the stool to progress down the tube. Instead of holding your breath and pushing (which if this is your normal pattern then we definitely need to chat a bit more!), I want you to breathe. Not only will this be more efficient once you get the hang of it, but by straining you can add extra stress to your tissues that are healing and have already taken on a lot of stress. No hemorrhoid here!!
6. Splinting During the BM
Splinting is a technique that is commonly used for women who have a rectocele (a prolapse of the rectum into the vagina). In this case, I use it to create support to any tissues that tore or are particularly tender. For this technique it is imperative that you are very gentle with your pressure (especially in the early postpartum phase). I tell patient to meet the resistance of the stool as it passes by, NOT pressing firmly into the area or the tissues. To do the technique, you will simply insert your thumb into your vagina and place your thumb along the back side of the vaginal canal (this is where the rectum runs). This helps to create a rigid backstop along the backside of the vaginal canal. For the first couple BMs after delivery, this can help minimize the stress and stretch to the healing tissues as the stool passes. Think about when you have had a papercut and you inadvertently stretch it back open…IT HURTS! Splinting helps to minimize that from happening. To be frank, this is not always a glorious thing especially if you are you still bleeding, but it is really effective and can make it quite a bit more comfortable. So don’t rule it out, just because you’re bleeding.
7. Positioning
Positioning during a BM can be a big help. Many have heard of The Squatty Potty. If not, check it out here . In short, squatting allows the muscles of the pelvic floor to be a bit more lengthened and relaxed. The key to this position is having the knees above the hips. You can use a couple rolls of toilet paper or some yoga blocks and prop your feet up on them to give it a test run. Many people ask if they can use their kids potty training step stools or a small kitchen step stool. They can still work, however the key difference will be your foot position. The Squatty Potty positions your feet a bit wider which further allow for opening of the pelvic outlet. Try it: place your feet close together and knees together on a small step stool and take a few deep breaths, don’t you feel closed up? Now try a position where your feet are wider. Take a few deep breaths and see what the sensation is in the pelvic floor. I have had a handful of patients over my career that this position didn’t work for them. Don’t try it just a couple times. Give it a go several times before you decide to give up.
SWELLING
Let’s be real…there is a lot that happens to the vagina through the course of pregnancy and delivery. Though clearly there can be a more apparent effect on the tissues after a vaginal delivery, don’t be surprised if you have some symptoms after a cesarean too. Especially if you had labored and progressed any notable degree towards a vaginal delivery. There are some tricks that you can utilize to help manage the swelling and soreness after delivery. Here are some of my favorite and most recommended products to help keep you comfortable.
1. Crotch-sicles
Gotta love the name, right? This is a large postpartum, menstrual pad or infant diaper that has been drenched with witch hazel then frozen. You can also add some lavender essential oil (approx. 5-10 drops) and aloe to easy any discomfort. I encourage women to pull the frozen pad out and allow it to soften for 5-10 minutes before getting it situated so you’re not sitting on a hard lump of ice. Place the pad in your underwear or shorts to help keep them in place. Ideally, you would be lying or sitting down when using these, but sometimes Mom Life calls and we’re on the run. You can use a towel tucked from front to back to help keep the ice pad positioned more effectively (I know, that’s a beautiful picture to have someone capture and hold on for later use!).
WARNING: Place a soft, thin barrier over the frozen pad before applying it against your skin. This is definitely not the area that you want to get frost bite 😉
Apply for 10 min on and 10 min off as much as you need to help stay comfortable.
2. “TendHer” Reusable Perineal Ice Pack
These are the same concept as the crotch-sicles, however just an ice pack your put in your freezer, place in the soft cover and use. They can be found on Amazon for a reasonable price. I’m sure there are more similar items out there that I haven’t come across yet.
Apply for 10 min on and 10 min off as much as you need to help stay comfortable.
3. Bag of Frozen Popcorn Kernels
Everyone always laughs when I mention this one. The great thing about this is that it contours rather comfortably to the perineum so there is less likely to be a pressure point or lumpy parts like with using bags of ice. The other perk is that they don’t smash like frozen peas if you sit on them! They do take a bit to cool down, so I recommend having two bags frozen so you can cycle between them while the other is re-freezing.
Apply for 10 min on and 10 min off as much as you need to help stay comfortable.
4. Sitz Bath
This is a great method to help soothe and ease any irritated tissues while encouraging healing. I recommend using plain Epsom salt with maybe a few drops of essential oils and perhaps some herbs (put in a small cheesecloth tied up). I’m always cautious with what is applied to this area after delivery as the tissues are already extra sensitive and you don’t always know how the skin will react. There are special sitz bath setups you can use that area done while on the toilet. I believe your local medical supply store should carry them or again, find them online. I find it easier to hop in the bathtub with some warm (not hot) water. Some people suggest sitting in just a few inches of water. I have a hard time with that simply because when I tried it with my first go ‘round, I was so cold and uncomfortable I didn’t want to stay in long enough. I filled up the tub, got cozy and enjoyed my bath.
Enjoy the soothing water for 15-30 min as needed to help with healing and stay comfortable.
RETURNING TO ACTIVITY
The first week-ish you may be rather sore. Allow yourself plenty of time, rest and grace to get through this phase. But when you are feeling like you’re ready to do a bit more less is more in this phase of healing. Start slow and light with doing 10 minutes of comfortable walking. Do this most days of the first week you return to activity. Each week, if you’re doing well increase the duration of time by 5 minutes. Continue to walk that same duration of time for the week.
If you have any increase in pain, bleeding, vaginal pressure or other abnormal symptoms, take a few days off until symptoms resolve. If things aren’t improving within 12-24 hours, reach out to your health care provider for them to assess and ensure all is well with your healing body. When you return back after a period of rest to manage symptoms, decrease your time back to the prior duration of your walk for the first time or two, then increase by TWO MINUTES. It seems small, I know, but you’d rather go slow and steady here than plow through it and struggle with symptoms for longer.
2 – 4 WEEKS AFTER DELIVERY
Things are starting to feel a bit more comfortable, hopefully easier to move and change positions though not quite normal yet. This is a great time to connect with a pelvic health physical therapist to talk about how you can start waking up the core (transverse abdominis specifically) and the pelvic floor in a safe and effective manner. This can be key to minimizing stress on the diastasis, the pelvic floor and keeping you comfortable. I love to educate women on how to properly engage their core when they are changing positions (because you may feel you’re moving like you’re pregnant still), lifting baby, carrying the car seat, wearing baby, lifting their other kids or many of the other to-do’s in our life.
It’s not appropriate to dive right back into exercise, though you may be chomping at the bit to get moving again and regain some of that strength. It is best to work slow and steady to build that foundation in order to minimize any potential long-term problems. I often use the analogy of building a beautiful house on sand. Over time, the foundation under the house will break down, give under the stresses of the house and create bigger problems for the house. Same goes for our bodies after having a baby. If we don’t properly address any weaknesses, muscles tightness and poor recruitment patterns of the muscles then we may struggle a lot more than is necessary in the coming years.
So be gentle, be kind and reach out to your pelvic therapist to get the specific guidance you need in order to succeed in your healing journey.
6+ WEEKS AFTER DELIVERY
This is the standard milestone that is talked about for women in the postpartum period. Women return to their providers and look forward to receiving the “all clear” for resuming all activities and returning to sexual activity. However, just like we discussed earlier, there can be a lot of healing left to occur and things may need a bit more guidance. I will often hear women in this stage of healing mention that they had returned to a particular exercise or spent more time on their feet doing work around the house and then they had an increase in abdominal discomfort, heaviness in the vagina or even a return of bleeding (though only temporary). All of that is a sign that you have have overdone it. I will say that if you have a marked increase in bleeding or a return of bleeding that doesn’t resolve after resting for 24 hrs, I recommend checking in with your provider.
This is the time that I really encourage women to take it slow, do the work to restrengthen the true core and ease back into activity. Recent guidelines are leaning more toward delaying running or higher impact activity until 12 weeks postpartum to allow for more adequate strengthening to minimize injury. Couch to 5K programs where there is a mix of walking and running are a great option and method to ease your body back running. It is also best if you work to increase your training time or distance first before increasing your intensity to minimize injury. Keep in mind that while you’re nursing your ligaments are still looser than your normal (non-pregnant or nursing) ligaments which means that they’re are going to be as supportive nor will they provide information to your brain/body as quickly if you’ve gone too far. This is where having a therapist or trainer who is very cognizant of the effects of a pregnancy and nursing can be vital.
Additionally, if you feel you are working diligently and not seeing the results you would expect, the first thing that comes to mind is “Are the muscles being contracted properly?” OR “Is there an underlying tightness in the tissues that’s limiting the muscles from contracting effectively?” Those two questions are probably the most frequent questions that come to mind and the two keys to effective rehab after baby. It’s not about quantity of your training…it’s about quality.
IN CLOSING…
There are so many nuances to the healing that occurs through the postpartum journey. This is where finding a therapist that is really knowledgeable in this phase of life and how to guide you properly both for the core and the pelvic floor can be pivotal to your full rehab. Taking time to rehab the body fully and effectively in the first year or two can be key to minimizing many other problems that occur or persist (peeing when you sneeze, urgency, chronic back pain, etc). Additionally, I suggest ALL women, even if you’re not having symptoms, have at least 1 – 2 visits with a pelvic therapist to ensure they are on the right track and strengthening properly. Often times I see women later in their life that didn’t have problems after pregnancy but things started to occur as they progressed towards or into menopause because the pelvic floor muscles weaken even further, the decrease in estrogen changes the fullness of the tissues.
So let’s create a change and start sharing this information to all our girlfriends, moms, daughter and even husbands. The more we share and normalize these conversations, the more change we will see for our future Mama’s.
Reach out to me at info@tvpelvichealth.com if you have any specific question or call me at 208.629.1030 and I’m happy to have a conversation to see what guidance you need to through your healing journey.
