POSTPARTUM REALITIES 

The first few months after giving birth marks a transformative time in every new parent’s life. As a midwife I have heard countless women recount their postpartum time with sadness and regret. The most common thing I have heard is, “If I had only known...” It is simple and easy to think of the time after giving birth as a physical recovery, followed by familial bliss in welcoming a new member. However, this type of simplistic conceptualization of the postpartum period sets new parents up to feel like failures or ungrateful when they struggle through the emotions, identity changes and unforeseen physical healing processes. In other words, it is not enough just to say, “At least we are all healthy.” This type of thinking undermines the ability to grow through the struggle of being a new parents and instead forces them to replace their sense of self with self-less gratitude for the health and existence of their child. In an effort to prepare new moms for the emotions of the postpartum period, I have created a list of the most common concerns and things that may help. The postpartum period is different for everyone, but the one universal is that having a baby changes you in ways you would never imagine.
Postpartum Growing Pains
It is common to hear about the Baby Blues and Postpartum Depression. However, what few people recognize, but all mothers experience, is Postpartum Growing Pains. Growth can hurt. Becoming a new mother is a profound physical and emotional turning point. The pregnancy and birth of your child marks a time in your life that will change every part of it, forever. One of the hardest parts of motherhood is redefining your life now that you have a new identity and be present for your child who is wholly dependent on you for their survival. It is vital for mothers and their partners to look at the postpartum period not as a race to get back to your old self, but rather as the growth of a new you. Growth is not always easy and it has no endpoint. As you and your partner grow into your new roles be patient, kind and forgiving to yourself and the one staying up with you at night.
What Helps:
- Talk to someone about what you are experiencing
- Acknowledge your feelings
- Know that it is totally normal to feel empowered and totally terrified all at the same time
- Admiring that you are having a hard times does not mean that you do not love and adore your baby
- Avoid talking to anyone that starts a sentence, “Well, at least you ...” it is counterproductive to let “positivity”
stifle the truth of what you are going through
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Your Breasts/chest
Your breasts have changed in shape, size and color during your pregnancy. However, it is not until you start breastfeeding that things really change. Before pregnancy your breast may have been a source of pleasure, or pride or insecurity. Whatever your relationship to your breasts were in the past, it is about to change. Breastfeeding can bring up many emotions. Every woman has a different reaction to feeding their infant. The most important thing to do is not convolute your emotions by adding guilt, shame or embarrassment to what you are feeling. Feeding your baby Talk to someone about what you are experiencing, sometimes just acknowledging how you are feeling is enough to start working through the emotions.
Your belly
Your uterus by 24 hours postpartum is at the level of your belly button, the same place that it was when you were about 5 months pregnant. However, now it will be loose and jiggly instead of tight and baby filled. Seeing your body for the first time postpartum can be quite a shock for many women. It takes about four weeks for your uterus to go back to its’ pre-pregnancy size. However, it may take months before your hips joints move back into place, your abdominal muscles come back together and the extra skin, fat and muscle that you built in pregnancy reduces. Your belly will slowly go back to resembling something you recognize, however it may never look the same. Keeping positive, staying active, being patient and being realistic will help you to keep the changes to your body in perspective.
What Helps:
  What Helps :
- Be kind to yourself
- Patience
- Good support, if you do not have it, get it!
  - Slowly increasing activities like walking and weight lifting - Listening to your body
- Being kind to yourself
- Setting realistic goals
- It took your body almost a year to grow this baby so give yourself that same time to recover.
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Your Bottom
Your “bottom” includes your labia, urethra, perineum and anus. Your bottom has been through a lot while giving birth and supporting a pregnant belly. Swelling and throbbing are normal in the first few days. This usually subsides by the end of the first week and will gradually improve over time.
Urinary Incontinence
Leaking pee is very normal in the first few weeks, especially after coughing, sneezing or jumping. There are many factors that contribute to postpartum incontinence. The most common cause is a relaxation or the pelvic floor (see photo below). This should get better over time as muscle tone comes back and the nerves begin to function normally. If you are leaking urine after six weeks, talk to your provider. If you are losing fecal matter, call your provider right away.
- Time
- Kegels
- Pelvic floor strengthening
- Weight loss (for obese women),
Perineum
Most women who tear will tear in this area located between the vagina and the anus. Ask your provider to draw
you a picture of where they stitched so you have an idea what is healing. The majority of the swelling should subside over a week. Most stitches dissolve within a few weeks, occasionally a knot may come out, indicating that the stitching material has dissolved.
What Helps:
1st 24 hours
- Icepacks
- Rest
- NSAIDs(ex:Ibuprofen)
After 1st 24 hours:
- Warm sitz baths once or twice a day (can use Sitz bath herbs)
- Dermoplast numbing spray for comfort while using the bathroom
- Rinsing vulva with a peribottle filled with warm or cold water (whatever feels good to you) to keep the area
clean.
- Donut cushion, a specialized cushion with a hole cut out of the middle for comfort with sitting
Anus
Hemorrhoids may appear after delivery or remain after pregnancy. Hemorrhoids are swollen blood vessels in the anus and lower rectum. They can be painful and itchy.
What Helps:
- Tucks Pads placed after a bowel movement against the hemorrhoid and left in until you use the bathroom the
next time (Tucks Pads can also been placed in the refrigerator for more cooling)
- Hydrocortisone cream on hemorrhoid
- Avoid constipation and straining with bowel movements
- Activity (ex: walking, changing positions etc.)
  What Helps:
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Your Vagina
Rugea (the folds in the vagina that allow it to stretch) will come back around week 3 to 6 postpartum. This means that for up to 6 weeks (more for some women) the vagina may feel full or heavy as the edema (swelling) subsides. Aside from the edema and lack of elasticity, vaginal discharge has also changed. Prolactin, the hormone that encourages breastmilk production also reduces the amount of estrogen in the blood stream. This in turns leads to less vaginal discharge and, therefore, feelings of dryness.
What Helps:
- Taking it slow when it comes to putting things in your vagina
- Lube- as much as you need
- Open communication with your partner about how you feel and what would feel better
C-Section Recovery
Healing from a c-section can be very difficult. If you were not planning on a c-section you may need to re-think the amount of help that you will need once you are home. If your birth did not go how you planned or you do not feel positively about your birth, talk to someone! A good place to start is your provider or delivery team. It is OK to ask “what happened” and to get honest and complete answers. If you are not getting the answers you want, keep asking. Constipation and gas pain may be the source of the most discomfort, especially when compounded with pain medications. See below for tips on constipation. Incision pain and some numbness around the incision is normal, but increasing, severe pain, redness or puss is not and you will need to call your doctor. You may not be able to use your baby carrier right away as you heal, but you will be able to eventually.
What Helps:
- Take your pain medication as prescribed
- Rest
- Get help for household chores and for the baby
- Talk to a lactation consultant for ways to feed with the incisions
- Talk to someone about how you feel about your birth
- Be kind to yourself, you just had surgery and birthed a baby- pretty incredible!
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