Have you heard the phrase, “Be careful not to plan for the wedding and forget about the marriage”? Well, we often treat postpartum recovery much the same way.
So many women pour all their attention in to the birth process, but the 4th trimester (or first 40 days after delivery) is sometimes an afterthought.
Maybe in years past you could have gotten away with just taking it day-by-day and figuring it out as you went along, but if we’ve learned anything in the last 2 years when our “villages” have been limited and our support system in jeopardy, it’s that planning ahead is essential to a healthy postpartum recovery.
The postpartum period is officially considered the first 6 weeks after birth where the mother experiences several physical and emotional changes.
But let’s start with what’s going on in the first few minutes postpartum. Did you know that in an uncomplicated vaginal birth, the third stage of labor actually happens AFTER the baby is born? The third stage of labor is delivery of the placenta. I remember right after giving birth to my first child, being asked by my midwife to give a small push and thinking, “Is there another baby in there?!” Luckily it was just my placenta. Here are some other things you might want to know so there are fewer surprises after birth.
Afterpains are strong, menstrual like cramps that can occur as your uterus begins to contract back towards its pre-pregnancy shape. Traditionally, these cramps can become stronger with breastfeeding and with each subsequent childbirth. After the placenta is birthed, your uterus should contract to the size of a grapefruit and still be palpable above your pubic bone. Your nurse will most likely perform a fundal massage, but this will be nothing like the spa-like rub-down of bygone years. Instead it’s more of a vigorous kneading to encourage the uterus to contract and to prevent postpartum bleeding.
Speaking of bleeding, the official term for the vaginal discharge after giving birth is lochia, and it should resemble a heavy period for the first few days.
It’s not abnormal to experience a “gush” especially when changing positions or pass a few small clots, and the color will go from red to pink to brownish in the first 2-6 weeks after birth.
Signs to contact your provider are bleeding that saturates a pad in 2 hours or less, bleeding that increases after it has slowed and doesn’t decrease with rest, cramping and clotting after the first few days, discharge with a foul smell, running a temperature, or bleeding beyond 6 weeks postpartum.
Your hospital or birth center will provide long pads meant for postpartum bleeding, but some women prefer to bring their own Depends sanitary pads. You will most likely be offered ice to help with the swelling in your perineum for a day or two after birth. Say yes. And you will use a device called a peri bottle filled with (preferably warm) water to help clean yourself after urinating to avoid aggravating the area with traditional wiping techniques.
Some women are surprised to learn they will still bleed from their vagina following a Cesarean section. The lining of your uterus has grown to be quite thick during pregnancy to build a beautiful bed for your baby, and it needs to shed after your baby is born. In the case of a C-section, you most likely will have a waterproof dressing covering the wound that will be checked and/or removed in the day or so after delivery. You will learn how to clean your incision, and in some cases your stiches will dissolve while other times you may need to return in 5-7 days.
There are some things that are the same regardless of your method of delivery. For example, managing constipation becomes extremely important. You may be offered a laxative preventatively and there are also other things you can do to help. Stay hydrated and eat regular meals containing fiber. Don’t ignore the urge to have a bowel movement, and do your best to move gently and frequently if your pain levels and/or surgical restrictions allow. Just like there’s work station ergonomics, there’s better positions to align your body to help evacuate your bowels. Elevating your feet on a stool or foot rest can create a situation that is more ergonomically correct and more efficient as well.
One change in postpartum care over the last 2 years is that women have been spending less and less time in the hospital afterwards. And many are not returning to settings where relatives are as readily available to join them like they had been prior to Covid.
As a result, it’s important they are aware of normal and abnormal patterns of recovery and have access to resources where they can get the postpartum help they so desperately need and deserve, especially in the absence of support from their inner circle.
Meg Smith is a birth and postpartum doula with Cloud Nine Birth services who supports women not only in birth but in the weeks after childbirth and beyond. Her advice is “Take the help!” She sees so many women determined to do things themselves and strive to be “super Moms” and she reminds them they need to nurture themselves.
“Having a baby is a huge physical and emotional shift. Give yourself time to heal. Let someone bring you a meal. Let someone sit with the baby so you can take a warm shower and a good nap.”
If you have family or friends that can fill that role, take the help. But if you don’t, that’s where a postpartum doula can assist.
A postpartum doula provides physical and emotional support to the mom after birth. They can help with newborn care (diapers and baths and feeding) and play with older children. They can do some light meal prep or light housework. They can go on field trips with you to the store to figure out how to get that pesky car seat into the cart, fill out thank you cards, and even provide some limited breastfeeding support.
Lactation support is another service postpartum women have been needing more in the last 2 years. Some/most women’s milk has not even come in during their hospital stay. While most hospitals/birth centers have lactation departments, you may not get to see a specialist in your abbreviated hospital stay or these visits may be shortened.
Establishing care (verifying insurance and maybe even having a voice to voice introduction) with someone who can visit you in your home or do a video call with you can prove to be invaluable in the early days/weeks of new motherhood.
Heather Dvorak is an internationally board certified lactation consultant who is trained to identify tethered oral tissues like tongue and lip ties. She is the owner of A Baby Place, a business designed to support women from pregnancy through weaning. Her advice is to take a breastfeeding class. She also recommends exploring methods of giving a little extra milk such as using a syringe, finger feeding, spoon, or open cup in case there are concerns.
One final piece to postpartum recovery that cannot be neglected and often needs to be planned for ahead of time is mental health.
Sarah Cline, LCSW is certified in perinatal mental health and perinatal loss, and has some helpful suggestions for ways to love yourself and take care of yourself in the postpartum time (which include wearing stretchy pants as much as possible).
She recommends setting boundaries with family members about who will visit and when.
Also, resentment towards your partner can slowly seep in to even the strongest of bonds. Instead of resenting your partner because he’s sleeping, ask specifically for what you need.
She also gives you permission to the let the “to do” list go. The only thing on that list should be rest, drink, eat (you’d be surprised how many new moms forget even the most basic of tasks), and sleep. In the weeks following birth you need to become a master outsourcer.
And finally, Sarah recommends you don’t weigh yourself, diet, try to begin a workout routine too soon, or look at social media that glamorizes thin, young, wealthy, airbrushed bodies. Instead, you might use that time to instead join a new mom’s support group.
Angel Ianakiev, LCSW also has advanced training in perinatal mental health. Angel is passionate about caring for new mothers and leads a free support group (in person and on Zoom) for pregnant and new moms. She loves offering practical advice for women at this stage and recommends the following apps to help with postpartum mental health: Happify, Peanut, Mood Tools, Headspace, Calm, and Sound Sleeper.
The first few days after birth are often termed “the honeymoon phase” because you’re running on pure adrenaline and baby bliss.
But eventually the adrenaline turns to fumes, and sometimes those newborn cries and fussiness begin to compete with the bliss. And that’s OK. You are not alone. You are standing (or laying down!) in solidarity with thousands of other women going through a similar journey, and millions before you, and millions more to come.
If you plan for your recovery with the fervor with which most plan for their birth, you’ll be setting the stage for a better “happily ever after.”