Pelvic Care After Childbirth: What New Moms Can Expect
The human body is truly amazing. An expectant mother’s body prepares for and recovers from delivery in ways that are nothing short of miraculous.
Pregnancy and childbirth can put a fair amount of stress on the pelvis and the pelvic organs, so it’s perfectly normal to experience changes and even a few challenges during postpartum recovery.
As a urogynecologist, I receive calls from patients asking “what to expect after expecting.” These issues can feel embarrassing to talk about, but we are here to help. We want you to feel less apprehensive and more empowered as you learn more about what to expect post-delivery—especially if you’re a first-time mom.
It’s important to stay in contact with your healthcare provider, trust yourself and listen to your body. It knows how to recover quite well and, if problems or concerns arise, reach out to our team—this is what we do!
Mom Needs Attention, Too
After delivery, everyone—including mom—is focused on the baby’s health and well-being. That’s normal and expected. But we also need to make sure we focus on helping moms take care of themselves, and we hope that their partners, friends, family, fellow moms and support systems will do the same.
Even the smoothest, most problem-free childbirth can be traumatic to the body. And a complication or two can make recovery more challenging. Be patient as your body recovers—getting better is a process that takes time.
After delivery, it’s important that we pay just as much attention to mom’s health as we do to baby’s. Learn more from Dr. Alexis Dieter. @MedStarWHC via https://bit.ly/36rJwZW
Exercise and Lifting During Recovery
Long-term problems are rare, but most women will experience a “new normal.” Parts of your body will change during pregnancy and after delivery, and some of these changes may be more permanent than others. This is healthy, to be expected and, in most cases, perfectly normal.
For at least six weeks after delivery, we generally tell moms to limit lifting as much as possible, while your body is still healing. This can be hard when caring for a newborn and other young kids. When my son was born, he weighed 10 pounds, my daughter weighed 25 pounds, and my obstetrician told me not to lift anything over 10 pounds! So, we understand that you must take care of your kids and that lifting can be a necessary part of life for many new moms. If you have someone who can help, please ask them!
You may also reduce abdominal strain and pressure and feel more comfortable with movements such as turning on your side or pushing yourself up with your arms instead of doing a sit-up when sitting up.
Of course, moving around is good and helps your body stay healthy and regain strength and muscle tone. But don’t overdo it. We would not recommend that moms begin a new exercise routine right after delivery (no CrossFit!). Walking is usually best. During the early days after having my first baby, walking my driveway felt like miles, so please be patient with yourself and listen to your body—you have just finished an amazing but strenuous marathon! As your body recovers, trust that movement will get easier with time. Stay hydrated, and rest when you can. As long as you feel better over time, you’re doing fine.
Bleeding and Bruising
Postpartum bleeding is normal, although it can be disconcerting (especially the first time you stand up after delivery, as everything seems to fall out!).
Bleeding can be pretty heavy and can be on and off during the first several weeks. But if at any time you’re using two or more sanitary pads per hour, or you are lightheaded or dizzy or have other concerns, call your doctor.
The postpartum underwear given to you in the hospital is excellent and works well to hold pads so that you feel protected and supported. Ask for some extras before heading home!
I also advise my patients to refrain from looking “down there” for at least a month, as what is a normal appearance during recovery can seem quite concerning to some women and cause unnecessary anxiety. Bruises and swelling are totally normal. Just like a black eye, the vagina and outside tissues will look bruised and swollen as everything begins to heal and improve—they have been through a lot! So, unless you have a specific concern, let your doctor do the looking and focus on caring for yourself and your new baby.
Short-term, some pain is normal. The postpartum medications you’re provided should help but won’t necessarily make you pain-free. They should lessen your discomfort so you can manage daily responsibilities and feel comfortable when resting. If they don’t do that, please reach out to your doctor.
Beyond prescription medications, other helpful aids that I often discuss with my patients are over-the-counter ibuprofen, a warm or cold compress, or “padsicles.” Padsicles are made various ways, but I recommend either using an ice pack or making one by filling a few plastic zipper bags with aloe gel, molding them into the shape of a pad and putting them in the fridge or freezer. Once frozen, wrap the frozen pad with cloth or place under your sanitary pad so it is not directly against your skin. You can also add witch hazel on top of your sanitary napkin to help provide additional relief. Some women, particularly those who had a C-section, feel better with an abdominal binder or support, which you can get in the hospital and online. If your pain is worsening or doesn’t resolve over time, definitely reach out to your provider, as we want to make sure you are OK and talk about possible treatments.
In the Bathroom
Almost every new mom I’ve known is concerned about the prospect of that first bowel movement after delivery. Will it hurt? Will I tear again? It’s always better to have a loose BM rather than constipation, so hydrate and start a stool softener like Colace® (docusate), if you had not already started one and if you’re prone to constipation. Or, if you’re very worried about straining, you may also want to try a laxative like MiraLAX® (polyethylene glycol), an over-the-counter powder that you can mix into any drink to help make the stool looser and stimulate a bowel movement. Do not be alarmed if there is some bleeding and pain, it will get better! If you are having a hard time, try increasing the MiraLAX or reach out to your provider.
Hemorrhoids are common during pregnancy and typically disappear on their own during recovery. If you are having discomfort or irritation, witch hazel pads can help soothe and reduce swelling, and you can also use over-the-counter hemorrhoid creams. If your hemorrhoids become really uncomfortable, let your doctor know.
Urination can be uncomfortable as well, especially if you’ve had stitches, as sometimes it can sting the healing tissue. To find relief, some women dilute the urine as it comes out by spraying water on the vulva and vagina while urinating, either using a squirt bottle (they usually have this on the postpartum hospital unit so ask before you leave) or a bidet sprayer on your toilet that can be ordered online. Or you can even just pee in the shower or bathtub.
Sitting with your vulva and vagina in a few inches of warm water in the bathtub for up to five minutes a few times a day can help you feel a lot better. Sitz bath kits are available at drug stores or you can use your tub at home. After soaking, use a towel to dry off or, if the tissue is too sensitive, use a hairdryer on the cool setting.
Bladder leakage may persist for months after delivery. Although distressing and annoying, this is normal! As your body recovers, this should improve. If you are 6–12 months out from delivery and your bladder symptoms are no longer improving, see your provider about what to do next.
After delivery, we recommend “pelvic rest,” which means avoiding tampons, baths and swimming, and, of course, refraining from penetrative vaginal sexual activity. Most women will be healed enough to resume sexual activity after about six weeks; however, the timeframe varies from person to person so listen to your body and what your provider recommends. It’s perfectly OK to wait longer if you are not feeling up to it.
When the time does come, to help set yourself up for success, I always tell my patients to use a high-quality, silicone-based lubricant. Reduced estrogen levels, which are normal after delivery, can often cause dryness. However, please avoid lubricants with scents, flavorings or products that heat up, until everything is healed and you are at your new normal.
If pain occurs during sex, do not worry. Stop, take some time, and try again in a few days. It should get better but, if the pain persists, please talk to your doctor.
Estrogen levels are naturally lower following delivery and can take time to return to normal. When you have low estrogen, the vaginal tissues can become thinned, drier and more prone to irritation. Delivering a small, safe dose of estrogen directly to the area—as a cream, tablet or vaginal ring—can make a real difference. Because it acts locally on the vaginal tissue, it does not significantly change the level of estrogen in your body and therefore is safe for most women. Also, for breastfeeding moms, it shouldn’t interfere with breastfeeding, but talk more with your provider if you have any concerns. It’s available only by prescription, so it’s important to consult with your doctor to see if this is right for you.
Vaginal laxity or looseness can be a common concern, even up to a year after delivery. Although the vagina may not completely return to its pre-pregnancy state, you should not have any bothersome bulge or pressure in the vaginal area. If you do, please see your doctor so we can discuss how to make this better.
When Laxity Becomes Prolapse
The vagina is like a sock, with the toe of the sock at the cervix or mouth of the uterus. With stretching of the vaginal tissues and during recovery, sometimes the toe end of the sock can start to fall and the vagina starts to turn inside out a bit, causing a feeling of heaviness or pressure in the vaginal area. Some women even see or feel a bulge at the entrance or coming out of the vagina.
Prolapse usually resolves with recovery and I am constantly amazed at the body’s ability to heal itself! But if it doesn’t improve as expected, we have a few strategies. A simple and time-tested option is a vaginal pessary. It’s like a diaphragm but designed to provide structural support to the vaginal tissues. The concept has existed for thousands of years, in nearly every corner of the world, with historical evidence of women using everything from waxed pomegranates and potatoes to cork and forged metal. Today, pessaries are made of silicone—comfortable to wear, simple to maintain.
Some of my patients wear them all the time; some during the day or during exercise. It’s totally up to you, but it’s a simple way to provide a helping hand to relieve bothersome symptoms of a bulge and pressure.
Pelvic floor physical therapy (PT) can also be very effective. And it can be a great way to learn how to lift and position yourself to reduce strain on the back and pelvis and also work on abdominal strengthening and reducing rectus diastasis (a separation along the middle of the abdominal six-pack muscles due to abdominal stretching during pregnancy). PT can help after a C-section as well, to increase abdominal strength and break up scar tissue. In some countries, every new mom gets pelvic floor PT, which I think is a great idea!
In women with persistent symptoms that do not improve with time, surgery is an option to treat prolapse. But we always try to wait until after active childbearing, since subsequent pregnancies and deliveries would place extra stress on the repair.
A couple of other things to watch out for during your postpartum recovery:
- Fever: Fever is usually an indication that something is wrong. Infections can develop in the breasts, uterus or at the C-section incision site. If your temperature is 100.4 degrees Fahrenheit or higher, call your doctor without hesitation. The earlier we treat an infection, the better.
- Nerve Issues: In rare instances, nerves may become stretched and damaged, causing numbness, tingling or other symptoms, mostly in the legs. Injured nerves will generally regrow, but the process is slow—about 1 millimeter per day, or an inch per month. Persistent issues should be referred to your physician.
Growing the Family
Your first delivery doesn’t necessarily predict how future deliveries will go, but almost all women have an easier time with subsequent deliveries. Your body becomes accustomed to managing the process, and the initial “remodeling” is already done.
And once you know what to expect, you’re less likely to stress about it. It’s like driving to a new place you’ve never been—the first time is challenging and seems to take forever, but, once you know the route, it becomes easier.
If you are planning for more children, we generally recommend separating siblings by 18 to 24 months, to give your body time to recover and heal. It’s a personal decision that has many factors to consider, but data shows there are fewer complications if you allow adequate time to recover from childbirth.
Expert Care in Washington, D.C.
At MedStar Washington Hospital Center, we’re fortunate to have a talented and experienced group of providers who have dedicated their careers to the treatment of pelvic disorders. If a pelvic disorder should present itself post-childbirth, we can offer many approaches to treatment, from conservative management with behavioral changes through physical therapy and surgery, if necessary.
If surgery does become necessary, most of our surgeries are same-day, using minimally invasive vaginal, laparoscopic and robotic techniques; it’s very rare that we must make a large abdominal incision. We specialize in these minimally invasive procedures because we want to offer the best surgery for our patients. Minimally invasive surgery allows patients to recover more quickly and carries less risk of complications, so that women can return to their active lifestyles as soon as possible.
Keep Talking, Keep Learning
It’s important to keep seeing your provider throughout your postpartum recovery, even if you’re feeling great. And besides attending your regular appointments, never hesitate to reach out to your provider if you have a fever, significant bleeding or pain that’s getting worse. We can typically begin to get things under control right away.
In rare cases, postpartum symptoms linger longer than they should—or disappear only to return later in life. So again, it’s very important to keep talking to your healthcare provider because, in almost all cases, we have strategies to help!
And rest assured that, whenever we do see you in person, MedStar Washington Hospital Center is extremely safe with all COVID-19 protocols in place.
Here’s to a happy, healthy postpartum recovery!
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