Navigating Postpartum: Hormonal Changes, Perineal Tearing, Returning to Sex, and More

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woman hiking with newborn

My name is Jen, I’m a pelvic floor physical therapist. As I write this I am 6 months postpartum. The birth of my daughter was amazing. In the immediate moments following her birth I was full of adrenaline, happiness, excitement, accomplishment  and looked forward to bonding with her in the weeks to come. Those weeks came and with them a bit of a haze. 

Reflecting on my postpartum experiences to date there are a lot of things I would have chosen to do differently that may have helped me navigate this time. My early postpartum experiences challenged me and my partner. While we grew through those experiences and have gained a new appreciation for things that go smoothly, I’d like to share with you a few things I wish I had known about navigating postpartum life.

Baby Blues, Hormones, & Identity Shifting

Questioning Everything

The first few days of postpartum left me questioning a lot. I questioned if I would ever sleep again. I questioned if I would know how to calm my baby. Do I swaddle? Sing? Feed? Pacifier? Change diaper? Is she too hot? Is she too cold? Does she just need to cry? Should I just hold her close and let her cry? Wait this cry feels like she needs something, I just don’t know what to give her.

Beyond worries of caring for a newborn for the first time I began to question my own identity. I wondered if I would ever feel like myself again. I questioned if I was ready to be a parent. I even questioned our decision to have kids. 

These questions left me feeling guilty over changing the awesome live my partner and I had known in such a big way. As a pelvic floor physical therapist I knew that coming off of the endorphins of birth and adapting to my new post-baby body was going to be an adjustment. But the huge hormonal and identity shift was unlike anything I’ve ever known.

The Desire to Do Rather Than to Rest

This questioning also left me tired. While I knew my body needed to rest, I hated being in my bedroom. I wanted to get up and resume my regular household actives. I wanted to get out and walk the dogs. I wanted to clean up the house or do some laundry. 

I have always been fiercely independent and I did not want to ask other people to do stuff for me. I knew I could ask others for help if it was needed or let certain household tasks go, but the problem was that I really felt this urge that I wanted to get up and do them.  I wanted outer order because I thought it could help keep me calm. 

I wanted to sleep, but even when I got the chance I had difficulty getting any sleep. I felt guilty for asking friends and family to hold her to give me a break, so my attempts at rest were usually filled with feelings of shame.

In Hind Sight

While it took me time to let go of the need to do everything myself, I am so thankful to have had such a supportive team including medical (my midwives) and friends/family. The gifts of having food dropped off, baby cuddles, hugs, listening ears, and much more made a huge difference in my ability to rest, recharge emotionally, and recover.

I wish I could revisit myself six months ago and cultivate a go with the flow attitude. After getting over my initial baby blues and feeding issues, having a calm “we’ll just see what happens” attitude really helped ease future decisions for us.

Lastly, I have to give a big shout out to my amazing husband, Alex. I don’t know how I could have done this without you.

Navigating Sleep

I heard several times (and I have often given this advice before my experience), “sleep when baby sleeps,” Well my baby wasn’t sleeping. So here I was: sleep deprived, anxious, baby blues and everyone else seemed to be talking about how their newborns slept all the time. It was hard. 

Turns out my baby was hungry. I wasn’t producing enough and she was inconsolable. Those first few weeks were harder than I ever imagined. Yet it could have been so much worse. I realize how lucky I was to have my dream birth experience, be with my healthy full term baby right away. I was able to be off of work for 9 weeks. I was privileged even to have choices and access to quality care. But there was still a struggle for me in this new role. 

Recovering from a Perineal Tear

I had a first degree perineal tear (least severe, perineal skin tear) and chose not to get stitches and let it heal naturally. I looked at the tear with my midwives in making this decision – that’s the pelvic PT in me. I don’t necessarily recommend you do that unless you want to. I did my best to keep my thighs together for the first 7-10 days while things healed. I took short strides while walking, did steps 1 at a time if I needed to, rolled in/out of bed using a log roll with my legs together (and protecting my abs healing). I used SRC compression recovery shorts for support of my perineum and abs. 

I let the area heal for the first 6 weeks and attempted not to touch it too much. Just some light gentle touch over underwear or gently on skin to decrease my tissue sensitivity but not too much that I was moving any skin. After 6 weeks things had closed completely and I verified tissue healing with my midwives. I then began perineal scar tissue work. You can read more about that in a blog post all about perineal massage.

In Hind Sight

I would highly recommend investing in a postpartum perineum and abdomen support. I found the SRC health high waisted compression shorts and they were a huge help in make me feel more comfortable after birth. Additionally, I wish I had stock piled lots of diapers (for me!) for postpartum bleeding. I found depends easier to use than pads.

Returning to Exercise Postpartum

My own experience returning to exercise went pretty smoothly and followed the advice that I often give clients. Take a very individualized approach based on what your body is telling you and what your prior activity level was during pregnancy/pre-pregnancy. The first few weeks I took very small walks increasing daily only a few minutes at a time and increasing the number of walks I did a day.


By week 3 I had slowly worked my way back up to a mile walk, and by week 4 I was doing two separate mile walks (one morning, one evening). Around week 6, I started to do a small amount of jog/walk intervals, but it didn’t feel super great (pelvic heaviness), so I focused mostly on walking. 

Pelvic Floor Exercises

Already around week 3, I started slowly to add in some gentle pelvic floor exercises with movements: mini squats, mini lunges, bird dogs, fire hydrants, standing hip abduction and hip extension, heel raises, push-ups at a countertop, arm exercises with 8 lb. weights.

This was all really scaled back versions of what I was doing during pregnancy. I went to my first crossfit class around 6-7 weeks postpartum and scaled significantly. Going at my own pace and number of reps/sets and not keeping track of my totals. 

*All things I attempted return to within the first 6-12 weeks were things that I regularly did before pregnancy and had continued to be active with throughout my pregnancy. They were also things I could do without pain, leakage, or feelings of falling out/pelvic heaviness. If something didn’t feel right I modified. (We can help you with this via our online wellness sessions.)

Returning to Sex Postpartum

Self Exploration to Reduce Sensitivity

I worked on decreasing my scar tissue sensitivity with touch and massage a few times a week. Once that was feeling better and less painful, I was ready to try some more self-exploration before adding my partner back into the mix. I made sure there was minimal to no pain with pressure along the entire vaginal opening (introitus) and with touch to the deeper pelvic floor muscles inside the vagina.

I masturbated to include penetration and orgasm and was a bit sore after, so I tried this at least one more time before feeling ready to try with my partner. 

Returning to Sex with a Partner Postpartum

With plenty of water based lubricant, we attempted our first time back at sex post-baby with the communication prior that we’re ready to try, but might not go for very long or go to orgasm if it was too much for me.

And it went alright. It felt different for me. I could tell I was a bit guarded. I didn’t feel like moving much. And I mostly focused on relaxing and breathing. It was slightly uncomfortable around my scar, but overall not painful.

Each time after felt a little better, more enjoyable, less guarded, less sore, more ready to move/try various positions again. In the months that followed I still would get a slight twinge near my scar but it usually decreased with change in position or depth or speed. And as I continued to work on my scar, this lessened in intensity and frequency. 

Other Things That Helped Me Postpartum

Here is a quick list of some of the things that I am thankful to have had during my postpartum recovery that I hope may help other mothers to be prepare for postpartum life.

  • Easy to eat/digest foods: Smoothies, bone broths and protein shakes.
  • Plenty of snacks on hand: nuts, Lara bars, fresh veggies, and fresh fruit.
  • Keeping my water glass full!
  • Fresh air .
  • Showering in the morning before my husband left for work. This helped me start my day feeling clean and like I accomplished something. 
  • “Happy nipples,” a locally made nipple balm by Erica Macrum (I have also heard good things about Motherlove and Earthmama organics).

Things I Would Have Done Differently Postpartum

While the last six months have undoubtedly happened for a reason, and I am thankful for the growth that my partner and I have had through it all, there are a few thins I would do differently if I could:

Request More Paternity Leave of My Partner

Asked my husband to take 2 weeks of paternity leave. Summers are his busiest season with work so we hesitated to have him take more than 4 days off, but he’s my rock and I was really shook without him. I wish I would have had 2 weeks of just us to adjust to this transition. 

Pick a Formula In Advance

Had a formula picked out just in case and/or a source of donor milk, so that I didn’t feel so pressured to provide all the food via breastfeeding or pumping (in case there was difficulty with production on my end). 

Prepare for Breastfeeding Challenges

Once I realized I wasn’t supplying enough milk to my baby on my own, I wish I would have surrendered sooner to the idea that I may not exclusively be able to provide her food and used a combination of donor milk and/or formula, so that I could try a more relaxed breastfeeding/pumping schedule. 

Rest More In Weeks 1 and 2

I wish I would have practiced what I preach to clients here. If my husband had been home and our baby better fed, I would hope to create a better set up that felt open/calm to heal and rest in. I spent a lot of time visualizing my birth space. I wish I would have spent more time visualizing my postpartum recovery space. 

Closing Thoughts

Here we are six months postpartum. Things are pretty great. We have a very happy, healthy baby. She’s so easy going and fun to be with. Her giggles and cuddles are some of my favorite things to look forward to each day. 

Just as there are a wide range of birth experiences possible, there can be a variety of postpartum journeys. Some things may be within your control and other things out of your control. Know that you’re not alone in this rollercoaster. And if you need further professional help, we’re here for you. All of us at the Vagina Whisperer have our own stories to tell, but we’re also here to listen to yours. We’re here to help you through your postpartum experience. 


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