During pregnancy, I spent a lot of time picking out nursery decorations, reading books about childbirth, and preparing for breastfeeding and pumping after the birth of my baby. But there was no one to guide me on selecting the best breast pump for my lifestyle. What were my options? Did insurance pay for it? Would I get any lactation support after the baby was born?
A major topic that is under-discussed in the postpartum journey is how breast feeding or pumping can affect your pelvic health and pelvic floor. I wanted to shed some light on changes that occur after childbirth and how breast feeding or pumping affect your pelvic health.
How does breastfeeding affect your hormones?
During pregnancy, you have almost 30 times as much estrogen in your body! Hence, the occasional emotional outbursts! This increased estrogen plays a big role in your baby’s development and your milk duct system in preparation for breast milk production. Immediately following childbirth, your estrogen levels drop drastically allowing for an increase in prolactin, which is the main hormone responsible for breast milk production. As you continue to produce breast milk, your prolactin levels stay high and estrogen levels stay low, which can have an unexpected effect on your pelvic health.
How does breastfeeding affect your pelvic health?
Low estrogen levels contribute to three main issues related to your pelvic health.
Vaginal dryness. Within a few weeks after childbirth, your vagina can start to feel very dry, like super dry, like Sahara desert and can stay this way as long as you continue to produce breast milk. Vaginal dryness can cause discomfort wearing underwear or tight pants and contribute to pain with sex.
Lack of a period. Decreased estrogen may cause your postpartum period to not return for quite some time. If you breastfeed for only a short period of time, your period may return with 6-8 weeks after childbirth. But if you breastfeed or pump for an extended period, your period can take anywhere from 6-9 months to return or not until you completely stops breastfeeding, which may be over a year.
Lack of libido. Decreased estrogen levels during breastfeeding and pumping can also contribute to a decreased sex drive. Returning to sex after having a baby entails a complex orchestra of factors. Sleep deprivation, leaking breasts, body image, pain and parental responsibility all play a role as to why frequency of sex may decline after childbirth, especially in the early postpartum weeks and months.
What can I do for pelvic health during breastfeeding?
Get support! Working with a lactation consultant to guide you through latching, feeding, milk supply issues, and using a breast pump can help minimize stress and promote optimal rest and recovery postpartum.
Moisture is key for vaginal dryness! Prick a small capsule of Vitamin E and apply oil to labia and vaginal opening several times a day. Using a water-soluble lubricant can decrease friction during intercourse. Your physician or midwife may also recommend an estrogen-based cream, but this may affect your breastmilk supply so speak to your healthcare provider about possible side effects. If pain with intercourse persists after these remedies, work with a pelvic health physical therapist for muscle relaxation and tissue softening to help decrease pain and sensitivity.
Your postpartum period may have a heavier flow compared to pre-pregnancy and require some changes to your menstrual care routine. Consider using a menstrual cup for a heavier flow, switching to pads and liners if tampons do not comfortably stay inserted, and using organic nontoxic products for sensitive vaginal and vulvar tissues.
Regarding your lower sex drive, try not to put too much pressure on yourself or your relationship to return to sex, especially if it’s painful or uncomfortable. As your breastfeeding sessions become less frequent (and you start to get more rest), your sex drive may start to increase again. However, if pain is limiting your desire to have sex, let your medical provider know and work with a pelvic health physical therapist for help.
Will these changes last forever?
The effects of breastfeeding on your pelvic health are short term and will all improve as milk production decreases and your feedings become less frequent.
Breastfeeding also will not have any long-term affects on urinary leakage or pelvic organ prolapse as research found no increased risk of these symptoms in women who exclusively breastfed. Your breastfeeding journey may last a few days or several years and it is an individual experience for every mother.
How do I know if I need to see a pelvic health physical therapist after childbirth?
If you experience changes in your pelvic health with regards to urinary leakage, bowel movements, sexual function, organ support, scar tissue or returning to fitness, a pelvic health physical therapist can assess your pelvic floor and abdominal muscles to rehabilitate and strengthen you during postpartum recovery.
Sara Reardon PT, DPT, WCS is the owner of NOLA Pelvic Health and founder of The Vagina Whisperer, a resource for online pelvic health education and therapy to help women worldwide with pelvic health conditions. She is a board certified women’s health physical therapist with a special interest in treating pelvic pain and pregnancy and postpartum conditions. She is a mom, wife, Saints fan and wanna be yogi.