February 8, 2022

The Truth About Fourth Trimester Healing

One of the hardest parts of the 4th trimester is that you do not even know there is one.

mom and newborn

One week after the birth of my son, I found myself lying down with a heating pad under my back, an ice pack over my vagina, and hooked up to my breast pump for several hours of the day. While I was not sure what to expect after childbirth… this certainly was not the picture I had in my head.

Postpartum Healing Misconceptions

One of the hardest parts of the fourth trimester is that you may not even know there is one. As expecting moms, we give a lot of attention and do a lot of preparation for pregnancy and childbirth, but often do very little preparation for life after the birth. 

The fourth trimester is commonly considered a time of transition for a baby from the womb to the world. However, it is also a time of transition for the mother. Her body is healing and recovering from the past 10 months of pregnancy and childbirth while also navigating the waters of life with a newborn. Many changes are taking place and yet new moms receive very little guidance on physical recovery, breastfeeding and pumping, and transitioning back into day-to-day life. There were so many times I thought, “I wish someone would have told me this sooner!” Well mommas, wait no longer, because here ya go!

What To Know About Breastfeeding 

It’s hard, y’all. Like really hard. I saw my twin sister pop her days-old baby on her boob like it was no big deal, and I thought that’s how breastfeeding worked. Well, not so, friends. It was neither intuitive or comfortable for me, and the lack of support in the hospital and once home had me scouring the internet at all hours of the night unsure of what to do. 

So my advice is to get informed before your baby arrives! Here are some resources I found helpful and a few recommendations:

  • Two great books are Ina May’s Guide to Breastfeeding and The Womanly Art of Breastfeeding. Having an idea of what to expect can be helpful so once the baby arrives you have some education and background about when to start breastfeeding, how it should feel, and when to get more support. 
  • Work with a lactation consultant to guide you through latching, feeding, milk supply issues, and using a breast pump to help minimize stress and help you focus on your physical recovery and snuggling with your new baby. Ashland Breast Pumps provides support in-home consults with board certified lactation consultants through their Lactation Network! I had no idea if my son was getting enough milk, how often to feed him, should I wake him to feed, when to start pumping, or even what breast pump was the best for me.
  • Pick the best breast pump for you! Ashland Breast Pumps can also connect new and expectant mothers all over the country with free insurance covered breast pumps. They help you select which breast pump is right for your lifestyle, deliver it directly to your doorstep, and work with your insurance provider to secure breast pumps, parts and accessories. There are different pumps, different suctions, different size flanges depending on your breast size… who knew?! Ashland Breast Pumps can help you navigate these questions.  
  • Hang in there. Know when to keep going and know when it’s not serving you. This is not always clear! There is so much pressure that “breast is best” and I really feel “fed is best.” So be gentle with yourself, know you are doing the best you can, and if ever you feel it might be time to stop (whether that’s at two days or two months or two years) don’t feel guilty about it. We have a long road of motherhood ahead of us and we can’t be beating ourselves up at the very start of the journey. 

Baby Your Lady Bits

During the fourth trimester, your pelvic floor and abdominal muscles are healing. Take the first few weeks to rest and recover before rushing back into day to day life. Here are some strategies to help early recovery:

  • Trauma to the pelvic floor from pushing for a prolonged period, use of forceps or vacuum, or a perineal tear or episiotomy can cause pain. For the first several days, ice is your best friend. Use an ice pack, bag of frozen peas, or a pad-sicle (a frozen witch hazel soaked maxi-pad) over your vaginal area for 20-30 minutes several times a day. After using ice for the first 3-5 days, switch to taking a sitz bath to promote circulation and healing.
  • Start performing kegels 2-4 weeks post-delivery. This may be the last thing on your mind, but performing these exercises early on can promote blood flow to the pelvic floor area to promote healing and re-engage with deconditioned muscles.
  • Following a perineal tear or episiotomy, you can begin massaging your scar gently once it has completely healed. Get confirmation from your doctor or midwife that the scar is healed and work with a pelvic health PT or do an online session with one of our therapists. 
  • To learn more about how breastfeeding/pumping can affect your pelvic floor healing, read our blog post here

The 411 On Peeing Postpartum

Peeing may be difficult and painful initially due to anesthesia, healing tissue, and shock to your pelvic floor muscles. Here are a few tips to help navigate peeing after having a baby:

  • Drink plenty of water! Hydration is the key to getting your urine stream flowing. Walking around, running water, or soaking in a warm bath can help relax your muscles and initiate your stream.  
  • Use a peri-bottle to spray warm water or witch hazel on your vulvar area during and after urination. Pat dry instead of wiping, as tissues may be sensitive. 
  • Urinary leakage may occur immediately after delivery as well. This should improve gradually, but if leakage or urinary issues persist after 6 weeks, see a pelvic health PT or do an online session with one of our therapists. 

 The 411 On Pooping Postpartum

We are sorry to inform you, but constipation immediately postpartum is super common due to pain medication and dehydration. To help relieve blockage here are a few tips: 

  • Drinking plenty of fluids will help get you back to pooping normally. Like gobs of water! Due to blood loss, medication, and your breast milk coming in, you need plenty of fluid to replenish yourself.
  • Avoid straining when you poop. Use optimal positioning to relax your pelvic floor by placing your feet on a stool or squatty potty, lean forward, and exhale like you are blowing out a candle as you gently bear down. This helps relax your pelvic floor muscles to avoid straining, hemorrhoids, prolapse, or damage to incisions. 
  • Take stool softeners or Magnesium powder in the hospital to be proactive in preventing constipation, especially if you had any anesthesia or pain medication.

C-Section Recovery Tips

Following a cesarean section it is important to recognize that you are recovering from major surgery. Focusing on recovery in the first few weeks can make a huge difference in your postpartum experience. Here are a few things to keep in mind immediately following a c-section:

  • Wear pants with a soft waistband and use ice over the incision site for the first week postpartum. You can also place a small pillow over the incision when you are riding in a car, coughing, or having a bowel movement. Finding a comfortable position to breastfeed may also be a challenge. Make sure to check in with Ashland Breast Pumps for an in-home consultation with a board certified lactation consultant through their Lactation Network.
  • Start getting out of bed to walk every day. Make sure you stand upright and avoid slouching to allow your abdominal muscles to elongate and not get restricted at your incision site. Make sure to roll over onto your side to get in and out of bed instead of sitting straight up. 
  • Perform gentle belly breathing when you are lying down to relax your abdomen. Progress to performing gentle pelvic floor muscle/kegel contractions to initiate regaining muscle strength and function. 
  • Massage your Cesarean incision after it has completely healed to decrease scar tissue restriction that can lead to bladder and bowel issues and pain. Get confirmation from your doctor that the scar is healed and work with a pelvic health PT or do an online session with one of our therapists to learn how to massage your scar. 

Caring For Your Baby And Yourself Postpartum

The first 3 months following the birth of your child can be exhilarating, exhausting, adventurous, and overwhelming. So much focus is rightfully put on your tiny beautiful baby, but as the mom you also need nourishment, care and support. 

We recommend keeping your focus on healing, breastfeeding and bonding with your baby.  We also encourage all postpartum moms to check in with a pelvic health PT around 4-6 weeks postpartum.

We hope these tips help make your postpartum healing journey easier!

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Are you currently pregnant or planning to conceive? If so, make sure to download my FREE resource — 5 Myths We’ve Been Told About Pregnant Bodies!  I correct common pregnancy myths and give you tons of tips to help you feel strong and healthy for 40 weeks and beyond.
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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.

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