Most moms spend time preparing for birth and the newborn that comes with it. We take courses, create birth plans, and set up a Pinterest-perfect nursery. But what about our own recovery? We know the early weeks of postpartum recovery will be difficult, but are we really prepared for the long haul? I asked real moms what they wish they had known about postpartum recovery before birth and their responses are below.
“I wish I had known how weak my core would feel without a baby in my belly.”
The baby is pushing all your muscles, organs, and support outward for the entire time they call your belly their home. Once they come out, their exit route (through vaginal birth or c-section incision) is not the only place on your body that might feel a little disconnected.
The early weeks can feel like a shock to the system, especially for a mom who is used to feeling capable and independent. Remember that you’re not “missing out” on anything if you’re not up and on your feet right away. During those early weeks, your body is working hard to pull all of its structures back together. The best thing you can do is allow your body to rest and do its thing.
Other strategies might include asking for plenty of help from family and friends, especially if you have older kids at home. A postpartum support garment can offer recovery support for your body while performing essential tasks and new baby care. Exhaling every time you stand up can help your body recruit pelvic floor muscles & abdominal muscles, so you don’t wind up holding your breath and applying more pressure to the vulnerable areas.
To learn more about navigating those early first days of the postpartum period/fourth trimester, check out this resource.
“I wish I had known how to take care of my nursing breasts. Breastfeeding can be so stressful!”
Breastfeeding can be a beautiful way to feed your child, but for many moms, it can also be especially stressful at the beginning. It can be helpful to take a prenatal lactation class if you do plan to breastfeed. If you do not plan to breastfeed, discuss your milk management strategy with your provider ahead of time. Sometimes breastfeeding will go according to plan and sometimes it won’t but by preparing ahead of time, you may be better able to recognize warning signs and seek support when it’s needed most.
Regardless of whether nursing comes easily for you or not, breast milk production takes several weeks to stabilize. Many mothers may experience engorgement, sore nipples, and leakage once their milk comes in. To be best prepared, having nursing pads, nipple care products (such as lanolin), and even a nursing pillow on hand may save you time and discomfort in the early days of breastfeeding your baby.
Clogged ducts and mastitis are complications that can be extremely uncomfortable. They can’t always be prevented but good breast health strategies can certainly help keep breast milk flowing. Gentle massages to breast tissue during a warm shower, coupled with daily upper chest stretches and non-restrictive bras are some of the basic strategies used to prevent and manage clogged ducts. For more significant or stubborn clogs, warm compresses, vibration around the clogged area, nursing positions that use gravity (such as the “dangle nursing” position), and the support of a lactation consultant may help you find some relief.
Mastitis is an infection in a milk duct. You may notice redness, heat, or painful breast tissue, and you may feel more broad flu-like symptoms of infection including fever, chills, or body aches. Mastitis requires urgent medical attention – do not wait to contact your healthcare provider as soon as possible if you begin to notice these symptoms.
For more info and tips for managing breastfeeding success, check out this guide.
“I wish I had known that after six weeks, you aren’t magically back to normal!”
The timeline of postpartum recovery varies for everyone but in general, it’s a whole lot longer than the six weeks before your follow-up appointment.
When you show up for your postpartum checkup appointment, your provider is looking for signs that indicate your healing might not be on track due to things such as infection or delayed healing, and is also checking in your vital signs to make sure your body is adjusting as expected. They’re focused on the immediate recovery phase, so when they say “you look good!” they mean your structure and healing look to be on track.
Getting the “all clear” for exercise and intercourse at 6-8 weeks postpartum is a positive step, but it really represents the beginning of the recovery journey – not the end. In fact, it takes more than 4-6 whole months for pelvic structures to recover from the impact of pregnancy and birth. If you have a c-section, your scar takes 7-9 months to regain most of its tensile strength. With today’s societal pressure revolving around a quick recovery and the saying “no pain no gain,” it’s clear that many moms feel frustrated when they get a few months out from delivery and don’t feel fully recovered.
These physiological changes are not related to willpower, or how hard you’ve worked to “bounce back.” They’re simply the time it takes for our bodies to settle into a non-pregnant state.
The good news? There’s plenty you can be doing along the way to keep yourself moving forward and feeling like yourself again – without risking injury. Start slow, and work on low-impact, low-intensity exercise for at least the first twelve weeks.
Keep an eye out for signs that could indicate you need to slow down at every point along the way. This could include increased bleeding, incontinence, pain, soreness, heaviness, or the feeling that something is falling out of your vagina. All of these symptoms could be related to doing too much physical activity, too soon. Gradual progression is key. Do just what you can comfortably achieve without causing damage, and slowly work back up to your usual levels of activity during those first few months.
If you’re a high-level athlete or a seasoned competitor, it’s recommended to seek the support of a physical therapist or qualified coach to help guide your training program. The timelines listed are approximate, and recommendations may change based on your personal circumstances, goals, and history.
As always, if you’re experiencing pain or discomfort, particularly when returning to movement or exercise as a new mom, seek the support of your care provider and a physical therapist to address the root of the issue and get you back on track.
“I wish I had known that bleeding past six weeks is considered normal, even with a c-section!”
Most providers will let you know when to be concerned by lots of bleeding, with cues such as “filling up a large pad within an hour” or “passing a clot that’s larger than an egg.” High volumes of blood loss could be a medical emergency. Call 911 or your doctor right away, depending on the severity of your symptoms.
In the absence of a medical emergency, you may quickly realize that there is quite a bit of blood even in the “normal range.” After all, your uterus was the baby's home for nine months, and suddenly all that uterine lining isn’t needed anymore.
The duration of blood loss (known as lochia) varies widely. The most commonly reported range is around 24-36 days, but lochia can last up to twelve weeks postpartum. Usually, postpartum bleeding will gradually lessen over the weeks following delivery, though some women experience postpartum bleeding that stops for a few days and then starts again. A temporary increase in blood volume may be a sign that you’re doing more than your body is ready for, and prioritizing rest for a few days can help your body focus on healing.
Large pads, postpartum-specific underwear, hydration, and plenty of rest are essential tools for managing and monitoring postpartum blood loss. Always call your provider if you have any concerns about blood loss or symptoms of low blood pressure.
“I wish I had known that my mental health was just as important as my physical health during recovery.”
Perinatal depression is more common than we may realize. Depression during pregnancy affects 10% of expecting parents, and significant postpartum depression is diagnosed in up to 15% of new moms.
Though the hormonal shifts immediately after birth can lead to “baby blues” for a few days or weeks, prenatal and postpartum depression is generally more severe and longer-lasting.
Symptoms of postpartum depression include feelings of anger or irritability, crying & sadness, appetite and sleep disturbance, loss of interest in things you used to enjoy, lack of interest in the baby, possible thoughts of harming yourself or your baby, and feelings of guilt, shame, or hopelessness.
Perinatal mood disorders, including depression, anxiety, obsessive symptoms, and more rarely psychosis can come at any time, including during pregnancy, early postpartum, or even months after birth. If you or a family member/friend notice a change in your mood or behavior, don’t hesitate to seek professional support. Contact your care provider as soon as possible to ask about where to start, and click here to read more about Perinatal Mood and Anxiety Disorders (PMADs).
“Hemorrhoids happen. I wish I had known how to help them heal.”
Most first-time moms say that the first postpartum poops were more manageable with stool softeners, plenty of water and fiber, and a stool under their feed. But it was the hemorrhoids that took them by surprise.
Hemorrhoids are veins that become swollen and irritated inside or around the end of the rectum/anus. They can occur internally or externally and can cause itching, pain, discomfort, and sometimes small amounts of bright red bleeding. Hemorrhoids are usually caused by excessive amounts of pressure on the pelvic floor (think of things like constipation, pregnancy, and you guessed it, labor & delivery). Because of this shift in pressure balance, hemorrhoids are extremely common in pregnant and postpartum women.
To alleviate discomfort in the short term, try an over-the-counter cream or a hydration lubricant to decrease friction and sensitivity to the area. A sitz bath once per day, or after bowel movements can help to relieve discomfort, and medicated wipes containing witch hazel may also offer some relief. If you’re experiencing extreme discomfort, don’t hesitate to speak to your ob-gyn or healthcare provider about medications that allow for quicker healing.
To learn more about postpartum bowel movements, and longer-term strategies for hemorrhoid relief after birth, check out this blog.
Caring for Your Cesarean Incision
“Just thinking about my c-section scar would make it feel sensitive. I wish I had known how to care for it after my initial healing process.”
Many moms report lingering sensitivity to their cesarean scar. Nerves and connective tissue take time to heal, but there are some strategies you can use to help the area become less sensitive and more comfortable.
Scar massaging is a well-known strategy to help the scars and structures underneath move more freely and therefore cause less discomfort related to restriction. Touching the scar and the surrounding area can help remind your nervous system that some types of touch are normal and safe, thus allowing the sensitivity to reduce. Once your incision is fully healed at around 6-8 weeks postpartum, you can begin to move the tissues in all directions, thinking of it as a gentle stretch and massage. Continue this for a few minutes each day for 4-6 weeks to soften and mobilize the scar tissue.
The Motif Medical C-Section Bandage System may also be a helpful tool for protection and scar tissue healing. This multi-step system consists of a series of wound care items for your lower abdomen that is used in succession based on where you are in the wound healing process. To learn more about the medical benefits of c-section bandages, click here.
“I wish I knew what warning signs to look out for since some urgent conditions can look a lot like normal postpartum symptoms.”
The Center for Disease Control (CDC) has outlined a list of postpartum “warning signs” to indicate that a call to your healthcare provider is not only warranted but urgent. If you are experiencing any of the following signs & symptoms, call your healthcare provider right away. It never hurts to let them know what’s going on, and it may be important to get help sooner rather than later. These warning signs include:
- Severe Headaches
- Dizziness or Fainting
- Changes in Vision
- Trouble Breathing
- Overwhelming Tiredness
- Chest Pain
- Severe Belly Pain
- Severe Nausea & Throwing Up
- Severe Swelling
- Thoughts on Harming Yourself or Baby
Below are a few of the more common postpartum conditions. As always, call your provider if questions or concerns should arise.
Postpartum Hemorrhage: Postpartum blood loss is carefully monitored in the early days and hours after birth due to the risk of postpartum hemorrhage. A postpartum hemorrhage is most common within the first 24 hours after birth but can occur up to twelve weeks postpartum. Once you leave the hospital or birth center, it will be up to you to monitor the amount of blood you’re losing and any other warning signs that might indicate you’re losing too much blood too quickly. Most providers will let you know when to be concerned about bleeding, with cues such as “filling up a large pad within an hour” or “passing a blood clot that’s larger than an egg.”
If you’re experiencing large amounts of blood loss at any time or noticing signs or symptoms of low blood pressure or shock including lightheadedness, blurred vision, chills, clammy or pale skin, rapid heartbeat, feeling dizzy or weak, nausea or vomiting, it may be a medical emergency. Call 911 or your doctor right away, depending on the severity of your symptoms.
Postpartum Preeclampsia: High blood pressure that is left unchecked can quickly take a turn into preeclampsia which impacts the liver, and may even progress into the more sinister conditions of eclampsia and HELLP syndrome. Postpartum preeclampsia generally begins after birth, and often with no signs or symptoms during pregnancy. The symptoms of postpartum preeclampsia may feel very similar to symptoms of early postpartum recovery, so it can be difficult to identify on your own.
Symptoms of postpartum preeclampsia include elevated blood pressure over 140/90, severe headaches, blurred vision or light sensitivity, pain in your upper belly, nausea and vomiting, shortness of breath, or decreased urine output. Some postpartum women experience swelling that is not a concern, but if swelling progresses suddenly, becomes severe, or is coupled with any of the above symptoms, call your doctor immediately to let them know.
Postpartum UTI: Infection in the urinary tract is fairly common after both vaginal and cesarean births, affecting 2-4% of postpartum women. Unfortunately, most moms will have some amount of discomfort while urinating after birth. After a vaginal delivery, pelvic structures will likely have some degree of swelling, and stitches (from an episiotomy or c-section) can cause discomfort while urinating for a few days postpartum. After a c-section, you may have some lingering irritation at the urethra from the catheter that was necessary during surgery. Use a peri-bottle/squirt-bottle to splash warm water over the perineal area when you urinate to keep discomfort down and add a little witch hazel & aloe to the inside of your pads can help with stinging as well. This type of discomfort should lessen over the course of the first few days.
If discomfort while urinating doesn’t improve after the first few days, or you feel your symptoms are worsening, you may need to be evaluated for a urinary tract infection. Some common signs and symptoms include pain or burning while peeing, pressure or sharp pain in the lower abdomen, feeling a need to pee often, urine that’s cloudy or smells foul, and pain with urination that seems to be getting worse (or not better) after the first few postpartum days. If you’re noticing any of the above or have concerns about lingering pain, it’s time to call your care provider.
Postpartum Infection: Infections can occur both internally and externally, and may not be visible to the eye. A c-section scar may become infected even if you take care to clean it properly, though you may or may not see overt signs of infection like redness, heat, or foul-smelling discharge. With an infection that is not visible, such as within a deeper layer of your c-section incision or even a uterine infection, you may notice other symptoms such as fever, chills, sweating, pain, or just a general feeling of malaise or illness. Do not put off addressing symptoms of infection, as infections can progress and become systemic if left untreated.
At the end of the day, several moms echoed the sentiment that preparing for postpartum before birth, resting a lot, giving yourself grace, and taking plenty of deep breaths will go far during the first postpartum year. As one mom said, “I wish I knew that it would all be ok. Every difficult stage passes eventually.” Don’t be afraid to lean on loved ones for postpartum care, assistance, and support. And lastly, never hesitate to call your doctor after birth if you are experiencing any of these signs or symptoms, as infections can progress and become systemic if left unaddressed.