Navigating Postpartum Recovery

Almost 5 months ago before I ever had a baby myself, I wrote this post on postpartum hormones and caring for yourself during the postpartum period. I wrote it from my perspective as a dietitian and nurse practitioner after doing ample research on the postpartum period. This post is part 2 of that post – written from my perspective as a dietitian, nurse practitioner and new mom who has now gratefully been able to live out those first 12 weeks postpartum.

Maybe as you read this, you are currently walking through the postpartum period. Maybe you’re months or years past the postpartum period (the timeline to which a woman is considered postpartum varies depending on who you talk to – considering there is so much change in that first year after baby arrives, I think of the postpartum period from birth to 1 year) and you look back at that time with anxiety, fear, sadness or other difficult emotions. Maybe that first year was really, really hard. Maybe you’ve started reading this post and you’re aching for a baby. I see you. And my heart aches so badly for you. I hope and pray that ache goes away one day <3

Every woman’s body is different, therefore every woman’s experience after giving birth will be different. What works for one woman, might not work for the next. While one woman might go through postpartum and adjust to newborn life quite seamlessly, another woman might find it much more difficult. She might need the support of medication, therapy, extra help and many other things. One way is not better than the other – they are simply two different ways of navigating the postpartum period. What matters is mom getting what she needs to be well. I hope this post in addition to part 1 helps you better care for yourself and navigate this huge life shift with a few less bumps, whatever that means for you. There’s no right or wrong way to care for yourself as a mom or your new baby.

In part 1 of this post series, I wrote all about postpartum hormones in addition to postpartum depression and anxiety. I’m not going to repeat that here, but it might be helpful to read that post first if you haven’t already and then come back and continue reading this post.

First, let’s just lay out the tidal wave that is the weeks and months following baby’s birth.

• you just experienced the most intense hormonal drop of your life – going from having loads (think 100 birth control pills a day) of estrogen and progesterone in your body back to non-pregnant baseline in just a few days
• your body is healing from childbirth and depending on your birth experience, that could be an even longer and harder road that includes healing from physical and emotional trauma
• if you choose to breastfeed, it’s a big learning curve and can present many challenges that can be very stressful for you and baby
• if you don’t choose to breastfeed, you might be experiencing guilt or shame even though the best way to feed your baby is the way that keeps you and baby physically, emotionally and mentally healthy — not what your mother-in-law or friend or random mom at the grocery store tells you
• you’re sleep deprived – that’s a doozy
• you’re learning to CARE FOR A HUMAN. it’s a big deal

In short, it’s A LOT.

Physical Healing 

Whether you had a vaginal delivery or cesarean, your body needs a lot of rest and time to heal. If it’s feasible for you, I’d highly recommend barely leaving the couch or bed for 10 days, two weeks is even better. I think as women we have a natural tendency to be “doing” and in America we give a new mom this badge of honor if she can just “bounce back” and keep up with the things she did before baby. Everyone’s situation is different, but if it’s available, say yes to all the help you can. Allow others to care for you so you can care for baby, establish breastfeeding if you’re choosing to do that, bond with baby, get as much sleep as you can, care for yourself emotionally, and let your body heal physically.

For me, I found short walks outside (if it wasn’t freezing given it was winter in Boston) really refreshing + healing. Five minutes was the most I could walk that first week before my body was tired. Be gentle with yourself and listen to your body. I experienced a second degree tear, so I knew it was enough when my pelvic floor started to get tired and my stitches “ached” – that’s the best word I have to describe it. You can’t under-do it, but it’s certainly easy to over-do it. Be gentle.

A few things that I think are really helpful for healing from a vaginal birth:

1. A soothing perineal spray + balm | I used the spray until I didn’t feel sooo fragile and felt comfy touching down there to apply the balm. But the balm was 1000x more soothing than the spray. I really liked this spray and this balm.
2. A really good peri bottle | The hospital will give you a peri bottle, but I found this angled bottle to be a jillion times more effective. I didn’t want to wipe for a solid 3 weeks because I was nervous, so this peri bottle was gold.
3. Herbal sitz bath for your peri bottle + padsicles | I steeped these sitz bath packets in hot water to make a pretty potent “tea” and then added a couple tablespoons of the tea to humongous pads and froze them. When you’re feeling tender, slip a padsicle into your panties and it feels like magic. I also used the water to fill my peri bottle and used that frequently throughout the day. If you’re like, “what’s a padsicle?!” here’s a good tutorial on how to make them. I didn’t want to buy all the different products because that felt $ and complicated to me, which is why I just used the sitz bath packets.

That first poop can be really nerve-wracking and scary. My doula gave me a really helpful tip that I hope is helpful for other new moms. When you feel the urge and go to the bathroom, take a piece of toilet paper and fold it in half and place it in your palm. Then, place your hand on your perineum and press gently, applying light pressure. This helps you relax and takes the pressure off your perineum, making it a lot easier to go poop.

I was grateful to experience a vaginal birth. If you had a C-section experience, your recovery will probably look much different and be more difficult physically and likely emotionally too. I’d encourage you to read C-section birth + recovery stories. I read a few in preparation for birth and it was really helpful. Our doula called C-section births, belly births, and I loved that. If I do experience a C-section birth in the future, I’ll come back here and update this post.

Lochia, the postpartum bleeding you experience regardless of how your baby entered this world, can last up to six weeks. For me, I bled up until right before my six week postpartum visit. I found if I was walking around the city more than normal that day, I bled a bit more and I would try to rest more the next day. I hadn’t worn a pad in over a decade. Although a little pricier, I found these pads to be non-irritating and gentle on my skin. I started with the huge, overnight pads. Then the normal day time ones. And when the bleeding lightened to spotting, I used the panty liners.

I know not all health care providers routinely recommend pelvic floor physical therapy, but I’m a huge proponent. Although I’m thankful to have had a pretty smooth and quick recovery, pregnancy + childbirth takes a huge toll on the body. Your ligaments are loose, your posture changes and center of gravity shifts, your uterus grows exponentially, your organs get smushed to the side, your body size changes quite rapidly and a little human is rolling and kicking inside your body. Our pelvic floors need rehab to get stronger, regain function and get back in alignment. It is crazy to me, although I had a wonderful OB team, that the six week postpartum check up is very brief – a quick peak at your vagina and uterus, a few questions about healing, breastfeeding, depression and what you plan to do for birth control and that’s it. So it makes sense, that as women, we think we should just bounce back to our normal lives without much, if any, additional care. Unfortunately, pelvic floor PT isn’t covered by all insurance and is often an out of pocket expense. But, if it’s accessible to you, I’d highly recommend it.

Breastfeeding + nutrition

If you’re exclusively formula feeding or combining formula with breastmilk, know you’re doing great and exactly what you and baby need. Prior to having a baby, when I was pregnant, I felt kind of icky about breastfeeding. I knew I wanted to breastfeed if I could, but it just felt weird to have a baby sucking on my boob. I am really, really, really thankful that I’ve had a positive breastfeeding experience since that is what I felt most anxious about in pregnancy. Caleb did recently develop a dairy allergy that our pediatrician discovered after he was pooping mucus-y blood and screaming while nursing. That meant I had to stop eating diary. Which meant reading food labels and making sure literally zero dairy was in my diet. I feel like I could write an entire post on intuitive eating and having to eliminate foods while breastfeeding for medical reasons. Maybe I will? For me, I’m really glad I’ve had years of intuitive eating under my belt and have tried to have as many satisfying food experiences as possible. I’m also keeping in mind this is temporary which is helpful.

Hunger cues also pick up considerably when you begin breastfeeding and/or pumping. If you Google caloric needs while breastfeeding you will find a range of numbers, but you’ll probably most commonly see 500 calories. But, there are so many variables – the age of your baby, if your baby gets exclusively breastmilk or a combo of breastmilk + formula, your own body fat stores, etc. So just like nobody can tell you how many calories your body needs as a non-pregnant, non-lactating woman, nobody can tell you how many calories you need while breastfeeding. Nutrition is so incredibly important to keep your milk supply up. If your hunger and fullness cues were reliable before breastfeeding, use those cues to guide your food intake. Eat to hunger and drink to thirst. If you have history of disordered eating, dieting or an eating disorder, your hunger might feel out of control and stressful. Seek support from a knowledgable dietitian if you need. Takes some deep breaths. Your body is communicating to you. Remember you are growing another human during the most rapid year of growth with milk YOUR BODY IS MAKING. That is incredible. 

A few resources I recommend:

The book, The Womanly Art of Breastfeeding

This nipple cream to help with cracked and sore nipples when you first begin breastfeeding

These hot and cold packs for you boobs. I found them helpful for engorgement when my milk first came in and if you experience clogged ducts, tenderness, or swelling they are helpful for that too. Also, I heat them up and put them on my neck at the end of the day and that feels amazing. Why not get some more use out of them?

The Kelly Mom website, has tons of evidence-based articles on breastfeeding that I’ve found really helpful.

Body Image

Kylie wrote a really great post on postpartum body image here. I’ve written a lot of posts on body image over the years you can read here. Our bodies are always changing throughout our lives. We can choose to spend our time and energy trying to maintain the same body size, or we can spend our time and energy on more meaningful things. If your body size feels the most meaningful to you, then these words might not resonate with you. For me, I want to invest my time and energy in my family, friends, faith, my work, and other things I value. Not my body size, that feels really distracting. Postpartum is a season where our bodies change a lot. Your body made a human. That’s amazing. Of course it’s not going to look how it did pre-baby. How could it?

Wearing clothes that don’t feel good on your body can make anyone vulnerable to negative body image thoughts and feelings. One of the best ways I’ve found to care for my post baby body is wearing clothes that feel good on my body. Right now that’s a lot of leggings and a couple pairs of jeans that are stretchy and don’t cling. This is allowing my body to journey as it needs to. Remember, that if body image is really hard for you postpartum, the goal might be to tolerate your body and focus on putting your energy towards caring for yourself and your baby. You don’t have to accept your postpartum body right now, but can you tolerate it so you are able to nourish yourself and give your body the rest it needs.

Exercise + Sleep

Moderate to high intensity exercise and lack of sleep both cause an increase in cortisol levels. The postpartum period is stressful no matter what. Between the disrupted sleep, hormonal shifts and huge learning curve of motherhood, your body is already under enough stress. I think adding moderate to high intensity exercise on top of that has a high likelihood of doing more harm than good. Of course, everyone is different, but ask yourself if you’re engaging in movement because it feels good or because you want to burn calories. I just walked until about 8 weeks postpartum when I started craving more movement. For me, I’ve found the online 30 minute Barre3 videos, yoga and very light cardio like slowwww jogging, walking and the elliptical to feel really good on my body and be helpful for healing my pelvic floor and core. Remember, exercise can impact a woman’s milk supply. Even if it feels good to do high intensity workouts (I love a good sweat too!) that may impact your milk supply so be mindful. Make sure you are getting enough sleep and eating enough calories + macronutrients to care for your body and your milk supply.

I’m not a baby sleep expert. But Cara from Taking Cara Babies is. I bought her course and both Nick and I found it really, really helpful. What she taught really resonated with me versus other books I read that felt a bit too strict and “this is how it goes.” I really like her nurturing and responsive approach that is both structured and flexible. Her Instagram account is really helpful too. Every baby is different and so every mom is going to experience varying levels of sleep disruption and deprivation. What I’ve found most helpful is to nap when the baby naps and let everything else go. Your kitchen doesn’t need to be cleaned, the laundry can wait, you can text people back later. Get rest, momma. You’ll feel so much better emotionally and physically which will help you enjoy these days and care for your baby.

There is so much more to say on all this! If you have found this helpful, I’d love to expand on these topics to incorporate more of the research and provide helpful information to you. Share your thoughts and questions in the comments!