Postpartum Health and Healing

Postpartum is a very special time when the full range of human experience is intensified. It is extremely different family to family and baby to baby. You may experience these days as blissful or exceedingly difficult. Encourage each family member with grace and gratitude during this time. Fill your home with love. Lay the foundation you desire for your family. This will carry you through this time, whether it is one of trials or a honeymoon period. With humor, commitment, and the tips contained in this article, your postpartum days can be a special and fulfilling time!

Practically speaking this means:

  • Assume that everyone is doing all they know how to do and more, and appreciate each person’s contributions. Even if everyone is contributing more time and energy to the family than they ever have before, there will be unmet needs at first. This is OK! Keep appreciating one another. Appreciation is one of our deepest needs during demanding times.
  • Become a team! Teamwork, teamwork, teamwork.
  • Brainstorm together when things need to change to support anyone’s wellbeing, yours or your baby’s.
  • Do your detective work together when the baby is hard to soothe, has a mysterious rash, or so on.
  • Share your insights about the baby with one another.
  • Discuss the strong emotions of parenting and be one another’s safe zone to express all feelings.
  • Tag team so everyone gets a break now and then.
  • Pitch in where you can and agree to let as many of life’s responsibilities as possible go for a time…

What to expect from the early weeks postpartum

A woman’s cervix remains open for a few days after giving birth, gradually closing. My experience has been that this is a time where the body asks for as much inner stillness as possible. Busy-ness, rushing, stress, interruptions, and a sense of hosting or expending social energy are a mismatch with the needs of the body and spirit. Too much, too fast after birth leads to more anxiety, overwhelming emotions, and difficulty healing. If there is a high stress or high activity day anytime in the first week, prepare for it with days of quiet ahead of time, a good nap before the scheduled activity, and a nap afterwards. Do this even for doctor’s appointments, visitors, or a necessary trip to the store. Recover afterwards with as many agenda-free days as possible. Follow your own cues as to when to return to more busy-ness. For most women the “rest before and after anything that takes energy” rule applies for at least 2 – 3 weeks. Avoiding these situations all together is highly recommended for the first five days.

Many cultures around the world have postpartum traditions that include a “confinement” period of 40 days after birth during which time the mother and baby are completely cared for by other female attendants and nothing is expected of the mother except to focus on her healing and being with the baby. Special foods are prepared for her and massage and bathing rituals are offered daily. In some cultures, the period ends with a huge celebration and introduction of the baby to the community. How would you feel if someone threw a feast to celebrate all you did bringing this life into the world, and to welcome your special baby… a few weeks after you’ve had time to rest, recover, and soak it all in? In spirit, this is what we should aim for as a family. Here are some ideas:

  • For the first week, for both partners: Rest, rest, rest. Don’t do anything non-essential even if you have the time and energy to do it. Spend that time enjoying your baby or sitting under a tree. Take a babymoon just as you would take a honeymoon. Consider it a “stay-cation.” Prepare and freeze at least seven dinners ahead of time before the baby is born, or use a web site like Meal Baby to organize meals from friends. Line up someone to come by and walk your dogs and take out your trash. Ask family members to stop by Target for whatever you need. Take a 100% break from all life duties to the fullest extent possible. Limit visiting and activities to situations where there is a calm, celebratory, and “new family focused” feeling. Since the point is to have fun, enriching, or nurturing visits/activities, mom and baby should of course be free to withdraw and rest instead if that feels better. Do not feel obligated to entertain family and friends. Visit only if you really want too! Anyone staying with you to help with the baby should be fully aware that their role is to help you get as much restful time and baby time as possible. Be prepared to talk frankly about this if needed.
  • Week two: Add back in only those things you must do. Plan ahead so that week two is not a sudden return to your full work load. Try to arrange it so that whoever is responsible for the baby at the moment has no other responsibilities, but begin to tag team a bit so that the other person has a chance to get some work done or take a long nap.
  • Week three: Aim for “full time” work load for one person, made up of a combination of career and family work. Begin doing small things around the house while caring for the baby. Learn to use a baby carrier or sling. Take the baby out on a walk or to a store or social activity if you haven’t done so yet.
  • Weeks four – six: Continue to add more and more activities/work back into your life. Aim to have a sense that life could go on like this for a few months by week six. Take a moment to consider the many aspects of life that keep you personally happy and healthy (e.g. mental stimulation, time with friends, exercise and so on). Which are in place in your life? Which are absent since having a baby? Begin taking steps to incorporate them into your life once again – not necessarily in the same ways as before, but in new ways that fit with your new reality and priorities.

Postpartum Rest

Rest! Even if you feel great, birth places a major demand on the body and requires a period of rest to rebuild. Women who do not take resting seriously for the first two weeks experience a subtle drain on their energy which catches up with them in 4 – 8 weeks and can cause illness, breast infections, irritability, or blues just when you expect for feel 100% normal again. Men who do not rest become less confident in their role as a dad and a husband, more sensitive to criticism, and more overwhelmed with a sense of helplessness – that there is nothing they can do or do right.

  • As soon as you lay the baby down for a nap, lay down yourself. Walk directly from the baby to your own bed or couch. Do not clean up or catch up on chores or phone calls. Before you know it, the baby will be up again and your window to sleep or relax will be gone.
  • Six months from now you won’t care if your house was a mess, but you will still remember if you were tired and frazzled or peaceful and rested!
  • Save steps and time. Keep the baby’s bed close to yours or sleep near your baby during the part of the night when you are “on baby duty”.
  • Take one 4 hour period each day where you sleep far from the baby while the other parent is in charge of the baby, and wake only if the other person really needs you. If mom is needed for breastfeeding during a another’s “shift,” bring the baby to her completely ready to feed, barely rouse her enough to latch the baby on, and take the baby again immediately after the feeding is done to burp, change, or soothe him/her back to sleep. It is remarkable how much better each person will feel with at least one four-hour chunk of deeper sleep each day.
  • One approach to getting enough sleep is to track the amount of actual sleep you get beginning each evening and keep at it until you get eight hours. In the morning, continue sleeping unless you are taking care of the baby or eating. Stay in your pj’s, stay in bed. Keep this up until you reach eight full hours of sleep, even if it takes most of the day! Once you’ve reached eight hours, get up, bathe, dress, and have your “day” even if only for a few hours before evening begins again and you get ready for bed. Gradually your “mornings” will get earlier and earlier until you have a regular sense of day and night again.

A lot of holistic birth professionals, including mental health experts, recognize that most women do way too much in the first two weeks postpartum. Overactivity and lack of rest contribute to many physical and emotional complications. I have recently seen more online posts encouraging women to stay in bed for a minimum of 10 days after birth.  I appreciate the effort to reeducate women on the importance of a period of withdrawal, nesting, and rest after the baby is born, but in my opinion walking or gentle rocking/dancing are important, beginning the very first day, for encouraging circulation and prevention of unwanted blood clots – and it just makes you feel better!  Stay home and rest often, but get yourself up and around for a few minutes every 2 hours or so when you are awake.

Relaxation

Deep relaxation is a wonderful aid for nurturing your body and lifting your emotions, in postpartum and in life. Take 5 – 10 minutes a day to slow your breathing, relax your body, and visualize life as you love it. Once breastfeeding becomes easy, it can be a great time for this. Once the baby is latched on, take a few deep breaths, relax your shoulders and your face, and clear your mind. Enjoy this quiet time and free your body of all tension.

When faced with fatigue but having only a few minutes to rest, try the “Constructive Rest Position”. Lie on your back with your knees up. Your feet should be placed slightly wider than your hips at the level where the knee would be if the leg were extended on the ground. Allow knees to fall together. Lengthen your spine and neck. Criss-cross your arms over your chest with your fingers loosely draping over the shoulders. This is a position which will maximize restoration of your physical and emotional energy.

Eat Well and Often

Whole foods and variety are the key. Special nutritional needs at this time are iron and water for rebuilding the blood. Your body will demand extra calories as you are healing your own tissues and also providing 100% of your baby’s nourishment through breast milk. Snack on raisins, dried apricots, nuts and seeds while nursing, increase your intake of dark leafy greens, and have water by you at all times. Eat regular healthful meals. Do not skip meals. Increasing B vitamins (nutritional yeast and molasses are very high in B vitamins) may help balance your mood. Continue taking your prenatal vitamin and consider supplementing your diet with fish or flax seed oils. If you received antibiotics in labor, take probiotics or eat live yogurt to rebuild your natural flora and prevent yeast. If you are exhausted, pale, dizzy, depressed, nervous, or feeling like you have a racing heart rest more, drink more, and increase your iron by eating red meat, eggs, dark leafy greens, or dried apricots. Liquid chlorophyll is a supplement that can also enhance the rebuilding of your blood and help with energy, though it is not a substitute for iron. If you feel you need an iron supplement Floridix is non-constipating.

Postpartum Visitors and Help

Nurturing attention and practical help around the house are fantastic postpartum. That being said, you need a lot of time with your baby. Someone who will hold and soothe the baby when you need to rest, eat, or shower can be great, but be sure that you are the ones with your baby most of the time. Ask for your baby, or have your partner ask, anytime you feel the desire to have your baby in arms. It’s also important that your “nest” is secure. You need to feel comfortable in your home and autonomous; free to follow the whims and desires you have and free to fully express all emotions. You know yourself and people who are able to help you. Take honest stock of the family or friends who are willing to help, and trust your gut about having them with you during your early postpartum days. You may want them there as soon as possible after the birth, or you may find that preparing for a week on your own before help arrives is better timing. Anyone in the home in the early days should be deferring to mom and dad for any decisions that must be made and for how to care for the baby. That being said, it’s a great time to gather insight and advice from those more experienced if you want some tips and ideas. However, make sure to never go with something that doesn’t feel right to you based on the advice of another.

Postpartum Doctor’s Visits for You and Baby

Postpartum Warning Signs

Call your doctor or midwife if you experience any of the following:

For Mom

  • A fever greater than 101 degrees F.
  • A very tender uterus.
  • Foul odor coming from your vagina.
  • Excessive cold sweats.
  • Fast pulse.
  • Anxiety, panic attacks, or marked irritability.
  • Inability to sleep even when baby is sleeping.

For Baby

  • Fast rapid breaths, grunting, wheezy sounds with every breath, or skin being sucked in around the ribs and belly with each breath. You’re baby is working to hard to breath.
  • Blue, gray or white color in the face or body. Your baby should be pink. Blueish or purple tint in the hands and feet are okay during the early days.
  • A yellowish color in the whites of the eyes or in the skin.
  • Temperature that won’t come down with undressing or that you can’t raise with skin-to-skin contact and a blanket.
  • A red ring around the umbilical cord.

Seek professional advice anytime you have a question about your wellbeing or your baby’s. Do not be talked out of concerns you have until you FEEL reassured. Feel free to insist on being seen if the assurance you receive over the phone does not make you feel better. There are many physiological changes going on for both moms and babies, and even dads though to a lesser degree. You deserve thorough attention to all your questions and physical needs. Ironically it is sometimes hard to get the care you need postpartum as our culture has a tendency to consider postpartum mothers as “over sensitive.” This is shameful at a time of such heightened change and vulnerability. All families deserve careful assessment and real assurance in the midst of a new and unknown time. And postpartum complications do exist!

That being said, most moms and babies do great! Massive change is normal and healthy, and while it is challenging work, it is a strong healthy time! Both moms and babies are negatively impacted by too much activity, stress, and exposure to viruses or bacteria. Too many doctor’s appointments for healthy, confident moms and babies decrease postpartum wellbeing, especially if there is not adequate time to rest before and after the appointment. Choose home visits if they are an option, and select a family doctor or pediatrician who provides a satisfying number of well-baby visits in the first two weeks of life. Common practices for routine well baby visits range from one visit, at two weeks, to four visits on days 3, 5-7, 10, and 14. If mom feels good, she is fine. If your baby is eating well, peeing, pooping, waking up to feed at least 10 times per day, and has good normal color for your ethnicity (not yellow), your baby is likely doing great!

Postpartum Massage and Healing Touch

It is important to care for mom’s physical body after she gives birth. It may not be via professional massage, but it could be! Massage of any kind, warm baths, simple loving holds, and other forms of physical care show the body that went through so much while birthing that there is plenty of love and support in the world. This is necessary after giving birth.

Postpartum massage for mothers is a standard aspect of postpartum care in many countries. After experiencing the intense force of birth, the body benefits from gentle loving touch. Nurturing touch returns a sense of safety and love to the unconscious physical place we hold experience and knowledge. Gently resting warm and loving hands on mother’s lower belly and hips can be wonderful, as is holding. Massage on feet, legs, back, upper chest, face, and head relaxes, restores, and encourages circulation to promote healing. Concentrate on just one area when time is limited. Avoid all varicose veins, use light touch, and as a general rule, massage towards the heart. Massage can be done while mom is nursing or holding the baby, as well as during times when she is taking a break from baby care. A massage oil greatly enhances massage. Stick primarily to unscented massage oils in the postpartum period as your natural smells are most familiar to your baby. Some moms feel “touched out” by baby care. In this case, you may want to show her physical body good care by creating time for grooming and dressing and providing satisfying foods.

Babies also benefit from massage or loving touch. All babies can enjoy this as a time of play and connection. For those babies experiencing nursing difficulties, gas, or unexpected fussiness it can be a healing modality. You can learn the art of massaging your baby intuitively though trial and error and exploration. Babies prefer a firm steady stroke and fairly deep pressure except over their heart and lungs and face. Avoid direct pressure on their spine and twisting joints. Infant Massage: A Handbook for Loving Parents is the classic book on infant massage and is a wonderful resource. For a shorter read that does a great job teaching basic strokes, see Baby Massage: The Calming Power of Touch

Professionals who do massage and other forms of bodywork on postpartum mothers and/or babies work in many towns. They will often come to your home, and their services are a great investment in your wellbeing.

Postpartum Exercise

Exercise can begin on the first day after your baby is born. Begin slowly and build gradually. Avoid full sit-ups, leg lifts, and strenuous or bouncy exercise for the first six weeks.

Beginning early with very gentle exercise will keep tone to the muscles in your abdomen and pelvic floor that are slack from pregnancy and birth. This prevents atrophy of the muscle cells and makes it easier to regain strength and pre-pregnancy posture once your return to more vigorous activity in a few weeks.

Early exercises (if you’ve had a C-section, see “Variations for Cesarean Birth” below):

  • Ankle, neck and shoulder rolls for circulation.
  • Rocking in a chair or swaying – increases circulation and decreases gas pains.
  • 1 – 5 repetitions of each of the following abdominal exercises. During all of these exercises protect your stomach muscles by crossing your wrists over your belly and hugging the abdominal muscles together. All of these exercises are done lying on the back with your knees up.
    1. Lift your chin to your chest.
    2. Press your back into the floor – this is a pelvic tilt.
    3. Allow your legs to lie flat on the floor. Leaving your feet on the floor, bend the knees.
    4. Side to side mini curls – lift one shoulder off the floor at a time.
    5. Belly squeeze – slowly tighten stomach while breathing in, release your stomach a bit at a time as you gradually release your breath. This can be done while lying on your back or on hands and knees.
    6. Stretch out the kinks by laying on your back and pressing your upper shoulders, lower back, and knees into the ground, while flexing feet.
  • Kegels: These are essential to strengthen the pelvic floor in order keep the bladder, uterus, and bowels from sagging in the long run. It is normal to feel like you can’t do a Kegel the first day or two after birth. Practice everyday with as many pulses as you can do before feeling weakness. Aim to increase the repetitions until 30 can be comfortably done. When doing Kegels, I recommend that you think about your pubic bone, tailbone, and sitting bones as four points. On your inhale allow the four points to open or spread apart, on your exhale pull the four points up and together. These thoughts will help you tone your entire pelvic floor rather than only the sphincters, which may be activated by the traditional Kegel instructions to use the muscles that “stop the flow of urine.” I also find this revised way of doing Kegels much more pleasant.
  • Sit on a large exercise ball and do hip circles or rock front to back and side to side. Babies love to be held while doing this! It is a great strengthener for your pelvic floor and a gentle work out for your abs.

Additional exercises as you feel ready for more:

  • Walking.
  • Gradually increase repetitions of abdominal exercises to twenty.
  • Curl shoulders as well when lifting chin.
  • Add more stretching and strengthening exercises as comfortable including large arm movements (these may release tension from breastfeeding), shallow twists, and bends.
  • Bridging: Lying on back with knees raised, push up until bottom is in the air, creating a straight line from lower shoulders to knees.

Variations after Cesarean birth:

  • Begin exercises immediately, but keep to early exercise and walking only for the first two weeks.
  • Eliminate curls of any kind, including lifting chin to chest.
  • Bend only one knee at a time when doing leg bends.

Perineum

The following will aid healing of your bottom whether or not you’ve had stitches, but are especially worth while if you experienced a tear or episiotomy:

  • Gentle movement (while keeping legs together) such as swaying, rocking, and walking will increase circulation which is necessary for healing.
  • Warm shallow baths or sitz baths (a bowl which fits on your toilet for soaking the bottom) also increase circulation and keep the area clean. A warm bath will often relieve soreness for a few hours. I recommend 2 – 3 a day, with a few drops of lavender or tea tree oil and cypress oil if you have hemorrhoids. Cypress oil is a strong essential oil. It must be diluted in milk (5 drops to 1/2 a cup of milk) before being added to bath water. The milk will break the oil into tiny droplets to minimize the chance of skin irritation.
  • Sit on a pillow or soft ring.
  • Exposing your bottom to sunlight will promote healing.
  • Bottom sprays are available to aid with stinging.
  • You can spray the lidocaine spray available for sunburn on your bottom for a light numbing effect.

Bleeding

The discharge after birth is called Lochia. It will be heavy and bright red with clots at first, but will taper off quickly. In two days to two weeks the color will turn brown, possibly followed by a period of yellowish/white discharge. It will likely be gone by six weeks, and possibly sooner. Any time that bright red reappears, it is a sign that you are over-doing it. Rest more if this happens. It is not a serious problem to worry about, but it is the body’s signal to you that it needs you to respect the healing time. Change your pads often, avoid tampons, and nurse the baby frequently. Wear cotton underwear to prevent yeast infections.

Urination

Sometimes urination stings after birth as there may be small skin abrasions in the vagina. You may spread the lips of your vagina while urinating and spray the area with warm water from a peri bottle (any sanitized squirt bottle will do, such as an old dish soap container). This will dilute the urine causing it to sting less. Sometimes you can also figure out how to direct the stream of urine away from the stinging area by leaning forward or back. The peri bottle can also be used as a substitute for wiping with toilet paper. You may still want to pat dry.

Bowel Movements

Bowel movements normally do not cause pain after childbirth, however constipation is a common complaint. It is normal not to have a bowel movement for the first two days after birth as the digestive system was cleared and slowed during labor. To prevent or treat constipation, eat lots of roughage – dark leafy greens are best. Drink plenty of water and avoid caffeine. Other foods that may be particularly helpful are mashed potatoes with the skin left on, bran, oatmeal, whole flax seed, and aloe vera juice. Short walks will also help. Over the counter stool softeners are available, but ask your health care provider for a recommendation. Colace is a brand that is often recommended. Avoid laxatives.

Hemorrhoids

You may suffer from hemorrhoids or have never see them at all. The difference seems to be beyond the control of our best efforts. There is a genetic component that determines who is more susceptible to hemorrhoids. The following will optimize healing and may bring comfort:

  • Eat a diet rich in whole foods.
  • Gently use a finger to push the veins back in. A lubricant such as olive oil or Slippery Stuff may be used.
  • Try to avoid straining for a bowel movement and do not avoid moving the bowels. After a bowel movement, wash with warm water and pat dry.
  • Use a sitz bath or shallow bath for comfort – you may add geranium and cypress essential oils or witch hazel. (Cypress and geranium essential oils are strong oils. The must be emulsified before adding them to water. Put 2 drops in 1/4 c of milk and add the milk to the water.)
  • Cold compresses with witch hazel or the oils above may bring relief. Natural witch hazel free of alcohol is recommended. If using the oils in this way add 2 drops to 3 Tablespoons of a basic oil such as a massage oil or cooking oil.
  • Aloe Vera gel applied topically after bowel movements or whenever they are itchy.
  • Over-the-counter relief such as Tucks or Preparation-H.
  • Homeopathic crèmes such as Nelson’s H+Care.

Afterbirth Pains

  • Put pressure on your uterus when you have the pains by lying on your belly with a pillow underneath or lean forward, cross your legs and press hard with both hands against your uterus. Jiggling your belly while in the position may bring relief.
  • Hot water bottle.
  • Relaxation and deep breathing just as used in labor.
  • Ibuprofen.
  • Crampbark herbal tincture.

Muscular Aches and Pains

You will use muscles during labor that you never imagined using. It is normal for arms, neck, ribs, and hips to be sore like they are after a tough work out. Massage and heat may bring relief to achy muscles. Muscle rubs such as Sombra or Tiger Balm are safe in limited amounts during breastfeeding. Do not exceed directed amounts and a test patch is always a good idea before widespread application. (Do not use on baby’s skin.)

Baby Blues

The heart is wide open after birth and hormones are rapidly changing. It is normal to feel the full range of human emotions very powerfully and with fast transitions from one to another. Exercise, a change in scenery, good nutrition, B vitamins, deep relaxation, and connection with your baby all help to ease the baby blues. If you cannot see the light side of things, are increasingly irritable and anxious, and fear that you’ll never feel like yourself again, get help. These feelings, especially if the dominate for two weeks or more, are indications of postpartum depression and need to be treated just as any other complication or disease. Postpartum depression responds well to treatment. Postpartum is a short, high impact, memorable time. You will be very glad you took care of yourself! Seeking help does not force you into anything. At least get the information, and don’t delay. You may call your primary doctor, your OB or midwife, or a mental healthcare provider.

Sexuality

Sexual intercourse can be resumed after stitches have healed, soreness has diminished, and vaginal discharge is light. Many midwives recommend abstaining from intercourse until two weeks after your active bleeding has stopped in order to give your body time to rebuild all of its natural defenses against infection. Vaginal dryness is very common. The use of a lubricating gel or natural oil prevents discomfort.

Both partners are affected by the many changes in your family life and sleep patterns after birth. Some couples are very ready for a rapid return to an active sexual relationship and others find that a gradual approach is more comfortable. Emotional intimacy, cuddling, and a gentle slow approach to love-making may help couples find their way back to a wonderful sexual relationship in tune with the return of their energy and the establishment of new routines. Arousal changes after having a baby! Find new ways to interest one another in sexual activity. Involvement with caring for the baby, appreciation of one another’s new growth as a parent and compliments about parenting abilities are more effective in foreplay for many new parents than whatever images and words they were previously attracted too. Touch changes. Breasts are often “off limits” but not for every woman. Obligatory sex, or having sex solely because we know it’s been awhile and we think we really should, is detrimental to a marriage. Figure out how to turn one another on given the new person your spouse has become. When arousal and attraction are nurtured, a sexual relationship is a great break from parenting, re-energizes, and connects you. Positive sex increases wellbeing and marital strength.

Get Ready! Look at the Postpartum 101 Planning Guide.

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