Thriving Through the 4th Trimester: Caring for the Healing Postpartum Body & Mind

Welcome to the third post in this series, Thriving through the 4th Trimester. Follow me as I share what I learned applying traditions from other cultures to my own postpartum journey. It is my hope that this knowledge will serve as a guide for how to truly care for a woman, as she transitions from maiden to mother, in the most wholistic way possible.

Oh, the changing body… It goes through so much transition in such a short time! During my first experience with pregnancy and postpartum, I felt like I was emotionally distraught the entire time. I tried to love my pregnant body, but it was a struggle. I tried to love and accept my postpartum body, and that was yet another struggle. But the second time around, it seemed easier. I was more accepting of the change because I had proven to myself that these transitions were necessary and, for the most part, temporary changes. One of the most helpful quotes or mantras I had for myself during my first postpartum experience was, “This is temporary.”

Many times when I felt like I needed to hear that phrase, I was experiencing physical ailments. So, from a physical therapy/rehabilitation standpoint, I feel like I learned an extensive amount about the human body by having my two children. Throughout my pregnancies and postpartum experiences, I had the opportunity to learn first-hand about things like nausea, shortness of breath, pregnancy rhinitis, sacroiliac joint pain, pubic symphysis dysfunction, umbilical hernia, incontinence, constipation, hemorrhoids, and even a mild case of internal rectal prolapse! Lucky me.

But when it comes to treating pain and dysfunction, there’s no better learning experience than your own body. Working through these issues on my own and getting treated by different types of practitioners (chiropractors, massage therapists, acupuncturists, midwives) taught me about how I wanted to treat my pregnant and postpartum patients when they came to me with similar issues. I became fascinated with how different the experiences of pregnancy and postpartum recovery can be from one pregnancy to the next (even in the same person), and how the different experiences during pregnancy, labor, and birth can set the tone for that recovery.

No matter what you are physically experiencing during your postpartum window, I believe that by taking small preventative steps, one can create a profound change in their outcome. Here are a few concepts of physical healing that I wish all Mamas understood while going through this transition:

  • Birth is a miraculous feat, regardless of what path your baby took to come into this world. You have a placenta sized wound inside of you. “Bouncing back” should not be on your mind at this time. That is not to say that you should beat yourself up if you find yourself mourning the loss of your pre-pregnancy body. There is a grieving process to go through when moving and transitioning from one place in life to another. Respect your feelings; allow yourself to feel them and know that you are not alone. Healing takes time. Your body performed a miracle. You and your body will never be the same. But you can feel good in your skin again, and there are people like me out there that want to help you achieve that. Reach out when you feel ready. You are powerful and resilient. Remember: This is temporary.
  • Tissue healing takes time: Clinically, we know that tissue goes through three stages of wound healing: inflammation (days 1-4), proliferation (days 4-24), and remodeling (days 21- 2 years). Rest is an important part of that healing process. Rest now so that you and your tissues can fully heal. Try to be patient and trust the process.
  • Exercise should only consist of lying down and breathing, and trying to do necessary tasks with good mechanics for the first few weeks. That is all. Progress to gentle/specific motor control exercises for the core and pelvic floor when you feel ready. Walking around the house, stretching, and moving in ways that help you relieve pain, when you feel ready, are also encouraged.
    • Ergonomics for postpartum Mamas – NOTE: Squatting video included for mechanics only. The action of squatting can be done to pick up toys/items from floor, or to simply stand from a seated position with good form. I do not recommend squatting to be completed as a repeated “exercise” until you feel ready and have been cleared by your physician.
  • Try to avoid straining to poop! The pelvic floor has had nine months of pressure building on it. Avoiding straining now can decrease your chances of prolapse later. Staying extra hydrated, eating foods that encourage a smooth stool (like stewed prunes) or drinking a magnesium supplement (like CALM powder) can make things much easier. Splinting to defecate might also be helpful if the reason you are straining is mechanical and not related to stool consistency.
  • Your core muscles are weak right now. It’s not just you! During pregnancy, the abdominal muscles get stretched out to make space for baby. This process of expansion took almost ten months. They are not going to return to their former strength overnight. Muscles that are trying to perform from an overstretched position are never as strong. These muscles need time to return to their normal length and regain their strength. Wearing any of the following garments can help provide some support and help the muscles perform from a place of improved position so that they are able to contract to the best of their ability. (Just make sure they are not too tight!)
    • Belly band
    • Compression tank
    • Compression shorts
    • Compression pants
    • Belly binder — Belly binding is a tradition in many cultures around the world. When I began learning about belly binding in my first pregnancy, I utilized the Benkung binding technique. I found it to be too time-consuming and cumbersome for me to do on my own, and it wasn’t comfortable to sit in at all. I found this velcro belly binder much to use and more comfortable to wear, so I ended up utilizing it after my second pregnancy. Everything I read told me I should be binding my abdomen anywhere from seventeen to twenty-two hours a day. This is not realistic for me. I think it’s important to listen to your body and do what is comfortable. Read more about belly binding here.
  • Roll to your side to get up from reclining or lying down. One of the muscles that controls the “crunch” or “sit up” activity is called the rectus abdominus. It is the muscle that separates while allowing the belly to expand and grow. Sometimes that separation will continue postpartum, which is referred to as diastasis recti. It is a good practice to avoid activating that separation as the tissues are trying to heal. So when getting up from lying down, or sitting upright from reclining, try to roll onto your side first (see  my tutorial on log rolling – I’m pregnant in the video, but the actions are the same for the postpartum window). When returning to exercise, AVOID sit-ups and crunches.
  • Set yourself up for success with posture!
    • The core and pelvic floor musculature are designed to work as a pressure system naturally and automatically as you breathe. But during your early postpartum window, try to notice how you are holding your body while standing and sitting. What postural compensations are you making to feed your child or hold them while standing? Just notice, don’t worry about it right now. Get familiar with your new patterns. Approach this change from a place of awareness (see my video on posture).
    • There is also a strong connection between the way you hold your body and what you feel in your mind. There is even a term for it: Power Posing! Try this technique and see if you can feel that connection for yourself. Posture can be a very powerful tool for the musculature and the mind when it’s used correctly.

During my second pregnancy, I was much more relaxed, mentally and physically. I had very little emotional attachment to the physical changes I experienced. I respected the physical demand being put on my body to create a human life in a way that I couldn’t seem to do during my first pregnancy. Some of the pains I experienced were the same as the first time, but they were always much less intense and never lasted as long. Even my labor was different the second time around. My postpartum mental outlook, emotional stability, and physical wellbeing were much better.

With the first baby, I felt like I experienced trauma during my labor and delivery and my postpartum mental and physical state followed suit. The second time I gave birth was a positive experience. My labor and delivery went as smoothly as I could imagine a natural birth experience could ever go. And, overall, my postpartum recovery (mental and physical) was vastly improved. I attribute this positive second outcome to many factors: experience, listening to my body throughout my pregnancy, receiving a labor-prep massage and that provided emotional healing and physical readiness for labor, having a birth doula, having postpartum meal delivery, and planning thoroughly for my postpartum experience.

No matter what happens during your birth, it is important to recognize that your postpartum emotional state and physical symptoms can be connected to your birthing experience. Bodyworkers, like myself, refer to this as a somato-emotional connection. Soma refers to the body, and emotional refers to your feelings. The issues that we all have can get expressed through pain in our body. Don’t let your issues get stuck in your tissues.

One way to try and prevent that from happening is to process the emotions you’ve attached to your physical experience giving birth to your baby. Tell your birth story. Write it. Share it. Process it as much as you can in whatever way feels best to you. Your mental health affects your physical health. It’s all woven together.

No matter what you are feeling, the postpartum window is the time to give yourself, and your body, as much grace and forgiveness as possible.

For the Partner, Family, & Tribe — Here are some ideas of how you can contribute to optimizing physical and emotional healing during this time:

  • Encourage her to tell her birth story. Don’t pressure her; she may not be ready. She may want to tell it over and over. Listen to it as much as she needs to tell it.
  • Make sure she is staying hydrated. Refill her cups frequently. Try to ensure she has something warm to drink and a room temperature water on every bedside or couch-side table.
  • Fill her peri bottle with warm (body temperature) sitz bath herbal tea. If she has tearing or stitches, this is a life saver.
  • Make pad-sicles and nipple-sicles with those same herbal sitz bath herbs. Detailed directions for making pad-sicles and nipple-sicles can be found here!
  • Massage her with warm oil. Massage is a wonderful way to process these somato-emotional connections and get the issues out of the tissues! Don’t be surprised if emotions boil over during massage. This is a healthy part of the process.
    • Hire a professional! Get a licensed massage therapist to come do an in-home massage for Mama while you watch baby. Allow Mama time to rinse off in a warm shower afterward if possible. A gift certificate for an in-home massage would be a great gift for a new mother.
    • Anyone Mama feels comfortable with can massage her. Set your intention to help her relax, be gentle, ask about your pressure, and encourage her to breathe.
  • Draw her a bath. Steep some sitz bath herbs (and/or make a salt bath blend) and draw her a full bath, make up a sitz bath, or even set up a vaginal steam. Light a candle. Care for baby while mother enjoys 15-20 minutes alone, without interruption. Remove baby from ear shot so Mama can’t hear any crying.
  • Help her with belly wrapping, or just remembering to put it on. If mama is belly wrapping, help her don that garment. Mama- make sure the garment is not too tight and wear it as much as you can, but most importantly remain comfortable.
  • Bring her Supplements. If she is taking supplements, ask if she has had them or would like them now. Bring them to her and refresh her water.
  • Keep her warm. Ask her if she is comfortable. Bring her a blanket. Ask if she would like a hot pack or hot water bottle on her low back or belly. This helps calm the nervous system, decrease low back pain, improve digestion, and ease abdominal cramping.

If you are currently pregnant or have just had a baby, consider sharing this with your support group so that they can provide you with the kind of help you need to be able to focus your time where it’s really important!

Next post in this series—Thriving Through the 4th Trimester: Support From the Partner

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