We’re so engaged in preparing for birth and the needs of a new baby, that we often don’t anticipate taking care of ourselves and our afterbirth bodies.
When we give birth vaginally, our vagina, perineum and rectum need some loving attention afterward. When we give birth via Cesarean section, we may have much of the same tenderness- along with surgical recovery. Traditional cultures honored this time with a devotion to convalescing the mother as well as giving mother and baby time for gentling-in together. Modern culture forgets the need for slow timelessness after birthing, and we often feel the need to prove our sturdiness by jumping up and back into the fray in a matter of days.
Honestly, giving birth is heroic enough. The era of proving our maternal mettle through silently suffering and marginalizing our needs is over. My generation did just that; daughters, do not.
What to Expect
With the first birth, regardless of venue, we can be stunned by the transition from privacy with our bodies to finding ourselves on display for apparent legions of people coming and going with nary a thought. In the moment, during labor or C-section, there’s plenty of distraction from the weirdness of it all. Whether we birth at home or in the hospital, we move quickly from a team of caregivers to managing much on our own. And, an important part of self care is the willingness to take some time attending to ourselves- without guilt or apology.
First Six Weeks
- Soreness and swelling
Tenderness and swelling of the vagina, vulva and perineum is expected. That was a big hurdle, and we’re not pathologizing birth by recognizing that it’s normal to be almighty sore and swollen. During pregnancy and birth, there’s an increase in bloodflow and fluid in the entire vaginal area, and it doesn’t diminish overnight. Childbirth places a lot of pressure on the integrity of our tissues, and sometimes there’s tearing. Additionally, an episiotomy will usually be extra tender, and the stitches can be uncomfortable and itchy until they dissolve, which is generally 7-10 days.
These are the little contractions that come after baby arrives. Immediately after birth they can be surprisingly strong, and most women know about the belly kneading and need for these contractions. We may not be aware that afterpains continue for a few days and are particularly noticeable when we breastfeed. These afterpains are necessary contractions, part of the process of returning the uterus from approximately 1000 grams (over 2 pounds) post-birth back to 50-100 grams (2-3.5 ounces) 6 weeks later.
- Vaginal bleeding and discharge
Postpartum discharge is called lochia. It’s bright red to begin, and can contain clots. Clots are normal but can also indicate too much activity. Remember that this is time for resting. If you don’t have help, your house may not be impeccably cleaned and you may need to let dishes sit. As your uterus returns to its non-pregnant condition, the lochia will slowly shift to pink, brown and then white. The process will normally take 2-6 weeks. We don’t use tampons during this time and instead rely on sanitary napkins. Remember to contact your doctor or midwife if the flow of lochia increases after having slowed, or if it becomes more red after lightening, or clots reappear after stopping.
- Difficulty going to the bathroom
This includes both constipation and trouble urinating. The havoc of birth combined with inflamed and sometimes bruised tissues around the urethra can result in difficulty peeing. Sometimes we just need to sit a moment and wait for our body to respond to the pee-now message.
Constipation is also normal. Initially, pain medication used during delivery or immediately postpartum may cause constipation. Pre/postnatal vitamins that are high in iron may also be a culprit. And, breastfeeding can be dehydrating when we don’t drink enough water, which contributes to constipation. In the early post-partum days, we may also be holding back to avoid pain; and yes, a sore perineum, episiotomy, C-section and hemorrhoids can all make defecation more than a little uncomfortable. The problem is that holding back leads to constipation- which just makes it all the more difficult.
And, urinary incontinence is quite common during the postpartum stage as well. Childbirth can temporarily weaken the pelvic floor muscles and compress pelvic nerves, both of which are involved in bladder control. This situation is usually self-resolving, and over by the time we no longer need sanitary napkins at around 6 weeks postpartum.
Many women develop hemorrhoids during pregnancy. For the lucky who don’t, the strain of pushing during delivery can cause rectal veins to become varicosities, and range from mildly uncomfortable and itchy to sincerely painful. Like constipation and incontinence, hemorrhoids that emerge during childbirth usually resolve by the time we reach 6 weeks postpartum.
- Dry vagina and vulva
Vaginal dryness can be a struggle during the first year. Our postpartum hormones can result in very dry and uncomfortable vaginal and vulvar tissues; breastfeeding benefits our long-term health in many ways, but it does come at the price of some predictable vaginal dryness.
In the United States, about a third of moms have our babies via C-section. The incision is smaller than one would imagine, only 4-6 inches, usually horizontally just below the public hairline. It will likely be red and swollen at first, but will eventually fade to silver. After a Cesarean, it’s important not to lift anything heavy for two weeks, and be cautious for about 6 weeks.
Old school. During the first 24 hours, we benefit from applying ice wrapped in a soft cloth the the entire anogenital area. Simple and effective.
Yes, we can relax in a postpartum bath to soothe tender tissues – whether we’ve had stitches or not- soon after birth, as long as we’re healthy and there are no signs of infection. (Unfortunately, when we have a cesarean, we do need to wait to submerge fully, but can settle our bottoms in a sitz bath - which means filling the tub with water to about 4 inches deep.) An herbal bath after birthing is soothing to our flesh and goes a long way when nourishing an overwhelmed psyche.
- Perineal care
Compresses and rinses are traditional ways of applying botanical infusions to the anogenital area after birthing, and are very helpful in reducing stinging, inflammation and discomfort. Witch hazel is classic (please don’t use the alcohol-containing products that are generally available!) along with calendula, chamomile, yarrow, chickweed and sage. When we forget to prepare, we find one of the most effective herbs for our purpose in the cupboard: green tea is beautifully high in tannins and anti-inflammatory, and a teabag makes for a nice little compress in a pinch.
- Hemorrhoid care
Again, compresses and rinses are useful self care for the entire anogenital region, including use on hemorrhoids. Additionally, products designed for anogenital wound care can provide support for tissue repair and pain relief during the postpartum recovery phase. Addressing constipation becomes crucial when we’re dealing with hemorrhoids.
- Constipation care
First, water! When we’re breastfeeding, we need a lot more water. While this may seem obvious, it can be hard to keep up. Hot teas tend to be supportive of digestive motility, and a simple hot lemon with honey water is a nice encourager of movement. We’ve all heard about prune juice, but fresh pressed juice blends of all kinds are both helpful and nutritive. High fiber foods and dried fruit are terrific: an example of a perfect constipation-reducing breakfast might be oatmeal with dried fruit and fresh-ground flaxmeal, with a side of juice AND tea.
- Intimate skincare
It’s important to use intimate products that first do no harm; meaning, no endocrine disrupting, carcinogenic, hyperosmotic or microbiome disrupting ingredients. Many if not most intimate care products are problem-causing, and include endocrine disrupting, carcinogenic and microbiome disrupting ingredients in hyperosmotic formulas that cause inflammation and epithelial cell damage. Look for daily intimate moisturizer that supports microbiome and pH balance, and promote cellular health and tissue elasticity. When we’re ready for sexual encounters to begin again, it’s important to be relaxed and give ourselves time for arousal. The impact of hormones and breastfeeding can lead to vaginal dryness, and the postpartum condition of our tissues may require the addition of intimate skincare.
- Cesarean wound care & scar reduction
Typically, staples are removed 4/5 days postpartum, and most stitches will dissolve in a few weeks. While you’re generally able to shower during this time, submerging in water is discouraged for the first 10-14 days. After that, you’re free to use wound care or scar reducing formulas to support the healing process, minimize scar formation and speed recovery.
Postpartum Herbal Bath, Peri-rinse and Compresses
This herbal formula is anti-inflammatory, astringent and supportive of anogenital recovery of injured tissues. You’ll want to make a big batch, and use it in different ways.
Calendula flower 4oz
Chamomile flower 4oz
Witch Hazel leaf 4oz
Green Tea leaf 4oz
Rose petals 4oz
Chickweed herb 4oz
Sage leaf 2oz
We’ve posted links to Mountain Rose Herbs. They’re a beloved company that have been around for a very long time. That said, they tend to be out of stock pretty regularly. Starwest Botanicals is another reliable source of quality botanicals and supplies.
For your bath, you can take a nice full tub or just sitz bath a few times a each day. Just scoop a cup of the herbs into a big bowl, pot or other similar vessel. Pour over with a teapot full of off-the-boil water and allow the herbs to steep for 15 minutes or so. Then, simply pour the bath tea through a mesh sieve into the tub and fill to the desired level.
Use the peri-washing container given to you by the hospital or midwife, or purchase one that’s a little better designed for ease of use. We like the FridaBaby Fridet Momwasher. Pour two cups of off-the-boil water over a half cup of the herbs in a mason jar. Once it’s cooled, pour through a tea sieve into a pyrex measuring cup; fill into the Momwasher. Keep cool in the refrigerator between uses. Make a fresh batch daily.
There are two different ways to make a compress.
- You can make herb tea as described for the Peri-rinse, but instead of filling the Momwasher, you simply soak a soft, clean cloth with the tea and wring it out a bit, so it’s not dripping. If you’re soon after birth, apply the compress after cooling in the refrigerator. As time passes, you can apply the compress warm.
- You can fill a teabag with the herbs and soak it in some off-the-boil water; and either cool in the refrigerator for use soon after birth, or allow to cool until warm and NOT HOT; apply directly to the perineal area. We use both disposable teabags and reusable cotton muslin bags for compresses, as you choose.
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