The Postpartum Care I Wish We All Had
With my first child I was brave (or I thought I was), and the only set of helping hands I had around was my husband’s. I remember washing the floors on Day 3 but I also had to go out for plenty of medical appointments very early on.
My second child was born in Europe where my visa didn’t allow me to stay longer than 90 days including pre- and post-birth, so we had to leave the country pretty soon – which meant we had to get my new-born daughter her passport and visa as well. So, on Day 10 I took a train to The Hague carrying my little one in a carrier (totally sweet), but because you don’t go to The Hague just for a baby passport, I spent the whole day walking around the town and visiting the museums.
By the time I had my third child I really truly wanted to stay quiet, but with two other kids around that was a myth – however, I did know better by then and took every chance to put my feet up. Anyway, after a while I saw myself doing something I have never done before: running. Running with the pram, you know. My pram was not fit for running, I was not fit for running – but that’s what you do after you had a baby, right? … Oups .. It isn’t.
I had beautiful midwives and my mum was around to help with no. 2 and no. 3, but it took me a few more years, a Feldenkrais® professional training program and putting together and teaching a few Pelvic Floor workshops and courses to figure out how my postpartum care was supposed to be in the ideal world ….
(Before we go any further, I will just emphasize that this blog post is a blend of my personal and professional opinions and does not replace a medical consultation).
1. Rest: Horisontal
Some traditional cultures prescribe 40 days confinement for Mum & Bub after the birth. This more or less corresponds to our 6 weeks postpartum: time for the new mum to be “released” by her midwife and get cleared for exercising etc. Confinement or not, the biggest difference with the old ways is that during this time it is the mum who is being taken care of and pampered, given special nourishing foods and spices, and kept warm.
Of course, this is very pragmatic and is done in order to protect the women’s reproductive health so that she’s able to provide as many children as possible for the benefits of the community, let’s not romanticise it.
But aside from benefits of good nourishment and warmth, there is a very specific physiological reason for staying “horisontal” for as long as possible during those 6 weeks and minimising the effects of gravity on pelvis, pelvic floor and other parts of the body. There are a lot of things that are happening for the new mum and her future health is defined in the first weeks postpartum:
· Mother Nature has provided for your uterus to contract (involution)
· Mother Nature has provided for your ligaments to shorten back to their original length (that's the only case in one's life when they do!)
· Mother Nature has provided for your rectus abdominis ("abs") to retract, losing about 15 cm they added during the pregnancy
· Mother Nature did not provide for a new mum to become vertical very quickly: stand up after the delivery before her pelvis was stabilized; being upright day and night, baby in her arms; carrying shopping bags or even a heavy capsule with the new-born; spending hours sitting on a couch with her back rounded while feeding her baby ...
· You have only those six weeks to let Mother Nature do her work – but only if you permit.
The priority of the first weeks is, apart from bonding with the baby and being nourished, to let the internal organs come back to their place and let the pelvis “close”. To allow this, you need to rest “horisontal” as often as practically possible. During the first three weeks postpartum a good rule of thumb is that the time spent horisontally needs to be longer than the time spent vertically every day.
2. Pelvis: Stabilise
Staying horisontal will help already, but we can also help by wearing a bandage or wrapping the belly and the pelvis – or even the whole body – with a scarf like rebozo.
If you have someone who is specialising in the postpartum body wrapping, please go for it; if you are looking for a gift for the new mum, this could be the most awesome thing. (My amazing midwife and friend Claire Eccleston - currently based in Auckland - is providing the Closing of the Bones ceremony which has a similar effect; if you know of anyone doing closing of the bones or postpartum body wrapping locally - please sing out, I want to know!)
If the postpartum body wrapping or closing is not available to you, a very simple thing to do would be asking your two friends to tightly tie a scarf around your pelvis at the level of hip joints (it is not the same as “on the level of your hips” – by this people often understand the top of your pelvis. To locate your hip joints, imagine you slide your hands in your pants’ pockets and direct your fingers towards your pubis: your hip joints are likely to be under the tips of your middle fingers – yes it’s that deep).
This is best to be done before your get up after the delivery for the first time, otherwise – as early as possible. It can serve as a mechanical and symbolical “closure” of the birthing process. You could wear this bandage for a few hours and repeat it again during the following days. In the traditional cultures such a bandage would be worn for 21 days post-partum.
Later on, you could use one of the commercially available postpartum belts. Make sure the belt you choose goes around your pelvis at the same level as your bandage above (hip joints) and is tight enough but still elastic and doesn’t constrict your movement and especially breathing.
3. Breathing: Use It to Support Your Internal Organs
It may sound unusual but your breathing is the key to your pelvic health. This is what we usually start our Pelvic Floor workshop/course with.
You can learn to breath in a way to decompress internal organs (including uterus and bladder) and assist them in returning to their original position, as well as support the involution of the uterus. This technique is called “decompression breathing” and it is done while you’re lying on your back or on your side.
The same technique might be very helpful if you have a prolapse.
Another good exercise is blowing the air out (as if blowing a candle or a balloon) until your lungs are “emptied” as much as possible while sensing the movement of your lower ribs. For the efficient functioning of the diaphragm - pelvic floor system you need to find movement of those ribs.
This is something we can successfully teach during an individual Feldenkrais® session as well.
Art work: Travis Bedel
4. Pelvic Floor: Get awareness and Protect
Quite often women are recommended starting pelvic floor exercises straight after 6 weeks postpartum. But before anything, those 6 weeks are the best time to start protecting it. Prevention, engagement and letting go are the key words here.
“Blow before you go”. This is the rule I learned from the Canadian PT Julie Wiebe, she’s doing great work in the field of educating women and professionals. Breath in, breath out, engage your pelvic floor and then do the action that requires some effort: picking your baby up, getting up from the chair … Make this a habit of your daily life. (On a side note, a Feldenkrais® class or session are great ways to learn how to reduce effort in every movement you make)
Find out what are the different areas and levels of your pelvic floor and how one area can be felt differently available or engaged. Again, creating this experience is a big part of the workshops/courses we offer
Learn to integrate pelvic floor into your breathing and everything you do. Learn letting go as well as contracting: a healthy pelvic floor is dynamically responsive.
Other ways to protect your pelvic floor are through decompression breathing (see above) and through avoiding constipation (see below)
Avoid abdominal exercises that put pressure on your pelvic floor (be careful with crunches, sit-ups and the “bicycle” – I don’t say don’t-do-them-at-all-never-full-stop - but rather learn to sense how these can affect your pelvic floor and decide when you’re ready for them if you wish)
5. Constipation: Address “from Down Under”
Pushing down in order to empty your bowel is never a good idea, but it is hyper important to avoid doing this in the first weeks postpartum. While the importance of addressing constipation through liquid and food consumption (“from above”) is quite known and well described, we rarely – if at all – speak about how to support the efficient mechanics of bowel movement. Here are a few tips:
· Go at the first sign from your bowel. Most often you will notice this first sign in the morning, after the breakfast or after having your first drink. Please don’t delay as it will be the strongest combination of reflexes on this day. Let everybody and everything else wait: your baby can stay in a safe place for a few minutes. Otherwise, you might need to wait until the next day.
· Choose a good position: feet supported by a small stool, bent forward from your hip joints to imitate squatting.
· Don’t push. And don’t ever push towards the front area of your pelvic floor (one that contains openings for your vagina and urethra)
· Learn to sense different areas of your rectum and how you can mobilise them – it is possible !
6. Take time
And of course, to be able to do it all, you’ll need to get a support team during those weeks. Your only job is to let people know how they can help, organise it way before the delivery day and delegate what you can. Remember: you have only those six weeks to protect your future health; see it is an investment in your future wellbeing.
If it didn’t happen for you – it doesn’t mean you cannot do anything to improve your current situation. But you might have to work a little harder towards your optimal health and be proactive in exploring some of those avenues. Please get in touch if you need help!
Resources:
Bernadette de Gasquet, My post-baby body: Everything is decided before six weeks (in French)
Blandine Calais-Germain, The Female Pelvis: Anatomy & Exercises
Blandine Calais-Germain, No-Risk ABS : A Safe Workout Program for Core Strength