POSTPARTUM, The first 6-8 weeks - Recovery from Vaginal & Caesarean Deliveries


This is such a crucial time period to allow for recoiling, recovery & healing to take place so the following tips are the same for every delivery method. Regardless of if you had a c-section, uncomplicated vaginal delivery or an assisted/instrumental vaginal delivery, this is all going to apply to you.


Main goal in this period of time: Rest, recover, sleep & have zero expectations of yourself. Make no plans, eliminate any pressure on yourself.

 

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  • You’re likely to be in pain the first few days & weeks as 90% of first time vaginal deliveries will have a tear or cut, or you may have had a caesarean so take painkillers! Ask your midwife, pharmacist or GP if you’re not sure what to take especially if you’re breastfeeding, but don’t be afraid of taking something. And if it’s not your pelvic floor or abdomen giving you pain, or your uterus contracting back down, it might well be your boobs giving you discomfort as your milk comes in, so be mindful of/expect this too. 
  • So long as you don’t pick up any infections & there hasn’t been any delays to the healing process, all tears, cuts & wounds should have fully healed by 6-8 weeks and any stitches usually have dissolved before this around the 2-3 week mark.
  • Any other pains, for example in your hips, back or pelvis, are not normal or if any of your other pains start to increase again contact your midwife, GP or local pelvic health physiotherapist.
  • You’ll also have vaginal bleeding after delivery – this is called lochia and completely normal, even with a caesarean section – it’s the uterus cleaning itself out and the site healing from where your placenta was attached. This will lessen as the days go by but is normal to last up to 4-6weeks.
  • It’s common to feel open and vulnerable in your pelvic area, especially after a vaginal delivery. You might also feel as though your middle isn’t really connected to your brain & it’s certainly normal to still have a bump in those first few weeks before everything has had a chance to shrink back down.
  • You may also experience feelings of heaviness vaginally – this doesn’t necessarily mean you have a prolapse, there’s a lot of shrinkage required from our uterus, pelvic floor muscles, ligaments & tendons in those first few weeks so do be aware of this as they will be more at risk of injury or developing prolapse if you do too much too soon. This sensation should lessen with time with continued pelvic floor squeezes and being mindful not to put too much pressure downwards. 
  • Lots of women will find that it’s a lot harder to control their bladder and/or bowels in this early postnatal period too & might experience some leaking or not making it to the toilet in time – this is mostly because of weakness in the pelvic floor muscles and will be more likely if you had a tear/cut or an instrumental delivery eg forceps/ventouse.
  • Pelvic floor exercises daily (building up to 20 short & 20 long per day) separating each rep with big breath in/out in between each one. Even if you’ve had an episiotomy or tear, even just a few gentle squeezes per day will help aid circulation and therefore the healing process. There are pelvic floor apps available to help you to remember doing your squeezes. 
  • Postural awareness – sitting up & standing up tall whenever and as much as you remember – will help your postural muscles to begin to strengthen and re-align.
  • Avoid straining on the toilet at all costs – if you haven’t yet, buy a step that you can put under your feet when opening your bowels and then just breathe into your tummy, don’t ever physically push down when opening your bowels. Use a laxative if you think that is necessary especially in the first few days. 
  • Consume lots of fruit, veg & water. Eating as well as you can and nourishing your body will help your body to recover.
  • Avoid all heavy lifting and abdominal exercises. Short slow walks are allowed in these first few weeks but only if you feel up to it & are without pain (max 30mins walk at a time). But do not do any intense or high impact exercise in this time frame. 


FROM 8 WEEKS 


Book in with a pelvic health physiotherapist for a postnatal check up. This will include the following;

  • Check any symptoms that you may be having 
  • Check any scars
  • Test for diastasis and tummy muscles 
  • Test pelvic floor muscles – lying & standing if appropriate
  • A tailor made plan to you for return to more activity and exercise depending on what your goals are.

You should now be doing at least 20 short & 20 long pelvic floor squeezes per day. The position you do your exercises in has an effect - lying is easiest, then sitting, then standing. We are all aiming to get to do them easily in standing but this can take anywhere from 3-12 months to achieve depending on your baseline.


It’s crucial to still avoid straining on the toilet at all costs – this is actually for all of us for life, not just the postnatal period. 


Scar Massage:

  • Suitable and often necessary for tears, episiotomies and c-sections 
  • Not before 6-8 weeks & only once the wound has fully healed 
  • If you have an infection or any delays to healing then it might well take longer than 6-8 weeks 
  • Using pressure with movement and any plain oil that you have in your home, massage the scar for a few mins twice a week until its soft, supple and no longer tender. This can often take a least a few weeks.
  • This can also really help the appearance of scars eg the ‘overhang’ or ‘pooch’ from a c-section scar

Begin to then build up your activity & exercise levels ideally after your physio check and working with a trained pre/postnatal instructor. 

 

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Helen Keeble (www.Helen-Keeble.com) is committed to providing women with evidenced based yet easily digestible information about every single aspect of pelvic health. Helen is the Clinical Specialist Physiotherapist and team lead in Pelvic Health at Blackrock Clinic, Dublin. She also mentors and manages a team of pelvic health physiotherapists in her London clinic (www.pHphysiotherapy.com) and is one of the founders of Umi Health (www.umi-health.com) - making pelvic health accessible to every woman, every where!