Whether your birth goes according to plan or not, many new moms are surprised by the initial postpartum period and recovery. According to a postpartum nurse, here’s how to recover after vaginal birth.
The truth is, new mothers may feel unprepared to take care of their healing bodies while managing new challenges of motherhood. As a postpartum nurse, most of my job involves education (which I love) and reassuring moms of the following facts:
- Yes, this is hard!
- You’re doing awesome
- It’s a learning process. You and baby are just getting to know each other. By being present and holding your baby, you are doing enough.
My goal is to walk you through the process of postpartum care to share tips on recovery after vaginal birth: what to expect, when to expect it, and how to survive it.
To help you better navigate this post, it’s broken into sections:
- The early hours: meeting your newborn
- 12-24 hours
- Three days
- One week
- Four to six weeks
- 12 weeks
- Six months
- Two years and beyond
The early hours: meeting your newborn
In the first hours after delivery, hold your baby, and spend time doing skin-to-skin contact. If you’re unable to for whatever reason, have your partner unbutton their shirt and put baby skin to skin with them. This keeps babies warm as they adjust to the extra-uterine environment, but this is the beginning of bonding (cited from Medline Plus).
Attempt to breastfeed (if that is your choice) within the first hour of birth, as long as you can, and baby doesn’t need extra medical attention. Babies who breastfeed within the first hour when they are most alert have more success breastfeeding.
Soon after, they will become sleepy, and they may be too tired to nurse. By the way, this is perfectly normal. Holding them tightly via skin-to-skin will help regulate their temperature and blood sugar and allow them more opportunities to nurse once they’re ready.
Addressing healing with BUBBLE-HE:
Episiotomy and perineum
This is what we’re assessing when we come into your recovery room to ensure you are stable. We’re checking vital signs, which include temperature, heart rate, blood pressure, pulse oxymetry, and pain.
And yes, this is where we have to massage your fundus (aka the top of your uterus) as it starts involuting. You will feel some discomfort and contractions as your uterus begins to shrink back down while you bleed. We do this to make sure it feels firm and is gradually lowering below the belly button.
Your breasts produce milk in response to baby’s sucking. You have colostrum in the early days, in small quantities (but don’t worry because the baby’s stomach is tiny at this point)! Your nipples should point out, and you should see little drops of colostrum when you express your breast tissue. As long as you have a good latch, you shouldn’t have extreme pain while breastfeeding and no cracking or bleeding. An IBCLC aka, a lactation consultant, can help.
Your uterus is slowly shrinking back to pre-baby size. This process takes up to 6 weeks! Afterpains are common, especially when breastfeeding. You’ll be offered pain medication. However, you can alternatively take nursing-friendly herbal tinctures that may help. Talk to your provider about different options.
You should have full function of your bladder once your foley catheter is removed (if you had an epidural). Use an upside-down peri bottle filled with warm water while urinating to help wash off bleeding. This is also helpful for stitches. Then, gently pat dry with toilet paper.
Stay hydrated and empty your bladder frequently. You may find that you pee out a lot more in the postpartum period- that’s because you’re flushing out all the retained fluids from pregnancy!
Also, bladder incontinence may happen early on, but it is not normal if it persists. Seek a pelvic floor PT if you’re having bladder issues. If you have a sense of frequency, urgency, burning while voiding, or foul-smelling urine, these are signs of infection and must be reported to your nurse or provider immediately.
Many women are afraid of their first postpartum bowel movement, especially if they had hemorrhoids, tears, or episiotomies. The best thing you can do to support your digestion and bowels is stay hydrated and eat plenty of fiber. You’ll be offered a stool softener, which is recommended for at least the first couple of bowel movements.
Recovery from a vaginal birth requires a lot of gear.
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This is a fancy word for postpartum bleeding. Most women have moderate period-like bleeding for up to 6 weeks. Bleeding should gradually become scanter. It is normal to see small clots and see more bleeding when you are up and about, physically active, or breastfeeding. It is NOT normal to saturate a pad in less than an hour or pass huge clots.
Episiotomy and perineum
Even if your perineum is intact and you suffered no tears, swelling and inflammation are common in the early weeks. To best support your perineum, continue using your peri bottle. You can also set up a sitz bath. Some women find cold therapy helpful, and you can apply cold packs. Your provider can also order a combination of topical medication containing witch hazel and hydrocortisone, which you can use as needed for extra relief.
While uncomfortable, hemorrhoids are common during the late part of pregnancy and early postpartum. Communicate your discomfort with your care team as needed – use witch hazel pads and organic hemorrhoid balm (like this one), plus a stool softener to help encourage healing.
The first thing we want to know is whether you’re in pain. If so, you have options. Secondly, how are you feeling? It’s normal to be overwhelmed and experience a range of emotions during this time. Try not to go into “host mode” and be mindful of visitors sucking up your time and energy. Ask for help. Sleep when the baby sleeps – especially during that sleepy period I was talking about earlier.
12-24 hours after birth
Here’s what you can expect recovery-wise the hours after a vaginal birth.
- You and your baby will have multiple opportunities to practice breastfeeding or bottle-feeding
- You will have voided by this time, but not necessarily had a bowel movement
- You should have a pain management plan
- You should start walking as soon as you can
- Start to do active breathing exercises to connect your pelvic floor – no exercise yet
- Stay hydrated and keep your bladder empty
- If breastfeeding, continue to do so frequently and on-demand to help your milk come in
Three days after birth
At this point, you should be back at home if you delivered in the hospital without complications.
If breastfeeding, this is typically the day your mature milk will come in. You may experience engorgement and fullness, which can be relieved with a warm shower or warm washcloths. Frequent breastfeeding is recommended, and you can choose to apply cabbage leaves or cold compresses between feedings for continued discomfort (cited from Arora et al., 2008).
If you’re not breastfeeding and would like to slow the production of your milk, apply cabbage leaves, cold compresses, and wear a supportive bra. Do not pump milk or express, because this will only cause your breasts to produce more milk.
What’s not normal: breasts that feel hard, have hot spots or red spots, appear shiny, flu-like symptoms, and fever. These are signs of mastitis, and your provider can give you further direction on treatment.
One week after birth
You’ve survived one of the hardest periods of your life. That first week is tough as you, your family, and baby get to know each other and experience a shift in routine. That first week is all about survival.
Tips for a smoother transition:
- Slow down. Don’t feel obligated to take care of the house. Ask for help.
- Sleep whenever baby naps.
- Ask for help with diaper changes, baths, holding the baby, bottle-feeding, rocking the baby, and anything else that will allow you to take small breaks.
- Don’t feel guilty about spending most of your time chilling and holding your baby.
- Stay hydrated. Keep a water bottle near you. Set up a breastfeeding “station” with water, high-protein snacks, and Netflix.
- Take pain medication and stool softeners as needed during this early recovery phase.
- Call your doctor about any concerns
Four to six weeks after birth
In the next couple of weeks, you may have your postpartum visit scheduled. This is a time to ask questions. According to the AGOG, the below points are a great place to start.
- Follow up on your birth- what went well, what could have been better about your experience
- Talk about bleeding, pain, stitches (if you had any)
- Talk about bladder symptoms, pelvic floor rehabilitation, and ask about physical therapy
- Talk about how breastfeeding is going, as well as nutrition, self-care, your support network
- Bring up any emotions you’re experiencing, especially if you’re having persistent anxious or depressed thoughts
- Ask about postpartum labs to get a better idea of your nutrition status
- Get medication refills
- Get a PAP smear if you’re due
- Ask about returning to work and exercise
- Talk about birth control and family planning methods you feel comfortable with (hormonal or non-hormonal)
Preparing for postpartum?
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12 weeks after birth
The fourth trimester is over! Congrats – you survived the hardest period.
By now, you may start feeling more like yourself. Your baby may be sleeping longer stretches at night and having more of a consistent schedule.
This is the time to take note of symptoms that make you feel like you’re not yourself.
- Excessive fatigue or lightheadedness
- Excessive weight gain or loss
- Difficulties with breastfeeding that persist
- Lingering baby blues or anxious thoughts
- New symptoms, such as digestive issues, skin reactions, brain fog
Remember, postpartum isn’t only six weeks. It’s forever. If something feels off, don’t brush it off. Check-in with your provider and advocate for yourself.
One frequently asked question our moms have is about hair loss. Postpartum hair loss is normal around three months, but it should not last for months and months.
This leads me to my next point — have your thyroid checked if you haven’t already. Many women experience postpartum thyroiditis, which can become chronic Hashimoto’s if left untreated. A full thyroid panel is recommended, including:
- Free T3
- Free T4
- TPO antibodies
And about the stretch marks and saggy skin – they’re totally normal. Your stretch marks and darkened skin will fade over time. You can improve your skin’s elasticity by eating collagen-rich foods or taking a supplement.
If you haven’t already, it is essential to assess for diastasis recti (ab separation) and see a physical therapist or check out the Every Mother workout program to help you safely strengthen your core.
Six months after birth
As your baby’s feeding schedule changes, with more time between feedings and skipped feedings and the introduction to solid foods, your hormones will continue to recalibrate.
Many women will see their period return if they’re still breastfeeding, though not all. Your period may be back, but it will likely be irregular because the hormone prolactin (known as the breastfeeding hormone) is still circulating and affecting your sex hormones.
Remember that you may still ovulate even if your period hasn’t returned, so be sure you’re clear on which family planning method you’d like to use.
Two years and beyond after birth
It took your body nine months to grow a life and one or more years to breastfeed a child. It may feel like your body is not your own until you’ve weaned. Hormones are still fluctuating until you completely wean your child, so expect to go back to “normal” after you’ve stopped breastfeeding.
Hopefully, you have enough support at home to take some time for you. It’s not selfish to take care of yourself. Take a relaxing shower, get a massage, spend 2+ hours at the hair salon if you need to, nap instead of working out, or skip doing the dishes.
Your body did a fantastic thing, and you need to nurture it accordingly.
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Catherine McLeod-Moya is a Registered Nurse and health coach at Holistic Health Code. Her mission is to provide holistic health education and coaching services to women and new moms seeking hormone balance. She lives in sunny Florida with her husband and three boys.