Postpartum Pain & Discomfort Management

The postpartum period is a time of profound change and adaptation for new mothers. It's a phase marked by exhaustion, emotional highs and lows, hormonal fluctuations, and physical adjustments as the body recuperates from pregnancy and childbirth. During this whirlwind, mothers are tasked with the demanding responsibilities of caring for their newborns, which can often be overwhelming. It's common for women to experience various forms of pain and discomfort during this period. However, the good news is that there are effective solutions available. In this comprehensive article, we will explore postpartum pain and discomfort management from the perspective of obstetrician-gynecologists (OBGYNs). We will delve into common postpartum discomforts along with their management strategies and hands-on, drug-free options for postpartum reconditioning.  

Common Postpartum Pain and Discomforts 

1. Nipples Cracked/Bleeding/Pain

Sore and cracked nipples frequently trouble breastfeeding mothers. To manage this discomfort: 

• Ensure a Proper Latch: Ensuring a proper latch during breastfeeding can minimize friction and damage to the nipples. 
• Nipple Creams: Lanolin-based nipple creams, such as the Mommy’s Bliss Lanolin Nipple Balm, can soothe and protect the skin around the nipples. 
• Air-Drying: Allowing nipples to air-dry after feeding promotes healing. 

• Experiment with Positions: Trying different breastfeeding positions can help find the most comfortable one. 

2. Breast Pain

Breast engorgement, mastitis, and general breast pain can be common during the postpartum period. Management strategies include: 

• Frequent Breastfeeding or Pumping: Breastfeeding or pumping every 2-3 hours helps relieve engorgement. 

• Warm Compresses: Applying warm compresses of your choosing to the breasts before feeds promotes milk flow. No need to buy a new product for a warm compress; warm wet face cloth, warm shower or a heating pad on low are reasonable options. 
• Cold Compresses: After feeds, cold compresses or ice packs can reduce inflammation. 
• Over-the-Counter Pain Relievers: If recommended by a healthcare provider, over-the-counter pain relievers can provide relief. 

3. Abdominal Cramping

Postpartum uterine contractions, known as "afterpains," can cause abdominal cramping. These contractions aid in the uterus's return to its normal size. Management options include: 

• Heating Pad: Applying a heating pad to the lower abdomen can alleviate discomfort. 
• Over-the-Counter Pain Relievers: If advised by a healthcare provider, over-the-counter pain relievers can help. 
• Deep Breathing and Relaxation Techniques: These methods can help ease discomfort. 

4. Incision Pain

Mothers who have undergone a cesarean section (C-section) may experience incision pain. Management strategies include: 

• Incision Care: Keeping the incision clean and dry is crucial to prevent infection. 
• Pain Relievers: If advised by a healthcare provider, over-the-counter pain relievers, opioids, or gabapentin may be options. Cesarean section can be associated with significant post-operative pain, which can hinder a mother's recovery and her ability to connect with and breastfeed her newborn. While opioids are commonly used to manage this pain, they come with adverse effects like sedation, nausea, vomiting, and constipation. Non-steroidal anti-inflammatory drugs (NSAIDs) can help reduce opioid usage but may not be suitable for all patients. An alternative approach to enhance post-cesarean pain control may be Gabapentin, a medication that modulates pain signals in the nervous system. 
• Avoid Strenuous Activities: Avoiding strenuous activities that could strain the incision site is essential. 

5. Vaginal/Perineal Pain

Vaginal and perineal pain are common after vaginal deliveries. Management options include: 

• Sitz Baths: Soaking in warm water with sitz baths can soothe discomfort and promote healing. 
• Over-the-Counter Pain Relievers: If advised by a healthcare provider, over-the-counter pain relievers can provide relief. 

• Perineal Care: Practicing gentle perineal care and hygiene is crucial to prevent infection. After childbirth, women experience significant hormonal fluctuations. Estrogen levels drop during the postpartum period, which can contribute to vaginal dryness, discomfort, and potential complications with perineal healing. Proponents of using vaginal estrogen argue that it may help improve tissue elasticity, moisture levels, and overall comfort in the perineal area, potentially aiding the healing process.  
• Use of Cushions: Using a cushion or donut pillow when sitting can reduce pressure on the perineum. 

6. Urinary Incontinence

Urinary incontinence, or the loss of bladder control, can occur due to weakened pelvic floor muscles. Management strategies include: 

• Pelvic Floor Exercises: Pelvic floor exercises, also known as Kegel exercises, can strengthen these muscles. 
• Timed Voiding: Ensuring regular bathroom breaks through timed voiding. 
• Dietary Modifications: Making dietary modifications to reduce bladder irritants like caffeine and acidic foods. 
• Pelvic Floor Physical Therapy: Seeking guidance from a pelvic floor physical therapist for personalized advice. 

7. Constipation

Postpartum constipation can be uncomfortable and is often related to hormonal changes and medications. Management options include: 

• Hydration: Staying hydrated and drinking plenty of water. 
• High-Fiber Diet: Consuming high-fiber foods such as fruits, vegetables, and whole grains. 
• Stool Softeners or Laxatives: Using gentle, over-the-counter stool softeners or laxatives if advised by a healthcare provider. 

• Postpartum Pelvic Floor Physical Therapy: Promoting proper bowel function through specialized therapy. 

8. Postpartum Depression

Postpartum mental health conditions, such as the baby blues, postpartum depression, and postpartum psychosis, are critical aspects of maternal well-being that require attention and understanding. The baby blues, which typically surface around 2–3 days after childbirth, may bring feelings of depression, anxiety, and irritability, often accompanied by unexplained tears and difficulties with sleep and decision-making. Thankfully, these symptoms typically resolve within a few days or 1–2 weeks without the need for treatment. 

However, postpartum depression is a more persistent and intense condition that can arise within 1–3 weeks after childbirth, lasting for up to a year or more if left untreated. It often stems from a combination of factors, including hormonal changes, a history of depression, emotional stressors, fatigue, and lifestyle circumstances. Women with postpartum depression may experience overwhelming sadness, anxiety, and despair, making it challenging to carry out daily tasks. 

• Treatment for Postpartum Depression: Treatment for postpartum depression may involve antidepressant medications and talk therapy (cognitive behavioral therapy), either individually or in a group setting. Antidepressants work to balance brain chemicals that influence mood, while cognitive behavioral therapy focuses on identifying triggers that contribute to depressive or anxious states and recognizing automatic negative thoughts. Therapy can help you establish behaviors that help avoid triggers and improve mood. It's essential for women who suspect they have postpartum depression to seek help promptly from their healthcare provider, as early intervention is crucial. 

Hands-on, Drug-Free Solutions for Postpartum Reconditioning 

Osteopathic Manipulative Treatment (OMT) 

Osteopathic Manipulative Treatment (OMT) stands as a valuable hands-on therapy that offers drug-free relief and recovery for postpartum mothers. OMT is administered by specialized osteopathic physicians (D.O.) who employ their hands to diagnose, treat, and prevent a wide array of medical conditions, including postpartum discomforts. To find a physician practicing osteopathic manipulative treatment near you, search at https://findado.osteopathic.org/. There are two OBGYNs in the nation fellowship trained in OMT, Carolyn Moyers, DO and Meaghan Nelsen, DO. 

During pregnancy and childbirth, the female body undergoes significant transformations. The pelvis may become misaligned, muscles can weaken, and the spine may experience undue stress. OMT seeks to address these issues by gently manipulating the body's tissues and structures. Here's how OMT can benefit postpartum mothers: 

• Release Tension: OMT can help alleviate tension in muscles and connective tissues, providing relief from discomfort and pain. 
• Strengthen Core and Pelvic Floor: Pregnancy and childbirth often lead to weakened core and pelvic floor muscles. OMT plays a crucial role in reconditioning and strengthening these essential muscle groups. 

• Realign Hips and Spine: Misalignment of the hips and spine is a common occurrence following childbirth. OMT can effectively realign these structures, enhancing overall posture and reducing pain. 

Pelvic Floor Physical Therapy 

Pelvic floor physical therapy serves as a conservative yet highly effective approach to addressing postpartum discomforts. This specialized therapy centers on the pelvic floor muscles and the surrounding areas. Each therapy plan is tailored to the individual's specific needs and may involve various techniques to optimize postpartum recovery. 

Pelvic floor physical therapy can address several aspects of postpartum recovery, including: 

• Strength: Strengthening the pelvic floor muscles is vital, as they provide support to the bladder, uterus, and rectum. Weak pelvic floor muscles can contribute to issues like urinary incontinence. 
• Mobility: Improving mobility in the pelvic area can alleviate discomfort and pain. 
• Breathing Patterns: Proper breathing techniques can help relax and engage pelvic floor muscles effectively. 
• Balance: Attaining balance in physical activities and movements is essential for a smooth recovery process. 

Research has demonstrated that supervised postpartum pelvic floor physical therapy can significantly reduce the number of women experiencing urinary incontinence by the end of treatment. However, it's important to continue the exercises and strategies learned during therapy to sustain these benefits. 

Conclusion 

The postpartum period is a time of immense change and adapting for new mothers. While pain and discomfort may be part of the journey, remember that there are effective management strategies available. Understanding and addressing common postpartum discomforts, such as nipple pain, breast pain, abdominal cramping, incision pain, vaginal/perineal pain, urinary incontinence, constipation, and mood changes, can greatly improve the overall postpartum experience. Additionally, hands-on, drug-free options like Osteopathic Manipulative Treatment (OMT) and Pelvic Floor Physical Therapy can play a significant role in postpartum reconditioning. With the right support and guidance, new mothers can navigate this phase with more comfort and confidence, focusing on the joy of motherhood while their bodies heal and recover.