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 sore, cracked 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, an option is over-the-counter pain relievers. 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. 

• 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. Due to postpartum hormonal changes, including a drop in estrogen levels, some women experience vaginal dryness and discomfort. Vaginal estrogen, a prescription treatment, may be recommended by healthcare providers to help with tissue elasticity and moisture levels. Always consult your healthcare provider before considering this option.  

• 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. If you or someone you know is struggling with postpartum depression, please reach out to a healthcare professional for support and treatment options. 

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 changes. The pelvis may become misaligned, muscles can weaken, and the spine may experience added stress. OMT is intended to help address these issues by gently manipulating the body's tissues and structures. Potential benefits of OMT for postpartum mothers may include: 

• Release Tension: OMT may help alleviate tension in muscles and connective tissues, potentially easing discomfort and pain. 

• Strengthen Core and Pelvic Floor: Pregnancy and childbirth often lead to weakened core and pelvic floor muscles. Potentially easing discomfort and pain, reconditioning, and strengthening these essential muscle groups. 

• Realign Hips and Spine: Misalignment of the hips and spine is common after childbirth. OMT may assist in realigning these areas, which can contribute to improved posture and reduced discomfort. 

Pelvic Floor Physical Therapy 

Pelvic floor physical therapy serves as a conservative and often beneficial approach to addressing postpartum discomforts. This specialized therapy focuses 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 support postpartum recovery. 

Pelvic floor physical therapy may help with several aspects of recovery, including: 

• Strength: Strengthening the pelvic floor muscles is important, as they provide support to the bladder, uterus, and rectum. Weak pelvic floor muscles may contribute to issues like urinary incontinence. 

• Mobility: Improving mobility in the pelvic area may alleviate discomfort. 

• Breathing Patterns: Proper breathing techniques can help relax and engage pelvic floor muscles effectively. 

• Balance: Promoting balance in physical activities and movements can support a smoother recovery process. 

Research has demonstrated that supervised postpartum pelvic floor physical therapy may help 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 supportive 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 help improve the overall postpartum experience. Additionally, hands-on, drug-free options like Osteopathic Manipulative Treatment (OMT) and Pelvic Floor Physical Therapy may play a valuable 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. 

This information is educational and not a substitute for professional medical advice. Please consult a healthcare provider for diagnosis and treatment.