What to Expect: A Guide to Physical Recovery After Vaginal Birth

Welcoming a new life into the world is an extraordinary experience, but the physical changes that accompany childbirth can leave even the most prepared mothers feeling a bit overwhelmed. I'm Dr. Sterling, a board-certified OB/GYN and a mother of three, and I've navigated the challenges of postpartum recovery both personally and professionally. In this article, I'll delve into the essential aspects of recovering from vaginal birth. While this won't cover every single detail, my aim is to provide you with a wealth of information to make your journey smoother and more informed. So, let's settle in and explore the world of postpartum healing together. 

Postpartum Bleeding 

In the initial days following childbirth, postpartum bleeding is an unavoidable reality. It's not uncommon to experience heavy bleeding and even pass clots during the first 24 hours. The good news? Your postpartum nurse will be your guiding light during your stay at the hospital, assisting you through this phase. The bleeding during these initial days shares a similar appearance to your regular menstrual flow, albeit with increased volume – this discharge is referred to as "lochia rubra." By day three or four, the discharge transitions to a more pinkish hue, known as "lochia serosa." As you approach the 10 to 14-day mark, the discharge takes on a yellowish or white color, aptly named "lochia alba." Over the next 6 to 8 weeks, you'll notice a gradual decrease in bleeding. If you find that your bleeding gets slightly heavier after increasing your activity level, there's no need for alarm – this is a normal response. However, soaking through more than two pads an hour for over an hour might indicate an issue, and you should promptly contact your OB provider. Late postpartum hemorrhages, heavy bleeding that occurs one to two weeks after giving birth, is experienced by approximately 1% of people recovering from birth.  

Uterine Cramping: The Path to Restoration 

Your uterus embarks on a remarkable journey post-childbirth. By the end of pregnancy, it's stretched to around 40 cm in length, but it rapidly shrinks to about a tenth of that size within four weeks after delivery, and it returns to its pre-pregnancy size by eight weeks. Uterine cramping accompanies this incredible transformation, with the most intense cramping, known as "afterpains," lasting approximately three days. These afterpains can be as intense as labor contractions. Interestingly, these pains are typically more pronounced during breastfeeding, triggered by the release of oxytocin from nipple stimulation. This hormone, responsible for uterine contractions, also plays a significant role in mother-baby bonding. Talk to your provider about using ibuprofen and heat pads to help ease the discomfort and pain of uterine cramping. 

Vulvar, Vaginal, and Perineal Healing 

Whether you experience tearing during delivery or not, it's likely that you'll experience vaginal, vulvar, and/or perineal pain. The perineum is the area between your vaginal opening and anus and is the most common place for lacerations to occur. I recommend discussing the exact locations of any tears and stitches with your healthcare provider, as understanding the healing process can alleviate anxiety. Additionally, don't hesitate to look at your vulva and perineum using a mirror – it's often less intimidating than you might imagine. While cold treatments work well for initial swelling and discomfort, warmth is more conducive to healing and muscle relaxation. Your provider may recommend Sitz baths, where you soak in warm water for about 20 minutes, as a means of applying warmth and promoting healing.  

Another very important aspect of caring for your postpartum lady parts is avoiding constipation. The first poop after having a baby can be an experience. Your pelvic and abdominal muscles are traumatized, and it can be hard for your body to remember how to push and relax at the same time. You don’t want your body straining to push out a hard, firm poop. Do yourself a favor and drink plenty of water, eat fiber-rich foods and take a stool softener, such as Colace, unless you are already having loose stools. 

Hemorrhoids: Unwelcome Visitors 

Hemorrhoids, those pesky swollen blood vessels around your anus and inside your rectum, often become more pronounced after childbirth. While time generally aids their resolution, you can alleviate discomfort through sitz baths and over-the-counter treatments. However, consistently avoiding constipation is key, as straining can exacerbate the issue. Adequate hydration, a diet rich in fiber, and a stool softener, can contribute to smoother bathroom experiences. If you have hemorrhoids in pregnancy or in the hospital after giving birth, make sure you discuss this with your provider and add Mommy’s Bliss Soothe Hemorrhoidal Wipes for soothing, cooling comfort with witch hazel, aloe and rosewater.  

Understanding Pelvic Floor Changes 

Pregnancy and birth have a significant impact on the pelvic floor. If you’ve ever seen a skeleton you may have noticed that the pelvis is open at the bottom. The pelvic floor is what prevents your organs from falling to the floor. It consists of the muscle and connective tissue that forms a basket-like support for your vagina, uterus, bladder, and intestines. As the baby passes through the birth canal, the pelvic floor muscles and connective tissues are stretched and sometimes injured. While your pelvic floor is healing you may experience urinary incontinence (peeing when you don’t want to), difficulty emptying your bladder, pain and difficulty with bowel movements, and/or the sensation that something is falling out of your vagina. These sensations should slowly improve over the course of weeks to months. If you are still experiencing discomfort or incontinence at 6 weeks this needs to be addressed and discussed with your OB provider. Pelvic floor therapy is an invaluable resource for addressing these concerns and should ideally be accessible to all postpartum individuals. 

Your Abdominal Strength 

Your abdominal wall consists of layers of fat, muscle, and connective tissue. Its job is to keep your internal organs, well…internal. During pregnancy, your abdominal wall undergoes significant changes to accommodate your growing baby. Those changes took place over the course of many months, so they aren’t going to reverse quickly. Almost everyone will leave the hospital with a bump, although it is typically smaller than the one they arrived with.  

One reason for the postpartum bump is the separation of the abdominal muscles, known as the rectus abdominis. The separation of these muscles is called a rectus diastasis. Over the course of 6 months, this separation typically improves, even without intervention. However, there are exercises that can potentially help bring the muscles back together. If you have a significant rectus diastasis, your provider may refer you to physical therapy. Keep in mind that you can always ask for this referral and, depending on your insurance and where you live, you may be able to self-refer for physical therapy. 

Red Flags of Recovery 

Recovering from birth can be challenging even when everything is “normal.” Here is a list of some of the red flag symptoms to be aware of during your recovery. If you experience any of these symptoms, or are otherwise wondering “Is this normal?” contact your OB provider or head to the ER right away. In some instances they may advise you to return to Labor & Delivery Triage for evaluation. 

• Heavy bleeding: We often say to return to the hospital if you are bleeding enough to saturate 2 pads in an hour. Make sure you find out from your doctor how much bleeding is too much. Depending on your unique characteristics, your doctor may want you to be more cautious. 
• Shortness of breath: This is not a normal symptom in the postpartum period and could signal a blood clot in your lungs or a problem with your heart.  

• Fever (T >100.4 F or 38 C): There are numerous reasons you may have a fever in the postpartum period; some of them are no big deal and others are very serious. It is not up to you to determine the seriousness of your fever— that is the job of a trained medical professional. All fevers in the postpartum period warrant a phone call to your provider or a trip to the hospital. 
• Headache not relieved by over-the-counter medications such as acetaminophen or ibuprofen: This could be the sign of high blood pressure and warrants medical evaluation. Preeclampsia is a pregnancy related condition that can progress quickly and can be life-threatening. While most cases of preeclampsia are diagnosed in pregnancy, it can also occur postpartum. The good news is that under appropriate medical care we can drastically reduce complications and risks from this condition. 
• Change in vision, seeing stars or spots: Another potential symptom of preeclampsia or elevated blood pressure. These symptoms are not normal or expected, and need immediate medical evaluation. 
• New pain in the upper portion of your abdomen: This is yet another possible sign of a blood pressure issue and warrants immediate medical evaluation. 
• Pain and swelling in your leg: This could be a sign of a blood clot. These frequently occur in just one leg making one leg more painful and larger than the other. Blood clots can be life-threatening, particularly if they travel to your lungs.  

• Increased pain, swelling, redness, drainage or warmth of vaginal lacerations or hemorrhoids: This may be a sign of an evolving infection. Contact your health care provider right away. 

*This list does not cover every possible postpartum complication, please always contact your health care provider should you be concerned about your symptoms. 

Embracing the Journey Ahead 

As you embark on your postpartum journey, remember that it's a process extending beyond the traditional six-week timeline. You deserve comprehensive support, encompassing physical recovery, emotional well-being, breastfeeding, and newborn care. Sterling Parents is a membership that offers the preparation and support that new mothers often lack in traditional healthcare systems. Your birth and recovery deserve the best care, guidance, and education. Here's to a smooth delivery and a robust start to your postpartum journey. You've got this!