Early Postpartum: What's Happening Down There?

"I had a baby two weeks ago and I feel like I have a golf ball in by vagina."

"I pretty much freaked out when I took a peek down there. It looks like my vagina is swollen and something is coming out."

"I feel totally broken and gross after birth."

"The bones under my butt feel so bruised."

These are all common feelings I hear from mamas after giving birth. If you are freaking out, first take a nice deep breath and know you are not alone. The early postpartum period may not be glamorous but it also doesn’t need to be terrifying.

If you're freaking out about a possible prolapse or incontinence, I get it as I was there too. I see you. I hear you. The best thing to do is not panic (I know, easier said than done) and ask for help.

If you’re anything like me you’re probably thinking, “Why? Why me? What did I do to cause this”

4 reasons you may feel ‘off’ down there after having a baby

1. Here's the thing...our pelvic floors did what they were meant to do! During labor some of our pelvic floor muscles and ligaments lengthened over 3x their normal size to make space for the baby to shimmy into and out of the pelvis. That swelling, pressure, and feeling like a golf ball is in your pants isn't actually a sign of harm or danger in the early postpartum; it's a reminder that it's okay to slow down and let the tissue heal. In fact, in those early days swelling can actually help heal the tissue! Think of it like a nasty ankle sprain..it takes a little bit of time for the swelling to go down and the muscles and ligaments to recover but most people fully recover after some time.

2. During pregnancy your body naturally creates more estrogen which helps make the muscles nice and hydrated so they can easily move. After birth those estrogen levels drastically decrease and can cause irritation, stiffness and pain down there. It takes a few weeks for the hormones to regulate and usually once they do, the pain naturally subsides. There is a catch on this one because if you are breastfeeding it can take up to a year for hormones to fully regulate but there are alternatives like hyaluronic acid or topical estrogen which can help after 6 weeks.

3. Postpartum sleep deprivation is no joke. Unfortunately poor sleep can actually reduce our bodies pain threshold making us even more susceptible to pain. Sleep itself also helps our body heal by releasing hormones to help increase blood flow which sends nutrients and oxygen to the tissue for repair and decreases inflammation.

4. Birth trauma, both physical and emotional can increase pain down there. Physical birth trauma like perineal tears, episiotomies, forceps ro vacuum delivery can all cause pain down there. Pain can also be caused by emotional stressor from birth trauma.

The early postpartum - What can I do to help heal down there?

Often times mamas reach out right after their baby is born freaking out that something is wrong because they might have a prolapse or feel off or they are leaking a little. The first thing I want you to know is that there is a lot of recovery that naturally happens in those first six weeks and you may not even have a prolapse or pain or leaking at your postpartum checkup! With that being said, if you are in the early days or first three weeks postpartum, it doesn't mean you have to struggle through this alone. If you are concerned you might have a prolapse, reach out as there are a lot of things you can do to help relieve the discomfort so you can enjoy this time with your little one.

Five tips to navigate the early postpartum discomfort down there:

1. Breathe - a deep, full, slow breath that reaches your pelvic floor is a beautiful way to both relax and strengthen the pelvic floor. Aim for 15 minutes a day of focused breathing...this doesn't have to be all at once and ideally you sprinkle it whenever you think about it throughout the day. Breathing is not only a pelvic floor "exercise" but it also increases blood flow into and out of the pelvic floor to help with pain and swelling.

2. Take it easy. If you have older kids this one is hard...there's always housework to be done, toys to pick up and beautiful fun-loving kids to play and snuggle with. If you can, ask for help. Let someone else do the dishes and laundry. Your number one priority is healing and caring for the baby. One way to monitor your activity is by looking at your lochia or bleeding. If you increase your activity level and notice an increase in lochia, slow down.

3. Toilet habits to minimize constipation and straining. That first postpartum poop can be a doozy. Check out this blog to help ease postpartum constipation. Remember to “breathe your poop out” rather than “push your poop” by making low moans and gently breathing.

4. Ice or heat down there. Both have a place in healing postpartum. If you are in pain from perineal tears, a padsicle or ice pack to the perineum may be your BFF to help ease the pain. If you have more muscular tightness then a heating pad or heated rice pack on the perineum or over your low back/butt may be soothing. You can try both and see what it most comforting for you.

5. Reach out for help. If you are in pain or freaking out, you don't need to go through this journey alone. Find a pelvic floor provider who can help you figure out what you need based on your body and your goals. Sometimes the best exercise might be a yoga restorative pose and other times it could look like a deadlift in CrossFit...the key is figuring out what you need.

Incontinence after Miscarriage

“I just had a miscarriage and now I keep peeing my pants.”

“Why do I have incontinence after my miscarriage?”

“I never leaked before my miscarriage!”

An early miscarriage is when we lose the baby before 12 weeks of pregnancy. Here’s the thing, a loss, no matter how early on is still a loss. Just because your baby arrived before the second trimester, doesn’t mean you were any less pregnant…your body still went through a ton of changes during that time. Here’s a few of those changes that you may notice increases incontinence after a miscarriage:

1. Hormones and Increased Blood Flow
   During early pregnancy we are metabolically active to the point that there’s a 50% increase in flow to our kidneys by the end of the first trimester. (1) These changes mean that urine production is actually at it’s highest during the first 9-16 weeks of pregnancy.
   
   Additionally, estrogen/estradiol increases from the time of ovulation throughout the first trimester before spiking in the second trimester. Estrogen increases muscle laxity and decreases muscle stiffness. After a miscarriage, estrogen drastically decreases and can increase muscle stiffness and reduce the amount the pelvic floor muscles can relax.

   
   Although you may have miscarried before 12 weeks, these drastic hormonal shifts still occurred. Your body still increased the amount of urine it made and still changed the elasticity of your pelvic floor tissue. The good news here is that these hormonal shifts are transient and will usually self-correct around 4-6 weeks after a miscarriage. If you “feel off” or like you don’t have energy beyond this, please find a functional medicine provider near you that can help create a specific care plan for your needs.
   

2. Pelvic Floor Tightness
   Beyond those hormonal changes you experienced after a miscarriage that directly affect the pelvic floor, the added stress/tension you feel may limit your ability to relax and lengthen the pelvic floor. Relaxing and lengthening the pelvic floor helps release tension and allows the body to quickly respond to things like laughing, sneezing or coughing. After a miscarriage, it’s not uncommon for mamas to find comfort in the fetal position or basically pull their pelvic floors upward. It’s like we are trying to hold on to the baby that we lost and keep everything in. Unfortunately, this adds increased tension to the pelvic floor to the point the pelvic floor can’t relax to lengthen and in return it can’t respond quickly to contract and keep pee from leaking. If you feel any pressure, pain or discomfort “down there” after your loss and it continues beyond 4 weeks, please reach out to a pelvic floor rehab provider to help you.
   

3. Constipation

   Remember that drastic decrease in estrogen? Unfortunately, those large fluctuations can also lead to constipation. If you find yourself constipated, it may be helpful to make sure you stay hydrated, eat fiber (if you haven’t eaten a ton of fiber in the past, it’s a good idea to start slow and gradually add probiotics and soluble fiber), exercise, eat cruciferous vegetables like broccoli or Brussels sprouts and meditate (Expectful offers a free meditation for miscarriages).

Like almost everything in line, there is a fine balance in healing following a miscarriage that is unique for each of us. It’s important to find what works (and what doesn’t work) for you.

Find a functional medicine provider:

• Institute for Functional Medicine: https://www.ifm.org

• Integrative Women’s Health Institute: https://integrativewomenshealthinstitute.com

Find a pelvic floor rehab provider:

• Pelvic Guru: https://pelvicguru.com

• Pelvic Rehab: https://pelvicguru.com

• Can’t find someone local or nervous to have an assessment? You can perform a self-assessment using our guided assessment here: https://drlaurenkeller.com/programs

References:

1. https://doi.org/10.1161/CIRCULATIONAHA.114.009029

Babywearing with a Prolapse

“Can I safely babywear with a prolapse?”

“Will I make my prolapse worse if I wear my baby?”

“I was told I can’t babywear since I have incontinence.”

The answer to all of these questions is simple- it depends. It depends on your goals, what you want to do, and ultimately how you feel after understanding the risks, benefits and alternatives to babywearing. Admittedly, I’m going to assume you know the amazing benefits of babywearing so I will focus on the risks, alternatives and considerations. 

Baby Wearing Risks with a Prolapse

A few important things to note is that symptoms of prolapse do not correlate to severity. This is important because a lot of people are worried that if they feel heaviness or pressure that they are making their prolapse worse. Another important part of prolapse is the emotional connection- if you have a prolapse it doesn't mean you are broken and forever can't do things. If someone sprains or breaks their ankle, we rehab them back so they are stronger and can continue to reach their goals. It’s the same with prolapse, our goal is always to get you back to what you love, like carrying your child.

It is important to know that to-date we do not yet have research directly looking at prolapse and babywearing or even carrying a child!  What we do know is that anytime someone carries or holds a baby, they alter their posture and how they walk. A lot of people with will dip into their low back and sway forward. Interestingly, these are the same changes we see at the end of pregnancy and it's suggested that it is actually the body's way of preparing for the caregiver to hold the child.

Considerations for Babywearing with a Prolapse

When it comes to carrying a baby/infant/toddler, we have the same considerations whether they are being carried or they are being worn. Interestingly though, it takes more energy to hold a baby in your arms than to wear them in a sling.  Here are a few things I look at:

-Comfort: There isn't one best carrier. It's important to see what carrier the caregiver feels most supported utilizing. For some they love the comfort and support of a wrap and others feel most supported utilizing a structured carrier. My number one recommendation is to see if you have a Babywearing group that will let you loan carries to see what fits best for you and the baby. (https://www.facebook.com/groups/BWIChicagoland/) 

-Breathing: It may sound like a no-brainer but it's easy to hold your breath and the gasp for air when holding a baby..others realize they can’t get a full breath and catch themselves sucking in the abdomen to babywear. Remember to continuously breathe when babywearing. We want the caregiver to be able to breathe in 360 degrees and we can use the carrier as feedback to breathe. I love the @core360belt during workouts but when babywearing you use the straps around your back and the baby weight as a reminder. First, are you breathing? Now, are you breathing into my lower abdomen, pelvic floor, back and ribs?  If you find yourself struggling to breathe while babywearing, you may need to find a different carrier, practice breathing or loosen the straps (as long as baby is still secure).

-Time: If you have a background in fitness this is the same as endurance. Think of this as a couch-to-5k program for babywearing. A lot of changes happen from birth to the first six weeks and beyond. We want to slowly build up to babywearing. I love shorter walks while babywearing in the early postpartum days and building up to longer times or more walks as you heal and recover. 

-Posture: Remember how we naturally change how we stand when holding a baby? Sometimes posture matters and sometimes it doesn’t...the key is to figure out if it matters for you. If you notice pain or discomfort, you can change your posture to see if it makes it easier to ease any pain or discomfort. First, stand in front of a mirror and see how you are standing while holding the baby. How do you feel? What do you see? Now, if you are swaying forward, try to pull your shoulders back so they are over your hips. If you see your low back is curved so your butt looks like it is popping out, try to tuck your butt a little to bring it down. Do you see your low back and think, “man, my pants are going to fall off because I don’t have a butt” then try to curve your low back to create a little more butt. How does changing to these positions feel? If you don’t feel any better, then they may not be right for you and that’s okay! The key is to experiment and listen to the feedback your body is giving you to figure out your needs. 

-Check in Down There: Every time we inhale our pelvic floor should *gently* descend and lengthen and it should *gently* lift with every exhale. Sometimes when we add a lot of load (even an adorable little baby) we squeeze our pelvic floors or butt to try and create stability. On the flip side, we also may bulge or bear down instead of allowing our pelvic floors to gently move. It's about finding a happy medium where your pelvic floor can move with ease.

Check in as you babywear to see how you feel down there. If you are early postpartum and notice increased lochia, try to wear the baby for a little less time to see if you heal faster. If you constantly feel tension or you feel like your insides are going to fall out, please don’t hesitate to call your provider and a pelvic floor provider for a personalized consult.

-Respect: My goal is that mamas don't fear prolapse but they respect it. You can listen to your body and the signals your body is giving to make changes as you need. There isn’t one “right way” to babywear with a prolapse, the key is to figure out what is right for you.