“Hey Samantha, can you come here for a second?”
I walked from where I was standing next to the newborn baby in the bassinet, and went over to the bathroom door. “Sure, what’s up?” I asked. As a doula, I pride myself on being someone other women can poop in front of and not making it a big deal so very little is off limits, including handing her a roll of toilet paper if she was out.
“No, I mean… can you come in?” As I opened the door, she looked up at me and said “I just want to know if it looks… normal? I didn’t want to ask my husband.” I paused, hand still on the doorknob, and titled my head while thinking. “It? Oh! Your vulva! Ok!”
Thankfully, she laughed, since I would have hated to make her feel uncomfortable. I mean, it’s only natural to wonder what things are supposed to look like during those initial days of recovering from a vaginal birth.
I went in, and found a hand mirror for her from under her sink, while stifling a small chuckle. Because I’m not a doctor or midwife, we decided to look for her hospital discharge paperwork and compare it to that. There were no red flags- no signs of infection, and some soreness, but not really pain. I also asked her to try to remember what it used to look like, and she decided it seemed similar enough.
While not many clients have asked this, I think it’s a good question. We know that you need time to heal after having a baby. But it’s hard to know what to expect.
What exactly is recovery after a vaginal birth?
I’ll walk you through a few things to consider. And as always, please remember that:
- “Normal” is a broad spectrum
- I’m a doula on the internet, who may not know you personally. If you’re concerned about something, you should ask your midwife, or OB.
Using the Bathroom
The first things to consider happens soon after birth, while you’re still in the hospital (if that’s where you give birth)- using the bathroom may feel like a much bigger effort than before. I recommend two things:
- Use a peri bottle to dilute your urine as you pee, and then dab, rather than wipe.
- If you’re feeling sore when moving your bowels, put a cloth or toilet tissue in your palm and apply pressure to your vulva. It balances the pressure in your rectum.
Tearing
This is one of the biggest fears clients have- “Will I tear while pushing?” It’s not unusual to have a 1st degree tear, or possibly second degree. If you have a second degree tear there will likely be stitches that dissolve on their own. You can:
- Use a sitz bath. Fill this with warm (not hot!) water. You may decide to use some Epsom salts as well.
- Make padsicles. Soak large pads in water and place in the freezer. You can use witch hazel in these. If you do, freeze them in a freezer bag, or your frozen broccoli will taste like witch hazel, which isn’t delicious. Typically after the first couple of days, it is best to apply heat, rather than ice, to increase blood flow to the area and give an opportunity for healing.
- If you have third or fourth degree tears (less common), you’ll likely apply ice to the area for longer. You’ll also want to avoid lifting heavy objects (heavier than the baby) for several weeks. And be sure to make an appointment with a pelvic floor physical therapist for long term healing.
Soreness After Vaginal Birth
It’s very common to be sore after a vaginal birth. You may feel this because of the effort of pushing, and many women complain of pain after their epidural. Also, your body experiences many changes during pregnancy, so it can be difficult to know the exact source of your aches and pains. As a general rule, there are a few things that you can do:
- Rest. While you may feel the urge to return to physical activity, taking it easy after during recovery is one of the best ways to heal from a vaginal birth. Consider taking the stairs just once or twice per day, and limit yourself to gentle walks after the first couple of weeks. No judgement if you feel antsy before then. At the same time, remember- your body just grew a person and got them out! It’s okay to take a break.
- We also recommend getting support with getting yourself back in good alignment. A few specialists who may help are a pelvic floor therapist, a chiropractor trained in pregnancy and postpartum, and massage therapists who specialize in the perinatal time period.
Uterine Healing
You’ve likely heard about waiting 6 weeks to insert anything into your vagina after birth. (By the way, this guideline applies whether after a vaginal or cesarean birth). The reason for this is that when your placenta detaches from your uterus, it leaves a wound behind about the size of a small dinner plate. This is why you have postpartum bleeding known as lochia.
And remember, your uterus grew to the size of a watermelon to hold your baby, placenta and amniotic fluid. It does not shrink immediately. You can still feel your uterus up by your belly button in the first couple of days after birth (this is why the postpartum nurses press deep into your belly- to see how your uterus is shrinking). By about two weeks later, it is typically half the size, and it may take anywhere from 4-6 weeks to return to pre-pregnancy size.
So when postpartum doulas try not to roll our eyes about “snapping back” after birth, it’s not *only* about being body positive when it comes to weight gain. Physiological changes have happened and your body needs time to settle again.
Some valuable things to know and do to support this healing include:
- Expect your lochia to continue up to six weeks. It’s not unusual for it to stop sooner, but up to 6 weeks is normal. If you have clots larger than a golf ball, or soak more than a pad per hour, be sure to contact an OB or midwife.
- You may feel “afterpains”- contractions of the uterus- after birth. They are often stronger with second, third (or more) births, and typically felt during breastfeeding. This is normal- the same oxytocin that allows you to release milk causes your uterus to contract.
- For the first six weeks after birth, abstain from penetrative sex, tampons, menstrual cups and anything else in the vagina to minimize the chance of infection.
- Several African and Asian cultures have long recommended belly binding. This may seem cosmetic, as it’s said to help reduce lower belly pooch and improve posture. But it also can feel very supportive as your uterus returns to its size.
Cultural Postpartum Traditions
As doulas, we believe that there are many pieces of wisdom in cultural and family traditions. It was not unusual for our ancestors to see the first 40 days after birth as sacred, and a time for the new mother to rest. Even before Western medicine (which now advises a 6 weeks checkup after birth- so a similar timeline), we knew important things about vaginal birth recovery.
If you can, ask your mothers, Aunties and grandmothers what they did to heal. You may hear recommendations to drink and eat warm foods, avoid leaving the house or have a “lying in period”. Maye there are special foods or teas. Take what works for you.
If those aren’t resources that is easy to tap into, a couple of helpful books include:
- The First Forty Days by Heng Ou
- Nurture by Chidi Cohen
You can also ask your doula what she’s seen work for clients.
While everyone’s recovery after vaginal birth will be different, as postpartum doulas we’ve seen one thing that everyone needs and deserves- to be cared for and loved on during the first few weeks with a new baby. If you’re the sort of person who is seeking knowledge from a doula (or hiring one!), we trust that you’ll take care of your baby. Make sure that someone is looking out for you.
And pro-tip: if you ask me, postpartum continues long beyond the first 40 days, or even fourth trimester. Give yourself a solid year to adjust.
