Recently, Parents Magazine released an article called Healing Hints: What Postpartum Recovery Is Really Like which covered a topic that is close to my heart – postpartum recovery.
I was fortunate enough to be quoted in the article. My quote was that it can take longer than you think to recover. I wanted to take the time to elaborate on their article by writing this excerpt from my book Ending Pain in Pregnancy: Trade Secrets for an Injury-Free Childbirth, Relieving Pelvic Girdle Pain, and Creating Powerful Pelvic Muscles to include the additional important and specific information about what can really happen during labor and delivery and postpartum.
This post is not intended to scare you, but to empower you with information that will help you anticipate and be aware. The chapter from the book contains 25 things you might not know about birth, but these some of the top 10. The book is available from Amazon or direct from Renew PT. So read on, and arm yourself with knowledge so you can take action and have more control over your body during your pregnancy.
Birth is an all-encompassing experience filled with ups and downs. Its unpredictable nature can fill both grown women and men with fear. Fear is predominant because so many things can occur. Many times birthing partners are not prepared to handle the unpredictability or simply just don’t know that things can happen beyond their control.
When I thought about writing this blogpost I wanted it to be an exposé of sorts. As a physical therapist that rehabilitates women with obstetrical trauma I can share what I know in an honest way that is not as scary as what you may see on TV or read in the paper. Not only do I share things you may not want to know about birth but I take it a step further and provide you with simple solutions. I always tell my patients if I had had the perfect birth and recovery I probably would not have opened my amazing healing center. Life is like that: it teaches us lessons so we can share and help others along the way.
When you read this list, I don’t want you to become fearful or scared. Instead I want to give you information so that you can, if needed, seek appropriate help and regain your health more quickly. Knowledge is power and this chapter is filled with knowledge that most girlfriends don’t share. Why? Birth is a visceral and instinctual experience and many women are embarrassed by their experience or feel guilty because it didn’t go as “planned.” Society lays a heavy trip on women. The movies and the media are all filled with picture-perfect births and movie stars that recover in a New York minute. I find this depiction unfair and unjust. Women need to know that no matter what happens with their births they are both strong and resilient and will bounce back.
All recovery has its time frame and the postpartum period is no different. We find that some women bounce back quickly but the majority of women struggle in their recovery phase. Some women can take up to one year to feel like themselves again, even if they didn’t have a “complicated” birth. For others this can take longer than a year. That’s right: it can take longer than a year and that’s okay. It is my belief that the more women honestly discuss their birth experiences the better off all women will be. When there is open communication among women and when the media stops misleading us, we will be free of misconceptions and find joy in our births.
Open communication will paint the correct picture of birth. Birthing is messy and imperfect, but it’s our experience and we can ultimately accept our births as the ones we were meant to have. Women will understand that unexpected and even unpleasant things may happen in their births but nevertheless their experience can be a satisfying one. Arm yourself with knowledge of the “what if” so you are not taken by surprise. Help is available: This book (and my first book Ending Female Pain) will empower you with many of the tools you need to get back on track again after the baby comes. Read on and become the fearless warrior of your own story.
10 Complications About Labor and Delivery you Might not Have Known
1. You could separate your pubic symphysis.
The pubic symphysis (click here for a diagram) can separate during childbirth, can cause extreme pain. This split can happen during pregnancy oftentimes due to the hormone relaxen, and then get more acute if the legs are spread very far apart while you are laboring. The pain can be extreme and is usually centered around the pubic bone.
- See your doctor or midwife immediately and get a referral to a women’s health specialist. The faster you get help and start to get the massage and exercises you need the faster you will recover. Try to find a women’s health expert that uses cold laser therapy. This type of therapy can help reduce pubic bone pain.
- Consider using a specialized belt to bring the bones together. A physical therapist can help you pick the right belt.
- Avoid standing on one leg, avoid doing activities that bring your legs far apart and perform the pelvic brace exercise with transitional movements.
2. You could injure, fracture or have a misaligned tailbone (coccyx).
Tailbone injuries are very common and we treat many women who break, strain or misalign their tailbones in childbirth. Tailbone pain is strong pain at the base of your spine; it can be constant and just plain awful. This pain makes it impossible to sit and/or breastfeed and many women may need pain meds to deal with the pain.
- If you suspect a broken tailbone get an X-ray right away. To detect issues with the coccyx bone it is best to get a seated X-ray.
- Seek help from a trained women’s health expert. Don’t wait and go right away.
- Sit on a donut cushion and avoid slouching, which can put more pressure on the coccyx and result in more pain. Instead sit upright and in good posture and avoid sitting for longer than thirty to forty-five minutes.
3. You may feel as if you just ran a marathon: sore, tired, and achy.
You just spent nine months growing a human being and then labored for hours to bring your child into the world. You may feel worn out, have pain, and feel extremely fatigued. Although common and expected, this type of pain can be managed and minimized with proper treatment. If you feel any of these symptoms:
- Talk with your healthcare provider about the pain you’re experiencing. It may or may not be normal soreness in the early postpartum period.
- Find a women’s health physical therapist that specializes in postpartum care.
- Avoid heavy lifting and positions that exacerbate your pain. Use proper body mechanics and posture when handling your baby. Take a warm bath with Epsom salts if okayed by your healthcare provider. Baths may have to be avoided until you stop bleeding.
4. You may feel as if something is falling out of your vagina.
Oftentimes, in the first eight to twelve weeks after giving birth you may feel heaviness in your pelvis, a feeling of pressure, or as if something is coming out of the vagina. Involution, or the process of the uterus returning to its original size, shape and position, can take up to eight weeks. In the meantime:
- Don’t panic! How you feel during the first eight to twelve weeks after giv¬ing birth is not how you will feel for the rest of your life. Talk with your healthcare provider to see if you may have weakness, prolapse, or instability leading to these sensations.
- Find a women’s health physical therapist that specializes in postpartum care so that you can learn the proper self-care tools and exercises to allevi¬ate your symptoms.
- Avoid any heavy lifting, pushing, or pulling which increases abdominal pressure. Use the pelvic brace with transitions, and you can Kegel as long as it is pain free.
5. You will likely require stitches in the perineum following vaginal birth.
In an ideal world, all vaginal deliveries would involve a perineum that grace¬fully stretches, but does not tear, during delivery. Unfortunately, we find that most women at our healing center do require stitches, or sutures, following vagi¬nal birth. Although stitches may cause pain or discomfort in the first few weeks following birth, they generally allow the vaginal tissue to heal in the best possible manner. Here are steps you can take to encourage full healing of the perineum:
- Follow your physician’s or midwife’s instructions for postpartum perineal care, such as the use of a perineal bottle, cold compress and/or sitz baths.
- At your postpartum check-up, ask if you may start to massage the scar tissue to increase the tissue extensibility. Find a women’s health physical therapist who can teach you how to massage the vaginal scar tissue to achieve the optimal flexibility and strength.
- You may think that the vaginal scar healed, until you experience pain with intercourse. Pain with intercourse may signal that the scar tissue needs more attention. It is never too late to see a women’s health physical thera¬pist to assess and treat vaginal scar tissue.
6. You may receive an episiotomy, even if it is not in your birth plan.
It is our experience that in general, episiotomies are more painful in recovery than natural tears. However, there may be situations during delivery when the physician is faced with difficult decisions on how to proceed based on the health of the mom and baby. If the baby needs to be delivered rapidly, your physician may choose to perform an episiotomy. With time and focused attention, you can heal your episiotomy scar. Here are steps you can take:
- Follow your physician’s or midwife’s instructions for postpartum perineal care, such as the use of a perineal bottle, cold compress and/or sitz baths.
- At your postpartum check-up, ask if you may start to massage the scar tissue to increase the tissue extensibility. Find a women’s health physical therapist who can teach you how to massage the vaginal scar tissue to achieve the optimal flexibility and strength.
- You may think that the episiotomy has healed, until you experience pain with intercourse. Pain with intercourse may signal that the scar tissue needs more attention. It is never too late to see a women’s health physical therapist to assess and treat the episiotomy.
7. You may not be able to control your urine after delivery.
Tired muscles make it difficult to hold urine, while a catheter during delivery may temporarily disrupt the signal that you need to urinate. Many women are surprised and embarrassed that they cannot hold their urine at the hospital. This is common and will improve with time! You can take the following steps:
- To reduce urinary incontinence, perform a pelvic brace every time you move from sit-to-stand, cough, laugh, sneeze or lift your baby.
- If performing a Kegel is not painful, you can begin to retrain your pelvic floor muscles. Stop performing Kegels if they increase pain at the perineum or worsen your symptoms.
- If you are experiencing incontinence at your six-week postpartum check-up, bring it to the attention of your physician or midwife and ask for a referral to physical therapy. All postpartum women should take part in a supervised pelvic floor and abdominal rehabilitation program so that they can regain their pelvic power.
8. You may have difficulty controlling gas and bowel movements.
The same muscles that control urination also hold back gas and bowel movements when needed. These muscles are often weak following pregnancy and childbirth. Commonly a healing episiotomy or perineal tear prevents these muscles from performing at their best. If you experience a third or fourth degree tear, you are at high risk for experiencing the above symptoms. You can take the following steps:
- When you feel the urge for a bowel movement, do not panic. Try to walk calmly to the nearest restroom. Becoming anxious often makes the stom¬ach hurt worse and may decrease your ability to hold off a bowel movement.
- If performing a Kegel is not painful, you can begin to retrain your pelvic floor muscles. Refer to Chapter 9. You can focus your Kegels at the anal sphincter by imagining that you are stopping the release of gas. If you are sitting, you can pretend you are lifting a pea off the chair with your anal sphincter. Stop performing Kegels if they increase pain at the perineum or worsen your symptoms.
- If you are experiencing gas or fecal incontinence at your six-week postpartum check-up, bring it to the attention of your physician or midwife and ask for a referral to physical therapy. All postpartum women should take part in a supervised pelvic floor and abdominal rehabilitation program. You may also benefit from gentle massage of your healing perineal tear or episiotomy.
9. You may develop an infection in your C-section scar and require additional medical care. 
Many women acquire infections in the hospital that complicate and delay the healing of their Cesarean scar. If your scar becomes infected, you may need to stay in the hospital longer or receive care from a visiting nurse once you are home. Here are some steps you can take:
- Report any signs of wound infection to your physician or hospital staff.
- Use a pelvic brace technique for all transitions and avoid jackknifing to prevent excessive stress on the healing scar.
- Once the infection has resolved, the sutures are removed and the Steri-strips have fallen off, you may begin to massage your own scar. (Numerous scar massage techniques are detailed in my other book, Ending Female Pain.) A pelvic floor physical therapist can also instruct you on effective scar mas¬sage techniques. Always receive physician clearance before beginning self-scar massage.
10. Your bottom will hurt (hemorrhoids).
Hemorrhoids are a real pain in the butt and you might get hemorrhoids that are so large you could mistake them for another unborn child. After my labor, I was shocked to learn that a lot of my pain was driven by hemorrhoids. I did everything to get rid of them and it took weeks before my bottom felt well again. Be aware that they can hurt pretty badly. For some women their anus will never be the same again.
THINGS YOU CAN DO INCLUDE:
- Continue your sitz baths and use your perineal bottle.
- Try natural over-the-counter remedies or see an herbalist. See your physical therapist for low-level laser light therapy. Low-level laser works wonders for hemorrhoids and it’s a natural solution. We use this modality at my healing center all the time with great results.
- If necessary contact your doctor and get a medical prescription for steroi¬dal cream to eliminate them.
Medical Disclaimer:The information on this site is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images and information, contained on or available through this web site is for general information purposes only. Check with your Doctor before attempting any of the recommendations on this website. NEVER DISREGARD PROFESSIONAL MEDICAL ADVICE OR DELAY SEEKING MEDICAL TREATMENT BECAUSE OF SOMETHING YOU HAVE READ ON OR ACCESSED THROUGH THIS WEB SITE. Renew Physical Therapy IS NOT RESPONSIBLE NOR LIABLE FOR ANY ADVICE, COURSE OF TREATMENT, DIAGNOSIS OR ANY OTHER INFORMATION, SERVICES OR PRODUCTS THAT YOU OBTAIN THROUGH THIS WEB SITE. If you are in acute pain and would like to have a physical therapy program developed for you for your condition please give us a call at 212-213-4660.
10 complications that can happen during childbirth labor and delivery and what you can do
