There was once a time when people who just gave birth were encouraged and expected to do little else than rest, recover, and nurse the baby. This was called lying in: a time for parent and infant to convalescence for the days and weeks after childbirth.

Some countries and cultures still honor the “lying in” period and it takes place up to the first three to six weeks after childbirth. It’s roughly the amount of time our bodies need to physiologically heal, the time when we schedule a postpartum checkup, and when we generally start to get into the rhythm of our parenting.

People who give birth in America are increasingly reclaiming this time and space. Some call it the fourth trimester. Others advocate for parents to cultivate their “village”—a support system of people dedicated to nurturing those in the postpartum stage.

Whether it’s “lying in,” the fourth trimester or the village, that postpartum period is crucial for our well-being. During the transitional weeks from giving birth to parenthood, we undergo incredible psychological, physical and emotional adjustments. We need to prepare for this postpartum phase with the same care and dedication we do our pregnancies and births.

Here are ten suggestions on how to support our postpartum progress:

1. Re-create that “lying-in” period for postpartum healing

It’s hard to predict how you’ll feel or how you’ll give birth. Regardless, it takes significant physical and emotional energy to get a baby out of your body. Even if you don’t think you’ll need a month of “lying-in” plan for it anyway so there’s less pressure on you to do anything other than feed the baby and recover. That means enlisting help and delegating domestic work, like cooking and cleaning, to family and friends before the baby is born. I know this is easier said than done!

Before you give birth, try to set boundaries with friends and family. This can be tough, I know. You may hurt feelings along the way. I know I did. Personally, I’ve found that it’s easier to have stricter boundaries first then relax them as we get a handle on a situation, versus creating boundaries on the go.

I remember visiting a woman who just gave birth and she had a list on her door outside her house for visitors. On it she graciously asked visitors to wash their hands upon entering, to limit visit time, which hours were best for her and her new family, and to help with one of several things: putting dishes away, heating up food, moving the laundry along, etc. I thought this was a clever way of reminding visitors about the parents’ needs, setting limits on their stay, and directly asking for help.

To help you get your plan on paper Amanda Lowe’s “Positive Postpartum Plan” from The Doula Guide blog offers a template for your planning. DONA International also offers a great postpartum plan guide to identify and coordinate help with food, cleaning, breastfeeding, older siblings, and the mom herself.

2. Put together your list of professional/medical help

“Mommy brain” is no joke. Have your list of medical professionals in one place so you don’t waste energy trying to google someone. Trust me, the simplest task becomes insurmountable when that baby is crying for food! On your list you may want your baby’s pediatrician, your OBGYN, a local lactation consultant, your pharmacy, Infant Risk Center (if you’re on medication), any relevant support groups, a postpartum doula, and/or specialists for any medical condition you have.

3. Make food prep part of your postpartum care plan

This is a popular “to do” for many pregnant folks. I’ve seen plenty Instagram pictures of freezers full of home-cooked meals. If you’re short on freezer space or simply don’t want to prepare all those meals on your own consider some of the following:

• Have a friend set up a food train.

• Request and have a few friends or family members stagger their pre-made or frozen meals over the weeks and months. Bust out a calendar and schedule it, if need be.

• Go to a local (inexpensive, but not fast food) restaurant and order ala carte entrees. Put those into containers and freeze/store them. (That’s what we did.)

• Don’t get meal kits like Blue Apron. It’s too much reading, standing, and actual cooking. Meal services that deliver “heat and eat” meals make much more sense during this time.

• Don’t forget about bite size snacks.

• Aim for food you can eat with one hand. Trust me. It’ll be a while before you have both hands free for eating.

4. Prepare a “kit” with some staples for postpartum healing

Depending on how you give birth, you may need different items. Regardless of how that baby comes into this world, you will bleed and need super absorbent pads. Also, you won’t want to strain going number 2, so prune juice or stool softeners help. These are just a few of the many items for your postpartum care at home. Click below for a more comprehensive list in a postpartum “kit.” Pro tip: designate a friend of family member to prep your kit immediately after delivery.

5. Seek out a pelvic physical therapist before and after you give birth

In the third trimester, the physical discomfort of pregnancy are at its height. Those swollen joints, achy muscles, and back pain won’t necessarily go away on their own after giving birth. (Spoiler alert, sorry!) We have postpartum hormones that keep our body in a similar pregnancy state where joints can feel loose and our skin feel different, especially “down there.”

A pelvic physical therapist (PT) can help you navigate that physical transition from your third to fourth trimester. They’re savvy about how hormones affect the mobility and strength of our pelvic organs and tissue. Culturally, we don’t have a strong postpartum tradition for physical healing. If anything, women feel pressure to “bounce back” and may start physical activity too soon after giving birth. This can exacerbate existing postpartum symptoms like a leaking bladder.

Whether you deliver vaginally or via C-section, that baby puts pressure on our pelvic floor and stretches out our core muscles. A pelvic PT can assess the function and alignment of your body in its most incredible state: pregnancy and postpartum!

6. Find ways to gently reconnect with you body

In that first postpartum month, I felt too injured to do anything physical. But that didn’t mean I should do absolutely nothing. After a long labor, hours of pushing, and birth injuries, I felt disconnected from my physical self. I felt broken and there were certain parts of my body I didn’t want to touch. This isn’t the case with everyone, but I know I’m in good company when it comes to struggles with relating to our postpartum body.

Remember those prenatal massages? Why not get postnatal ones too? Have a massage therapist come to your home, if you can afford it. Reconnecting could also be time spent in nature or doing belly breathing exercises.

There are also online programs that help postpartum women reconnect with their pelvic floors and ease them into strength-based exercises. The MUTU System is a medically recommended one. They have a community of over 50,000 women and tons of resources to help moms navigate postpartum changes to their bodies.

7. Hire a postpartum doula or night nurse

Family and friends can be wonderful help, but this isn’t always an option for new moms, especially those who live far away from their loved ones. Don’t go it alone. It’s worth examining your budget to include a postpartum doula or night nurse. In those tense and difficult moments navigating new motherhood, it might help to have a professional by your side. Check out CAPPA or DONA International for doula help.

8. Take your time recovering

This one sounds weird, right? Of course you’ll recover on your own time. This tip is more about checking our expectations about our postpartum recovery and progress. We have the six-week check up where many women get the “green light” for sex and exercise. Six-weeks is just an estimation. Depending on your OBGYN, you may only get checked for infections and whether your uterus shrunk back to size. Give yourself the space and grace for the ups and downs you’ll feel about your postpartum body for months to come.

I know I felt upset after getting that “green light.” Sex and exercise were the last things I felt like doing. My body still hurt and I felt like something was wrong with me because I wasn’t healing fast enough. I had significant issues like incontinence and weird scarring, and I sought the help I needed. It took me a while to ease up my own expectations about how quickly I should feel “normal.”

Even the American College of Obstetrics and Gynecology (ACOG) recently reassessed the six-week postpartum follow up in favor of more customized care. Check out ACOG’s guidelines that now includes earlier checkups and on-going follow up as needed.

9. Cozy up with some books or podcasts on the subject of postpartum care

I wish I could say that there’s no shortage of books or material on postpartum care, but there is! Unlike books on pregnancy or parenting, information on postpartum care is in short supply. That said, there are a handful of books and podcasts. I’m grateful they exist. They include, but aren’t limited to:

• Kimberly Johnson’s The Fourth Trimester: A Postpartum Guide to Healing Your Body, Balancing Your Emotions, and Restoring Your Vitality

• Heng Ou’s The First Forty Days: The Essential Art of Nourishing the New Mother

• Kathe Wallace’s Reviving Your Sex Life After Childbirth: Your Guide to Pain-free and Pleasurable Sex After the Baby (This book is about so much more than sex after childbirth. It’s a great guide for understanding our postpartum bodies, written by a pioneer in pelvic physical therapy.)

• The Longest Shortest Time podcast (Check out the host’s, Hillary Frank, earlier episodes about her birth story, healing from birth trauma, and other unique stories about creating a family.)

• The Birth Hour podcast (This is a recent find, courtesy of a good friend. I like the range of stories. There’s something for almost everyone.)

10. Let people help

I don’t know why, but this is tough for a lot of us, especially when we feel vulnerable and need help the most.

There are many ways to do this. The key is to really consider what we may want and need during those few weeks. Take some time to plan and research what resources are out there for you, whether they're family, friends or services in the community. Don’t be afraid to ask. People want to help. Give them direction.

If we’re lucky enough, we may already be part of a group or community with strong postpartum traditions and support. Even still, it can help to take stock of our postnatal “village” and call those members to action.

Have you thought of postpartum planning? What are some ways you’re planning for self-care in those early postpartum weeks? If you’re already a mom, what were some of your postpartum challenges? How did you get or ask for help?

*Updated from June 15, 2016

**Medical disclaimer: This post is provided as information and resource only. This information should not be used as a substitute for professional diagnosis, treatment, or advice. Always seek the guidance of your physician or other qualified health care provider with any questions you may have regarding your postpartum care and conditions.

Affiliate disclaimer: This post contains affiliate links, which may offer a small commission that helps maintain this website. You won’t pay more through purchasing through these links. All of the products I share in this post I’ve personally used and have found helpful in my recovery. I am not paid to promote any individual items found on this page.

My reason for that is probably not what you think.

Sure, we can talk about the intense pressure women feel to “bounce back” after pregnancy and child birth, or the about society’s constant messaging to girls and women that our value is placed on physical appearance. But those aren’t my issues with the postpartum “body pics.”

In fact, if a woman feels like posting her postpartum body on social media for whatever reason, that’s her choice. If that feels empowering to her, great! Who are we to judge?

There Are Two Trends in Postpartum Body Pics. Both Focus on the External Body.

The first trend is the “pre-pregnancy” and “post-pregnancy” selfie. These images on my Instagram feed seem geared toward inspiring and motivating (I follow the hashtag #postpartumbody among many other postpartum-related hashtags). These shots inevitably include women in bikinis or sportswear exposing their mid-section.

The second trend is the “real” shots of women who still look pregnant or with stretch marks, looking less than idyllic by society’s misogynist standards. If I’m partial to one type of postpartum “body pic,” it’s this one. But only by a slight margin. I appreciate the rawness and vulnerability of these images. There’s beauty in that.

Together, these trends in body pics suggest postpartum women fall into one of two camps: “working it” or “embracing it.” Neither are wrong or bad, but this division sets up limited narratives about postpartum bodies. They both focus on our exterior physique and, in broad terms, both suggest health.

I felt excluded from both camps. I resembled neither a “pre-post” inspiration nor a “real” postpartum woman.

Here’s what I mean.

I “bounced back” relatively fast. Within a few months I was at my pre-pregnancy weight and my physique hadn’t changed much from before giving birth.

Many people commented on my body.

“Oh my gosh, did you even give birth?” “What’s your secret?” “You look amazing!” “Are you sure you’re eating enough?” “You need to take care of yourself.” “Have you been dieting?” “Ugh, no fair.”

"No fair” is right. I didn’t do anything special. I just fed my son when he was hungry and fed myself when I was. I recognize the immense privilege of not having to worry about losing weight. But I was somehow made to feel bad about it. Too many of those comments on my postpartum body carried a tinge of critique or jealousy.

But I wasn’t mad. I understood the sexist world we live in and the pressures placed on women to be thin. We end up policing each other as a way to navigate our own struggles. Besides, pregnancy had prepared me for the ways in which people feel entitled to comment on my body.

What astounded me was that few people asked how I felt.

I didn’t feel great those early postpartum months. I was wearing adult diapers because I had incontinence. My perineum was still sore and irritated. I had vaginal heaviness if I stood for more than a few minutes. I looked “great” so people assumed I had it “easy” with no postpartum issues to overcome.

This is another examples of how thinness is conflated with healthiness.

“Real” Postpartum Women

“Before and after” images did little to inspire my postpartum recovery and “get back” my body. I also felt little comfort from those “real” postpartum pics.

Just as those “before and after” images are evocative and emotionally “charged” so are the “real” postpartum images. The narratives that accompany “real” shots push back against the expectation that women should “bounce back.” I too oppose such an expectation.

But I didn’t get stretch marks (again, nothing I did to deserve) and I wore regular clothes not long after giving birth.

While I support this movement for women to embrace their postpartum bodies, I wasn’t sure that movement included me. There’s a specific aesthetic of what Instagrammers consider “real.”

A “real” postpartum woman has stretchmarks, loose skin, rolls folding over underwear lines. She also has visible stitches and cellulite, but looks at the camera anyway. She is celebrated as “brave,” “honest,” “real.”

I saw virtually no women who looked like me in those “real” images. Was I not “brave,” “honest,” “real”?

It’s of tremendous privilege that I escaped the scrutiny of “fat shaming” during my postpartum time. That period is already so fraught with emotions and vulnerability. I can only imagine the insult and devastation.

While my experience with “body shaming” wasn’t so much shaming as it was fielding misguided compliments, I grew sick of the focus on my physical appearance as the barometer of my postpartum health and progress.

I was physically NOT okay. I felt dismissed, as if I had no right to complain because of how I looked.

I wanted to give my middle finger to some of those backhanded compliments.

Looking Healthy Isn’t the Same As Being Healthy

My pelvic floor was ripped open, and for months I struggled to hold in my pee, poop, and farts. I couldn’t sit comfortably for a very long time. I was afraid to have sex. I didn’t ride a bike for a year.

The tension between these two types of postpartum “body pics” is just obnoxious to me now. The images themselves don’t bother me. If it’s empowering for the woman posting, that’s amazing! If they validate or inspire the women consuming those posts, awesome!

But can we focus beyond those two types of aesthetics for postpartum bodies? If we shame women who “show off” their sculpted postpartum abs, aren’t we still policing them? If we celebrate a certain aesthetic as “real” are women without stretchmarks somehow not as “real”?

I’m not opposed to women posting their postpartum bodies. I think it’s great that we’re able to do so. But, I want us to expand “body positivity” to mean more than external physical aesthetics or putting yourself “out there.” Could “body positivity” also be about not assuming someone’s bravery, vanity, recovery, ambition, vulnerability, or healthiness based on a “type”?

I sure hope so.

What do you think of postpartum body pictures? Did you find inspiration or solace in them?

I looked at my vagina for the first time since giving birth the week before my 6-week postpartum checkup.

I'm so glad I did.

I won’t lie, this scared me a little. I had a third degree tear and many stitches along my perineum. The stitches eventually dissolved but they turned into bumpy granulation tissue. When I touched my perineum during showers, it felt swollen, tight, and irritated.

Jenna Perkins, a Women's Health Nurse Practitioner at George Washington Hospital in DC, sees a lot of postpartum women, and she's a huge advocate for women looking at themselves with a mirror.

Perkins believes that when women can see all of themselves they can better advocate for their health, "because then, they can go and talk to other providers and say, 'I’m not okay. When you put that speculum in, you’re completely missing the fact that my labia are gone or that I’m so red.' Or just seeing that redness and being able to say, 'Okay, this is not in my head. This is not something that I made up because it’s real and I can see it.'”

Like Perkins's patients my symptoms were vague until I could actually see what was there. In those first postpartum weeks, I felt detached from such an intimate part of my body; one that ushered life into this world.

Ignoring it didn’t help, but attempting to look at it, I wondered, What mess was I going to see? Will I even recognize myself?

It was important that I took a good look at my vagina and its surrounding area before my OBGYN poked and prodded it. I wanted to see that flap of granulation tissue, which was still bleeding. I wanted to describe to the doctor the areas that still hurt and ask questions like, "Is it normal to feel stinging in this area when I go pee?" or "I feel pulling here when I sit cross-legged, will that go away?"

To my surprise, my vagina and its surroundings looked somewhat "normal." It didn't look like a stitched up mess I had envisioned in my head for the past month. My perineum looked intact, though it had accumulated scar tissue.

I was happy that it looked like a "normal-ish" vagina, but it was definitely still healing. Also, it didn't look like my vagina. I know because I've taken peeks over the years since college.

Reclaiming My Medical Experiences

To get pregnant, I had undergone years of medical and fertility treatment that left me feeling like I had little agency over my body. Too many fingers, speculums, catheters, needles, and surgical instruments have entered this body. None of which were pleasurable experiences, and at times even felt invasive.

Perkins notices practitioners in the OBGYN world take for granted informed consent. She's seen many women go through medical exams who weren't really given an option to say "no." She's observed how patients are told, "You’re going to feel my fingers," rather than being asked, "Is it okay if I check your cervix?"

"How many women have gone through decades of exams, sitting in stirrups, and they have no idea what’s happening on the other side of those sheets. Why?" Perkins asks.

As someone who sees a lot of postpartum women with pelvic and vulvar pain, Perkins says medical exams can be traumatizing especially for those who already experience pain. "[A]nything can cause trauma when it hurts. To be complicit in that is something I never want to do," she says.

Perkins hands a mirror to all her patients during pelvic exams: "The first time I did that with a patient, it just changed me. It felt like I was really consenting them, like I was really saying, 'You have full authority to stop me whenever you want. You have full authority to see what’s happening to you, and to really participate in this exam.’"

My OBGYN didn’t offer a mirror during my 6-week checkup, but I was one step ahead of the game. Exploring my genitalia before that appointment let me to feel like an active participant in my postpartum follow-up that included a pelvic exam.

Being the first to "poke and prod" myself (inside and out), instead of my doctor, inched me toward reconnecting with my body. It took away some of the shame I felt over how I delivered (vacuum assistance) and mild resentment over my son's big head.

My 6-week checkup raised no flags for my doctor. My uterus had returned to its pre-pregnancy size, and according to the OBGYN, my perineum healed really well. He had no concerns about my recovery, and he gave me the "green light" for exercise and sex.

I wasn't ready for either.

Because I looked at and probed the area beforehand, I was able to discuss my concerns without any vagueness. Although some of my issues weren't fully addressed, I felt good that I could articulate all of them.

I was doing my part as the patient and advocating for myself, which meant that I would eventually find the right providers who could address my specific postpartum concerns. And I did.

Saying Hello on a Regular Basis

I look at my vagina often. This isn't about vanity. It's about keeping tabs on my personal and sexual health.

With my pelvic floor issues, scarring, and pelvic pain, it makes sense not to wait for those infrequent checkups to see if something is up. When the area acts up, changes, or feels irritated, I'm the first to know and see.

I believe we should all be doing this, especially postpartum women. Even those who delivered via C-section.

But more than looking for problems, why not get to know ourselves a bit better, especially after having that baby? Give yourself permission to look. Make it a date. Cozy up with her. Tell her "thanks" for the gifts she brings.

Have you looked at your postpartum vagina? What was that experience like for you? Did a perinatal health professional ever encourage you to look between your legs?

 **Medical disclaimer: This post is provided as information and resource only. This information should not be used as a substitute for professional diagnosis, treatment, or advice. Always seek the guidance of your physician or other qualified health care provider with any questions you may have regarding your postpartum care and conditions.

I am STILL rehabilitating my postpartum body. And it's been over three years. The reason my healing is taking so long has everything to do with how much I've put off my self-care, as well as a host of pelvic health issues I had before getting pregnant.

Those same pelvic health issues linger today, which include stage four endometriosis, ovarian cysts, and scars from surgeries of the pelvis. Before getting pregnant, my husband and I struggled with fertility. That meant a lot of medical poking and prodding of my vagina and cervix.

I hated all the medical intervention, and after years of it, my body started to resist. I had to coax my pelvic floor to relax every time I saw a speculum or transvaginal ultrasound wand. My physical therapist at Body Connect explained that I was in an "upregulated" state during those pelvic exams. Meaning my body was in "fight-or-flight" mode, which also meant that my pelvic floor was tensed up for "protection."

In fact, for the first years after giving birth, my pelvic floor was constantly clenched and tight. That meant those muscles were weak.

Imagine trying to strengthen your biceps. If they're perpetually contracted with elbows bent, you aren't able to do a bicep curl. Also, constantly holding that position is exhausting. To build that muscle by doing a bicep curl, you'd need to relax and extend to curl up right? Well, the same principle applies to the pelvic floor.

I paint this picture to show you not all pelvic floor issues are the same, so why do we all get the generic advice to do Kegels (if we get advice at all)? For the first year of seeing my pelvic PTs, they advised me against Kegels until I could actually relax those muscles and address my pelvic pain.

When “Good Enough” Turns into Complacency

I got comfortable with the progress I made over the year with pelvic PT. It was “good enough,” but not great. I let my busy schedule take over and l lost healing momentum. The result? Some of those pesky symptoms crept back into my life: urinary leakage, poor posture, pelvic pain, queefing!

It's no longer okay to feel "good enough." I want to thrive, not survive with this one body I have.

I miss jumping on a trampoline without leaking, doing inverted yoga poses without queefing, and running on pavement without feeling like my hips are going to give out.

So, I'm going back to basics, and making some shifts in my mindset about my birthing injuries.

I Would Rehabilitate My Injured Ankle, Why Not My Pelvic Floor?

When I was in college I sustained injuries from athletic competition: broken ankle, dislocated patella (knee cap), and rotator cuff issues in my right shoulder. I rehabbed the heck out of those injuries because I wanted to continue competing. As a varsity athlete, I also had at my disposal a sports medicine clinic with dedicated trainers, physical therapists, and doctors.

Every once in a while, those past injuries act up, but I know how to restrengthen them.

It dawned on me recently that I should view my pelvic floor injury from giving birth in a similar way: rehab the heck out of it, and do maintenance when it acts up!

Coming to this revelation took self-reflection. I resented the idea of perpetual maintenance of my pelvic floor. Why can't it just work? I also resisted viewing my experience giving birth as "traumatic" or that it injured me. Those words "injury" and "trauma" are so loaded, especially when it comes to the act of giving birth.

But, then I realized, I don't have to view giving birth as "either/or." Birthing my son was an intense, emotional, difficult, easy, magical, real, out-of-body, in-the-body experience. Regardless of what emotion I attach to the experience, the reality is that I did sustain a pelvic floor injury.

I pushed for seven hours and I tore, three degrees into my perineum.

Doing a little everyday goes a long way

My pelvic floor isn't perpetually tight and irritated anymore, so I can focus on building its strength. I'm also working on breathing mechanics, specifically, coordinating my transverse abdominis to contract with my pelvic floor when I exhale, and for those muscles to relax when I inhale.

I'm also working on posture and stretching out tight muscles or foam-rolling fascia (connective tissue) to help with alignment.

To jump start my progress, I've committed to doing one or two exercises from each category below, every day.

1. Spinal Alignment

Release with a ball or foam roller: psoas, quadratus lumborum, diaphragm, quads, hamstrings, glutes

Stretch: hamstring and pelvic relaxation poses (child's pose, happy baby)

2. Breathing Mechanics

Inhale: abdomen expands, rib expands

Exhale: abdominal contracts, pelvic floor contracts (gentle), transverse abdominis (TA) isolates (gently), little movement of chest

[NOTE: I do this sitting, lying down, standing, and during functional activity. This works towards duration-based activities like running. I do this 3-4 times and then I take a break, for about 3 cycles.]

3. TA Isolation

A. Reciprocal breathing (movement/action only occurs on exhalation; rest occurs on inhalation)

Hooklying (on my back with knees bent): clam shells, marching, heel slides, kicks

[NOTE: I focus on my core isolation and that the TA, pelvic floor, and spine are doing the bulk of the work.]

B. Non-reciprocal breathing (activity occurs regardless of the breath)

Hooklying: clam shells, marching, heel slides, kicks

Quadruped (on hands and knees with neutral spine): bird/dog, push-ups, lifting both knees, knee to elbow

[NOTE: My TA/pelvic floor/spinal stabilizers are contracted continually. When they start to get weak, I stop!]

Ben and I working our pelvic floor as we talk about the future of America. #benjaminfranklin #philadelphia #labordayweekend #pelvicfloor #mamaonthemend

17 Likes, 3 Comments - Yuka Polovina, PhD, MPH (@mama.on.the.mend) on Instagram: "Ben and I working our pelvic floor as we talk about the future of America. #benjaminfranklin..."

4. Pelvic floor strengthening

30 daily: half are rapid contractions, the other half are for endurance

Contract and release (x15)

Contract, hold (5 secs), rest (7 secs) (x15)

[NOTE: When my pelvic PT examined my pelvic floor contractions, she told me that I was only contracting the top and bottom walls. She encouraged me to contract using my side walls too.]

5. Internal pelvic floor releases

I do this once a week or so to check in on my pelvic floor. If I find some tight areas I apply pressure to release. I use coconut oil and medical gloves for this.

There you have it. My daily routine to get restregnthen my pelvic floor and core. My ultimate goal? To feel strong and grounded in my body again.

Do you have a physical therapy or postpartum healing routine? What types of exercises do you do?

**Medical disclaimer: This post is provided as information and resource only. This information should not be used as a substitute for professional diagnosis, treatment, or advice. Always seek the guidance of your physician or other qualified health care provider with any questions you may have regarding your postpartum care and conditions.

Disclaimer: This post contains affiliate links, which offer a small commission that helps maintain this website. You won’t pay more through purchasing through these links. All of the products I share in this post I’ve personally used and have found helpful in my recovery. I am not paid to promote any individual items found on this page.

“Scar tissue needs to be rehabbed too,” says Lauren Collins a pelvic physical therapist at Body Connect Health and Wellness.

Honestly, what a concept!

These are hopeful words. Why? Because I never really thought of skin as being “rehab-able” (like a knee injury) so I stressed about living with discomfort from my perineal scar forever.

When it comes to scar care, the advice (if you get any) is usually to break up the scar tissue to help it become mobile and supple again. That means a lot of self-massage, rubbing oils, and possibly having your partner help you with it, which can be a nice way to connect.

Marisa Alonso, co-founder of Body Connect Health and Wellness explains that people have scarring tendencies. “Some people when they get a scar they get [keloids] and the scar tissue gets really bound. Some people have really mobile tissue,” says Alonso.

My perineal stitches turned grainy and bumpy. I even had a few granulations that I had to remove. The skin felt raw, tender, and stretched out for months after giving birth. My physical therapist taught me how to gently stretch and massage the skin helping desensitize trigger and pain points. She said I was "retraining" my body to not associate pain and discomfort with touching my perineal skin. I used 100% raw organic coconut oil for the massaging. It helped to replenish the skin with fatty moisture, plus the oil is antimicrobial and smells like the tropics!

Don’t Let the Scars Be

“One of the more common things we treat related to cesareans is…pelvic pain. Part of it is that if people develop scar tissue here [pointing to abdomen] and it starts to pull up on their pelvic floor it can lead to pelvic tightness and vaginal pain doing intercourse. Another one is bladder dysfunction and urgency, again because the scar tissue just irritates the bladder, and sacral pain because the scar tissue just pulls back on the sacrum,” says Alonso.

When you have any surgery it’s going to affect our sensory nerves. Alonso explains that scar tissue limits the ability of a muscle to contract. When muscles are bound from scar tissue it can't function normally. She says, “A lot of times you have to loosen up that scar tissue in order to get that contractility back.".

Institute for Birth Healing - Lynn Schulte, PT

Perineal scars are similar, it’s just that perineal scars are a little more “out of sight out of mind."

The last thing you want to do is ignore your scars for more reason than you’re ignoring an entire part of your body. “I can’t tell you how many people tell me, ‘Oh, I just don’t touch it.’ And you’re like, ‘No, no, no, you have to touch it,’” says Alonso.

Our scars are as unique and individual as we are. Also, scars from childbirth can be layers deep (physically and emotionally). For these reasons, I highly recommend you work with a physical therapist, naturopath, or other professionals who specialize in postpartum and scar care. A good practitioner will help you understand how your body tends to scar, what to look for, and teach you how to care for scars on your own.

For C-section mamas, check out this cool video by Andrea Hammad at Tripoli Physical Therapy on her Instagram account.

C-Section scar giving you issues? ✔️Pain ✔️Abnormal contour of your belly ✔️Physical Dysfunction Here are 3 simple steps to addressing your scar issues. (Disclaimer: Always be cleared by a medical professional before starting scar massage) #1 Desensitize: Gently introduce those healing nerves to different sensations/materials #2 Peripheral Pressure: ease into scar massage by starting around the scar and not directly on it. Press down gently, do deep circles, and glide the skin #3 Direct Pressure: Start into direct pressure on the scar, deep circles along the length, or pinch and lift skin off the underlying fascia Contact me for your tailored Postnatal Physical Therapy needs! Tripoliphysicaltherapy@gmail.com Tripoliphysicaltherapy.com #scarmobilization #csectionscar #postnatalfitness #postnatalcare

119 Likes, 46 Comments - Andrea Hammad (@tripoliphysicaltherapy) on Instagram: "C-Section scar giving you issues? ✔️Pain ✔️Abnormal contour of your belly ✔️Physical Dysfunction..."

Do you have childbirth scars? How did they heal? What advice, if any, did you get on caring for it?

*Updated from October 20, 2016

**Medical disclaimer: This post is provided as information and resource only. It s not to be used or relied on for any diagnostic or treatment purposes. This information is not a substitute for professional diagnosis, treatment, or advice. Always seek the guidance of your physician or other qualified health care provider with any questions you may have regarding your postpartum care and conditions.

As with most kinds of recovery, the road is a long and winding journey.

I had my son about three and a half years ago and I STILL have lingering issues from that perinatal time in my life. The seven hours of pushing, vacuum assisted delivery, and third degree tearing no doubt have a lot to do with where I am now. As you might imagine, I had persistent vaginal pain, for months. The intensity of it lessened over time, but I was never truly comfortable until I sought professional help.

I also had incontinence of all kinds: urinary, gas, fecal. Here’s a story of how I crapped myself, for those interested. Time also helped the severity of the incontinence, but it only got so much better.

But I couldn’t stand the constant heavy feeling in my vagina and the tight stinging and irritation of my perineum anymore. So at around eight months postpartum, I checked in to see a pelvic physical therapist (PT). (I may have gone sooner, but I didn’t have access to a pelvic PT until we moved to the D.C. area several months after giving birth.)

Consistency Is Key

For the first six months or so, I went to my PT somewhat regularly. I noticed quick improvements in my perineal scar. I learned a ton about my pelvic floor and what happened to it during pregnancy and delivery. My PT armed me with activities I can do at home to release my tight psoas and pelvic floor, and to massage my scar tissue. I felt less vaginal and vulvar pain. The vaginal heaviness went away. The incontinence wasn’t nearly as bad as it once was.

And then the realities of teaching and grad school threw a kink in my progress. I succumbed to the overwhelm of trying to finish my degree quickly. I crawled under a rock to write my dissertation and fulfill teaching duties. What little time I had left, I spent with my family. There was no mental or physical energy left for my pelvic rehab and self-care.

Besides, I had made “enough” progress to function normally, more or less. And I wasn’t in constant pain anymore. Plus, my grad school and teaching salary could only cover so many expenses. I stopped going to my clinic for a few months. Then I’d check in once every so often for “maintenance,” but I never really worked toward feeling 100% whole again.

After graduating this summer, I finally had a moment to check in with myself physically. I had aches and pains from spending most of my hours sitting at a computer typing. My body was stuck in fight-or-flight mode from the stress of meeting deadlines and worrying if I’d graduate. My muscles atrophied from not working out in the past half year, and I felt wobbly in my hips when I carried my son.

I also started leaking urine again when I jumped or laughed. Gas was harder to hold than a year ago. The tenderness in my vulva persisted.

I knew I had to rededicate myself to pelvic PT as well as my overall health.

Now that I’m not putting out fires everyday, I’m able to integrate pelvic floor care in my life with new resolve.

At first, I wasn’t sure I wanted to talk about why I’m still seeing a pelvic PT years after giving birth. I’ve been on my soapbox touting it as the best thing since slice bread. I didn’t want people to think that pelvic PT doesn’t work because, look, Yuka’s still going and it’s been years! My regression and lack of FULL return to my normal healthy self is on me.

In fact, below are the five top reasons why I’m still rehabbing my pelvic floor. I wish for this list to offer hope for postpartum mamas, even if the journey takes a little longer than expected.

ONE: I quit too soon

You know when the doctor prescribes to you antibiotics, you’re told to take it all even if you start to feel better? Well, quitting as I was getting better was kind of like the antibiotic situation. Going to pelvic PT with no doubt improved my symptoms and that progress gave me some permission to stop prematurely. Unlike the antibiotic situation, my pelvic floor didn’t become a super strain of bacteria resistant to Kegels. It just got weaker again.

TWO: I didn’t do my PT exercises regularly or consistently

I simply didn’t prioritize self-care for my pelvic floor. There’s no easy way around this fact. My family, work, and dissertation came first and I stretched myself thin to get everything done. Sound familiar?

In hind sight, taking 15 minutes a day to release my psoas or work on diaphragmatic breathing was totally doable. The internal PT exercises were a little more involved (time and energy wise), but doable nonetheless. Yes, I was busy. Yes, I had a an overloaded plate. But truth be told I didn’t have the right mindset around taking physical care of myself. That’s something I’m working through now, as I transition careers.

THREE: I had pelvic floor issues before I ever got pregnant

This one is a newer revelation. I recently learned that female athletes commonly have pelvic floor issues because they’re not taught how to properly breathe and engage their pelvic floor when training. I was a competitive athlete throughout high school and college (volleyball and squash) and I spent a lot of time squatting heavy weights and doing muscular conditioning including intense core workouts.

I didn’t know then that contracting my transverse abdominis or abs during inhalation while doing a crunch put undue pressure on my pelvic floor. Today, my breathing mechanics are off when I exercise! When doing heavy squats and deadlifts, I didn’t engage and lift my pelvic floor. I remember pushing it out. I also had a lot physical therapy in my sports clinic for misaligned hips, which may or may not have been due to the sports I played.

I also struggled with fertility. I have endometriosis. To get pregnant, I had a handful of surgeries, many intrauterine insemination (IUI), three rounds of IVF, medication that changed the tissue of my vagina and pelvis, and way too many transvaginal ultrasounds. It was a lot for my body to take. During that time, I noticed sex started to hurt, speculums and internal ultrasounds also hurt. My vulva started to get more red and irritated, and I’d clench my pelvic floor during medical exams. That bracing continued into pregnancy and postpartum.

As much as I want to think that the pregnancy and delivery caused my current pelvic issues, I definitely had problems beforehand. Delivery exacerbated them. But the silver lining is that those issues got me in to see someone who can help me get to the root of the problem.

FOUR:I want to feel like my best self NOW, and not settle for a lousy “new normal”

Need I say more?

FIVE: Some things just take time

I’m a results-oriented person. I’m also a little impatient with myself. I hate that it’s been too long since I’ve felt grounded in my body. I’m tempted to “grad school” my way to improvements, which means making an ambitious to-do list and attack! Then feeling bad about myself when progress is slow or stalls, and repeating the cycle from square one. With the help of my PT, I’m figuring out a balance between gettin’ it done and letting my body lead the way.

What did your postpartum healing journey look like? What got you over “the hump” if you struggled to get back to your normal?

**Medical disclaimer: This post is provided as information and resource only. This information should not be used as a substitute for professional diagnosis, treatment, or advice. Always seek the guidance of your physician or other qualified health care provider with any questions you may have regarding your postpartum care and conditions.

Ever wonder whether to see a physical therapist during and after pregnancy? Folks at Therapydia Denver sat down to ask their in-house pelvic physical therapist (Cami Hatch, DPT) about treatment for pregnant and postpartum women.

Check out their guest post below to learn more about when to get treatment, how to prepare for common postpartum issues, what treatment can look like, and more!

Should I see a Physical Therapist (PT) during pregnancy?

Everything in the body is changing during pregnancy, PT can be very helpful to strengthen muscles and normalize tissues. It’s quite common to experience low back pain, neck pain, pelvic pain or hip pain, all of which can be addressed with physical therapy. That being said, it is not 100% necessary to see a PT during pregnancy if you aren’t having any pain or issues, though it can be very beneficial for the postpartum recovery process.

Why should I see a PT during pregnancy? Isn’t my body all out of whack already?

This is exactly why seeing a PT can be helpful! Working on things like normalizing muscle tissue with stretches and exercises can prevent issues as your pregnancy progresses. Physical therapy can be especially helpful for women who have a history of pelvic floor issues or pain. If the issue is tightness, your physical therapist can work on relaxing muscles prior to delivery. Alternatively, if the issue is weakness or incontinence, your treatment will focus on strengthening the pelvic floor muscles while maintaining muscle extensibility to avoid tightness prior to delivery.

Should all pregnant women see a PT?

Not necessarily. Sometimes exercise isn’t recommended with high-risk pregnancies. These women can still benefit from some manual and soft tissue work but physical therapy may not always be appropriate. If you have concerns, this can be a good thing to discuss with your OB.

Can I prevent tearing/diastasis recti/prolapse/other common issues?

While these issues are not always preventable, you can definitely prepare in the best way possible by learning how to use the deep core muscles and pelvic floor. This usually starts with the same exercises you perform after delivery. We will teach you how to keep the spine and pelvis stable and neutral while the extremities are moving. Exercises start with easy positions, like lying on your back, and progress to harder things such as squats and single leg activities. After delivery, all of these muscles will feel weak again and the exercises will start over but with a good understanding of anatomy and the musculature, you will be more prepared to treat potential postpartum issues.

Will I harm my baby or myself if I do physical therapy or exercise while pregnant?
Absolutely not. All physical therapists are trained on what is/isn’t safe during pregnancy. If you ever feel like something is not right, speak up! Your PT should always be able to explain their reasoning for every aspect of treatment and no treatment should make you feel worse. When I work with my patients, I make sure to constantly check-in and ask how everything feels both during and after each session.  

Do I need clearance or a referral from my OBGYN in order to see a physical therapist?

For internal pelvic floor work, yes, but in all other cases, no. Even PTs who are not trained in Women’s Health specifically should know which treatments are appropriate and which are not. The process is similar to any other physical therapy treatment: Your PT locates the issue or cause of pain and addresses it with various treatment options. That said, every pregnancy is different. While clearance is not necessary for non-complicated pregnancies, women who have any sort of high-risk conditions should definitely get clearance from an OB prior to beginning a physical therapy or exercise program.

When should I see a PT after giving birth?

This is something that EVERY woman should do and I recommend coming in six weeks after delivery. The benefit of seeing a PT prior to delivery is that you can discuss which exercises and activities are safe during those first six weeks. For most women, tissues have healed after six weeks and it is safe to begin an exercise program. I believe a visit about six weeks after birth is necessary for every woman to at least get an internal health assessment.

Waiting six weeks to see a PT doesn’t mean that you should do nothing in the meantime. Physicians will typically tell women to rest but realistically, this isn’t happening. The birth of your baby brings about a number of new motherly tasks: lifting, carrying and bending among them. While these actions may be unavoidable, they can also cause a variety of problems.

Through a combination of manual therapy techniques, custom exercises, stretching and patient education, your physical therapist will work with you to pinpoint the cause of your pelvic floor dysfunction and create a plan of care that is unique to your body and specific symptoms.

What does treatment look like?

With postpartum patients, I like to focus on the body as a whole. Usually the early sessions focus on regaining core strength. I also like to conduct an internal assessment to check on the healing tissue and to make sure there are no prolapses. Ideally, all is fine and we can provide exercises to help you focus on getting back to your pre-pregnancy lifestyle.

If you experienced a trauma in any other context, your physician would immediately send you to a physical therapist. In the case of pregnancy, it is important to remember that even though women’s bodies are designed for it, childbirth is also a trauma that forces you to endure many changes. Despite common beliefs that women’s bodies just “bounce back” after giving birth, this is not always the case.

How different will my recovery be if I have a Cesarean section compared to a vaginal birth?

Women who deliver vaginally often have to work on pelvic floor strengthening, whereas, women who deliver with C-section experience more issues around general core weakness. Either way, it is important come in for an appointment after delivery. I utilize a lot of manual techniques to work on the C-section scar to ensure there aren’t any organ or scar tissue issues. Buildup of tissue that is not mobile can cause pain, bladder issues, core weakness, etc.

Any final thoughts?

Yes. As a postpartum patient, you should not feel nervous or apprehensive about advocating for yourself. Occasionally I’ll hear about something unusual told to a new mother by her OBGYN or physician). If you are having an issue, don’t be afraid to speak up and do some of your own research. You shouldn’t feel like you have to take medications or have surgery. Speak with other providers and get a second opinion when needed.

Childbirth is a big part of a woman’s life and it can cause a lot of stress and anxiety, making medical decisions tough. In the end, this is your body and if you have an activity you want to get back to (ie: CrossFit after a prolapse) then you should be able to!

Cami Hatch, DPT, is a Women’s Health Physical Therapist at Therapydia Denver. Therapydia is a national network of physical therapy and wellness clinics that emphasize longer, one-on-one treatments with a physical therapist. Therapydia clinics take a special interest in Women’s Health Physical Therapy, specifically providing services for pre and postpartum women. Learn more about Therapydia’s treatment for pelvic floor dysfunction here. 

You’ve heard of writing a birth plan, but have you thought about your preferences after delivery?

I know. I know. You’re sick of planning and writing things down in anticipation of something, for which no amount of preparation will fully prepare you.

Here’s the thing. A lot happens in the first 24-72 hours of giving birth, and while you think the hard part is done, it’s just the beginning.

In the same way a birth plan can help you feel confident and safe about your birth, a postpartum plan can help guide your birth team to optimize their support for you and your new family.  

For instance, if you want immediate post birth bonding with your baby, make that known in your post birth plan. Too often I’ve heard about babies being whisked away from the mom right after delivery, only for the little guy to be poked, prodded, measured, wiped down, and burrito-wrapped before being handed back to mom.

Like your birth plan, the postpartum plan is all about honoring your preferences. Share those preferences with your OBGYN or birth team.

Here’s what our birth and after birth plans looked like. We’re visual people and the hospital staff seemed to like the icons. [You can find the birth plan icons here.]

Additional postpartum preferences can include:

• Request for a lactation consultant to visit

• Request to have or prevent certain people from being in the recovery room

• Your preferences for or against bottles, pacifiers, and formula

• Desire to have at least one parent present should a medical procedure be necessary

Tips to consider when writing your plans:

• Set a positive tone to encourage those who will be working hard along side of you

• Keep the plan short and sweet (one page ideally, two pages max)

• Show and discuss your preferences with your birth team or OBGYN near the end of your pregnancy

• Have your doctor sign off on your preferences and have her send them to your hospital ahead of time

• Pack a physical copy of the plan in your to go bag

• Stay open and flexible to change because life rarely goes according to plan

We had success with the plans even though things didn't go accordingly

We really wanted a natural birth. I’d undergone a lot of medical intervention to conceive and wanted so badly to make up for it on the tail end by giving birth naturally. My son was almost two weeks overdue, so I was induced.

Induction was a top fear of mine. In my head induction = pitocitin = really intense contractions = fetal distress = epidural = emergency C-section. I was tethered to an IV, strapped to several monitors checking vitals, and I couldn’t eat food. This scenario already nixed a few of my birthing preferences.

I ended up delivering vaginally with a vacuum assist. But most of my birth preferences and all my postpartum preferences were honored. We ended up changing our minds about a few items at the hospital (like the mirror and hep B shot).

Although not everything went according to plan, I’m so glad we had our desires stated ahead of time. They initiated a positive rapport with the nursing staff. The nurses worked with and encouraged me to stick with my preferences, especially during those intense contractions.

When my son was close to coming out, the nurse told me there was a chance I might not get to hold him right away. He had his first bowel movement inside of me. A nurse told me he might need fluid suctioned out. My birth team explained everything to me like this along the entire way because I asked for that.

No suction was needed and I got to hold and nurse my son right away. He even inched up to my breasts (with some help). We had minutes of skin to skin contact. My doc waited for my cord to stop pulsating and had dad proudly cut it. No one rushed to take my son away for cleaning and weighing. We had time to be. It was the best!

After a day of induced labor and seven hours of pushing, I didn’t have the energy or clarity to consider or negotiate my post-birth preferences. I’m glad we had most of it planned out ahead of time.

Have you thought about creating a birth and post-birth plan? Did you create an after birth plan? How did it work out for you?

*Updated from June 3, 2016

Sometimes childbirth scars us, physically and emotionally.

These two kinds of scars seem inseparable from one another.

For me, I didn’t know which one came first, but I knew that as long as my physical issues remained I suffered emotionally.

Like so much about the postpartum phase, we don’t often talk about self-care for our childbirth scars that are so intimately tied to our emotional well-being.

Whether it’s C-section scars, perineal scars, stretchmark scars, or emotional scars, moms are often left to figure out how to care for their injuries from childbirth on their own.

Sometimes we accept our scars as proud battle wounds from our pregnancy and childbirth, perhaps as a way to compensate for their impact on our bodies.

Sometimes we disassociate from or feel negatively toward those scarred areas.

Sometime this leads to feelings of shame and resentment toward our bodies.

For some women who’ve had C-section, the surgery evokes feelings of disappointment about not having a vaginal delivery and having a traumatic birth. Kinsee Morlan featured on this Longest Shortest Time episode talks about her complex relationship with her C-section scar. (This is a great episode to listen to regardless of how you delivered. A man gets a C-section!)

This is heavy burden for a woman to bear, both physically and emotionally.

Dr. Hannah Schoonover, a pelvic physical therapist who works with postpartum women makes it a priority to help women integrate scars back into their lives. “A lot of women are freaked out about their scars or they didn’t want the C-section, and they ignore this whole part of their body [pointing to abdomen]. [Scarring] penetrates down to the bladder, uterus, major abdominal groups. You can’t just ignore it…if you’re ignoring a whole part of your body it’s not going to function the way you need it to,” says Schoonover.

Perineal injuries can be emotionally charged as well. I remember feeling broken and worried about whether I would ever look and feel “normal” again. Unlike a C-section, my injury wasn't in a visibly accessible location. It also felt like fewer people knew about or acknowledged perineal trauma. That made it hard to get help.

Institute for Birth Healing - Lynn Schulte, PT

Doctors and birth teams hopefully provide initial care for childbirth wounds.

I was discharged from the hospital with a bag full of tucks pads, a peri bottle, and a sitz bath. Despite my midwife and OBGYN thinking that my third degree tear healed well, the scars were pulling my perineum in uncomfortable directions, which I could feel from sitting and walking.

It seems as though when wounds turn into scars with persistent issues (months and years later), we don’t get a lot of guidance.

With Cathy R’s first cesarean, she didn’t do any self-care because her doctor told her, “there’s nothing to be done.” She was afraid to wash the scar and area around it. “Pulling off the adhesive tape took me a week and it was incredibly painful. My doc told me to just ‘rip it off like a Band-Aid,’” says Cathy.

The second time around, Cathy’s postpartum recovery was more difficult. But she learned about caring for her scar from a physical therapist. She needed to desensitize the scar by massaging, pulling, pinching, and rolling it. She also realized that she couldn’t control (let alone feel) her lower abdominal muscles, but learned about retraining that area.

Every woman's feelings toward her body after childbirth varies. Some women may never view their birth as traumatic, while others may struggle to reconcile their experience for years to come. All I know is that for me, as I physically took care of my lingering childbirth injuries, I started to feel emotionally better too.

If our external scars are emotionally tied to our internal ones, then perhaps working on those physical scars can help us recover in more ways than one.

Do you have scars from childbirth? How did you take care of them?

*Updated from October 17, 2016

Did you know you postpartum scar tissue can be rehabilitated?

It took me seven months after giving birth to get myself to see a pelvic physical therapist (PT). But I should have gone much sooner. Perhaps around the six-week postpartum mark.

Instead, I suffered more than half a year with a wobbly back, back and shoulder pain, and unstable hips. I also had vaginal heaviness, perineal scarring and incontinence (urinary, gas, and occasionally fecal). I hoped it would all go away on its own since, well you know, childbirth is natural.

Pelvic PT isn’t only for women who’ve had vaginal births. A C-section requires rehabilitation too. That’s major surgery and incisions through layers of your abdomen. Regardless of how you delivered, pregnancy shifts the insides and outsides of our bodies, and sometimes we need help safely getting back to “normal.”

I knew about pelvic PT and the kind of help it offered these common postpartum issues, but I was hesitant to see one.

This kind of PT can be intimate. There's often both external work and internal work (as in vaginal and sometimes rectal) depending on the issue.

It's not the same as going to rehab for tennis elbow because we carry emotions in that region. When that area wasn’t working properly I felt more vulnerable and embarrassed about it. Having a stranger look, touch, stretch, move, exercise that area required my emotional commitment first.

5 Things I Wish I Knew Before Waiting so Long To See a Pelvic PT

1. You can ask for a consult with a PT over the phone or email. Discuss concerns or ask questions about what treatment looks like.

2. A well-trained and professional PT will always ask and wait for your consent. Some treatment involves internal vaginal or rectal work. If you feel “off” in those areas, having someone touch or examine them may provoke uneasy feelings. A PT should never pressure you to disrobe or receive treatment you don’t want that day. Your comfort and feeling of safety are extremely important.

3. On a related note, internal or intimate treatment is something you can work up to. A lot of treatment plans include non-internal work. This can include correcting posture, working on breathing mechanics, releasing tissue tension throughout the core, and strengthening exercises.

4. Ask if the clinic offers sliding scale or a new mom package. More often than not, insurance doesn’t cover pelvic PT. This to me is an outrage considering how important it is for postpartum women. The out-of-pocket expense is a barrier for most moms, but I think of the saying, “and ounce of prevention is worth a pound of cure.”

5. A good pelvic PT (or any health provider) will understand the limits of her practice. A good clinic will have a network of allied professionals to refer patients for issues beyond their scope of knowledge. For instance, I had an underlying hormonal issue that caused vulvar pain, making internal treatment uncomfortable. My PT sent me out to a specialist in this area.

If I knew about those five things before or soon after giving birth, I wouldn’t have hesitated for months to find a pelvic PT. Instead, I waited until I was desperate to seek help. Here’s what it took:

• I got sick of tolerating a lot of things I knew weren't normal like having trouble controlling my farts. I had constant spotting coming from vaginal granulations. I felt like my vagina weighed a ton and I wasn’t able to run without feeling like my lower back was going to crap out. Also, I could feeling my perineal scar tissue bunching in weird ways.

• I was terrified of never again feeling normal “down there.” I knew the longer I waited the longer it would take to rehabilitate my pelvic dysfunction. I wanted to not be afraid of sex and to not have any pain with it. I also wanted to not fear the OBGYN.

• I felt like a fraud. Quickly "bouncing back" to my pregnancy weight gave people around me the false sense that my pregnancy and delivery were no biggie. I'm just fit like that! How I looked physically didn't match how I felt. I wanted to feel as good as I supposedly looked.

• I started to feel resentful about giving birth, toward my husband for not "getting it," toward girlfriends for not giving any warning, and at my body for deeply disappointing me. I was in a dark and desperate place. My resentments were delusional. I knew this and decided to help myself to a better place.

When I started my search I didn't have any local recommendation for the D.C. area since I just moved. A good girlfriend of mine is in the industry and she pointed me in the right direction.

Qualifications

Pelvic PT is fairly new, but it's an emerging specialty in the physical therapy world. As it should be! Dr. Hollis Herman and Dr. Kathe Wallace are leaders in the field for the US. Those certified from the Herman and Wallace Pelvic Rehabilitation Institute are trained by the industry's gold standard. For those in Canada, you may want to check out Diane Lee (British Columbia) and Pelvic Health Solutions (Ontario).

Here are some tips to help in your search

• Ask your health professional, a girlfriend, or Google.

• Check out the clinic's website. This is the face of the practice and often the clinic's first interaction with you. The clinic website should put in the effort to answer common questions a prospective patient may have, explain what to expect at your first visit, educate you on what they do and how they can help, highlight the therapists' experience and credentials, and convey that their practice is an inviting and safe space.

• Reach out to the clinic. I called my clinic. The office manager listened to my questions and concerns. She also suggested I email one of the therapists for more detailed information. I emailed, and the therapist wrote back within days and answered all my questions.

• Find out if your insurance provider will cover pelvic PT sessions. At best, most insurers consider pelvic PTs "out of network providers." Why this isn't standard postpartum care and isn't covered fully by insurance companies is criminal.

• Talk to and try more than one therapist. Personal comfort and fit are important, also you gain different perspectives from each therapist. There are many paths to healing. Find one that feels right for you.

• Find out if you'll get one-on-one attention. This is very intimate care. You shouldn't be left alone with exercises or a device, while the therapist is off working on another patient or doing paperwork.

• Make a list of questions you want answered to help inform your decision. No question is too small. A good pelvic PT should patiently answer your questions.

A Note About Why Your OBGYN Never Recommended a Pelvic PT for You

It’s not your OBGYN’s fault. They weren’t trained to deal with pelvic floor dysfunctions. At my 6-week follow up, my doctor simply put his finger in my vagina, told me to squeeze and said, “Your pelvic floor is weak, that’s to be expected.”

I pushed for 7-hours and had a vacuum delivery with 3rd degree tearing. He was there. I old him about my incontinence and vaginal heaviness. His recommendation? Surgery, if it doesn’t get better. He’s a wonderful OBGYN and meant well, but he just wasn’t aware of all the options before surgery. This is common among women’s health professionals, but slowly changing.

Either way, have a conversation with your provider about pelvic PT. We need more women asking about it. Even if they’re not familiar with pelvic PT, you’ll still want to get cleared to engage in this therapy. If you’re getting the clear for sex and exercise at the 6-week mark, you’re probably fine for pelvic PT, which is milder on your pelvis than sex!

What obstacles stand in your way of seeing a pelvic PT? Are you curious about seeing one but still not sure how to start? Posts your questions and comments below.

*updated from April 26, 2016

**Medical disclaimer: This post is provided as information and resource only. This information should not be used as a substitute for professional diagnosis, treatment, or advice. Always seek the guidance of your physician or other qualified health care provider with any questions you may have regarding your postpartum care and conditions.

Congratulations! You had a baby or you're about to. Your poor awesome bottom is (will be) most definitely sore. In the midst of taking care of that precious little human, don't forget to care for the orifice she came out of. If you didn't already do so, put together a postpartum kit to nurse that vagina and pelvic floor back to health. Better yet, have someone grab these items for you.

If you're putting together a postpartum kit for yourself, a girlfriend, sister or partner, here's a list of essential items for your/her tender bottom the days (and weeks) after giving birth.

Must Haves

Tucks pads* - To provide healing for your two holes and perineum
Stool softener - Because you don't want strain after giving birth, but don't over do it because stool that's too loose is a challenge too
Peri bottle* - Spray with water while peeing if it stings and use in lieu of wiping with a tissue
Sitz bath* - To provide comfort to your sore sore bottom (warm and cool feel great depending on your mood)
Sitz bath herb blend - Add some healing herbs to the sitz bath water
Period undies - Don't dirty your nice undies, postpartum blood is inevitable and can last weeks (e.g. Thinx, Costco pack of full back cotton undies, any cheap cotton and full back undies, adult diapers, disposable undies*)
Witch hazel for spray bottle and crotchsicles - It's a natural astringent. Drizzle some on watered area of your DIY crotchsicle before freezing them
Heavy duty pads* for bleeding and crotchsicles - You won't be able to use tampons or diva cups. The thick ones are especially good for DIY crotchsicles
Aloe vera gel optional for crotchsicles - Some like to add aloe vera gel to the DIY crotchsicle
Inflatable donut* - To tolerate sitting on any firm surface, especially after tearing
Postpartum belly wrap - To help keep it all from flapping around. Many cultures practice postpartum belly wrapping

* Your hospital may provide these and may be included in your insurance coverage. Definitely ask for them (and extras) before you leave.

For Breastfeeding Mamas

Mother's Milk Tea - To help promote milk production
Nursing Bra - Get comfy, no underwire, and easy to wash ones
Lansinoh Heat/cold pack - Breastfeeding can hurt, especially at the beginning or when your ducts get plugged. Soothe them with heat or cold
Comfy soft button down PJs - To easily whip out that boob and feel comfy all day (and night)
Pump bra if pumping with a double breast pump - Technically you don't need this but it sure helps, especially when you're trying to massage your breasts while pumping

Oh-So-Worth-It Extras

Squatty potty - To help with passing bowel, ergonomic defecating, and less straining
Fridababy Fridet Mom Spray - It has an angled spout so that it gently sprays directly on the area you need it too. Think of it like a luxurious upgrade from the peri bottle with a cute water resistant travel pouch
Period panties - These are so good for eco-minded mamas who don't want to go through a bag of pads every other day. Thinx makes cute ones best used after the initial few days when the bleeding is heaviest. Get $15 off Thinx undies here
Placenta Pills - Help balance your fluctuating hormones and postpartum blues, as well as increase your energy and milk production. Talk to your midwife, naturopathic doctor, or health provider. You may also need to take a hepatitis C test

Click below for a printable version of this list

Disclaimer: This post contains affiliate links, which offer small commissions that help to maintain this website. You won’t pay more through purchasing through these links. Instead, you may get a discount for some of the links. All of the products I share on this post I’ve personally used and found helpful in my recovery. I am not paid to promote any individual items found on this page.

Pain with sex after giving birth is common. According to the American College of Obstetrics and Gynecology 75% of women experience painful intercourse at some point in their lives. For many women, myself included, this can occur during the postpartum phase when our bodies have hormonal shifts. Sometimes the pain lingers well past the fourth trimester, as it did with me.

I know this is an uncomfortable topic to discuss. I’m feeling self-conscious just writing this post. But I believe it’s so important that we say aloud, “I’m not okay,” when it comes to our sexual health, and that we get the care we deserve.

Several types of providers who can help, which is great news. And the field of sexual health and sexual medicine is growing. In the coming months I’ll discuss this topic from many perspectives, asking different practitioners how they help women like us.

To start off this series on postpartum sexual health, Jenna Perkins—Women’s Health Nurse Practitioner (WHNP) at George Washington University Hospital, in DC—answered a bunch of questions I had about postpartum pain with sex. I started seeing Jenna earlier this year and she is a wealth of information and passionate about her work.

Here’s our conversation.

*This interview has been edited for length and clarity*

Yuka: How common is your specialty in pelvic floor issues?

Jenna: I don’t know many other people who are doing the role that I’m doing. There was a WHNP who was working in DC who helped to train me but she was doing just sexual dysfunction, she wasn’t doing the urology piece. But everything is connected. My patients don’t just come with incontinence. They come with incontinence and recurring vaginal infections, and painful intercourse, and fecal incontinence. Everything is so related that I found it hard to deliver quality care without addressing all those pieces.

Y: What are the most common issues you see among postpartum women?

J: Postpartum is an interesting period because so many things are transitioning in the body. You have hormonal changes that are occurring. [These] women are hypoestrogenic, so you don’t have quite enough estrogen feeding the tissue and that can lead to dryness, especially if you’re breastfeeding.

Hormones can change the skin of the vulva and the vagina. If they are dry, they can atrophy and you can lose the architecture that’s there so things start to look a little bit different. The tissue can become weaker without those hormones. So you can have an increased incidence of something called pelvic organ prolapse because that tissue support isn’t there.

The other piece is muscular, which can also cause prolapse. If those muscles are weak, you can have a herniation of the organs: the bladder, the rectum, the uterus. They can actually come into the vaginal canal and sometimes out of it. It’s usually a combination of all three: hormones, muscles, and skin where you see most of the issues in the postpartum phase. And they are all very connected. The hormones can lead to dryness, which can lead to skin changes. The hormones can lead to the tissue weakness, which can further along any muscle dysfunction that’s happening with the prolapse. But those are the big three categories.

Y: Specifically with sex, what are some of the big issues that come up with the women that you see?

J: So in the postpartum phase, things have shifted and with the dryness you’re more prone to having urinary tract infections (UTI). I see a lot of postpartum and breastfeeding moms who have recurrent UTIs. One of the best things to do, if you’re experiencing UTIs in the postpartum phase and you’ve returned to sexual activity is to make sure you’re using lots of lubricant because that friction of having intercourse can make you more prone to UTIs.

Y: Any kinds of lubrication?
J: I have some personal faves. The KY jelly, the stuff you can just grab off the shelf at CVS, usually are not the best.

Y: Why is that?

J: I usually look for natural ingredients on the label. You want to keep it minimal with ingredients because the more ingredients you have the more chemicals, and if you’re in this phase where your tissue is already so sensitive, the slightest little thing can be burning and irritating. Some of the jellies are made with alcohol, so they might feel very slippery for the first minute or so and then you get even more dry than you were before because of the chemicals in them. I do have some faves and samples in the clinic that I can give to patients but it’s really what floats your boat as long as it has minimal ingredients. There are lots of great lube out there on the market.

Y: Is it normal for sex to be painful after you give birth?

J: I think you can expect some discomfort, but pain is subjective. Pain has the connotation that it’s not enjoyable. So, if you have a little discomfort but you’re still enjoying it, go ahead and do your thing. But if it’s painful and it’s causing you distress then I would recommend not pushing through it. You should never have pain. You can expect discomfort. A lot of things have shifted, your muscles can be tighter than they were before, skin can be more dry.

Society can lead us to believe that pain with sex or lack of interest is an expectation for women, and so many women feel guilty about it and don’t want to talk to their providers. Or when they do come into for their 6-week postpartum, or a couple months after, and things still don’t feel good, they can be “poo-pooed” on. The issue is not really addressed to their satisfaction and that can be discouraging.

Y: So how would a woman who is experiencing pain find a provider like you, especially if they’re being dismissed by their providers who act as gatekeepers to specialized services?

J: That’s a really good question. For me, now that I’m part of the OBGYN department, you usually don’t need a referral to see me. A lot of people can find me. If you google, “Jenna Perkins” in zocdoc, my page will show up so you can schedule with me right away for women who are in the metro DC area.

For other people, I would suggest, if you’re having chronic painful intercourse that you check out ISSWSH.org (pronounced ish-wish). It’s the International Society for the Study of Women’s Sexual Health. It’s a multidisciplinary group. We have nurse practitioners (NP), mostly in women’s health, some family NPs, lots of urologists, lots of OBGYNs. But anybody who’s a member of this society and has gone to a few of their conferences has more knowledge then a general GYN or a midwife. I would suggest finding a provider from them. That would be the easiest way to go about making sure that you find someone who has had quality training to really address your issues.

There’s another website, NVA.org. This is the National Vulvodynia Association (NVA). Vulvodynia is a diagnosis that means you have pain in the vulva. It’s just an umbrella term. Usually, women who have painful intercourse will fall under the diagnosis. NVA has done a really good job at putting out resources for patients. You can also find a health care provider list, on their website.

Y: Can you explain some of the specifics of why painful intercourse happens? I know it can vary from women to women.

J: It goes back to those three main things. Muscle dysfunction: tightness of the pelvic floor. Or sometimes it’s idiopathic, which means that we don’t have a rationale or a reason for it. The skin: dryness can cause things to be painful. And the last thing is hormones: sometimes, simply being on birth control (BCP) can shift your hormones and cause a lot of the pain you can experience in the postpartum period.

Y: Even with women who aren’t on birth control and aren’t in the postpartum phase, can they still experience pain as well?
J: Absolutely. A few major [times] for being in a hypoestrogenic state. One is being a new born, where you don’t quite have the hormones yet. So, if you were to look at the vulva of a baby girl, it could be red, irritated, chapped, dry. So, prepubescent is one area. Another time is when a woman is on the BCP. However old you are, you can have issues if you’re on the BCP and it shifts your hormones. The next big hormone phase is postpartum and breastfeeding. So, that definitely changes your estrogen levels. And the final one is menopause. You can find similar issues in all of these phases where you have recurrent infections, vaginal or urinary burning, pain, things like that.

Y: Why do you think it’s important to address these issues of painful sex after childbirth, and generally?

J: I think it’s because women deserve to have a healthy functioning sexual life the same way as other human beings. Sexual function is at the core of who we are as people. Literally, without sex, you would have no humans. I think it’s really one of the basic things to human life and women deserve to have some enjoyment out of that. And it shouldn’t just be a chore to bear children.

We should be able to enjoy ourselves. To have that sexual freedom is a right that every woman deserves, should she choose it. It should be an option. If you don’t have a particular interest in being sexually active then that’s okay. But if you do, and you have pain, that ties your hand and prevents you from having that choice of being a sexual being. Human beings are very sexual. When you walk outside you see sex everywhere but we don’t talk about the real things that are happening to a lot of women, when it comes to having healthy sex lives. I think the feminist in me is like “we deserve this.” And if we can give out Viagra for guys, then we should be getting something too to help us.

Y: Thanks Jenna for the work you do.

J: Thank you too.

**Jenna has an Instagram account where she shares her knowledge of women’s health and urogynecology. Follow her @discovherhealth

Need help finding a provider in sexual health and sexual medicine?

**Medical disclaimer: This post is provided as information and resource only. This information should not be used as a substitute for professional diagnosis, treatment, or advice. Always seek the guidance of your physician or other qualified health care provider with any questions you may have regarding your postpartum care and conditions.

Jess was juggling life as a mother of two young children when she had a sunken feeling of isolation and silence around her postpartum depression (PPD). It was the week Kate Spade and Anthony Bourdain died that prompted her to post her struggles on Facebook. She needed to tell her story.

“All these articles came out about how nobody talks about mental illness and about how a lot of times people don’t reach out. I don’t know if there was anything to prevent it, but I honestly think with postpartum depression there is a lot you can do…if people talk about it,” she told me. Those deaths triggered her to let people know that she wasn’t okay and wanted to talk about it.

Jess and I have known each other for a few years. Our kids went to daycare together and every so often we’d get together for play dates. I had no idea about her struggles until I saw that Facebook post.

As with so many women who experience PPD, Jess’s story is complicated. She didn’t have it with her first child, Sarah, and the signs and symptoms with her second child, Joseph, didn’t appear until close to a year later. What’s more, the symptoms typical of PPD didn’t quite match what she was going through.

Recognizing the Risks for PPD and Preparing for Prevention

Jess has a history of depression and anxiety. She’d been on and off medication for them since she was a teen. In college, she was diagnosed with bipolar disorder and was put on medication but never the right one until 2012. So, when Jess was pregnant with her first child, she was vigilant about self-care and the possibilities of developing PPD.

She explained, “I have an episode every five years or so and it’s usually associated with a transition. I anticipated the struggle. I was terrified I’d have [PPD] with Sarah so I stayed on my medication before and after pregnancy, which is really controversial.”

Jess took a calculated risk and remained on her meds (except one) and continued to work with her therapist. She remembered the birth of her first child, as traumatic. Sarah was premature so she was in the neonatal intensive care unit (NICU) for days. Research has shown mothers with babies in the NICU have higher risk of developing PPD.

At the same time, Jess was losing her mother to ovarian cancer, which increased her worry about developing PPD. But with Sarah, Jess was ecstatic. She never experienced PPD despite her mental health history, grief over her dying mother, and premature newborn.

So, with her second pregnancy Jess thought she was in the clear: “I was like ‘oh, it didn’t happen to me, I beat it, it’s not going to happen,’ which is weird, right, because I was so hyper aware before. After dealing with [mental health] for more than half of my life, I should have been more aware of my triggers, I should have seen this coming, and every single time, I don’t, until I’m in the hole or getting out of it.”

Since Jess thought she “beat” PPD she didn’t prepare for her second child with the same vigilance as her first. Like Sarah, Joseph, also ended up in the NICU (due to breathing problems), but he was only there for 30 hours. Jess was alone at the hospital while her husband took care of Sarah.

During the first half year after giving birth to Joseph, Jess chalked up her irritability to lack of sleep, caring for a toddler and infant, and her son’s round-the-clock nursing.

Jess only realized something wasn’t right until Joseph was closer to a year old. By that time she was struggling to do daily tasks, felt a strain with her husband, and had developed out-of-control anger and rage. Jess told me about this one time, “Joseph wouldn’t sleep, and I was shushing him and I screamed ‘shhh’ and almost shook him and freaked out. [My husband] came in and he was like ‘You need to leave!’ and pushed me away. I drove off into the night in my bathrobe thinking I was going to drive off the road. It was crazy…it escalated into this crazy rage thing where I was screaming at everybody, and it was horrible.”

These behaviors were out of character for Jess. “My whole life I’ve had these episodes of being depressed and my bipolar didn’t express in a typical way. My manic, is taking on the world, working a lot, thinking like I can do everything. My thing is I go up and then I go down and then I’m super anxious, which makes me exhausted. That’s my typical pattern. With Joseph, it wasn’t [like] that. Part of it was losing my mom…and starting to feel really angry. And I never felt angry, really, before in my life. I was always a patient person, kind of a doormat. So this anger was brewing and it didn’t hit until [Joseph] was born,” she told me.

Jess didn’t recognize herself, nor did she recognize her symptoms as PPD because when she read up on it the characteristics didn’t resonate with her. What Jess was experiencing were rapid cycles of mood shifts with rage.

For months she just thought those symptoms were due to sleep deprivation. Joseph was attached to Jess’s breasts day and night. He wouldn’t take a bottle and he wasn’t sleeping through the night in his first year. Jess had accumulated so much sleep debt that even when she had momentary respites with help from her in-laws and a short term night nurse, she never felt rested.

In Hindsight Jess Saw How the PPD Progressed and How She Slipped Through the Cracks

Jess’s first line of action was that she told her therapist about the anger and rage. Her therapist (who wasn’t a psychiatrist) told her to go to the hospital to get a psychiatric assessment and prescriptions for any necessary treatment. Jess was already on medication that helped with her depression and anxiety but resisted anti-psychotics because they posed higher risks to breastfed infants.

That bond Jess felt from breastfeeding Joseph was really important to her. She had already experienced so much loss with her mother’s death. She couldn’t bear anymore loss: “I didn’t want [nursing] to be taken away from me and [with] the medications I felt like that was being taken away from me and I was so pissed. I was like, ‘I’m not [weaning], I’m fine, I just need to get more sleep.’”

Jess researched some of the medications that were prescribed to her. She consulted staff at the Infant Risk Center (IRC) over the phone and they told her the risk levels of certain medications on breastfeeding infants.

With the guidance of a psychiatrist and information from the IRC, Jess took a measured risk and went on new medication to help manage her mental health. By this time, Joseph was almost a year old so he was taking less breast milk and eating solids.

But the process of getting to the point of seeking help took a huge toll on Jess and her family. Now out of the thick of her struggles, Jess believed that the triggering of her bipolar symptoms and PPD was at Joseph’s birth, or perhaps before.

Despite recognizing it close to a year later, Jess had some vague sense that something wasn’t right early on. “So I remember going to my OBGYN at my six-week checkup and telling [the doctor] I felt out of control. And he didn’t do anything about it. [I was] trying to ask for help, and he did nothing…Maybe he said something but I don’t remember. I remember feeling like he pushed me off and feeling more upset about it. And he’s a good doctor, I just feel like they were trying to check the box,” she explained.

That checkup, for many women, is the only place postpartum moms get screened for PPD, and close to 40% of women don’t even make the visit. Even though Jess went to her six-month postpartum checkup, she somehow fell through the cracks.

The Support to Screen and Intervene on PPD Is Lacking

As Jess reflected on her experience, she grew frustrated with how hard it was to get the support she needed. Even after recognizing she needed help, it took Jess four months to see a dedicated psychiatrist. It was her therapist not her OBGYN who sent her to this hospital’s psychiatric center.

Providers who work with mothers and postpartum women need better training to recognize the nuances of PPD. Jess noticed that her providers never said “they don’t know” or admit to not having answers when she presented issues. Instead, they kept telling her she was just sleep deprived.

Also, the window for catching at-risk moms is small, and the opportunities few. “They assess you at 2-weeks, if you say something maybe 6-weeks. After that, nobody sees you. You don’t have follow up from an OBGYN. You don’t necessarily have help from a lactation consultant unless you’re paying a lot of money. Most people don’t have a therapist because it’s out of reach financially or they don’t think they need it…and most people don’t have access to a psychiatrist,” Jess lamented. With mental health providers, there are also issues of fit, openings for new patients, and affordability. Depending on insurance, your options can be more limited.

When Jess was in the thick of her PPD symptoms, she couldn’t see her situation as she does now. Even though she knew she needed help, that was one more thing to do on her overflowing plate: “Who’s going to say, ‘you need help and I’m going to take you there.’ Because frankly if somebody doesn’t do the research and make the appointment for you, you’re not going to go. If you’re overwhelmed and depressed, how are you going to take that on?”

Jess also wondered about support for her husband. With tears filling her eyes, she told me how her episode with PPD almost destroyed her marriage. Partners aren’t trained to look for or deal with a spouse struggling with mental health issues. “We have breastfeeding classes, we have baby care classes. Why can’t we do emotional support? Your spouse is going to be the one who sees you like that,” she argued.

Although Jess never got to the point of physically harming herself, her children, or getting a divorce, she saw how easily that could have happened. As she gained more distance from her darkest days with PPD and has had a chance to reflect, Jess wanted to share her story with others and to let people know that PPD can happen well after the baby is born, and that it doesn’t look the same for all postpartum women. She has generously allowed me to tell parts of her journey on this blog with hopes of sparking a better conversation about postpartum mental health.

And we are so grateful for her courage.

Have you experienced symptoms of PPD? What kind of help did you receive, if any? How can providers and loved ones better support you?

Resources for PPD

New Mom Checklist for Maternal Mental Health (Below)

**Medical disclaimer: This post is provided as an information resource only. This information should not be used as a substitute for professional diagnosis, treatment, or advice. Always seek the guidance of your physician or other qualified health care provider with any questions you may have regarding your postpartum care and conditions.

She listened, without speaking or offering advice. When I was done, she told me what she heard me say. I thanked her for listening. Then it was her turn to tell me how she felt disconnected to her core.

Neither of us knew that we would bare our intimate struggles to a stranger that day. But as we engaged in this activity, the intensity of it caused tears to well up in both our eyes.

We were at the “Connect with Your Core” workshop for moms and pregnant women led by Frances Darnell of Dynamic Core. Frances is a Pilates instructor who brings a unique combination of healing and strengthening to the body while integrating reflection and coaching for personal growth.

With this workshop, Frances envisioned a space for pregnant women and moms coming together to deepen their connections with themselves and their community. She brought in perinatal professionals to help us engage in honest conversations about prenatal and postpartum experiences with local experts.

I almost didn’t go to the workshop because I felt like I didn’t have an entire afternoon to spare just for myself. It turns out virtually all the women there (including the panelists) felt the same way. This struggle to prioritize ourselves was one of the first issues we tackled.

France had designed the workshop in a way that created space for women to slow down, connect in with their bodies, and make decisions from this centered place from their core. It was a mini preview into her more comprehensive program Dynamic Mama.

We Hold Stress and the Weight of the World in Our Bodies

I personally loved the reflection and journal piece of the workshop. Just saying out loud how I felt disconnected to my body and to my sense of self, then having someone really hear me without comment or advice, was a rare gift. After the exercise, I could see that other workshop participants experienced a similar catharsis as they too were wiping away tears.

At this workshop, I explored my struggles with transitions. I felt in limbo during my post-graduation phase while trying to simultaneously adjust to my son’s new found “threenager” rage. I didn’t take good physical care of my health while surviving grad school and caring for my family. With the little spare time I had, I strove to be present for my son and partner, and had forgotten about myself.

It’s no wonder I felt so disconnected to my core.

But it was deeper than that.

I don’t know when exactly I developed this tendency, but I needed to be productive, always. If I wasn’t doing something, going somewhere, striving for the next goal or milestone, I somehow thought I wasn’t contributing enough to my family or society. Talk about self-imposed pressure, right?

This tendency made me an excellent student, but not very compassionate toward myself as a mother. It felt like a sum zero game: taking time for myself meant not taking care of others, which meant that I was selfish.

Sound familiar?

For a long time, I’ve carried this pressure and stress all over my body. My shoulders are perpetually tight. I regularly clench my butt, my abs, and my jaws. More recently, I learned I also clench my pelvic floor, which means it’s constantly tight and weak and not moving properly.

During the workshop, when Frances moved us through a gentle Pilates session, I could feel exactly how wound up I was. Even though I consciously blocked off time to be there, my body was confused by the nourishing movements I was giving it. Initially, my body resisted. It wasn’t sure exactly how to unclench that butt or jaw.

But after that short session, I felt a tad more in tune with myself. It was just what I needed to feel the difference between my clenched and unclenched self.

Perinatal Experts Offer Insight and Suggestions for Self-Care

In the second half of the workshop, Frances moderated a panel of perinatal specialists. It included a doula, pelvic physical therapist, a urologic surgeon, a clinical psychologist, and a dietitian.

Each spoke about common issues they saw among pregnant women and moms in their line of work. They offered recommendations, but more important than that they encouraged us, in specific ways, to nourish of ourselves during these intimate and intense times.

Below are some of their key takeaways:

Dr. Rachel Rubin, MD | Urologic Surgeon

Dr. Rubin started off by stating, “No one taught us real sex ed.” She was referring to straightforward topics like basic anatomy. Most of us, she suggested, weren’t educated on the location and function of our sexual anatomy and how hormones can change them, especially during and after pregnancy. For Dr. Rubin, it goes deeper than knowing our anatomy: “No one taught us how to talk about sex, it’s really hard.”

She emphasized that sex is never supposed to hurt, and that we can’t and shouldn’t just push through the pain. Sex doesn’t have to be penetrative either, it’s about having good experiences, Dr. Rubin told us.

As a medical doctor, and specifically a surgeon, I was expecting Dr. Rubin to be clinical and somewhat detached from the lived experiences of her patients. I was skeptical from countless experiences of feeling dismissed by my doctors. Dr. Rubin was nothing like that.

It was so refreshing to hear her encourage us to be an advocate for ourselves. She emphatically told us not to take “we don’t know” as an answer from our providers when we tell them we have pain. She explained that OBGYNs aren’t trained in the area of sexual function. It’s not their fault, they just didn’t learn it. So, if you have a problem with your clitoris—she said as an example—your doctor might not know how to examine it.

I loved that Dr. Rubin also talked about how motherhood isn’t necessarily a physical pleasure. I know for me, there was a lot of guilt in admitting that. She explained how breastfeeding women are menopausal and that breastfeeding isn’t always enjoyable because it’s an act of nourishment for another. Moms can also face sensory overload or feel “touched out,” which is why Dr. Rubin recommended that moms take time to explore their bodies and understand what’s pleasurable for themselves. I definitely related to that “touched out” feeling.

To nurture oneself, her suggestion was quite simple: focus on pleasure and avoid pain. If something is painful don’t do it, seek help, and be your own best advocate.

Dr. Ann Udofia, PT, DPT | Licensed Physical Therapist

Dr. Udofia sees a lot of postpartum women with core instability, diastasis recti, incontinence, and a general sense of not feeling stable in their bodies. In her talk she was fundamentally against this cultural belief that these conditions were our “new normal.”

She stressed that we shouldn’t normalize the fact that so many women pee when they laugh, cough, jump, or run. Nor should we accept pelvic pain with sex. Echoing off of Dr. Rubin, Dr. Udofia said that postpartum women aren’t always checked for issues of the pelvic floor, or even asked about it.

Dr. Udofia also spoke about retraining women’s bodies to their proper alignment. She noticed a tendency for new moms to over-arch their backs and protrude their necks forward. Malalignment has a cascading impact on rest of your body. I know for me, breastfeeding alone hurt my back like hell, never mind my wobbly torso. Some days I didn’t feel strong enough to hold my son, even if when he was just barely ten pounds.

To nurture ourselves, Dr. Udofia recommended creating time to receive body work. She told us how it’s important that we create a space to connect physically and feel into our bodies in nurturing ways. This can be yoga, Pilates, physical therapy, acupuncture, massages, etc. Her bottom line was to not accept our postpartum issues as our “new normal” and to have a better conversation to address them.

Emily Smith | Doula

Doulas are one of the most underrated providers in this pregnancy, childbirth, and postpartum spaces. I had a doula for my birth and during the postpartum phase. Because of my doula, I felt supported and cared for throughout this incredible and intense time in my life.

When Emily, co-founder of Doulas of Capitol Hill, spoke at the workshop she so clearly reminded me of the incredible work of doulas and what they have to offer. Simply put, she said doulas offer physical, emotional, and informational support for childbirth and the postpartum phase. (Some doulas focus on birth or postpartum only. Many do both.)

Not all doulas are created equal. Emily explained it was crucial that she and the practitioners in her practice provided support without judgment. Many of us have experienced the onslaught of people who suddenly have expert opinions and judgments on how to give birth and take care of our newborn. A professional and skilled doula knows how to empower women by meeting them where they are.

Beyond offering physical, emotional, and educational support, Emily shared how her team offers social services like mom-to-mom matching. It’s kind of like a blind date for moms going through a similar phase of early motherhood. How great is that? It’s part of one of their guiding principles: to build community. (The other two are to support the family and grow the profession.)

One of the ways Emily’s team helps postpartum women nurture themselves is by encouraging them to own their stories. The center gives out journals for women to document their journey. Even if it may be uncomfortable, it can also be nurturing for the soul. Emily closed her talk with words by Brené Brown: “Owning our story and loving ourselves through that process is the bravest thing that we will ever do.”

Dr. Sahar Esfahani | Clinical Psychologist

The transition to motherhood is anxiety-provoking. We have more decisions and options than any generation prior to us, yet with less guidance or communal wisdom. Dr. Esfahani said she sees the toll of this combination among her patients.

Dr Esfahani helps women navigate the uncertainty that comes with giving birth and dealing with a newborn through Cognitive Behavioral Therapy, which is helpful for anxiety. It’s heavy on implementing strategies, it’s goal-focused, and deals most directly with issues occurring in the present.

What really resonated from Dr. Esfahani’s discussion was her attention to the kinds of self-talk we engage in and the narratives we create around our anxiety and sadness, which can feel really heavy. She explained how she helps patients cultivate a different relationship with themselves and their feelings.

Dr. Esfahani also recognized how values and priorities can shift after giving birth. So through Acceptance and Commitment Therapy, she helps patients identify new values and facilitates their navigation through that transition.

One way we can nurture ourselves, according to Dr. Esfahani, is by showing up for ourselves. Find a time in the day (even if for five minutes) to do something just for you. She also recommended seeking help and learning more through the Anxiety and Depression Association of America.

Jodi Balis | Registered Dietician and Food Life Organizer

The panel discussion ended with Jodi. Her takeaway message was so simple: EAT !

Especially during that early postpartum stage, eating can be a challenge, but she emphasized the importance of nourishing ourselves with food to support the shifts within our body. She also encouraged us to have an energetic experience with the food we eat and to incorporate rituals around eating, which can include bringing special items or decoration to the table, cooking specific foods, eating with intention, and consciously feeling the food in us.

One mom asked what most of us were thinking: “How can we enjoy eating again? With a young child, the experience at the table just isn’t enjoyable anymore.”

As a mother of two, Jodi fully recognized how our experiences around meals can change with children. She wasn’t fighting this reality, rather she reminded us that this phase is temporary. In the meanwhile she recommended redefining and shifting that pleasure with meals to a to a smaller experience, like a cup of coffee or tea, and to really embrace it.

In addition to simply making sure that we eat to nourish ourselves, Jodi recommended allowing our friends to feed us, whether they cook for us or offer us take out. She also suggested broths, congee, and warm bowls that are packed with nutrients yet simple and cozy. It’s that season after all.

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To wrap up the entire workshop, Frances reminded us of the importance to create a space for ourselves that helps us connect with our physical and spiritual core. She asked us to huddle in a small circle interlinking arms as we each shared one word to describe how we felt at the workshop’s conclusion. Words like “love,” “acceptance,” “healing,” “community,” “empathy” floated around.

In our cluster Frances reminded us that the proceeds of the workshop were donated to Mamatoto Village to support perinatal care in another community, extending the energy from this workshop further out to others.

Before breaking out of the circle to return to our hectic lives, Jodi offered everyone delicious energy cacao bites. As we held this snack in our hands, Fran helped us thank the panelists and one another for our time together. We then promptly took a bite. Yum :)

What does creating a space just for you look like? How often do you take time just for yourself? What helps you feel connected to your core?

[For more information about the panelists, check out their bios and websites below

FRANCES DARNELL | DYNAMIC CORE

Frances Darnell facilitated this workshop and is the Founder of Dynamic Core, a Pilates and integrated wellness practice focused on empowering women to activate their innate power so that they can live the life they truly desire. Fran's passion is in helping women revolutionize the legacy they are living and modeling for their children and inspiring women to powerfully choose how they want to feel and what they want to embody both for themselves and their loved ones.

This fall, she will run a 9-week group program called “Dynamic Mama” for mamas and mama-to-be. Dynamic Mama empowers you to approach motherhood with energy, strength, and alignment. This intimate program, based in DC, combines mindful movement and coaching to help you reconnect with your body, reclaim your strength, and gracefully move through the miracles of motherhood. For more information about Dynamic Mama, visit https://dynamiccorewellness.com/dynamicmama. Enrollment is now open and the program starts October 16th.

DR. RACHEL RUBIN | INTIMMEDICINE SPECIALISTS

Dr. Rachel Rubin is a urologic surgeon who specializes in the treatment of sexual dysfunction in both men and women. Her expertise includes pelvic pain, hormone imbalance, low libido, sexual arousal/orgasm disorders, and urinary incontinence. Dr. Rubin prioritizes taking the time to understand her patient’s individual and unique situation and to develop a highly-personalized, evidence-based treatment plan based on each patient’s goals

ANN UDOFIA | BODY CONNECT HEALTH + WELLNESS

Ann Udofia PT, DPT is a pelvic physical therapist and co-founder of Body Connect Health and Wellness—a holistic physical therapy practice located in West End DC. She specializes in prenatal/postpartum health, pelvic health physical therapy, and Myofascial Release for the treatment of chronic pain issues. Ann has found a lot of success treating various musculoskeletal and urogynecological conditions using a hands on, whole body approach. She is particularly committed to community education and empowering her patients in taking active roles in their health and wellness.

EMILY SMITH | DOULAS OF CAPITOL HILL + DOULAS OF PG COUNTY

Emily Smith is the owner and Chief Operations Officer of Doulas of Capitol Hill and also a sister agency, Doulas of Prince George's County, which she co-founded with Nicole Bruno and Jacquelin Knighton in 2016 and 2018, respectively. She has worked for 10 years serving families in the greater Washington, DC area as a birth doula, hypnodoula, postpartum doula, childbirth educator, placenta encapsulation specialist, and sibling doula.

SAHAR ESFAHANI | WASHINGTON ANXIETY CENTER OF CAPITOL HILL

Dr. Sahar Esfahani is a clinical psychologist at the Washington Anxiety Center of Capitol Hill where she provides Cognitive Behavioral Therapies  to children, adolescents and adults. She works with clients with a range of anxiety, mood, and obsessive-compulsive spectrum disorders, and provides evidence-based treatments including: Exposure and Response Prevention (ERP), Mindfulness, and Acceptance and Commitment Therapy (ACT) among others.

JODI BALIS | RED LENTIL CONSULTING

Jodi Balis is a healer, food intuitive and personal chef who creates nourishing food to support women through body shifts. Jodi co-creates a food ritual with mamas that are navigating through transition, and incorporates a nourishing meal, Reiki, meditation and shamanic healing. She holds space for women, intuits what foods uniquely provide support throughout these shifts and incorporates those into a ritual meal.

**Medical disclaimer: This post is provided as an information resource only, and is not to be used or relied on for any diagnostic or treatment purposes. This information should not be used as a substitute for professional diagnosis, treatment, or advice. Always seek the guidance of your physician or other qualified health care provider with any questions you may have regarding your postpartum care and conditions.

I’ve abandoned this blog over the last two years. There’s no getting around that fact. It feels awful and embarrassing to say out loud, but that’s the truth and I’m so very sorry for this long absence.

I wish I could tell you something totally life-changing happened, like having surprise twins or being deployed to that one corner of the world without internet, but that would be a huge lie. Truth be told, my life took an uneventful turn and I was faced with choosing between two passion projects: this blog and my doctoral dissertation.

In the end I chose my dissertation. But the eternal optimist in me earnestly thought that I could blog once in a while to take breaks from academic writing. I was so wrong.

As the momentum of writing the dissertation grew, I knew I wasn’t going to get back to this website until I graduated. By that point I felt too embarrassed to say bye, offer an explanation, or let you know when I’d be back. I actually didn’t know when I’d be back running this blog because I actually didn’t know how long it would take me to finish my dissertation. (That’s a story for another time.)

But as I was nearing the finish line with doctoral work, I found myself thinking more about this blog. Heck, I was (and still am) dealing with lingering health issues exacerbated from giving birth.

And the Postpartum Saga Continues 

So, I’m still working through some pelvic pain. I uncovered lots of underlying health issues when I first went to pelvic physical therapy for postpartum complaints. I made a lot of progress with my PTs (like I wasn’t crapping myself anymore), but I still had some pain, trigger points in my pelvic floor, and a pretty grumpy vulva, which also made for a pretty grumpy me.

My PT suspected that I had underlying hormonal issues that were causing vulvar pain, which in turn stressed out my pelvic floor making it constantly tight and ultimately weak. The PT sent me out to see a specialist in vulvar pain and sexual dysfunction. That specialist found that I, indeed, had low testosterone, causing pain and a chain reaction with my pelvic floor.

“Through all this, what’s become even more clear to me is how bad we are, as a society, at talking about women’s bodies and women’s health in ways that encourage us to know and take care of ourselves without shame or embarrassment.”

Around the same time (late last year) my endometriosis symptoms made a slow creep back into my life. (I had some relief from the endo pain during pregnancy and while I was breastfeeding.) As I struggled with intensifying flareups, I felt like my progress with physical therapy was unraveling and I was dealing with my postpartum issues all over again.

So yeah, three years is a long time to still have lingering problems from childbirth but I also know that childbirth didn’t necessarily cause my issues. Either way, giving birth certainly exacerbated problems and brought them to the forefront.

I also know I’m not alone.

My PT says she often sees women like me and that research is only starting to investigate issues like pelvic pain, pain with sex, women’s sexual health, sexual dysfunction, prolapse, pelvic physical therapy, hormone imbalances, and more.

Through all this, what’s become even more clear to me is how bad we are, as a society, at talking about women’s bodies and women’s health in ways that encourage us to know and take care of ourselves without shame or embarrassment.

The Personal is Political

As long as women are giving birth, the need to support postpartum moms remains. We’re far from ensuring that support, and in the past few years it seems as though access to comprehensive women’s health is increasingly threatened.  

But there’s also been this really exciting energy and movement among women across the country (and the world) who are demanding equality and recognition on all fronts. I’m reminded of the slogan from second wave feminism of the 1960s and 1970s: “the personal is political.” Then, as with now, access to health and respect for women’s bodies were central concerns.

I was reminded of this history during my studies and kept thinking how that slogan still rings true, especially when we think about how society treats postpartum women and women’s health concerns, generally.

“I’m so incredibly excited to revive this website and blog. It’s been on my heart to return to this project since leaving it.”

So, even though my studies took me away from this blog, during that time I’ve gained a deeper appreciation for how postpartum healing is so much bigger than going to check ups and seeing a pelvic physical therapist. I’ve realized that we need to have better conversations about our postpartum struggles and triumphs, with more frequency and honesty; change the language around women’s bodies and their health; and most of all, find a way to create that “village” of support for postpartum moms.

For those reasons, I’m so incredibly excited to revive this website and blog. It’s been on my heart to return to this project since leaving it.

I’m doubling down on my original vision to use this platform as a way to bring more attention to postpartum health issues, offer helpful resources, and to tell it like it is. The good, the ugly, and the smelly!

With the forthcoming posts, I’ll be interviewing experts to help answer some of your pressing questions, integrate peer reviewed research, highlight other women’s stories, and share my own.

In October I’ll be talking to a nurse practitioner who specializes in sexual health and to a pelvic physical therapist who helps rehabilitate women who’ve experienced sexual and birth trauma. I’ll also be chatting with a fellow mending mama who wants to share her experience with postpartum depression and navigating with mood disorders after her second baby.

My mission is to serve you. So, as I rebuild this site shoot me ideas for topics you want covered and resources you’d find helpful. Or if you want to just say hello, that would be a delight!! If you’re a mending mama or you work with postpartum women and have a story you think would benefit readers, let’s definitely get in touch!

I’m around now :)

In the meanwhile, I’ll also be on Facebook and Instagram (@mama.on.the.mend). Come say hi!

Looking forward to reviving this much needed conversation about postpartum and women’s health!

P.S. In the coming weeks I’ll be tinkering with technical stuff like layouts and design, so please excuse the weird mess.

Enjoy!

To accompany these stories, I've included some of Jessica Shortall's Work. Pump. Repeat parody stock photos.

Oh, the Places We Pump…

"Once, I pumped in my co-worker’s car while we were driving. Two of my co-workers were in the car at the same time. The driver was male and the other passenger was female. I sat in the back seat and pumped. It sounds awkward, but I felt pretty comfortable because I trust my co-workers." (S.M.)

"When I first went back to work, my boss who is also female asked me to pump in a closet. There wasn't a chair or anything. It was full of supplies. It wasn't completely private. I had to put up a sign that said ‘Do not enter, pumping.’ I wasn't happy about that." (R.K.)

“I was on a grant that required me to travel all over the state and I pumped in bathrooms, airplanes, airports, random people's offices, in the rental car, etc etc." (J.C.)

"I would pump in a conference room designated as a pumping room in the WIC office. If the conference room was in use, one of the WIC workers would allow me to use their personal offices." (S.M.)

And It Makes Us Feel So…

"I would feel like a burden having to ask to pump in the conference room (or office) at work." (S.M.)

"The entire process took at least 40 minutes. It was really frustrating to have that 'stop and go' three times a day…And while I was pumping, I needed to constantly massage and squeeze parts of my boobs to squeeze out the milk. It was a super stressful experience which was probably turning into a vicious cycle reducing my pumping output. Nothing made me pump like a cow which is what I was expecting! I finally realized and accepted that my nipples just didn't respond well to pumps…pumping just SUCKED for me regardless of where I did it. I was exhausted from going back to work full-time and having two kids and being sleep deprived." (J.C.)

"I still worry that people will walk into the room when I am pumping. Not all the staff know I pump. Some do. I know, when I carry my bag and keys to go into the room, people look at me. My boss forgets sometimes and asks where I’m going. It can make me feel like I am doing something wrong even though I am just pumping instead of taking breaks." (R.K.)

Colleagues React

"People have all kinds of responses to me telling them I’m going to pump. One co-worker was like ‘oh’ and took a step back. ‘Relax and enjoy yourself.’ I’ve had another co-worker wishing she could’ve pumped as long as I’ve been pumping." (R.K.)

"Co-workers were always very accommodating and did not make me feel like a burden." (S.M.)

"Having my own office and schedule helps with this a lot but when I was traveling or away from the office, most people were very accommodating. BUT I work with mostly women so that made it more comfortable. I never had to ask a man to help me find a place to pump, I think that would feel awkward. With my first, I was more hesitant when I made the request but with my second, I was much more comfortable and confident. I realized that it was my right to pump and didn't feel as guilty about missing a part of the meeting or whatever." (J.C.)

Pumping Fails and Awkward Stories

"I was pumping behind my computer in my classroom. I had locked the door, of course. However, someone gave a substitute teach the key and he popped in to ‘kill time’ for an hour. He was an elderly man and couldn't hear the electronic pumping sounds, or decipher the freaked out look on my face. As he approached and made small talk, I had to stop, avoid spilling any liquid gold, reattach my clothing, pack up, and leave to the room next door to finish. But basically, that was the end of my session right there." (M.P.)

"The worst thing, is the fear of having someone walking in on you. I have that fear every day. It can also be hard to remind people that I need breaks twice a day to pump. It can be embarrassing to have your boobs so full and coming out of your bra." (R.K.)

"My colleague was trying to catch me for a quick meeting but I had to pump. She said well if you don't mind, I don't mind if you pump in front of me! She’s a nurse and a pretty good friend so I thought what the heck, why not. We were talking like normal. As I started to pump she all of a sudden said, ‘Oh I didn't realize there's a green tint to human milk!’ I was like 'uh, I think that's just the color of the bottle or something, my milk is not green!!!’"  (J.C.)

"The most embarrassing experience pumping was at a three-day training at a police station with lots of surveillance cameras. The trainer had to ask for a place for me to pump. People were not pleased. The first day, they let me pump in their teleconference room. The second half of the next day, the instructor had to kick 40 people out of the room (a court room) to allow me to pump. The next day, I had to pump in the court room again. They had to 'plan breaks' and kick people out so I could pump twice. It was awkward. I did it knowing I was probably being watched by the surveillance cameras. I just didn't have other options. It wasn't that well received." (R.K.)

Pumping Wins

"I was about to pump in the bathroom while I was doing research at this one office, but I met a woman who overheard that I was going to pump in the bathroom and offered me her personal office space to pump. I never met this woman before, but she was very generous and kind to me…she even had very encouraging words for me to continue pumping and shared her own experiences. I made some home baked cookies and delivered them to her the next day to thank her." (S.M.)

"I’ve had to ask strangers (at the airport or at conferences) for a place to pump and I’ve had people be awesome and go out of their way to find me a nice private space. BUT I've also had people tell me to go to the bathroom, which I never challenged. This happened with my first child and it was usually from an older woman. Now that I feel more confident (as a mom of two) and if anyone wants to tell me that now, I would ask them, ‘Would you prepare or eat your lunch in the bathroom?’ I've also had to travel for several days a few times while I was pumping so I had to figure out how to freeze and store my milk at the hotel and then transport it back on the plane without them thawing. That was a challenge but I loved how my fellow moms helped me out and gave me tips." (J.C.)

"The best thing about pumping is that I have to take a ‘break’ when I normally wouldn't. Even though a third of my co-workers often break to smoke, I never feel like I have the time to take breaks." (R.K.)

"I feel fortunate to have a relatively flexible schedule, and I don't feel pressured into not having enough time to pump. I also feel fortunate having a nice space (air conditioned and clean) to pump." (S.M.)

Pump-at-work mamas. You get extra kudos on this Labor Day. Why? Because pumping is damn laborious. Doing it at the office is at best, awkward. At worst, it solicits hostility.

Regardless of where you pump, it's labor-intensive. All those plastic parts. The sanitizing. Finding a plug. Hooking your boobs up to a mechanical suction. The careful transferring of expressed milk from container to cooler or bag. The whoosh, whoosh, whooshing.

There’s nothing like breastfeeding to remind a woman that she is mammalian, and there’s nothing like pumping to make her feel akin to a farm animal.

It’s a mean social experiment to insists mothers exclusively breastfeed their babies for six months without any paid maternity leave, a nursing recommendation from both the American Pediatric Association and the World Health Organization. (I don’t consider using paid vacation and sick days as maternity leave. It’s theft of employee benefits!)

Many of us already feel it’s a national crisis and moral issue to be the only industrialized country without some form of federally mandated paid family leave. Jessica Shortall, in her Ted Talk, also makes it an economic imperative.

Shortall, also the author of Work. Pump. Repeat.: The New Mom’s Survival Guide to Breastfeeding and Going Back to Work, created a series of stock photos that parody the realities of pumping at work. Her goal is to combat the ubiquitous image of working moms who are erroneously shown happily working and mothering in the same image.

Below are six of the eleven pictures for your viewing, laughing, and eye-rolling pleasure. They include Shortall’s original captions and hyperlinks back to her campaign. Share them generously! (With attribution, of course.) I’ve saved the remaining five photos to accompany the next post featuring pumping-at-work stories from four candid mamas!

Happy Labor Day to us mamas who labor relentlessly at home, in the office, and everywhere in between.  

I sat down with three therapists at Body Connect Health & Wellness (where I get treatment) to learn more about why every mom should check in with a pelvic PT at least once after childbirth.

“[Pregnancy] is one of the most normal phases of dysfunction. Your ligaments are going to be ‘laxed, your posture is going to be off," says Lauren Collins. The uterus grows exponentially, organs are pushed aside, our center of gravity shifts outward, we rapidly gain weight, and someone literally kicks us from the inside.

Returning our bodies to normal function and alignment is also a long-term investment.

Marisa Alonso, co-founder of Body Connect, says she sees a lot of postmenopausal prolapse. “…they already had a dysfunction growing, maybe because they didn’t rehab their core well, and so their bodies are still in this postpartum state for 30 years, after they had their kids…[T]hen they go move furniture and get prolapse because their bodies haven’t come back to a healthy position postpartum.”

There’s also the wonderment of delivery.

Regardless of how we deliver, something quite large is coming out of our bodies through a relatively small hole or layers of abdominal tissue. Pregnancy and childbirth inevitably take a toll on our bodies.

A brief six-week checkup, a peek at the uterus, and a battery of feeding and depression questions seem entirely insufficient as our postpartum care. Culturally, we’ve come to accept that once the baby is born, the focus should be on the baby. This paradigm makes any sort of additional maternal care seem like a luxury.

But the physical struggles after pregnancy and childbirth are very real.

Hannah Schoonover explains, “They all feed into a generalized core breakdown where if one thing isn’t working correctly, then everything that has to work around it or with it basically doesn’t work well either."

Typical culprits of such breakdown can include leakage (fecal and urinary), back pain, rectal pain, lingering issues from difficult deliveries, pain with sex, and organ prolapse. “So, if you have no back support or you have back pain, that can lead to or exacerbate a prolapse,” says Schoonover.

Some moms check-in with Body Connect therapists simply as a wellness visit. These women have no symptoms and are looking to safely resume normal activities.

On the more severe end of the spectrum, Alonso recalls working with a woman who fractured her tailbone during delivery from coccyx mobilization, “…so [doctors] take their thumb rectally and pull down on the coccyx…to create more space for the [baby’s] head.” Collins chimes in and adds, “Fecal incontinence as a result of stage four tears or episiotomies, those are pretty serious too.”

As for me, I checked into Body Connect to see about my third-degree tear that was scarring strangely, vaginal heaviness, and incontinence, among other issues. The good news is that these symptoms are among some of the most common and treatable. The bad news is that so few women get help or too quickly opt for surgery, which is sometimes necessary but has its own complications.

Can we approach pelvic rehabilitation like rehabbing a dislocated shoulder or knee injury?

In some ways, yes.

When Schoonover discusses pelvic physical therapy to patients, she often equates it to a more relatable injury, like a hamstring pull. “I put it on a level that is not intimidating, frightening, or weird…It really is just another part of the body,” she says.

The similarities tend to end there.

“With your bicep, you can see that working. You can see your arm working, but you can’t really see what’s happening with your pelvic floor on a regular basis,” says Alonso. Our pelvic floor also moves differently from other muscle groups, which for the Body Connect therapists makes it more interesting and challenging to rehabilitate.

“[B]eing that the shape of the pelvic floor is conical, you get telescoping motions. So you get the squeeze, you get the lift, and you get the contraction…It does more things than just one muscle pulling shorter that another one,” says Schoonover. Collins adds that our pelvis is the basis of our stability, “Everything flows out of our pelvis, so if it’s out of whack it’s going to affect something else, at some point, somewhere…it’s where our center of gravity is.”

Pelvic physical therapy can also be quite intimate, especially vaginal and rectal work. Good communication is crucial.

“We’re very descriptive… I’m always informing my patients of what I’m going to do, letting them know, ‘This is what’s going to happen, this is where I’m placing my hand,’” says Collins.

Alonso adds, “We don’t push anyone to go beyond where they’re comfortable going. We have all our models, we describe everything, we try to inform people as much as possible…I’ve rehabbed postpartum moms without doing any internal work because some people felt uncomfortable with it, and that’s fine. There’s a lot of different ways we can start to access the pelvic floor or work the structures around the pelvic floor.”

“And another thing that’s specific to the internal work is that there’s never going to be something we do to a patient that we haven't had done on ourselves. We’ve felt everything that we do,” says Schoonover.

You may have heard about pelvic PT recently, especially how it’s standard postpartum care in France (yet another way that country supports mothers better than America). French OBGYNs prescribe postpartum women 10-20 sessions of pelvic physical rehab, and it’s covered as part of the country’s government health care plan.

In America, pelvic physical therapy is still relatively new and it's typically an out of network service. Many moms and OBGYNs either don’t know this help exists or the extent to which it can help.

Alonso, who has been working in this field for over decade, says she used to get European patients who had to fight with their U.S. doctors to get a prescription to see her. It’s not as difficult to get a prescription or recommendation anymore, but patients still need to ask.

While we’re a far cry from having pelvic physical therapy as part of standardized postpartum care, PTs like Alonso, Collins, and Schoonover exist in our communities.

Seek them out. Ask your OGBYN, midwives, and doulas to help you with that search.

Pelvic pain, pain with sex, weird scarring, peeing when you laugh shouldn’t be any woman’s “new normal,” especially for those of us who’ve had the privilege and responsibility of ushering new life into this world.

Dr. Tracee Suetsugu, a Honolulu-based OBGYN, shares with us what happens at the postpartum follow up exam and why it’s important to go. She says the transition from pregnancy to motherhood in that first month is one of the toughest things women go through. I think it’s safe to say that most of us would agree.

Check out our conversation below, where Dr. Suetsugu talks about everything from when to go to your postpartum visit, contraception, breastfeeding, depression, the pelvic exam, and how her personal observations enrich her practice.

WHEN TO GO

When should women go to their postpartum checkup? Is it the same for all women or does it matter if you had a C-section or vaginal delivery?

Dr. S: So it does matter how you delivered and complications surrounding your pregnancy and delivery. If it’s a normal delivery without complications, then the 6-week check is all that’s necessary. If you had a C-section we’d want to see you in 1-2 weeks mainly to check the incision and to make sure everything is healing okay. If you have high blood pressure, we’d want to see you within the week you go home. If we’re worried about high risk of postpartum depression we’d want to see you right away.

If a woman wants to check in before the 6-week followup, is that okay?

Dr. S: There are certain insurance companies that require you to have a big reason but I think difficulties with breastfeeding or worries about postpartum depression are reasons enough to be seen sooner. Different areas treat things differently but I don’t know how much of that is based on insurance coverage.

We have to make sure that if they had any tears that they are healing well, that the cervix looks okay, and that the uterus is returning to normal size.

THE CHECK UP: AN OVERVIEW

Can you tell me what a typical checkup is like?

Dr. S: Well there are certain things that we do for everyone during that 6-week postpartum follow up. One being some sort of depression screening because postpartum depression is a problem and we want to make sure we are able to help our patients who might be experiencing some issues with that. So, for my office we do a standardized depression screening, which is a series of questions like, “Have you felt down?” “Do you feel like things are getting on top of you?” “Do you feel like you’re crying most of the time?” There’s even a question on there, “Have you ever thought of hurting yourself?” And it’s a standardized depression scale. So if numbers are high then we know that we need to get that person in to see a behavioral specialist as soon as possible.

Usually, we’ll talk about breastfeeding, contraception, sleep. We also make sure mom is taking care of herself, which I know if tough and if she’s going to the bathroom okay. Most people will have vaginal bleeding and it can be up to a month postpartum and even longer, and we want to make sure that it’s progressing as it should. And then we usually will do a pelvic exam, which is tough for some women. We have to make sure that if they had any tears that they’re healing well, that the cervix looks okay, and that the uterus is returning to normal size. At 6 weeks postpartum the uterus should be close to pre-pregnancy size.

During this visit when something is not quite right, what happens next for these women?

Dr. S: It depends on the problem. Usually, we try to refer the women to the appropriate people. So if we’re worried about postpartum depression we’d refer her to a behavioral health specialist who can see her. A lot of people refuse, and in that case I have a lot of patients come back at pretty frequent intervals just to make sure that things are getting better, to make sure they have a safety plan, and if they ever have feelings of being so overwhelmed that they feel like hurting themselves, that they have a plan in place to take care of that. For incontinence issues, they’ll have close follow up with their OBGYN just to see if it gets better, and if not then a referral either to a urogynecologist or a pelvic physical therapist.

ANXIETY AROUND THE PELVIC EXAM

For me that aspect of the exam was the most anxiety provoking because I had a third degree tears. Do you find that aspect of the exam is also difficult for your patients? And do they ever vocalize that they feel anxious about the pelvic exam?

Dr. S: I think a lot of women feel anxious about the pelvic exam regardless of the circumstances. I think it’s important for patients to tell the doc if they’re really anxious, worried or having pain prior to the exam. But most likely you’re still going to have to have the exam, especially if you’re having pain to make sure everything is as it should be.

You mentioned the term “pelvic rest.” What does that mean exactly?

Dr. S: So usually what I tell my patients is nothing in the vagina for 6 weeks. So no ocean, no pool, not even really sitting in a bath tub. Mainly for infection control, especially ocean and the pool. The cervix was just opened to the uterus and most people have tears even if they’re small we want to make sure they heal well and don’t get infected or disturbed.

FAMILY PLANNING & CONTRACEPTION

I was floored when my doctor talked about family planning so early on, partly because I wasn’t ready for anything to go in “down there,” which I know isn’t always the case for others. I also thought breastfeeding would have contraceptive effects.

Dr. S: I’ve seen people get pregnant in that first month, even though they’re supposed to be on pelvic rest for those first 6 weeks. I’ve seen patients get pregnant very very quickly after. If you aren’t exclusively breastfeeding, then that breastfeeding protection isn’t there and you may not have regular periods and so people may think they’re protected. If a patient is exclusively breastfeeding and has no menses, they have contraception protection for up to 6 months.

Ideally you want 18 months between pregnancies for the body to heal, but the biggest thing is talking to the patient about what their plans are for having children so that they’re not overwhelmed with two kids under the age of two. It’s not something that’s on anybody’s mind so it’s our job to bring it up and talk about it. The main goal is to make sure women have children when they’re ready to have children.

I've seen people get pregnant in that first month, even though they're supposed to be on pelvic rest for those 6 weeks.

ON FEEDING

Dr. S: It’s definitely really important to check up and make sure all aspects of mom are well, and that mom is receiving breastfeeding support to take care of the baby. Sometimes it’s even letting the mom know that if she has to supplement if baby isn’t growing or for other reasons that it’s okay. I know there’s a lot of anxiety among moms feeling like failures if they can’t exclusively breastfeed their baby, but that there are reasons to supplement, that it’s okay.

BEYOND THE CHECK-UP

Is there anything else about the 6-week checkup that you’d want other people to know?

Dr. S: If they had gestational diabetes they may want to do another glucose challenge test to make sure they don’t have diabetes when they’re not pregnant. We want to make sure they’re not diabetic outside of pregnancy.

Is it standard for those who’ve had gestational diabetes to do the test at the 6-week mark?

Dr. S: It’s usually 6-8 weeks when they’ll want to do the follow up test and it’s something that should be done. The effects of pregnancy can last that long so if at 8 weeks they test positive, then it’s probably more than just from the pregnancy. For a lot of women who have diabetes during pregnancy, once they deliver their baby they don’t have to worry about it too much, so the test gets forgotten or they have better things to do like take care of their babies.

Has your personal life experience impacted your practice?

Dr. S: I’ve had a few close friends go through pregnancy and give birth in the last two years, and that’s helped my practice a lot. I think I’ve gained more empathy for my patients. Having people tell me the everyday problems definitely makes me check in on my moms a little more. I think that every time someone shares their personal experience it helps me as a doctor, since I haven’t had children…I appreciate when my patients share because it helps me take care of the next patient who may be going through similar challenges.

I appreciate when my patients share because it helps me take care of the next patient who may be going through similar challenges.

**Medical disclaimer: This interview is provided as an information resource only, and is not to be used or relied on for any diagnostic or treatment purposes. This information should not be used as a substitute for professional diagnosis, treatment, or advice. Always seek the guidance of your physician or other qualified health care provider with any questions you may have regarding your postpartum care and conditions.

A gynecology appointment is a bit like going to the dentist. No one particularly looks forward to it. At best it’s going to be uncomfortable and we hope that they don’t find anything wrong requiring another appointment or a procedure.

According to a June report from the College of Obstetrics and Gynecology, 40% of women don’t go to their postpartum checkup.

That seems really high, but I kind of get it. I was definitely looking for excuses to avoid this appointment.

In those first weeks with a newborn, I agonized over the postpartum checkup. The inflatable doughnut was my crutch and I didn’t want anyone near my torn up perineum or my still chaffed nipples.

The idea of going to this postpartum appointment exacerbated whatever reluctance I already had to visiting the OBGYN. This was especially true considering I was still physically and emotionally recovering from the pregnancy and delivery.

But I knew it was a necessary evil.

I actually had quite a few questions and concerns. For instance, I wondered about that little red flap of raw tissue hanging out at the base of my vagina. I also had pain and a deep vaginal heaviness that felt like my uterus was going to fall out, and I could only hold my bowel movements for a few minutes from the moment I had the urge to go.

Despite these valid issues, I desperately tried to think of ways out of the visit, or at least postpone it for a few more weeks. Anticipating the possibility of being told something might be wrong was overwhelming.

I was already frustrated with how poorly I thought I was transitioning to motherhood, and I felt ashamed for trying to wimp out of this standard postpartum visit.

I was compromising my long term health for a near term anxiety.

My hesitation had a lot to do with not fully knowing what to expect or why the checkup was necessary, and fearing some loss of control (over what? I’m still not entirely sure).

I shared concerns with my postpartum doula and she recommended (with a clean finger) gently feeling around and inside my vagina.

Doing this isn’t for everybody, but it was good for me.

It helped me get familiar with the sensations I might feel during a pelvic exam, so I wouldn’t be surprised by any pain/trigger points. It made it easier to share with my OBGYN what hurt and where, or where I didn’t feel anything.

I didn’t bail and I didn’t postpone. Instead, I showed up prepared with a list of questions on my iPhone so I wouldn’t get distracted by my spontaneous urges to cry. Hormones!

The pelvic exam portion (with a speculum and all) felt surprisingly close to a regular exam—a tad more uncomfortable but manageable.

There were some follow ups and notes to keep an eye on certain issues, but nothing too overwhelming.

It now seems silly that I wanted to avoid this checkup for fear of finding something wrong. That kind of logic makes no sense.

Ignorance isn’t bliss when it comes to health.

To help me (and other new moms) learn more about why this appointment is so important and what we can expect, I connected with Dr. Tracee Suetsugu (a Honolulu-based OBGYN) to ask her about this standard postpartum checkup.

How was your postpartum follow up? Did you hesitate going? What questions did you have for the appointment?

**Medical disclaimer: This post is provided as information and resource only. This information should not be used as a substitute for professional diagnosis, treatment, or advice. Always seek the guidance of your physician or other qualified health care provider with any questions you may have regarding your postpartum care and conditions.