Postnatal Recovery in Lockdown
Congratulations on the arrival of your baby, I bet that was not the 3rd trimester, birth or homecoming you had imagined when you first saw that little blue stripe on your pregnancy test? Despite all the curve balls the lockdown has bought, you still need the essential care and support for your recovery. Without the baby groups or relatives and friends dropping round to lend a hand you may be wondering how to make the best of the post-natal period.
Put Your Needs First
Firstly, you have a great opportunity to retreat to the cocoon of your new family pod, free from the obligation to entertain or attend to anyone. No endless tea brewing and coordinating all those visitors.  Although everyone is hankering to see you, no doubt you might be getting even more messages than usual, you can put your phone on mute or leave it at the bottom of your bag to respond when you are ready. Getting the balance right is unique for each one of us. Having the support there to ask questions and cheer you on when you’ve been up feeding for what felt like the entire night, whilst not feeling overwhelmed by endless time on zoom calls is going to make the difference for your emotional wellbeing. No one can give you an exact formula of how much you will need each day but agreeing with your partner about how to protect your space and when to call in help will make it easier for you to look out for each other. Remember it is fine for you to change your mind switch up your plans, this is the time for you to put you and your family’s needs first.
In the first few weeks after your delivery your body will being making some of the most significant physical changes from your pregnancy. Your body adapted in some incredible ways (and I am not just talking about the engineering feat of your beautiful bump) from increased blood volume, adapted breathing patterns and altered kidney function. Initially you may notice the urge to go to the toilet more, which is completely understandable as your cardiovascular system initially off loads around a litre of fluid- This was there to increase your body’s capacity to deliver nutrients to the baby. Couple that with a vaginal delivery that caused stretching to the pelvic floor system and you are going to have a bladder that needs to go more frequently- This should settle down within three weeks. If you feel your urge to go is unreasonably strong and frequent, you find you are repeatedly having episodes of incontinence or are struggling to pass urine comfortably you may need to contact your GP to screen for a UTI.
Next Steps:Â Contact your GP or midwife if you have concerns. Ensure you are drinking at least 3L of water with minimal caffeine if you are breastfeeding, 2L if not and start pelvic floor exercises as early as possible. (see below for more details).
Natural Bowel Rhythm
One topic of conversation that quickly crops up amongst fellow new mums is the dreaded 3rd birth. Yes, you delivered a baby, then a placenta but now you must have your first poop. Whether you had a vaginal delivery or a c-section the change in pressures and movement of opening your bowels can feel rather different. This does not have to be painful and something to fear but postnatally keeping your bowels moving well can have a big impact on our pelvic floor and core recovery. Taking these steps will make it easier- especially taking the anxiety out of it as this too can impact on your bowels. When we worry our body tenses and we avoid ‘the deed’ which means we interrupt the natural rhythm of our bowels. Like a song, if you hold on or avoid going your bowels must kick start the process again, a bit like having to wait for the next chorus in the song. The longer you hold onto a bowel movement the more pressure builds up in your tummy causing potentially further discomfort. Whilst the idea of going might not be very appealing there is plenty you can do to make it easier. Not only the delivery itself but the reduced physical activity in the days after can impact the rhythm of your bowels. It is important to recover with walking or exercise kept to a short duration and of light intensity.
Next Steps: Drink plenty- at least 3 litres if you are breastfeeding to keep your bowels soft. Add up to a tablespoon of ground seeds like flax or chia- these work with the fluids to soft your stools making them easier to pass. Use support by wrapping your fingers in a tissue and placing them over your stitches or perineum then lightly pressing up to take off any excess pressure. As you pass the movement, gently tilt your pelvis forwards and back to facilitate.  DON’T STRAIN. If there is one golden rule to pelvic health is to avoid straining. Check out the video below by Michele Kenway on how to help open your bowels. Using heat over your tummy can help relax the bowels, if you find this helps try a meditation or relaxation as the anxiety surrounding this might be having an impact on the frequency of your bowel movements.
Making Sure To Rest
Labour is called labour for a reason, the culmination of approximately 9 months working, building, growing, protecting, and nurturing new life climaxes with your body making one giant leap through the final hurdle. Ironically just when you could do with an extended holiday your baby acts as a living, breathing alarm clock that further demands your body to give and compromise its needs. We know this is power for the cause and amongst the intense chaos of it all are some of life’s most powerful moments. Your physical body though is calling to you to readdress this imbalance in whatever way you can. In China, many women still honour a month’s ‘confinement’ in which their support network gathers round her enabling her to get the rest and nourishment she, her body, and her baby needs. Whilst that might not fit with our culture there is much we can take from this practice.
Pro athletes know how to get stronger and perform better- they rest. They are intentional and purposeful with their time. They plan to make sure when their body needs to perform its ready. I recognise in myself and so many women I meet how we are way off this. We expect a lot ‘out’ and put ‘in’ inadequate amounts of rest, nourishment, and care. I want you to get your pro-athlete mentality on. You have just prepped for the ‘Olympics’ that is motherhood with 9 months of graft and birth. You have landed in the arena and you can feel all the emotions that are welling up. That cocktail of pride and fear, exhilaration and exhaustion, empowerment and bewilderment are your companions for the rest of forever. That cocktail needs mixing perfectly, motherhood is not going to be all the sweetness and goodness without a few bitter tangs. But neither does it need to be potently intoxicating lacking flavour and depth. Life needs contrast and right now rest is the definition you need to bring to life. Your body is enabled to physically heal and repair when given rest. Rest is not lazy, rest isn’t getting lost on social media or flopping at the end (or middle) of a day. Rest is active. You must choose to rest but you also have to choose how to rest. Think of rest like a rich pool which you can drink all that you need from. It might not have ‘the thing’ you are wanting right now but I bet it give you the capacity to step closer to that.
Next Steps:Â Think about rest as a rich investment in your recovery. If you want to make the most of your postnatal period, make the most of your rest. What would be the richest investment you can make in your rest? Would you need time alone or social support? Are you craving nurturing or spontaneity? Rest is not necessarily laying down in a quite dark room (although that is a good option!) it can be nourishing movement or sitting outside with a book.
Pelvic Floor Rehab
Pelvic floor rehab is an absolute negotiable essential for every post-natal woman. A C-section delivery does not mean you have dodged any pelvic floor issues. Understandably a delivery with a severe tear or assistance via forceps could have a greater impact on the pelvic floor tissue like muscle and connective tissue which would require at least 6 weeks for those wounds to form their initial healing. Pelvic floor training exercises, sometimes referred to as Kegals, can be started as soon as you have passed your first wee post-delivery. Whilst this can feel strange, difficult, or different then before it should not cause any sharp pain.  If your pelvic floor feels especially weak start with just squeezing gently till you can feel the muscles contract, then let go. If you are experiencing weakness squeezing too hard or for too long can cause you to compensate with your breath or other muscles which is not helpful. Ideally you are aiming for 8 ‘holds’ (squeeze and keep it on for up to 10 seconds or 2-3 breath cycles) and 8 ‘shorts’ (as soon as you have squeezed then let go again, like switching  light switch on and off) a minimum of 3 times per day. Initially you might notice your sensation or endurance is less than before so work with that utilising positions such a as sitting or lying. As you get stronger and more confident try using your exercises in standing or with actions like bending down or sit to stand. You can use your pelvic floor squeeze in activities that load your body like lifting up your baby or when sneezing. Not only does this help you get stronger but also it teaches your body to pre-empt these activities with a squeeze.  One of the best things you can do for your pelvic floor recovery is to look after your bowels by eating plenty of fibrous food, drinking sufficient water and avoid straining to open your bowels. This will put unnecessary pressure on your stitches (if you had any), wounds and pelvic floor system thus compromising your recovery.
Next steps: Set an alarm or reminder to get your exercises done. You need the regularity to see the results so do them with feeds, use an app like Squeezy app or anchor them to other habits like having a drink or checking messages. The sooner you establish a consist pelvic floor routine the sooner you’ll be able to safely return to the physical activity you want to do and protect yourself from long term pelvic floor dysfunction.
Monitor How You’re Feeling Emotionally
‘Flying Solo’ is commonly heard in conversations around the time your other half or family are out leaving you to start navigating life with your new bundle. I have not spoken to a woman yet who has not remarked on this hurdle and the period leading up the milestone of 8 weeks postpartum. Those first 8 weeks are typically the most erratic, sleep deprived and blurry for many families. This is the bootcamp of babies where feeding, pooping and sleeping (or not sleeping) are the most favoured activities for stretching their new parents. I was once told by one of my midwives that during labour she noticed a large number of women would want to give up and asked to go home (yes mid labour!) when they were just reaching fully dilated. There was something about that final stretch on the 1st stage of labour that teetered women on the edge. Looking back, I can see how those first 2-3 months of a baby’s life can have that affect too. Just when you cannot do another night of 4 feeds something gives bringing you back from the brink and gets you drunk of the sheer joy of more than 2 hours sleep. That window between the build up of an unsettled baby and breakthrough can be deep, dark, and seemingly never ending. I do not mean to sound too intense but when you are there it can turn from tiring to suffocating without you noticing. Your wellbeing is so hugely important. We have talked already about your recovery, the need to protect and investment in that is a conscious act. I do not want you to fear reaching out, asking for help, and getting support. How you feel in this time is not a matter of right or wrong but more of a traffic light system. Getting to know your ‘red’ lights, your warning signs that you are getting stretched too thinly or are feeling too isolated, can help  you know you have gone too far without the support you need and deserve. It can be hard to work out what our traffic lights signals are. I want you to take out a piece of paper and divide it into three. First head one section ‘Green’ the list any feelings, activities and thoughts that are ones that show we are thriving. Your second section can be headed ‘Amber’. List in here anything that shows things are going off course, but you are still able to function and not notice any feelings of distinct despair, anger or disinterest in life. Lastly the ‘Red’ zone is where you need immediate action. If you have had a history of anxiety or depression you might know what is was to feel unwell or you may be aware of your triggers or even how to manage them. If you are noticing life feels it is constantly in the amber – red zone, then it’s time to speak up. Speaking to a health visitor, GP or midwife is essential to help you plan how to nurture yourself in this time and get any appropriate help. Including trusted loved ones into these conversations can help them be aware of your traffic lights. Sticking this up in your fridge or bedroom and putting a marker or magnet on the zone you are in today can help your partner be aware of your needs. This might take time to understand your traffic lights but as you do try to look at the green zone and navigate yourself towards those ‘green’ activities or people that positively invest in your wellbeing.
Next Steps: Each day monitor your ‘traffic lights’ and pick at least one ‘green’ activity to do that day. Even a short time outside or speaking on the phone with a friend can help slide your day towards the green and build healthy daily habits that nurture you and ultimately your family too. For more information on mental health and wellbeing in the childbearing year see the below links.