Our society tends to celebrate moms who quickly lose the baby weight and get back to “normal” once the child is born. After I gave birth to my daughter, I spent two nights in the hospital and returned home, joyful but also sore, seeping, and exhausted. I didn’t have another doctor’s appointment for six weeks. My newborn had five appointments in that same time frame.
Six weeks postpartum marks the halfway point through what some people call the fourth trimester. It’s the time during which a baby is learning to exist outside the womb, yet is still completely dependent on the parent(s). The woman is also learning to be a mother, whether it’s her first time or her fourth.
Women’s bodies go through enormous changes during and after delivering a baby. Many women experience symptoms for months and even years beyond their six-week check-up. Any mother will tell you, it’s hard to take care of yourself when you have a tiny, helpless human dependent on you for their survival. It’s not about bouncing back to your pre-baby weight or even your pre-baby activities. It’s about staying well through the transition to motherhood. This includes knowing the signs and symptoms to look for in case something is off, and knowing when to consult a doctor.
Pelvic Floor Discomfort
The pelvic floor is made up of layers of muscles, ligaments, and connective tissue that surround the vagina and rectum. The muscles stretch from the pubic bone to your tailbone and support the organs in the pelvis, including the bladder, uterus, and bowels.
These elements are integral to normal human function; they keep us upright, ensure we can go to the bathroom (or hold it), and help in the delivery room.
“Obviously, there are quite a few changes that go on after you have been pregnant, not necessarily just after a vaginal delivery,” says Dr. Kimberly Larson-Ohlsen, an integrative doctor at UCHealth Gynecology Clinic in Cherry Creek. “During pregnancy, a woman’s body goes through hormonal and structural changes that allow her muscles, joints, ligaments, and tendons to stretch, be more lax and mobile in order to accommodate a growing fetus. Oftentimes, they don’t return to normal structural locations, which can lead to pelvic floor issues and discomfort.”
Other pelvic symptoms that postpartum moms might experience include incontinence, uncomfortable sex, sciatica pain, nerve pain, or tailbone pain. It might hurt just to sit on the couch. Any pain closer to delivery that goes beyond the feeling of regular menstrual cramping should be brought up to your doctor right away, recommends Dr. Sonal Patel, pediatrician and owner of the NayaCare Fourth Trimester Clinic. Prolonged or intense pain and incontinence (urinary or fecal) are not normal. Bring these up with your doctor at your six-week postpartum visit.
Denver mom Leslie Boyce has a background as a fitness trainer, and began her first pregnancy feeling strong. A few days after delivering her healthy baby in February of 2021, she started experiencing intense pelvic pain.
“If I was standing perfectly still, both feet on the ground with my weight evenly distributed, I was fairly pain free. If I shifted any weight by picking a foot up off the ground (or even just starting to do so), I had a sharp and piercing pain right on my pubic bone,” Boyce explains. “It was nearly impossible for me to go up the stairs, get into bed, take a bath, etc., because I physically could not lift up one leg at a time.”
Boyce ended up in the ER, and found out she was suffering from symphysis pubis dysfunction. This normally occurs during pregnancy, caused by the hormone relaxin loosening ligaments in the joint between the left and right pelvic bones. While this helps women’s bodies give birth, it can also cause discomfort or pain. For Boyce, the pain came on postpartum and kept her bedridden for three weeks. Once she found a physical therapist that specialized in pelvic floor issues, she found relief.
Sarah Prowak, an occupational therapist in Wheat Ridge, experienced pelvic floor weakness after her second cesarean section. She worked with a pelvic floor physical therapist who helped her with pelvic floor tension release (both external and internal), and breathing work to reengage the muscles.
“I wish everyone got to go see a pelvic floor PT,” Prowak says. “Our bodies just went through impactful transformation in a short amount of time.” Rather than waiting for something to go wrong, she says, it’s important to engage the muscles as they’re healing. “I feel like that should be more preventative care—from my view as a therapist.”
Pelvic floor physical therapy is not always offered on insurance plans, and many women aren’t aware of it as an option for treating their discomfort. “I don’t think everyone necessarily needs to have it, but I think it would be a wonderful benefit if you have the opportunity,” Larson-Ohlsen says.
Women wishing to try therapy exercises on their own can reference online instructions, such as ones for Kegels from the Mayo Clinic. Make sure the exercises you are doing are recommended by a professional. Larson-Ohlsen also cautions: “It is really important to practice (Kegels) without urinating because that can lead to urinary tract infections. I often teach (patients) to squeeze their anus—the muscle to hold back gas—not their buttocks. I suggest doing both quick contractions and slow, and holding the contraction for the count of five.”
Postpartum Mood Disorders
Many new moms—at least 15 to 28 percent, according to Larson-Ohlsen—experience mood disorders. While it’s normal to have some mood shifts in the beginning, when symptoms last longer than a couple of weeks, it might be more than just the “baby blues.” And the ways mood disorders manifest themselves can represent a wide range of emotion, depending on the person.
Prowak experienced postpartum rage. She found herself yelling at her kids, thinking, “I know better. Why am I doing this? What’s going on?” She found an individual therapist who specialized in working with moms—although it took effort. “It was really challenging for sure, during pandemic times, to meet virtually, and be able to carve out a time where I can be in a mindset to be thinking of myself,” she remembers.
Jordan Glassberg of Denver experienced postpartum depression after her daughter was born. “I would say around maybe two weeks (postpartum) is when I started to have moments of feeling like I wasn’t in my body,” she says. A few days later she began sinking into a deep gloom, she remembers. “I felt so sad all the time; crying for no reason, and any reason.” Prior to becoming a mother, Glassberg hadn’t struggled with mental health issues, so these intense feelings were new for her. “I thought it was going to be sunshine and rainbows, and I would bake cookies for my happy child, and I would get dressed every day and take a shower,” she says. “It’s not that. So I think that’s something that kind of shook me up early on for sure.”
Glassberg’s doctor offered to help get her prescription medication for her postpartum depression, but at the time she was breastfeeding and felt hesitant to take anything that might affect her supply or be transmitted to her newborn through her breast milk. Larson-Ohlsen notes that Zoloft, a brand name of sertraline, is a good choice for an antidepressant to use if breastfeeding because very few adverse events to infants have been reported with the use of this drug. Luckily, Glassberg’s depression started to wane around seven weeks postpartum, when she started to have more good days than bad.
Colorado Springs mom, Whitney King, says her anxiety spun out of control after she gave birth to her first child. Her list of symptoms included not sleeping, feeling jittery, ringing in her ears, and OCD-like fixations. “Anxiety spirals,” she says. She would get to a point of thinking: “There’s something medical going on with me, and then that kind of freaks you out a bit more.”
King emphasizes that women should listen to their bodies—and ask for help. Someone offers to bring a meal or clean your house? “Take the help,” she says. “I feel like moms especially put so much pressure on themselves to do it all and be super-mom, and I was totally one of those people.”
Larson-Ohlsen urges new moms to remember it’s not a weakness to talk to a therapist, or even go on antidepressants for a short time.
“We think as women we should be able to do everything. We should be perfect. We should not have been tired or frustrated,” she says. “But we really need to ask for help.”
Postpartum Care At Home
Many women are “leaky” postpartum—peeing a little when they sneeze or do certain exercises, like jumping jacks. Dr. Sonal Patel, pediatrician and owner of NayaCare Fourth Trimester Clinic, says that this should start to resolve after six weeks, and definitely shouldn’t last beyond a year.
Patel has been through it herself. The mom of four dealt with her own dose of postpartum woes: pelvic pain, postpartum depression and anxiety, and interstitial cystitis (a chronic condition of bladder pain and pressure). For her, pelvic physical therapy was life-changing.
After experiencing those postpartum challenges firsthand, Patel started NayaCare. The clinic provides lactation support, pelvic physical therapy, postpartum depression screening, and four in-home visits for complete care, coordinating with an OB-GYN or midwife and the baby’s pediatrician. “It’s two months where families don’t have to go into a clinic,” Patel says.
Many women experience postpartum hair loss—which can be a real bummer after experiencing that shiny, voluminous pregnancy mane. “Most women don’t realize that after delivery, your estrogen drops significantly,” says Dr. Kimberly Larson-Ohlsen, an integrative doctor at UCHealth Gynecology Clinic in Cherry Creek. “There’s an unusual number of hairs that go into that resting phase, and then they can shed for months.”
There’s a term for this: Telogen effluvium. Women normally release about 100 hairs per day, Larson-Ohlsen says. But during the postpartum phase, it can be up to 300 hairs a day. So, if you are finding hair on your pillow or in the shower for up to a year postpartum, don’t worry; if it continues beyond that time, it might be time to see a dermatologist. In the meantime, try taking a prenatal vitamin with iron.
Nutrition and Supplements
“As an integrative doc, I get asked a lot of questions about herbal things that are safe in breastfeeding,” says Dr. Larsen-Ohlsen. While nothing has been studied significantly, she recommends herbal supplements including St. John’s Wort, passionflower, skullcap and milky oat, as well as the adaptogen ashwagandha. With any supplement, read the label carefully, and consult a qualified professional before using.
She also emphasizes good nutrition for new moms. “I don’t think we pay enough attention to optimal nutrition and blood sugar balance,” she says. “So I really encourage new moms to graze on complex carbohydrates, good quality protein, and fat every two to three hours.”