Postpartum Recovery with ‘The Vagina Whisperer’, Sara Reardon

take a hit during pregnancy and childbirth. Enter the vagina Whisperer Sarah Reardon. She's a pelvic floor physical therapist and she specializes in tender, loving care of your entire pelvic floor. Last week she was here on what to Expect, to talk about your pregnancy aches and pains, and how to prepare for birth. Today she's back to talk us through postpartum recovery. What will your recovery look like and how can you make it easier? Encourage healthy healing, come about

a whole new set of aches and pains. Help you regain bladder control, go back to pooping as usual, get moving again, and what about sex? Does that have to be a four letter word postpartum? Sarah, welcome back, Thank you hiding. I'm so excited to be here again. So I guess we've delivered our baby. Now we have to find out what we do postpartum to nurture ourselves, because it's not all about the baby, it's about nurturing yourself

as well. And I feel like there's a reason why we've changed the pregnancy timeline a bit, the traditional one that talked about three trimesters and then you have a six check up and then you're done. But pregnancy really is more of a for trimester process because recovery takes time. There are huge benefits to caring for your pelvic floor during pregnancy. But you say many patients don't show up at your door or virtual door until after they've delivered.

Is it like better late than never? It's any time is a good time. So whether it's you know, days postpartum, we have folks calling us asking about taking their first postpartum poop or six weeks when they're returning to sex and exercise, or even later down the line. But it's always better late than never. And I think that oftentimes we think if we're out of the fourth trimester, then our healing should be done, that our postpartum period is over.

But you and I both know that it really lasts forever. And there's just I think, such little care for moms postpartum, and we don't even know what care we need sometimes that we didn't even know where to start getting it on are the most common symptoms that bring new moms in to see you? So I would say some of

the most common ones are urinary leakage. So that may be leakage with a call for a sneeze, running after a kiddo getting out of a chair too, or it may show up later when they are returning to exercise and they're starting to run and do jumping jacks. I think oftentimes we think, oh, it's going to happen a

little bit in the beginning, but it'll get better. And research is really showing that a lot of folks who are experiencing leakage at three months postpartum may still be experiencing it at twelve months postpartum, So it doesn't necessarily just go away. If anything, we become more active when we start doing more and it could potentially get worse. So that's a common one. Another really common one is painful sex. That's kind of a scary one to enter

back into. And you know, six weeks is this kind of arbitrary timeline that's come up with. I tell you know, my patients, it's totally fine to wait longer. There is no rush. But some things to think about are you may have vaginal dryness if you are lactating, you may have some scar tissue in the area that could cause pain. You may have experienced trauma during birth that really could be affecting your intimacy or your muscle tension. So that's a really big one that I think you'd like to

address with moms. And then lastly, probably you know cesarean scar restriction, cesarean scar pain. Moms are having cecerean births these days, and there's no follow up on how do I manage my scar? What if it's painful? What does it feel fuzzy or uncomfortable when I'm wearing pants? And we do a lot of cesarian recovery as well, what is your timeline for recovery, Like when do you feel if I don't if I don't feel good by now, something's wrong and I need to come to see you.

In my ideal vagina world, I would see all folks, usually everyone I know. Hopefully we will live in that world, but I would see everyone for at least one visit POSTPARTU to say, looks good, you're doing this exercise properly, a everything looks like it's great and healing, carry on. Or to say there is a little bit of weakness here, a little bit of prolapse, a little bit of scar massage. Let's work on that. So around six weeks, we'd like

to see them. I think if by twelve weeks you're still experiencing pain, leaked pressure, abdominal weakness, discomfort, I would go in and start seeing a physical therapist around that twelve week mark. So the O B is going to the midwife, is going to see you at six weeks, should we also come in to see you at that six weeks. That's when we ask our clients to come in. After they kind of get their medical clearance of everything looks good, You're good to return to normal, we have

them come in to see us. Sometimes, you know, the very next day or within that week to get them started back to exercise, sex, living their daily lives. I mean we kind of get that sums up to like go back to your normal life, but like nothing is normally what is normal? And physically we haven't been rehabilitated, So how do we just go back to normal now? And if anything, it will be a new normal, but

hopefully ultimately a better new normal with our help. UM, So let's get into a little detail about that first poop that you mentioned, because I gotta say it comes with a lot of dread, understandably, especially if you've had stitches, But even if you had a C section, you're still stressed out about that first poop. In fact, having a c section all that medication can make you more constipated, and also you're moving less, which can make you more constipated.

So this too, shall pass, but how do we make it pass more easily? Initially? That's um one of the most common things I like to address with moms because we don't even especially first time mom, they don't even

realize that that first poop might be an issue. So the number one thing I tell folks is to take a stool softeners so you have blood loss you have dehydration, you're in pain, whether you've had a vaginal or cesarean birth, and taking those stool softomers will help keep your poops off so that it's not really hard and difficult to pass. And also tons of hydration. Your milk maybe coming in again.

You've got blood loss and dehydration, so making sure that you're really pushing the fluids the first two weeks and even after that. The other things are is to use a squatty potty. So we touched on this a little bit in our first chat together. But putting your feet up on a stool or a box or whatever you have. You know, in the hospital, I turned the garbage can sideways and put my feet on it so that I

could help my hips relax a little bit. Getting into that squatting position helps relax your pelvic floor so that you can poop. And those hospital toilets are high. You know, there's a little travel squatty potty that you can literally pack up and bring in your hospital back. I'm like, we need to rethink the hospital bag because we need pelvic floor support for moms in there. What are we bringing, Oh,

we're bringing a travel squatty potty. We're bringing a little peribottle with a curve nozzle so that it's a little more sophisticate it in the hospital ones. I love compression garments that aren't waste trainers, but give moms a little support for swelling and healing. The ice pack always an

ice pack. I love an ice pack. Um, and I tell folks to ice even after they get home from the hospital the first week, so um, the stool softeners, the stool under their feet, and then when they're pooping, it actually encourage them to use their hand to support

the parenneum. So that area vaginally and at the pareneum, whether you've had a tear or not, can be really vulnerable and we're trying to like push something out, So I tell them to take their hand and kind of hold up the volver and pyneal area as they bear down to poop. And if you've had a cesarean birth, to put a pillow over your tummy and hold that area when you're trying to have a poop. So just kind of protecting those really vulnerable areas when you're trying

to exhale and bear down to empty the balls. And clearly your hands are clean or actually you can use toilet paper, I tell me up over their hand. That's a good tip, great, great clarifica, no thanks. I really appreciate your poop PEP talk. We all need it sometimes. So on two P. The first time you pee, you may feel like it's kind of hard to because your bladder might feel paralyzed. You might need some encouragement. I always, you know, use the running water and you know, warm

water over your paraneum. Um. What are some things you can tell us about that first P and subsequent peace and how to keep them healthy? Right, So the very first P, I think is a big one. That you kind of feel a little bit frozen down there. And so that's the experience that I had, And I had to get into the shower and let warm water run over me, and that warmth and that water running kind of helps you relax a little bit and then pan a shower. Everybody, it's a great place to pee. It's

a totally fine, safe place to pe um. But when you're in the hospital you can do that and then also taking some just big deep breath, really not having mom's push when they p. We want those big deep breasts to help the muscles relax and then the bladder can push the p out for them. Um. That's if they're standing or sitting. And then again if they're sitting over the toilet or sitting on the toilet, having a little stool or support under their feet to help them

relax because those toilets are high. And then I even tell moms that they're really you know, not able to start their stream. Another thing for their hospital back to keep peppermint essential oil in their hospital back and you put ten or twenty drops of that in the toilet water and then you sit over that and the aroma or the fumes kind of stimulate the urine area sphincter to relax a little bit. So all of these just things to help options so that you don't end up

getting right to a catheter. But you have some tools to help facilitate relaxation. But if you've had a catheter because you had an epidural, that's going to make it even harder, right, And so that's why you really want to work on the they'll take that catheter out, you still want to work on the breathing, maybe the running water, maybe the peppermint drops in the toilet water. All things to really facilitate relaxation of that pelt floor. And also it's it's hard to be lying down, isn't it. I

mean if they give you a bad pan. So bladder control, we talked a lot about that because it's an important topic. Can you regain it after you've lost it? Yeah, I mean I think it's variable depending on kind of the

level the extent of loss of bladder control. So which will you know, typically present like urinary leakage, And that's one of the things is that a lot of moms one of two things happens after you give birth is that you can't pee at all, where you get up from the bed and like water gushes out and you're like, wait, I already had the baby. That's not my water breaking, and it's your bladder, right, it's your bladder leaking. And you've got a lot of urine loss because the muscles

are just tired. So it's one of those things that after the first two or three weeks it should get better. But you know, working on strengthening those muscles, reconnecting with those muscles can definitely help you improve bladder control over time. Okay, that's a good news, and if not, they should definitely see a pelvit for therapists. Correct, don't wait, don't wait for it to get better, right, don't wait, just go

ahead and go. I mean I say that all the time, like if we have, you know, I think of all the appointments I have. When you know, COVID ended, I was like, I'm getting my hair done, I'm getting my nails done, getting my eyebrows done, and like go see your public four therapists, like put that on your list of things you want to do after baby is born

as well. Absolutely. Okay, So let's talk about some recoveries specifics, which are going to be different depending on how your baby has arrived, whether it was your first baby or your fourth baby. Maybe how hard or how easy, or how long or how short your labor and delivery were, how much pushing you did. So from your perspective, what are the most important things a woman should know if she's recovering from a vaginal birth. Two. We already touched on how to pee and how to pool, like one

and two. Next is I think icing We touched on this a little bit, but really the cold in the very beginning helps decrease inflammation. UM minimize infection, improve healing, So you know, having a little ice pack that you put on the area for twenty minutes several times a day for the first week. UM. Also having a little peri bottle filled with warm water or which hazel that

you sprits on the area. That can also help facilitate your urine stream if you can't pee, but definitely rinse after peeing, after pooping, and even just you'll still be bleeding, so kind of rinsing the area so that you don't have to wipe aggressively. And there are a lot of sprays and bombs and different things you can use if you've had a tear or you have some soreness in the area that can be helpful that they may give you in the hospital. You can also keep at home.

But really baby the area, I mean really, you know, be tender to it, don't overdo it, and give yourself the first few weeks to really really rest and recover. Like you have been through a lot and you're sleep deprived now, so um, really just focusing on recovery those first few weeks. Now, Pecotomys are faithfully rare theseas how, if you need to have an apseotomy, and it would only be if you absolutely need one. How would you say it's best to heal and speed recovery. Ice is

a big one again for that. So when a psotomy is a cut, when they actually cut the muscle, and typically they're doing that now only and medically indicated. Back in the day, it was like everybody got one, and now we're showing that it's actually gonna be better if we just see what naturally happens to the muscles and tissues with birth. And most women do tear a little bit, but it's typically a minor tear, so in a psotomy is what we consider a grade to like into the muscle.

So I really encourage, you know, a really good nutrition because we want that for wound healing. So vitamin C, food, vitamin C, fish oil, you know, making sure that you're still taking your prenatal vitamins, good nutrition, good hydration, icing the area, maybe even using a little steak cushion to sit on, so that you're kind of staying off that wound while you're sitting, especially when pumping or breastfeeding. Would you say a donut to sit on. I don't love

doughnuts filled with air. They have so many great options that are kind of a phone that are kind of a little bit softer to sink into, or even your body pillow just turns to put that in the chair and just sit right on that, you know, and just

something to kind of elevate that area. And then actually it's a great time to kind of start thinking about doing little keygal contraction, so not really tight ones, but just to contract and relax, to start pumping some fluid out of that area, getting some blood float of the area to help appealing. I was going to ask about that because when you know, I'm all about keegals. But I remember so clearly trying to do keygles right after birth, and I think I could, but I couldn't feel myself

doing them, So is that normal? Yes? I also tried to do them right after birth, and I was like, wow, it is radio silence down there. That is normal. These muscles are tired. But what we're just looking for is connection. We're just looking to say, can I, you know, could wake through his muscles often, you know, I do tell people every once in a while you might want to be urinating and test it, like can you contract your

muscles and stop your stream. Don't do keegels during peeing as an exercise, but every once in a while you can test it, yes, just to tell that you're doing them correctly, right, because otherwise you could end up with U, T, I, S and all kinds of Yeah, that's not a good thing. Okay. So besides not you know, rushing in it, listening to your body, not overdoing lifting with care. What about a

mom who has had a C section? And as you said, thirty percent of moms are going to have one, whether you know we like it or not, and we should try to reduce those rates. But in the meantime, if you've had a c section, how do you best recover from that? For both of these and I didn't mention this with the psotomy either said there's kind of an early stage of healing and then like a later stage

of healing. So so Sarian Recovery really love moms to use like a really simple abdominal binder in the hospital, and most hospitals will provide it if you ask. They don't always offer it. And I'm not talking a waste train or I'm talking like a really gentle soft wrap that just gives you a little bit of support when you are trying to get in and out of bed and lift the baby. Next is you can ice your

scar right away. That's going to help produce inflammation. And then you know, even starting to do just some gentle breathing exercises to kind of bring just like you were thinking, do a couple of keegles to kind of wake those tissues up. Just take some breaths to kind of help open up and expand the abdominals and then start walking on day one. So often our Cesrian moms want to

hunch over and it's so painful. But the more that you can push yourself upright, So walk the baby around in the bassinet in the hospital and kind of help that push yourself up into a more upright position so that your abdomen, your chest can open instead of just kind of staying hunched down, because long term that's going to make it a little bit more difficult for healing. Absolutely, And how about getting out of bed? How do you

recommend getting out of bed? And this is why we love to teach moms this during pregnancy, is that we encourage moms to roll to their side, so you kind of don't even use your abs, you roll all the way to your side, let your feet kind of dangle off the edge, and use your arms to push up so that you can allow those abdominal muscles to relax a little bit, and you're using your upper and lower body to help you so you don't have to do

that sit up position. This is another tip that I like to tell a lot of moms is to exhale when they're picking up the baby or when they're lifting something. If you hold your breath, it kind of like tightens up everything a little bit. But if you exhale gently picking up the baby or you know, pushing something, pushing the stroller, it helps those muscles relax a little bit and takes the pressure for abdomen. Do you have other tips for lifting or for bending to help with your

back pain? Yeah, I mean always like a squat position is better than like the bending over arching your back. Another thing is break down the load. I mean, my husband used to make fun of me because in my third trimester I would put the trash in a wagon and wheel it out to the backyard instead of like lugging the doing that will he traveled, so I was

so during the week. But that's a great question. You know, even things like that just break down the load instead of curing all of these huge things, doing smaller you know, little trips with smaller amounts. And a lot of us have other kids when we have when we give birth, So again, practice that explation when you're lifting the kiddos in and out of the car, in and out of the bathtub, and you can also hug them from a

sitting position. I know, I know, and it's it's hard and it's kind of sad because you feel like you can't do the things that you want to do. But it really does come back with time, oh for sure. So speaking of that, of course, your body has been through a lot. Your pelvis has been through a lot. All those muscles have been through a lot, a lot of stretching, a lot of pressure. So of course you're

going to expect some pain. How much pain should you expect if everything is normal, whether it's bad pain, paraneal pain, pelvic pain, and when did you start looking for help? Really within the first two weeks is when the majority of healing, real like wound healing, and if an infection is going to happen, If something's gonna happen, it's gonna

happen within the first two weeks. So after that two week mark, if you're really like something doesn't feel right my scar my paraneum, I'm like, you've got to go to the doctor, because that's when we really want to kind of start looking for red flags of infection and things like that. But even after those two week marks is when I start saying, like, start getting out and walking a little bit more. Start you know, we start

doing some breathing with some abdominal contractions. And if you're having pain even after that two week mark that doesn't just feel like exhaustion or deconditioning, but real pain, then I say go back to the doctor, and then you know, check in with the PT after you get that six week mark. I concur Yeah, so what do you mentioned walking? And walking, of course is a great exercise for late pregnancy also when you have a new baby, because first of all, the fresh air is going to do so

much good on every level. How do you at the same time rest up enough and also make sure that you're moving enough. How much exercise do you recommend and

what kind? At what point I really recommend the first week one to two weeks, you were like at home in bed, and I think the past year has really taught us that moving slowly and having less on our plates and less visitors can serve us well, oh my god, silver lining, silver lining, I know, and I think it was something that we all really felt like we needed to slow down, and especially our moms who had tons of visitors come over and we want to go to

lunches and things like that. So the first one to two weeks is focused on healing, doing things around the house. And I always say the rule of thumb is if you have an increase in pain or an increase in bleeding when you do an activity, you're probably overdoing it. That could be a load of laundry, dish is or a walk. Around two weeks, I say start getting outside to go for walks around the block, maybe fifteen minutes,

twenty minutes. If you feel okay, you can start doing two of those a day, and then you can start going for thirty minutes. So every week, just kind of bump it up a little bit, and then around six weeks starting to do more core exercises, really basic, not sit ups, but like little contractions and bridges and maybe some squats and things that kind of start some movement and then return to higher intensity around twelve weeks, and at this point you might be wondering core, what core?

How do we find that core and how do we best support it at that point, So around six weeks I encourage folks to start working more on specific core stuff. So I always start with the breath. I haven't you know, started doing some diaplematic breathing and then on the exhale of their breath, I haven't learned to contract their public floor to pull in their transverse abdominals. And that takes sometimes a little bit of work in practice, and that's why it's great to do it before birth as well.

But you know, working on some of those simple exercises and actually the foundation for everything, the keegel in the you know, lower abdominal contraction is the basis for all core exercises. So whether you're doing a push up, a plank, a squat, a lunch, you have to pull that pelvic for an abdomen in before you do it. Okay, So then there's sex or is there is there? There doesn't have to be. I mean, let's take the pressure off of moms. So like, you know, get right back to

it now. You get the clearance at six weeks, but you may not feel emotionally or physically ready. What do you want new parents to know about postpartum sex that the first time it may not feel comfortable. So a common think that a lot of our patients says that they don't realize it's going to be so dry. If you're lactating or breastfeeding, you typically have lower estrogen levels, which causes your vaginal tissues to feel drier. So I

say proactively use a lubricant. I like to use a water based lubrican in or some folks use an all natural coconut oil. The forecast is mainly dry for the time that, yes, go slowly, mainly dry, and honestly, if there's pain, stop like you don't need to push through the pain. You might just need a little bit more time for recovery, or you may have some scar tissue that's still healing as a paradem, or you may even need to do scar massage so to the Cesarean scar

or the barren Neil scar. So you know, I think that dryness taking it slow. If there's bleeding or pain, you obviously want to stop, and then you know, just kind of see how you feel. You may be a little bit sore afterwards, so it's okay to ice, But consistent pain with sex is not normal, So if it continues to be painful, I think it's worth addressing. Are

there certain postpartum positions that you would prefer? So? I think it's really variable, you know, depending on how somebody feels, But typically lying on your back kind of in your on your back and your partner's on top is a less penetrating position. Your partner behind you in the spooning position is less penetray rating, but if your partners behind you, that may be more penetrating and more uncomfortable. If you've had a para meal tear, that may be meant an

or more uncomfortable position. And then some women like to be on top because then they can kind of control the pace of it as well. So I would say the most kind of uncomfortable position right away might be a woman on their hands and knees and the partner behind them, and your your sexual gps may have changed quite a lot. You know, you should make sure you also listen to your body and see what's comfortable what's not. I think communication is key, you know, to kind of

express what you're feeling, what's going on. And I also think, you know, I really want to take some of the pressure that we feel as women, as moms afterwards, it's like we have to get back there. It's a six weeks. We feel bad for our partners and I used to feel this way. Or you can have insecurities about your body. You may be licking breast milk. I mean, you may

still be bleeding. There's so many things that I really think if we give ourselves some grace and some time for recovery, it doesn't have to be so traumatic for us or so um exhausting for us. Yeah, for sure. And the most important kind of intercourses the talking kind, right, Yeah, I call it outer course. Of course. Well that could mean something else too, which is also might be more comfortable at this point, exactly exactly. Not all roads have

to lead to, you know, vaginal sex. So there's a lot of options out there, yep, So explore those roads, Sarah. There are a lot of things that I wish I could go back in time and tell my newly delivered mom self about my postpartum recovery. Now that I know what to expect. But what is your most important message to all about to become moms about postpartum recovery? Yeah, I have three. I think this isn't being related to recovery, but it's related to postpartum. Is that to get help

with breastfeeding. I knew everything about pelvic floor and I had wonderful bursts and wonderful recoveries, but my biggest struggle was breastfeeding and I didn't know I didn't prepare enough for that, and I felt like that really almost made my postpartum traumatic or really difficult, and despite my pelvic floor being in good shape. So the second is to

take it slow. And it's such a generic and corny and cheesy term, but I just look at how fast I tried to get back to walking and running and socializing and wanting to get my body back, And you know, twelve weeks is a sliver of time in the big scheme of things. And I really find now that my mom's who take it slow and really give them some time to heal and then get back into fitness and exercise do way better in the long run. So that's a really big one. That's probably one of the bigger ones.

And then you know, lastly is that if it hurts, get help. You know, we don't have to deal with things. We don't have to suffer. And whether it's physical, emotional, mental, whatever the case may be, is to really um we mentioned this in our previous chat, but strength isn't isn't asking for help and not feeling like we just have to bear the weight of the world and power through, you know, and we're not going to use the phrase just do it. Yeah, and you don't have to just

deal with it. You know, we have so much to deal with us new moms. I think that you know, I'm really seeing this. It takes a village come back. And maybe we're doing it virtually or on social media, but I really see moms rising up together saying we've been through this and you know, here are some tips, here resources, here's this amazing podcast, and just really trying to support one another through the process. We know what I say, motherhood is the ultimate sisterhood. We've got to

help our sisters out, that's right. So thank you for helping us out today. We really really appreciate And for those who don't already follow you, where can they find you from? More tips. The biggest place I have a presence is on Instagram as the Vagina Whisperer, and then it's also the Vagina whisper dot com, where we have a ton of blog posts about pregnancy and birth and online resources and courses to help support moms. It's awesome. Thank you so much, Sarah, Thanks for having me Baby Belove,

my baby Belove. I need you, Oh how I need you. Thanks for listening. Remember I'm always here for you. What to Expect is always here for you. We're all in this together. For more on what you heard on today's episode, visit what to Expect dot com slash podcasts. You can also check out What to Expect when You're Expecting, What to Expect the First Year, and the what to Expect app. And we want to hear from you. Connect with us on our community message board or on our social media.

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