Still, you’re going to need plenty of patience, rest, and support while you heal. Here’s an idea of what to expect as a C-section recovery timeline over the first hours, days, and weeks.

Just after delivery

After surgery, you’ll remain under close observation for a few hours. At this point, you still won’t have feeling in your lower body, and you may feel woozy or shaky because of the pain medication and the shifts in your hormones after giving birth. But, barring any complications, you’ll be able to cuddle and breastfeed your baby right away. You can have baby wrapped skin to skin with you in recovery just after getting out of the operating room. This will help baby regulate their body temperature, breathing, and heart rate, and prepare them for successful breastfeeding.

The first 24 hours after delivery

After the observation period is over, you’ll be moved to the postpartum recovery area. 

In many cases, the pain medication you were given for surgery will be effective for 18-24 hours to help you stay comfortable, as the regional anesthesia numbing your lower body will wear off after a few hours. Don’t be surprised when you’re encouraged to get out of bed soon after regaining feeling in your legs. Your care team hasn’t forgotten that you’ve just had major surgery. Movement is a critical part of the healing process and helps reduce the risk of blood clots. 

Soon after delivery, a nurse will usually massage your uterus to encourage it to contract to its usual size. The firm pressure stimulates contractions, which can be unpleasant. However, it’s important because it helps prevent heavy postpartum bleeding.

The day after delivery

The day after your C-section, your healthcare team will typically remove your catheter. Walking back and forth to the bathroom will now become part of your routine. Your doctors will also remove your bandages around this time and replace them with small, sticky bandages called Steri-Strips. These strips can get wet, so you’ll be able to shower. When you do, let the soapy water run over the incision area but don’t scrub. After your shower, gently pat the area dry. 

Expect to wear a pad for the first several weeks (no tampons while you heal). After birth, you’ll experience a completely normal vaginal discharge called lochia — a combination of red and white blood cells and mucus. The lochia will be red and heavier for the first few days after birth. Then it will transition to red-brown and then to pink/brown of lighter bleeding over the following 2-3 weeks. Eventually, it will become a paler, white discharge for the remaining 3-4 weeks before resolving altogether. 

Gas bubbles can be a real pain while you wait for your bowels to start moving normally again. All the walking you’re encouraged to do should help, as can a stool softener and anti-gas medication. 

Days 3-4

Most people will be cleared to go home around this time. If you have staples rather than dissolvable stitches, your doctor will usually remove them at this time. Don’t worry; the removal process shouldn’t be painful at all. 

Before leaving, you’ll be given the full rundown on incision care, plus all the dos and don’ts during your C-section recovery. Don’t be afraid to ask any lingering questions about your healing and life with your new baby. You’ve got direct access to a team of experts right now, and be sure you know who and what number to call once your home if you need to contact a provider urgently.

The first week at home

You’re going to need a lot of support after you leave the hospital. Round up your inner circle and get specific about exactly what you need. Try to rest as much as you can and delegate tasks like errands, cooking and housework wherever possible. If it’s an option for you, you could hire a postpartum doula to come to your home occasionally to give you a break from infant care, or to do some light cleaning, or food prep for you and your family. Some doulas also provide lactation support that can be crucial in the first couple of weeks.

Don’t try to lift anything heavier than your baby for now. If you have stairs in your home, consider asking someone to help you move your essentials to the first floor so you’re climbing them as little as possible. If you were sent home with prescription pain medication, know that it is perfectly acceptable to use it as directed by your provider. You have to take care of yourself in order to be present and able to care for your baby. As you near the end of your prescription medications, you may want to transition to an over the counter pain medication. Most, like ibuprofen and acetaminophen, are safe for breastfeeding. Talk to your doctor about which is the best option for you.

A heating pad can help relieve cramping as your uterus continues to shrink. Drinking plenty of water and taking a stool softener as well as making sure you’re walking daily can help with constipation. You should also take care to nourish yourself often and well. Your body needs extra energy to heal and to produce breast milk for your baby if you are breastfeeding.

Two weeks out

Even though you still have much healing to look forward to, you can expect to feel much better at this stage. You might have a two-week incision checkup with your doctor. In the meantime, watch for signs of infection, which include warmth, redness, swelling, or oozing at the incision site, as well as fever. Call your doctor right away if you notice any of these symptoms. 

Once you’re no longer taking prescription pain medication and can use the gas and brake pedals in a car without any pain, you may be cleared to get back behind the wheel. But expect that you won’t be driving for two weeks at the very least. 

One month after your C-section

By now, moving around will likely feel much more comfortable. And you should find that the vaginal bleeding stops between now and the six-week mark. Other good news: you can usually take a bath by now if you like. And your doctor might give you the go-ahead for some types of light exercise, especially if you were active before and during pregnancy. 

C-section recovery week 6 and beyond

Congratulations! By this point, many people feel nearly or fully recovered. Your incision will have healed, leaving a scar that will fade with time. However, you may continue to feel slight discomfort or numbness at the incision site for months to come.

At your six-week checkup, your doctor might let you know that it’s okay to have sex. Keep in mind that when you are physically ready and emotionally ready may follow different schedules. Don’t rush this step and when you do decide to go for it, take things slow and steady.

Remember, everyone has their own healing timeline. So it’s crucial to listen to your body and not rush your return to normal. You’ve made it through six weeks of recovery with your now six-week-old baby. There’s so much to look forward to as your timeline together continues.

Reviewed by the Ovia Health Clinical Team

Sources

• “Births – Method of Delivery.” National Center for Health Statistics. Centers for Disease Control and Prevention. March 2, 2021. https://www.cdc.gov/nchs/fastats/delivery.html
• “C-section.” Mayo Clinic. Mayo Clinic. June 12, 2020. https://www.mayoclinic.org/tests-procedures/c-section/about/pac-20393655
• “Pain Management for C-Sections.” Yale Medicine. Yale Medicine. https://www.yalemedicine.org/conditions/anesthesia-for-c-section
• “Cesarean Birth FAQs.” Acog.org. The American College of Obstetricians and Gynecologists. 2021. https://www.acog.org/womens-health/faqs/cesarean-birth

Postpartum depression is the most common health problem of pregnancy. Up to one in five mothers will experience postpartum depression. Like other types of depression, people with PPD may have the following symptoms:

• Loss of interest in activities
• Feelings of sadness, guilt, and worthlessness
• Reduced ability to feel pleasure
• Fatigue
• Trouble learning new things, focusing, remembering, or making decisions
• Difficulty connecting with your baby
• Thoughts of harming oneself or the baby
• Suicidal thoughts

How does zuranolone work?

Zuranolone is a lab-created form of allopregnanolone thought to help improve mood and treat PPD. Allopregnanolone is a form of progesterone that helps lower anxiety and the symptoms of depression. Low levels of it after birth may be linked to PPD symptoms. 

How is it different from other treatments for PPD?

Zulresso (brexanolone) is the only other existing treatment specifically for PPD. The intravenous therapy takes over 60 hours and requires a hospital stay of two and a half days. Other depression drugs don’t usually work as fast or target PPD and can take months to show improvement.

What are its side effects?

Drowsiness, dizziness, diarrhea, and fatigue are the most common side effects of zuranolone. The treatment has an FDA box warning about the risk of impaired driving or attention while on the medication.

Is it safe to take while breastfeeding?

Study participants were asked to stop breastfeeding while part of the study. So, the effects on breast milk, a nursing baby, or changes in milk production are unknown. Talk to your provider about whether breastfeeding while taking zuranolone is right for you. 

Will insurance cover zuranolone?

As with most new drugs, some companies may pay for them, and others will not. Check with your insurance provider and ask if they will cover this drug before it is prescribed to you to avoid unnecessary costs. 

Read more

• Postpartum depression: baby blues or something more?
• Postpartum by week

But what if you found out that BMI is not a useful indicator of your health? BMI is actually a deeply flawed calculation that was only intended to be used for populations, not for individuals.

Let’s break down the fraught history behind BMI.

BMI: The backstory

BMI (first called the Quetelet Index) was invented by a Belgian mathematician (you read that right, not a doctor) named Lambert Adolphe Jacques Quetelet in the early 19th century. He set out to find the “average man” by studying the height and weight of (mostly) European men. His work excluded women and people of color. 

BMI, a calculation of weight (in kilograms) divided by height in (meters squared), was later picked up by health insurers and medical providers in the U.S. They used various BMI categories (underweight, normal weight, overweight, obese, and morbidly obese) to determine insurability and individual health. 

Is this starting to raise some red flags for you?

OK, but does it work?

The short answer is no, it does not work and there are a few reasons why.

1. BMI was originally created to indicate population health, not to determine individual health.

Quetelet was a statistician. His intention was to collect large amounts of data to uncover population-level trends, not to assess an individual’s health or risk factors. 

2. These categories are problematic for individuals who were left out of the original studies

Given the fact that so many groups were excluded from the development of BMI in the first place, it doesn’t make much sense to apply it to them retrospectively. Further, BMI suggests that there is an ideal height/weight ratio. This is simply not true.

3. BMI equates muscle, fat, and bone

The body is made up of (among other things): bones, muscles, and fat. BMI groups all these categories together into one, treating bone, muscle, and fat the same. Not only that, but which out of these three parts of the body weighs the most? Bone. The least? Fat.

So is there a better way to calculate health?

There are alternative calculations of health informed by weight, but the issue at play here goes far beyond the biased history of BMI or its misguided application to individuals, because even weight itself is not a strong indicator of health. Research has shown that simply changing one’s body weight is not a reliable measure of improvement in one’s health. 

If you’re looking to feel stronger and healthier, there are things you can do, like starting a health promoting behavior. 

Here are a few examples of health promoting behaviors

• Setting a goal to drink more water
• Figuring out what type of exercise you enjoy and doing it consistently
• Finding a mindfulness practice that helps you tune into your inner needs
• Intuitive eating: listening to your body’s requests for nourishing food

Setting goals like these – that are based on how you feel, how your body functions, and what you personally need to be living in a healthier body – is more reliably associated with improvement in overall health. 

Providers that rely too heavily on BMI might be missing the whole picture of your health. If you’re concerned that your provider isn’t understanding the whole picture of your health, seek out a HAES (Health At Every Size) aligned healthcare provider. There are therapists, body image coaches, doctors, nurses, and dietitians who are all trained in HEAS. You deserve to feel seen and cared for by your provider, regardless of your BMI or the size of your body. 

Reviewed by the Ovia Health Clinical Team

Read more

• Pregnancy in a bigger body
• Tracking your weight during pregnancy

Sources

• Brazier, Yvette. “How Useful Is Body Mass Index (BMI)?” Medical News Today. MediLexicon International. September 6, 2021. https://www.medicalnewstoday.com/articles/255712.    
• Jackson-Gibson, Adele. “The Racist and Problematic Origins of the Body Mass Index.” Good Housekeeping. Good Housekeeping. November 1, 2021. https://www.goodhousekeeping.com/health/diet-nutrition/a35047103/bmi-racist-history/. 
• “Adult BMI Calculator.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention. January 21, 2022. https://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/english_bmi_calculator/bmi_calculator.html. 
• “About Adult BMI.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention. August 27, 2021. https://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/index.html. 
• The MNT Editorial Team. “BMI calculations and charts.” Medical News Today. Medical News Today. May 3, 2021. https://www.medicalnewstoday.com/articles/323586. 
• Devlin, Keith. “Top 10 Reasons Why the BMI Is Bogus.” NPR. NPR. July 4, 2009. https://www.npr.org/templates/story/story.php?storyId=106268439. 
• Eknoyan G. Adolphe Quetelet (1796-1874)–the average man and indices of obesity. Nephrol Dial Transplant. 2008 Jan;23(1):47-51. doi: 10.1093/ndt/gfm517. Epub 2007 Sep 22. PMID: 17890752.

Still, you’re going to need plenty of patience, rest, and support while you heal. Here’s an idea of what to expect as a C-section recovery timeline over the first hours, days, and weeks.

Just after delivery

After surgery, you’ll remain under close observation for a few hours. At this point, you still won’t have feeling in your lower body, and you may feel woozy or shaky because of the pain medication and the shifts in your hormones after giving birth. But, barring any complications, you’ll be able to cuddle and breastfeed your baby right away. You can have baby wrapped skin to skin with you in recovery just after getting out of the operating room. This will help baby regulate their body temperature, breathing, and heart rate, and prepare them for successful breastfeeding.

The first 24 hours after delivery

After the observation period is over, you’ll be moved to the postpartum recovery area. 

In many cases, the pain medication you were given for surgery will be effective for 18-24 hours to help you stay comfortable, as the regional anesthesia numbing your lower body will wear off after a few hours. Don’t be surprised when you’re encouraged to get out of bed soon after regaining feeling in your legs. Your care team hasn’t forgotten that you’ve just had major surgery. Movement is a critical part of the healing process and helps reduce the risk of blood clots. 

Soon after delivery, a nurse will usually massage your uterus to encourage it to contract to its usual size. The firm pressure stimulates contractions, which can be unpleasant. However, it’s important because it helps prevent heavy postpartum bleeding.

The day after delivery

The day after your C-section, your healthcare team will typically remove your catheter. Walking back and forth to the bathroom will now become part of your routine. Your doctors will also remove your bandages around this time and replace them with small, sticky bandages called Steri-Strips. These strips can get wet, so you’ll be able to shower. When you do, let the soapy water run over the incision area but don’t scrub. After your shower, gently pat the area dry. 

Expect to wear a pad for the first several weeks (no tampons while you heal). After birth, you’ll experience a completely normal vaginal discharge called lochia — a combination of red and white blood cells and mucus. The lochia will be red and heavier for the first few days after birth. Then it will transition to red-brown and then to pink/brown of lighter bleeding over the following 2-3 weeks. Eventually, it will become a paler, white discharge for the remaining 3-4 weeks before resolving altogether. 

Gas bubbles can be a real pain while you wait for your bowels to start moving normally again. All the walking you’re encouraged to do should help, as can a stool softener and anti-gas medication. 

Days 3-4

Most people will be cleared to go home around this time. If you have staples rather than dissolvable stitches, your doctor will usually remove them at this time. Don’t worry; the removal process shouldn’t be painful at all. 

Before leaving, you’ll be given the full rundown on incision care, plus all the dos and don’ts during your C-section recovery. Don’t be afraid to ask any lingering questions about your healing and life with your new baby. You’ve got direct access to a team of experts right now, and be sure you know who and what number to call once your home if you need to contact a provider urgently.

The first week at home

You’re going to need a lot of support after you leave the hospital. Round up your inner circle and get specific about exactly what you need. Try to rest as much as you can and delegate tasks like errands, cooking and housework wherever possible. If it’s an option for you, you could hire a postpartum doula to come to your home occasionally to give you a break from infant care, or to do some light cleaning, or food prep for you and your family. Some doulas also provide lactation support that can be crucial in the first couple of weeks.

Don’t try to lift anything heavier than your baby for now. If you have stairs in your home, consider asking someone to help you move your essentials to the first floor so you’re climbing them as little as possible. If you were sent home with prescription pain medication, know that it is perfectly acceptable to use it as directed by your provider. You have to take care of yourself in order to be present and able to care for your baby. As you near the end of your prescription medications, you may want to transition to an over the counter pain medication. Most, like ibuprofen and acetaminophen, are safe for breastfeeding. Talk to your doctor about which is the best option for you.

A heating pad can help relieve cramping as your uterus continues to shrink. Drinking plenty of water and taking a stool softener as well as making sure you’re walking daily can help with constipation. You should also take care to nourish yourself often and well. Your body needs extra energy to heal and to produce breast milk for your baby if you are breastfeeding.

Two weeks out

Even though you still have much healing to look forward to, you can expect to feel much better at this stage. You might have a two-week incision checkup with your doctor. In the meantime, watch for signs of infection, which include warmth, redness, swelling, or oozing at the incision site, as well as fever. Call your doctor right away if you notice any of these symptoms. 

Once you’re no longer taking prescription pain medication and can use the gas and brake pedals in a car without any pain, you may be cleared to get back behind the wheel. But expect that you won’t be driving for two weeks at the very least. 

One month after your C-section

By now, moving around will likely feel much more comfortable. And you should find that the vaginal bleeding stops between now and the six-week mark. Other good news: you can usually take a bath by now if you like. And your doctor might give you the go-ahead for some types of light exercise, especially if you were active before and during pregnancy. 

C-section recovery week 6 and beyond

Congratulations! By this point, many people feel nearly or fully recovered. Your incision will have healed, leaving a scar that will fade with time. However, you may continue to feel slight discomfort or numbness at the incision site for months to come.

At your six-week checkup, your doctor might let you know that it’s okay to have sex. Keep in mind that when you are physically ready and emotionally ready may follow different schedules. Don’t rush this step and when you do decide to go for it, take things slow and steady.

Remember, everyone has their own healing timeline. So it’s crucial to listen to your body and not rush your return to normal. You’ve made it through six weeks of recovery with your now six-week-old baby. There’s so much to look forward to as your timeline together continues.

Reviewed by the Ovia Health Clinical Team

Read more

• C-section incision area
• Mental health postpartum

Sources

• “Births – Method of Delivery.” National Center for Health Statistics. Centers for Disease Control and Prevention. March 2, 2021. https://www.cdc.gov/nchs/fastats/delivery.html
• “C-section.” Mayo Clinic. Mayo Clinic. June 12, 2020. https://www.mayoclinic.org/tests-procedures/c-section/about/pac-20393655
• “Pain Management for C-Sections.” Yale Medicine. Yale Medicine. https://www.yalemedicine.org/conditions/anesthesia-for-c-section
• “Cesarean Birth FAQs.” Acog.org. The American College of Obstetricians and Gynecologists. 2021. https://www.acog.org/womens-health/faqs/cesarean-birth

Unplanned but not unprepared

A C-section may be planned ahead of time if you’ve had one previously or develop certain pregnancy complications. But sometimes, people find out they will need one once labor is already underway. In those cases, things can move quickly, and the sense of urgency may feel overwhelming and scary. Having an understanding of what a C-section entails — before, during, and after — can help you feel more in control. 

Rest assured, your medical team is highly experienced in delivering babies this way. They know every step they have to take to keep you and your baby as safe as possible. While they may look very busy and hurried, you should also know that it is always within your rights to ask questions. You aren’t inconveniencing them. This is your body and your baby and you deserve to understand your provider’s decisions.

In most cases, your partner or support person can be by your side for a cesarean birth. While they may have to wait outside as you’re getting situated in the operating room, as long as you’re awake for the procedure, they should be there right by the head of your bed with you.

Know that It’s completely normal to have some difficulty letting go of the birth you had envisioned. It may take time — like any grief process — to work through everything you feel afterwards. 

What will happen?

A C-section is a surgical procedure. This means that you’ll be moved into the operating room. It’s a very bright, sterile environment that can be intimidating and it’s often a little chilly in the operating room. You can ask for a warm blanket across your arms if that feels comforting. Because you’re having surgery, you will be given fluid and medication through your intravenous (IV) line. You’ll lay down on the operating table and your abdomen will be washed. Then, you’ll have a blood pressure cuff and a pulse oximeter (clip on your finger to measure your oxygen levels) placed for monitoring. If you don’t already have one, a nurse will likely insert a catheter to collect urine as well. 

Regional anesthesia vs. general anesthesia

In most cases, you’ll receive regional anesthesia — typically a spinal or epidural block — so you’ll remain awake during the procedure but you won’t feel any pain. This means you’ll still be able to experience the birth and be ready to greet your baby immediately after delivery. In rare situations or emergencies, general anesthesia may be required, which would mean you’d be in a sleep-like state for the delivery. Again, this is reserved for rare cases when there isn’t time to place the regional anesthesia and is only done when it’s in your and your baby’s best interests.

What will it feel like?

Before surgery, a curtain is drawn between your upper and lower body to help you stay relaxed. Your partner can sit behind this curtain at the head of your bed while you await your little one’s arrival. You’ll also have an anesthesia provider right there with you whose sole purpose is to make sure you are okay. They can answer your questions and help treat uncomfortable symptoms (like nausea) should they arise. Once your surgeon has made sure you’re completely numb, they’ll make a horizontal or vertical incision in your lower abdomen and then another in your uterus to deliver your baby. Next, they’ll cut the umbilical cord and remove the placenta. Then your medical team will stitch you back up. The entire process is usually done in about an hour. 

Will I really feel nothing?

The anesthesia will ensure there’s no pain at all. However, there may be other sensations. Some women report feeling tugging, pressure, or shortness of breath as their doctor presses on their uterus and eases the baby out. It’s also possible to experience light shaking or shivering, which can be a side effect of a spinal block and is no cause to worry. 

None of these sensations should hurt; however, they might feel strange or even frightening. Using a breath technique or relaxation practice can help you through it, as can leaning on your support person. Keep your doctor and anesthesiologist informed about how you feel so they can ensure you remain as comfortable as possible. 

What happens with my baby?

Just like with vaginal delivery, unless there is an immediate medical need, you’ll be able to see your baby right away. As long as you’re feeling well enough, after the umbilical cord is cut and your baby is dried gently, they can be placed on your bare chest for skin-to-skin contact. Depending on your hospital and how you’re feeling, you may even be able to try breastfeeding in the operating room or recovery area. If you’re not up for having baby on your chest, you can have your partner hold baby cheek to cheek with you to get that skin to skin contact and feel the soothing presence of your baby near to you.

How will I feel after?

After birth of any type, you’ll probably feel sore, elated, and exhausted. However, a C-section is a major surgery, so the healing timeline may be longer than with vaginal birth, and you will likely be in the hospital for an extra day or two. 

In the hours after birth, you will receive pain medication to help you remain comfortable as the anesthesia wears off. You can spend time skin to skin with baby, start to breastfeed, and check out all their little fingers and toes. You may also feel really sleepy so this might be a good time for your partner to do some bonding while you rest.

When can I eat?

At this point you’ll be able to slowly start to eat some ice chips and drink some fluids. Once you’re feeling well enough, you’ll be encouraged to drink plenty of fluids and eat your first meal. Usually the day of your C-section or the morning after (depending on what time of day your surgery was), you’ll get up to walk around with the help of your nurse. You’ll gradually get better at this and will be encouraged to get up several times a day, which will help prevent constipation and reduce the risk of blood clots in your lower extremities.

In the days following the birth, your care team will keep a close eye on your incision to watch for bleeding or any signs of infection. During this time, you’ll most likely experience cramping in your uterus and vaginal bleeding as you would after a vaginal birth.

The first weeks

Over the first few weeks of recovery, it’s important to rest as much as possible and avoid lifting anything heavier than your baby. So get ready for plenty of snuggling and cuddling as you heal. Expect that movement may be uncomfortable and deep bending is off the table until usually four to six weeks after delivery. It is still important to continue doing several short walks a day, which over time you’ll be able to slowly increase in length. The physical limitations can be extremely challenging and frustrating as a new parent, so lean on your support system wherever possible. Full recovery typically takes about six weeks, so it may make sense to consider how you would handle this recovery period now, just in case. 

You’ve got this

(And we’ve got you.) Ovia’s goal is to help you have your healthiest pregnancy and most empowered birth experience. Part of that is feeling ready to make decisions with your healthcare provider that prioritize your and your baby’s safety and wellbeing. This information is meant to help you feel prepared and reassure you that birth can still be beautiful, even when it doesn’t go exactly as planned. 

Reviewed by the Ovia Health Clinical Team

Read more

• C-section incision area
• Mental health postpartum

Sources

• “Births – Method of Delivery.” National Center for Health Statistics. Centers for Disease Control and Prevention. March 2, 2021. https://www.cdc.gov/nchs/fastats/delivery.html
• “C-section.” Mayo Clinic. Mayo Clinic. June 12, 2020. https://www.mayoclinic.org/tests-procedures/c-section/about/pac-20393655
• “Pain Management for C-Sections.” Yale Medicine. Yale Medicine. https://www.yalemedicine.org/conditions/anesthesia-for-c-section
• “Cesarean Birth FAQs.” Acog.org. The American College of Obstetricians and Gynecologists. 2021. https://www.acog.org/womens-health/faqs/cesarean-birth

Vaginal and perineal tears 

It is not uncommon for those who give birth vaginally to experience a tear. When the tear happens between the vagina and anus, this is called a perineal tear. These are classified as either 1st, 2nd, 3rd, or 4th degree tears. Tap here for a digital image of the difference between these tears. 

It’s also possible to have small tears in other locations, within the vagina, on the outer or inner labia, or upwards near the urethra or clitoris. These are less common, and the care for them will be similar to a perineal tear.

1st and 2nd degree tears

A 1st degree tear impacts the perineal skin only whereas a second-degree tear impacts the skin and muscles of the perineum. In the case of 1st and 2nd degree tears, you may experience a stinging sensation or mild pain in the weeks after giving birth. In most cases, 2nd degree tears will require stitches. 

You may experience vaginal and/or perineal soreness in the weeks after childbirth. You can expedite the healing process by applying ice packs for the first 24-48 hours, and avoid straining. Washing your private areas with warm water during and after you use the toilet may also help relieve some of the discomfort. Squirt bottles may help. Sitz baths are also a great option (more on this below)

Trouble with urination

In the days after birth you may feel a burning sensation and/or pain from lacerations around or close to the urethra. Childbirth can also affect the tissue around your urethra and bladder, which might mean you need to set reminders to pee.

Temporarily leaking urine is common for up to 2-3 months after delivery, and is more likely if you were experiencing leakage during pregnancy. You should call your healthcare provider if you feel you aren’t urinating enough or if you’re concerned about urine leakage or pain. 

Obstetric anal sphincter injuries (OASIS)

3rd and 4th degree tears are considered obstetric anal sphincter injuries and require repair. The anal sphincters are the muscles that wrap around the anus and allow you to control gas and stools. Damage to them occurs in about 1-11% of deliveries and can be painful and slower to heal. 

OASIS risk factors

There are pre-existing risk factors for OASIS such as giving birth for the first time, infant weight over 8.8 pounds, advanced maternal age, VBAC, and shorter height. These are generally factors you cannot control.

However, some controllable risk factors may be:

• Use of midline episiotomies
• Use of vacuum or forceps
• Oxytocin administration
• The baby is in occiput posterior position, meaning facing up while you’re on your back

There are things you and your OB provider can do before or during labor to limit your risk of having a severe tear, like perineal massage and applying warm compresses during labor. 

Treatment options and recommendations

There are many treatment options for those who experience OASIS. A bowel regimen, including a fiber supplement and a stool softener, is strongly recommended for 3rd and 4th degree tears and sitz baths are recommended for everyone. 

Sitz bath

A common way to soothe sore areas after birth is with a sitz bath. Sitz baths involve exposing your perineum to warm water, medication, or Epsom salt, depending on what your provider recommends. In general, doing this in a tub with a few inches of water is preferred. If you don’t have access to a tub, you can purchase (or your hospital may give you) a disposable sitz bath that attaches to your toilet. Disposable sitz baths are not as comfortable, and should only be used for a few minutes at a time.  

If you have stitches from a tear, your recovery may be a bit more painful. There are things you can do to reduce discomfort like applying ice packs during the first 24-48 hours and keeping the area clean with squirt bottles and cotton soaked with witch hazel. You can also find pre-soaked witch hazel pads (usually marketed for hemorrhoid relief). Chill them in the refrigerator or freezer for a soothing cooling effect. 

It can be scary to think about vaginal and perineal tears before you give birth, but keep in mind that OASIS are uncommon and should you experience one, there are trained healthcare providers — including obstetricians and urogynecologists — to guide you at every step. There are also designated postpartum clinics to treat women with obstetric trauma.

Reviewed by the Ovia Health Clinical Team

Read more

• What is perineal massage?
• Recovering from childbirth

Sources

• Jango¨ H, Langhoff-Roos J, Rosthøj S, et al. Modifiable risk factors of obstetric anal sphincter injury in primiparous women: a population based cohort study. Am J Obstet Gynecol 2014;210:59.e1-6.
• André K, Stuart A, Källén K. Obstetric anal sphincter injuries—Maternal, fetal and sociodemographic risk factors: A retrospective register-based study. Acta Obstet Gynecol Scand. 2022; 101: 1262-1268. doi: 10.1111/aogs.14425

While there are pelvic floor-related conditions unrelated to pregnancy, we won’t be discussing those here. 

What are the pelvic floor muscles?

The pelvic floor is the set of muscles beneath your pelvic organs that support them, often referred to as a hammock. The pelvic floor wraps around the bladder, rectum, and both uterus and vagina (or prostate in men). Pelvic floor muscles control bladder and bowel function — this is why you can feel your pelvic floor muscles relaxing when, for example, you go to the bathroom. They also work together with other muscles to stabilize your spine. Having trouble visualizing the pelvic floor? Head to the first episode of our pelvic floor strengthening series in Ovia Parenting with Dr. Amy Hoover, where she explains it. 

What about during pregnancy?

During pregnancy, your pelvic floor muscles are working harder than they were pre-pregnancy, providing a solid foundation for your expanding uterus. This increased pressure can cause many people to experience frequent urination, lower back pain, or incontinence during pregnancy. 

What about postpartum?

Now, let’s get into some common symptoms during pregnancy and postpartum. While some of these symptoms can feel scary, they are also all treatable and it can be helpful to prepare for them. 

The pelvic floor muscles may be strained or injured during vaginal delivery. There are other reasons the pelvic floor might be strained, for example, during surgery or with age. The most common side effect is urinary incontinence.

OAB or Overactive Bladder

An overactive bladder, or the frequent or very pressing need to urinate, can be incredibly uncomfortable and frustrating. OAB is extremely common — 40% of women in the U.S. have OAB symptoms. 

Urinary incontinence

Urinary incontinence is the inability to control your bladder, which can result in leaking urine. There are two types: stress incontinence and urge incontinence. Stress incontinence might be triggered by coughing, sneezing, or laughing. Urge incontinence, which is a form of OAB, involves the involuntary loss of urine associated with a sudden need to pass urine. 

UI is particularly common during pregnancy and after birth as it can be the result of strained pelvic floor muscles and/or hormone changes. If you’re finding that urinary incontinence is impacting your day by preventing you from doing certain activities that you enjoy, that’s your sign to contact a provider. 

Flatulence incontinence

The inability to control gas. This is common but can be extremely frustrating. As with fecal urgency and incontinence (below), strengthening your pelvic floor muscles can help.

Fecal urgency and incontinence

The inability to control bowel movements. As with urinary incontinence, those with fecal incontinence can experience a range of severity, from small occasional bowel accidents to complete loss of bowel control. 

Seeking treatment 

While many people feel uncomfortable or embarrassed about these symptoms, we guarantee you that your provider really has seen it all before. There are treatment options and you deserve to have access to them. 

Pelvic floor exercises

Exercises (like kegels) can strengthen your pelvic floor muscles, and address or prevent issues of urinary and/or fecal incontinence. To learn more about how to do these exercises head here or talk to your provider. 

Kegels

A kegel is an exercise that involves tightening and lifting the pelvic floor and is an effective way to improve symptoms associated with a strained or weakened pelvic floor. Consult a provider before doing them during pregnancy or in the postpartum period. For more information on pelvic floor strengthening head here.

Once you get good at them, you can do your kegels from anywhere, no equipment needed. To learn more, watch our pelvic floor strengthening series. 

This content was reviewed by Dr. Lisa Hickman and Dr. Katie Propst. Dr. Hickman runs the Childbirth Pelvic Floor Disorders Clinic at The Ohio State University Wexner Medical Center. Dr. Propst runs the Postpartum Care Clinic at Cleveland Clinic. 

Read more

• Don’t be floored by postpartum pelvic floor dysfunction 
• Mental health postpartum

Sources

• “Accidental Bowel Leakage.” American Urogynecologic Society. 2016. https://www.augs.org/assets/2/6/ABL.pdf. 
• “Pelvic Floor Dysfunction: Symptoms, Causes & Treatment.” Cleveland Clinic. my.clevelandclinic.org/health/diseases/14459-pelvic-floor-dysfunction.
• Mayo Clinic Pelvic Floor Dysfunction Program in Minnesota. Mayo Clinic. February 5, 2021. https://www.mayoclinic.org/departments-centers/pelvic-floor-dysfunction-program/overview/ovc-20467221. 
• Mayo Clinic Staff. “What to expect after a vaginal birth. Mayo Clinic. Mayo Clinic. March 11, 2020. https://www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/in-depth/postpartum-care/art-20047233.
• Yvonne Butler Tobah, M.D. “What can I do to treat hemorrhoids during pregnancy?” Mayo Clinic. Mayo Clinic. August 16, 2019. https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/expert-answers/hemorrhoids-during-pregnancy/faq-20058149.

We won’t sugar coat it — using the bathroom after a vaginal delivery can hurt. Many people feel nervous about their first bowel movement, especially after tearing and stitches. Even urination can seem daunting. Many people are not effectively counseled about the difficult process of the first bathroom break after birth, but there are ways to help manage the discomfort. 

Urine

When at the hospital, most women will receive a gift from the postnatal-gods called a peri-bottle. This little spray bottle can be used to facilitate urination (and more solid bowel movements) long after the hospital stay is over. Fill it up with warm water and make sure to spray before, during, and after urination for best results. Wiping can be especially painful, so try to stick to the spray and blot method for at least a week after birth. Going to the bathroom may be more painful for those who experienced a tear, so ask your healthcare provider about the safest over-the-counter pain medications to use during this time, in case you end up needing them later.

Just like with so many other types of pain, some of the best ways to soothe your body involve applying either heat or cold. During the first 24-48 hours after birth, many people find a cooling pack or an ice pack to the perineum to be very comforting. After that time period, a warm sitz bath is helpful for both cleanliness and comfort.

You can either take a sitz bath in a bathtub or with a sitz bath bowl. Regardless of which option you choose, you can do this 2-3 times a day. Make sure to expose the affected area to the water for 10-20 minutes. If the water starts to feel too cold, refill it. Dry the area gently and if your provider has recommended it, apply a topical treatment. 

Now some more information about your options: 

Bathtub sitz bath

If you have a bathtub at home, clean your tub well before doing a sitz bath. Fill the clean tub with warm water (a few inches deep), and — depending on what your provider recommends — add in medication or salt. When you’ve filled the bath, lower yourself slowly into the water until the affected area is submerged and breathe deeply. Like when salt gets in a cut, you might feel a stinging sensation at first, but it should ease after a minute or two.

Sitz bath bowl

If you don’t have a bathtub at home, or you’re worried about lowering yourself into one, a sitz bath bowl is a good option — you can find them at most pharmacies. Place your sitz bowl securely on the toilet rim and fill it with warm water (make sure the temperature is comfortable). As with the sitz bath, add in medicine or salt (depending on your provider’s recommendation). The specific way that the bath bowl is filled and emptied varies depending on the brand, so make sure to read the instructions. Lower yourself down until you’re sitting on the bath bowl. 

Witch hazel can also be used to relieve pain. It is used most effectively on pads or washcloths. You can buy pre-soaked witch hazel pads, which are usually marketed for hemorrhoid relief, or make your own by soaking pads, and then chilling them in the refrigerator before sticking them in your underwear. If you choose the washcloth route, make sure to use ones you’re not afraid of getting dirty or even throw away. These can be also frozen as well for an even cooler effect. 

Bowel movements

Urination is sort of imminent after birth, but your first bowel movement might not come for several days after you leave the hospital. Here are some time-tested tips that will allow your body to regulate itself as swiftly and painlessly as possible.

• Hydrate: Water will not only help you out if you’re breastfeeding, but will also act as a natural stool softener.
• Get your fiber: In addition to a fiber supplement, prune juice, raisins, and leafy greens, among others, are excellent sources of fiber to help you keep everything moving in the days and weeks after giving birth.
• Stool softener: Fiber-rich foods help to make your stool soft, but sometimes the natural way just doesn’t cut it. You’ll probably be offered over-the-counter remedies at the hospital or birthing center, but you can also talk to your healthcare provider about other stool-softening medications.
• Remember that a little constipation is natural: Your body’s high levels of progesterone, your digestive system slowing down substantially during birth, and other drugs such as iron supplements or pain relievers can all cause constipation. It can help to eat hydrating fruits (like watermelon), vegetables, and other nourishing foods with high water content.

If you’re really afraid to go because you’ve had a severe tear, your provider should recommend a stool softener and a fiber supplement after delivery.

To ease pain and boost confidence that you won’t burst any stitches, fold a pad in half and hold it next to your perineum or over your stitches for support. This will reduce the pain that occurs from the downward movement of your perineum. You can also heat up baby wipes, prop your feet up on a stool to aid bowel positioning, and talk to your healthcare provider about other positions that might help your body out. Use the stool softeners and fiber supplement to help achieve soft stool that passes easily without straining.

A little pain is natural, but if painful bowel movements continue, talk to your healthcare provider.

This content was reviewed by Dr. Lisa Hickman and Dr. Katie Propst. Dr. Hickman runs the Childbirth Pelvic Floor Disorders Clinic at The Ohio State University Wexner Medical Center. Dr. Propst runs the Postpartum Care Clinic at Cleveland Clinic. 

Read more

• Postpartum urinary incontinence
• When to consider seeing a pelvic floor specialist

Sources

• “Assisted Vaginal Delivery.” ACOG. December 2020. https://www.acog.org/Patients/FAQs/Assisted-Vaginal-Delivery. 
• Kathleen Rice Simpson and Patricia A Creehan. Perinatal Nursing. The American Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN), Wolters Kluwer, Lippincott Williams & Wilkins. 2008. 3rd ed. Web.
• “Taking a Sitz Bath.” Saint Lukes. Saint Lukes. https://www.saintlukeskc.org/health-library/taking-sitz-bath. 

1. Prepare for uncertainty 

While we can probably all agree that accepting “uncertainty as the only certainty” is easier said than done, most of us worry less about uncertainty when we feel prepared. Writing a birth plan helps channel any anxious energy into something productive. Use your sense of accomplishment from creating your rock-star birth plan to help you conquer your fear of childbirth.

2. A birth plan helps you get to know your provider better

Talking early (anytime after 25-30 weeks) and often about your childbirth and postpartum plan helps you confirm that you have chosen the right provider for you. The right provider for you is someone who listens to you and who you can trust. When you trust your provider (or provider team), you can feel more confident that they have your best interest at heart.

3. Choose who should attend the main event

Just as you need to know that your provider has your back, you want to make sure the right people are around you when contractions start for real. (Who knows, maybe you have always been waiting for the chance to be able to tell your MIL to take a hike?) A birth plan can be a tactful way to have these difficult conversations before you’re in labor. Nobody wants family drama in their delivery room!

4. Birth plan = partner’s prep

Even if your partner is an OB/GYN, that doesn’t mean they know exactly how to support you in the delivery room. Every birth partner needs to prepare, regardless of who they are. Researching, writing, and talking about a birth plan together can help ease your birth partner’s worries too. The last thing you want to be worrying about in labor is your partner worrying about you.

5. Let your knowledge help you reclaim your power

Learn about what is and isn’t normal during pregnancy, delivery, and postpartum. There is a reason why What to Expect When You’re Expecting was such a blockbuster success — expectant parents need information to prepare. So geek out all you want on crafting the mother-of-all birth plans — doing so will help you prepare for the main event. You’ll feel more confident, powerful, and in control because less will be new, unfamiliar, or unknown during your delivery and postpartum.

6. Establish open lines of communication

Many people who are afraid of childbirth worry that they will not have a voice in decision-making. When it comes to a good birth, over communication is the name of the game. Talking about your birth preferences early and often with as many people as possible will likely help reduce your anxiety. Think of your birth plan as your opportunity to tell your doctor and labor and delivery nurses what you do and don’t want to happen at your delivery. The more practice you get talking about complicated health information with healthcare providers, the more your self-confidence and power will grow. It is time to claim your seat at the table (or birthing stool in the delivery room as the case may be).

Worrying less during pregnancy is good for you and your baby. A June 2013 review in ​Obstetric Medicine​ also found that prenatal stress — like fears about childbirth — can have lasting physical consequences for both expecting parents and their babies, including low birth weight, premature delivery, and gestational diabetes. Writing your birth plan can help you meet uncertainty with acceptance, not anxiety. When your birth plan is flexible and comprehensive, both you and your birth team can turn to it as a good birth wishlist — a guide to what matters most to you as you enter the next chapter of your life as an expectant parent.

Read more

• Building a birth plan
• Finding an OB/GYN or midwife

If I am infected with COVID-19 during delivery, what will happen to my baby after delivery?

If you are suspected of or are confirmed to have COVID-19 during your delivery, your baby will likely undergo testing to confirm their infection status and will be isolated from other healthy infants while receiving their normal newborn care [1]. You and your baby may be encouraged to share a room (“rooming-in”).

Can I breastfeed and have skin-to-skin contact with my baby if I am infected with COVID-19?

There are currently no known cases where COVID-19 infections have been transmitted through breast milk [2, 3], so breast milk itself is safe to feed your baby. 

Experts believe that it is reasonable to directly breastfeed your baby with proper precautions, such as wearing a mask and washing hands thoroughly [4]. We know that with other illnesses, you pass antibodies to your baby through your breast milk. Antibodies are what your body makes to help fight off illness. The research into COVID antibodies in breastmilk is really encouraging and suggests that antibodies are passed through breastmilk after infection or vaccination for about 90 days.

Rooming-in and skin-to-skin contact are still recommended. While it is the birthing parent’s choice how to participate in these practices, there are many benefits, including better breastfeeding, temperature control, blood sugar, and parent-child bonding. Still, it is very important to wear a mask over your mouth and nose and to clean your hands frequently. And when you’re not nursing, the CDC recommends having Baby six feet away from you if possible.

Will I be separated from my baby if I have COVID-19?

Parents who are COVID-19 positive and coping well with their symptoms should NOT be separated from their baby after giving birth [6]. Parents and babies should stay together according to groups, including the American Academy of Pediatrics (AAP), ACOG, CDC and WHO. 

If you have concerns about your particular situation, please bring them up with your healthcare provider, and make sure you fully understand all the risks and benefits.

What about my postpartum appointments?

If you test positive for Covid-19 during the early weeks postpartum, many appointments, including mental health assessments, birth control planning and general questions, can all be done virtually. Mental health is a major postpartum concern and standard perinatal depression screeners can be completed at home. In-office visits may still be necessary for those with underlying conditions, wound infections, desire for an IUD or implant, or in the presence of other concerning symptoms. However, be sure to let your provider know you are sick. Ask your provider what option(s) are most appropriate for you, and don’t hesitate to call them if you have any concerns about your physical or mental wellbeing. General recommendations suggest that each person have a check-in by three weeks and a comprehensive 6- to 12-week postpartum appointment.

Should I get the COVID-19 vaccine if I am breastfeeding?

Guidance about vaccination may differ depending on which health organization you rely on. ACOG (the American College of Obstetricians and Gynecologists), recommends people who are trying to conceive, are pregnant, and breastfeeding get vaccinated against COVID [7]. As always, your OB or primary care provider is a great resource.

Will my milk supply be impacted if I get COVID-19? 

Many anecdotal reports suggest that a temporary dip in milk supply can result during or after a COVID-19 infection. This is similar to many other illnesses. Prioritizing rest, and eating and drinking enough, is essential. Supply may take time to rebound, but most nurslings do well being fed on demand. If you are exclusively pumping,  you may need to dip into your freezer stash for a short period of time. Note that some people also experience nipple pain after feeds related to COVID-19 infection, which is believed to be the result of vasospasm. Warm compresses immediately after nursing or pumping can be helpful with this pain. It’s always okay to reach out to a lactation professional for support along your feeding journey!

Reviewed by the Ovia Health Clinical Team

Your COVID-19 guide

Read more

• COVID-19, labor, and delivery: Your questions answered
• COVID-19