Let's Talk Postpartum

Written by
Dr. Cortina McCurry
Published
September 6, 2020

The postpartum period can be difficult to prepare for - you don’t know what you don’t know right? And unfortunately, in many instances your doctor might not tell you. We've created a checklist of the 5 things you should be sure to talk to your doctor about before birth.

As you get closer to your baby’s birth day there are so many things to keep track of: What to pack for yourself? What to pack for the baby? What is my birth plan?

In the swirl of logistical preparation, one thing that often gets lost is how to best ensure your optimal recovery and healing after birth. Pregnancy is the longest lasting, highest endurance, highest energy requiring activity that a human can do. Fully recovering from pregnancy and birth isn’t a matter of a few days - it can take months. 

For many postpartum moms, the discomfort and bodily trauma that can occur post delivery are seen as the price of motherhood. As a result, they can often be seen as 'normal' and because of this may not ever get discussed. After birth, many moms find themselves on the internet, googling frantically to understand what their body needs to heal and recover. However, what is common is not necessarily normal and in many cases with the appropriate preparation many postpartum medical issues can be alleviated or even prevented. 

As in all things, knowledge is power. To keep you on the front foot, and to help you feel empowered and in control, here are the 5 topics that every woman should be talking to her doctor about in ADVANCE of birth. 


1. Diastasis Recti

Dia what? When it comes to things you need to speak to your doctor about I would place Diastasis Recti pretty high up on the list. 

It is also colloquially referred to as a ‘Mummy Tummy’ or ‘A Split’ - yes...as in your abdomen is split. In this situation the only thing separating your internal organs from the outside world at the point of separation is your skin and connective tissue. A Diastasis Recti can be interpreted literally as a separation (Diastasis) of your abdomen (Recti). Thanks to a hormone called relaxin and the pressure that your growing uterus places on your abdominal wall, the linea alba (the connective tissue between your left and right belly muscles) begins to stretch. All of us have some separation of the abdominal wall, but when it is greater than ~2cm it is referred to as a diastasis. While it is common (over 60% of women experience) it should not be considered normal. Diastasis recti can lead to symptoms such as lower back pain, constipation, pelvic floor dysfunction, urinary incontinence and abdominal weakness. If it is left untreated it can sometimes result in a painful hernia.

Be sure to talk to your doctor about diastasis and have them check the presence and width of the split - the earlier the better. Your doctor may not even consider checking you for a diastasis recti unless you request it. Ensure that they are checking both above and below your belly button. Here is a simple way to check for it yourself or perhaps ask your doctor to show you. 

There are a number of programs that may help towards recovery of a diastasis recti. Again, check with your doctor on the appropriate timing for exercise and for recommendations. I had my doctor provide me with a recommendation to a women’s health physiotherapist. 

Many women swear by wrapping using a belly binder or a splint as soon as possible after birth in order to help with recovery and healing in combination with light exercise. Check with your doctor on when you should begin wrapping ideally as early as possible after birth. Wrapping helps to bring the belly muscles together and speed up closure. While the research is still out on the effectiveness of this technique in extreme cases of diastasis, at a minimum wrapping is still worthwhile - even where a significant gap exists - as it provides a light compression of the muscles and ligaments that makes everything feel more supported after birth. When done properly, it also provides critical support to your pelvic floor as your body heals.


2. Episiotomy

An episiotomy is when a doctor makes a small snip in your perineum - the tissue that sits between your vagina and anus - in order to facilitate the birth of the baby. Ow! There was a time when this type of incision was fairly routine, and it was believed that making a snip helped to prevent extensive tearing of the perineum. Many doctors believed that it also helped the perineum to heal better. Research now suggests that this is not the case. To avoid any surprises, it is important to have a conversation with your doctor BEFORE birth to understand their approach and specifically how often they perform the procedure and for what reasons. 


3. Incontinence

Unfortunately, postpartum urinary incontinence is quite common so it needs to be on your radar. And getting your doctor engaged in a conversation around healthy bladder habits and proper muscle techniques is an important part of your postpartum care.

Incontinence results from a weakening of the pelvic floor and bladder after birth. You may find that your bladder leaks when you sneeze, cough, laugh, stand up, or lift things. Women over 35 are at the greatest risk and it is more likely to occur in women who give birth vaginally. It’s important to note that a cesarean section does not necessarily mean that you will not experience some incontinence. As the uterus begins to shrink back to its normal size after birth, it can result in repeat compressions on the bladder. 

Issues of incontinence can last up to a year after birth and a small percentage of women still experience symptoms after 5 years. On the positive there are things you can do to help reduce the risk of urinary incontinence. In fact if you head to the Continence Foundation of Australia's Pelvic Floor First website you will find high quality information that you can read up on before chatting to your doctor. Additionally, there is fairly rigorous advice on pelvic floor exercises that you can do to help your body cope with the growing weight of the baby. 


4. Postpartum depression

You have just made a baby and that means that all types of wonderful things are happening with your hormones. After birth, around day 5 or 7 you may experience a sudden drop in these hormones that can result in what is commonly referred to as the baby blues. It is important that you are aware that this will occur and to prepare, to the extent that you can, to have the social support in place to help you around this time. Know that these types of feelings are common. It is also important to stay tuned in to changes in mood which may be a sign of postpartum depression. Postpartum depression occurs in 1 in 6 women after birth. In a way postpartum depression is a misnomer as you may not necessarily feel depressed. Postpartum depression might manifest as a range of emotions from depression to rage, to anxiety and even obsessive compulsive disorder (OCD). Some women describe it as feeling nothing at all. 

Be prepared. Speak with your doctor in advance of birth about the timing and occurrence of baby blues and the support available in the event that you think you  might be experiencing postpartum depression. Your doctor will be able to point out to you helpful resources such as PANDA. Your doctor should be checking in on your after birth to assess your mood and mental state. If they are not, ask them.


5. C-section and Scar Adhesions

While many women may elect to have a c-section, at times there may be no indication that you will even need a c-section until...well, you need a c-section. 

There are a number of reasons why this may occur. Factors such as age, multiple pregnancy, placental position, fetal position, weight, previous history of c-section all influence whether you are more or less likely to have one. Again, it is incredibly important to have a conversation with your doctor in advance of birth to ensure you have a full and complete understanding. 

One thing that rarely gets discussed is the risk of adhesions resulting from a c-section which can cause problems later in life. After a surgical incision the fascia (a fibrous tissue that surrounds muscles throughout your body) becomes disrupted. An adhesion occurs when this tissue, which is normally smooth, begins to grow back in a haphazard manner and can start to attach to muscles and other organs. Yes, organs...the best way to imagine what is happening is to envision these adhesions as spider webs that look a bit like nylon rope wrapping around various structures and covering organs near the healing site. These adhesions result in a pulling sensation and can cause mild to excruciating pain. Reducing the likelihood of painful adhesions can take less than 5 minutes a day of massage. Make sure to check in with your doctor on the appropriate timing to begin massage and a good resource.

In fact, so many women find themselves bewildered when an unexpected c-section occurs, and even if planned don't feel prepared for recovery, that I've added a checklist of questions within our checklist of a few questions you should make sure to check in with your doctor on. Feel free to print these out and run through with your doctor.

"Hey, doc":

  • What is your approach to c-sections?
  • How frequently do you perform them?
  • In what instances would you recommend that I have a c-section?
  • How does a c-section work? Talk me through the actual surgery. 
  • What are the risks associated with a c-section?
  • How do you plan to mitigate those risks?
  • How will you close the incision back up? (e.g. sutures, staples, glue) 
  • How long will it take for me to recover from a c-section (again it is important to have a clear picture of what to expect so you can have the appropriate supports in place) 
  • What are c-section adhesions? When can I start to massage my c-section scar to reduce the risk of adhesions? Can you recommend a good resource?
  • What is vaginal seeding and is it something I should be considering if I have a c-section?


6. A bonus: What should I know that I wouldn’t think to ask?

This may likely be the most important question to ask your OBGYN. Pregnancy and postpartum is a period of time when you are at your most vulnerable. Ensuring that you have as much information in advance of birth is important for ensuring your healthy recovery. Many women feel nervous asking their doctor questions. Others don’t even know where to begin. To manage this, sometimes just leading with “What should I know that I wouldn’t think to ask” goes a long way. 

Take it slow, your body deserves it

Lastly, while it can be tempting to try to get back into gear as soon as possible after birth remember that you have just spent the last 9 - 10 months growing a baby from fetus to newborn. You grew a baby. In your belly. Some experts equate this to running a marathon...EVERY. SINGLE. DAY. For 40 weeks. Give yourself a break. Your body deserves to rest and what your doctor may not tell you is that returning to ‘normal’ too soon can result in long term damage. 

By starting the conversation with your doctor early you will be more aware, better positioned to self-advocate, and increase your chances of the best outcomes. Knowledge IS power. 

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