The Postpartum Body

by Tara Sullivan, from BirthWays Newsletter, Spring 2013

Much ink has been shed over the myriad changes a woman undergoes over the months of pregnancy but resources of the same caliber are hard to come by when it comes to a woman’s postpartum experience.

Fast forward (or backward) to a month past your due date.  One way or another, the baby is now outside your body.  I’m sorry, did I say “your body”?  Because I suspect if you’ve had the time and courage to contemplate it, you’re wondering where your body went and what to do with its replacement.

I went into pregnancy in the best shape of my life and stayed active until my son was born.  Still, the body that confronted me in the so-called “fourth trimester” came as a surprise. While I was elated to have my healthy baby alive and well, the aftermath of pregnancy was more intense and jarring than I expected.

If you are yet to have this experience, this article is not intended to frighten or depress you (if you’re pregnant, repeat after me: this too shall pass… this too shall pass…) but to inform and arm you with information.  As one of my teachers used to say, information is the antidote to fear.  Adding on to the usual tips that appear in lists all over the internet and in most birth books, I am going to share some of my own experiences.

First, some good news:.  You will wake up one morning and you will not be pregnant anymore. 

Even those dewy eyed, radiant mamas who love every second of being pregnant, in my experience, get to a point when they are DONE.  One way or another, you will wake up and be able to lie on your back, and roll over in bed.  You can lie on your belly.  You won’t be thinking constantly about where the next bathroom is.  And so on.

1. New body, new wardrobe.  One of first non-baby questions you ask will probably be: what on earth am I going to wear?  Maternity pants will likely be too big, beautyand your pre-pregnancy clothes almost certainly won’t fit for a spell.  Your body will be a different shape than before you were pregnant, and putting those old clothes on may not be fun.

One of the best things my mother did when my son was born was get me a new pair of yoga pants.  I had something new to wear, which made me feel a little more put together, and stretchy black pants were just the ticket.  I advocate recommend getting a mini new wardrobe for your fourth trimester and beyond.  Choose clothes that are Exclusively stretchy and soft and infinitely washable, in your dark, solid color of choice.  You may prefer tops that have wide, stretchy necks but definitely will need cardigans or zippies.

If you are nursing and/or pumping, you will need easy access to The Girls at all times.  I hate the feeling of my belly and lower back feeling exposed, so I limited my wardrobe choices to tops where I could access my breasts in a way that didn’t involve pulling my shirt up over them. Avoid binding clothing anywhere on your body because your lymphatic system goes through lots of change during this time.  Aside from being uncomfortable on your sensitive body, a too-tight bra can contribute to a blocked duct, which is an experience you will not forget.

2. Harden up. My son was born at home and, as is the usual routine with home births, I was expected to stay in bed for two weeks.  Before I knew it I was surrounded with even more pillows than when I was pregnant (which is saying something). I had pillows for behind my back, under my arm, and of course the seemingly essential nursing pillow.  I was engulfed in feathers, poly-fill and foam.  My back was killing me.  Different pillows started showing up: one of those ones with arms, different nursing pillows, bolsters.  My back hurt almost as much as my nipples.  A glimmer of pre-mama brain began to twinkle, like the first star appearing in the sky: I had to get out of bed.  I got out of bed and onto a wooden stool. I put it next to the wall and leaned back against it. My back started to feel better.

The body doesn’t like as much soft cushioning as we think, especially not when it is trying to shrink to a previous shape.  Your pelvic floor, regardless of whether you had a vaginal birth or a c-section, has been through a lot and will be overstretched.  Sitting on a very soft surface like a cushy couch or bed will get all up in your business, if you know what I mean, encouraging your sitting bones to widen, and your pelvic floor to do the same.  A firm surface helps create the conditions for your pelvic floor to rebound.  Also, the pelvic structure itself will benefit from the firm support as it gradually returns to its previous orientation.  If you have a soft chair, try sitting on a phone book for a firmer seat.  The plain wooden or cane-inset rocking chairs of previous generations are a fantastic choice and I recommend them above the soft, upholstered gliders that are so popular now. Think of lifting the perineum, similar to doing a Kegel, in a way that lifts in and up.  In yoga this is called Mula Bandha, the root lock, which directs the energy in and up, and is an essential part of all asana practice.

While you’re nursing, it’s important to make sure your body is supported.  Elongate yourself, whether you are in a rocker, leaning against the wall, or lying in bed.  Then use your arms to bring the baby to you.  Whatever cushioning or props you use (I found a bolster to be more helpful than a nursing cushion and appreciated its multiple functions), make sure you prop the baby up high enough, which will likely be higher than you think.  The point is, make sure you don’t wind up collapsing your whole spine to bring your breast down to the baby; always bring the baby up to you, even if it takes an extra few beats.  It’s worth the time now to keep your back from hurting in a few minutes.

3. Abs of…  The belly that was celebrated, rubbed, photographed and casted just weeks ago is now in a very different state.  The most common request new mamas make is abdominal work.  Mama wants her abs back!  It is a good idea to find out whether your rectus abdominis has a separation (diastasis recti). If so, check out the Tupler method to help repair it.  In any case, your abs have been stretched out and will need time to shrink.  Work mindfully and intelligently with your abs.  Overstretched muscles combined with the effects of relaxin (a pregnancy hormone)  create conditions that can lead to hernias and back and knee injuries.

You can strengthen your abdominal muscles simply by sitting upright and supporting your own weight.  Sit on a stool or an exercise ball for short periods and consciously lengthen the front, side seams, and back simultaneously while lifting your lower belly in and up.  Better than crunches.!  Twisting is very useful, as is Dandasana and Lolasana.  Forward bends like Paschimottanasana encourage the internal organs to re-orient after having been displaced by baby.

4. Exhale. One of the more peculiar experiences I had in my fourth trimester was the sudden reappearance of asthma symptoms one week postpartum.  I hadn’t wheezed in years, but found myself on the couch in the middle of the night nursing my son and trying to get a decent breath.  My midwife confirmed what I read in internet chat rooms:,there have been no studies on asthma inhalers and breast milk.  The idea of giving albuterol to my newborn was not appealing to me so I had to figure out something else to do.  What I wound up discovering was that my rib cage had become stretched out during my pregnancy and it was still overstretched.  Rib movement – both out and in – is a necessary component of breathing; the intercostal muscles do 25% of the work of breathing and the diaphragm does 75%.  With my rib cage still overextended and my pelvic floor overstretched and somewhat flaccid, of course my respiratory system was struggling!  Breathing is a pressurized system; ideally, a vacuum is created by the downward pull of the diaphragm which creates the inhale, and so on.  When the container is too large, either via an overstretched rib cage or a slack pelvic floor, the vacuum doesn’t properly get activated and breathing turns into work.

Hands-on bodywork is very helpful at this time to relax the back.  It’s also useful  to focus on exhaling; inquire whether you are exhaling all the air in your lungs.  Cultivate the ability to exhale fully without collapsing your body.  This will support the respiratory system enormously and help return your breathing to an ideal state while also helping ease back pain.

5. What am I doing? Your kinesthetic sense will have slowly adapted over the course of your pregnancy. With the sudden, drastic changes that come after birth it is important to re-calibrate your system.  For example, while you are pregnant, as your hips gradually widen it is natural to begin standing in a wide stance.  I notice in the post-natal classes I teach that nearly all the women have to consciously take a narrower stance, because they have gotten so used to their new habit.  In fact, bringing the feet closer together – either barely touching or, say, two or three inches apart – is a very supportive choice.  Try this.  It will help inform your whole system that it’s time for things to come back together, to return to the center, and that the time for letting it all hang out (your belly and pelvic floor, that is) has ended.

Many new mamas report feeling challenged by balance and coordination.  The body has gone through a long period of slow change followed by a rapid change and it takes time for the brain and kinesthetic system to adjust.  Suitable physical activity is important once the body has made its initial recovery.  Walking is ideal, as is post-natal yoga or even just gentle stretching.  The Alexander Technique is wonderful to help re-learn where things are and where you’d like them to be.  After your baby is born, take time to mindfully find your way.  You’ll both feel healthier and more connected. It’s well worth the effort.

Tara Sullivan credits the Alexander Technique and a daily yoga practice with giving her what she needed to withstand the epic five nights of labor that culminated in the home birth of her son.  She teaches yoga and the Alexander Technique both separately and together in the East Bay.  Read more at www.tara-sullivan.com

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