Postpartum from a Rehab Perspective

September 5, 2018

 

As I am working through my postpartum recovery I want to share my experience as well as some pointers from an occupational therapy perspective.  Each of my pregnancy, birth and postpartum times has brought different learning experiences and different challenges.  This is my third child so I have had a variety of experiences after giving birth and some things worked (resting way more than I thought I needed to) and some things did not (thinking my husband and I could do it all alone and not ask for help).  So here is what I feel like were the most important experiences I wanted to share.

 

Setting up for success

 

Physical
I spent my first postpartum standing next to an isolet while my first baby, Beck, was in the NICU for swallowing meconium.  I developed moderate edema, fluid buildup, in my legs and feet. I had experienced significant pelvic trauma and had incontinence, lack of bladder control, for two weeks.  Due to Beck having a breathing tube in his nose I decided to wait to try breastfeeding until we got home.  We tried in the hospital and it was too stressful for me.  I did request a pump the night we arrived and pumped for 30 minutes every two hours due to lack of knowledge of what I was doing.  (That's way too much pumping!)  When we got home I returned to my daily activities of housework and returned to physical activity soon after that.  I trained for and participated in a mini triathlon.  I had diastasic recti, where the muscles of your abdomen have been separated during pregnancy, which is fairly common.  But mine never fully healed before I became pregnant again 2.5 years later.


In my second pregnancy I was sick with cholestasis, a rare pregnancy induced liver disorder, and stopped working at 30 weeks.  I spent my second postpartum in bed for the first 1.5 weeks, but this was cut short by complications from a tongue tie, where the tissue connecting the tongue to the mouth is too short and the tongue is not able to move effectively to get milk, and I almost lost my milk supply.  I then spent the following weeks pumping every 3-4 hours to bring back the supply and taking my second child, Bri, to multiple medical appointments.  I learned about nipple shields and supplemental nursing systems.  I did stretches on Bri's mouth to avoid reattachment of the tongue.  Breastfeeding did not feel successful until about 2.5 months into my postpartum.

 

In my third postpartum I rested in bed for 20+ days.  I have yet to try to do more than walk or simple stretches, squats, and static lunges for exercise.  I also avoid lifting anything heavier than my baby when I can.  My third child, Bo, had tongue tie but this time I knew to supplement right away and establish supply with the pump.  I had to take Bo to many medical appointments and relearn how to use a nipple shield.  I still developed an oversupply, which is painful and annoying, and I am still pumping once to reduce discomfort about every 2-3 days. I had a postpartum massage and hired postpartum doulas from Better Beginnings of MN to help around the house and watch Bo so I could sleep as well as be a social connection for me when I felt lonely.  I scheduled chiropractic adjustments and a pelvic floor physical therapy assessment.  My pelvic floor assessment, a gentle internal exam of the pelvic muscles, revealed some tightness as well as very poor strength and coordination.  If my pelvic floor muscles were my bicep I would not be able to lift my arm off the table much less lift any weights!  I am now in pelvic floor rehab which will support my body going forward to avoid any pain (pelvic or back pain) or difficulty with going to the toilet or having sex.

 

Mental/Cognitive

In my first postpartum I struggled with memory, problem solving and organization.  I didn't clear out my email box for a whole year, 10,000 emails.  I struggled with spatial awareness, knowing where I am in space in comparison to other people and things, and I had two car "bumps" and one accident within the first 6 months.


In my second postpartum, I struggled with similar issues but was more aware and more forgiving of myself.  Actually I don't remember my mental state for most of that time.  Problem solving how to get two kids out the door and plan a whole day with smooth transitions took all of my brain power.

 

Here in my third postpartum I feel much clearer.  I still struggle with words but my planning, problem solving and organization is great. Instead of saying "I am so tired" I am saying "why am I not more tired?"  Not what I was expecting for my third.  

 

Emotional

After that first long and traumatic birth I was an emotional mess.  I screamed and cried in the NICU.  I was angry for a very long time.  I was seeing a therapist for adjustment disorder.  I would cry all the time at any sign of challenge or difficulty.  I was easily overwhelmed by little changes to the day. I was bummed my body was different and struggled with not being able to wear what I used to wear.

 

After the second birth I thought I would take better care of myself emotionally but I still struggled.  Having the unexpected tongue tie threw me off.  And then my grandma died at 2 months postpartum and I just gave up on not feeling sad for a year.  I could not pick apart what might be postpartum issues and my own grief for the death of one of the most important people in my life.  I still struggled with body image.

 

Here after this third birth I still got angry and weepy a few times but have felt much more stable mood-wise.  I do not take mood stabilizing medications but had mentally prepared myself to take them this time if things did not stay even.  I still struggle with body image but feel like it is much less.  I can look in the mirror and find things I like everyday.

 

Social

For the first postpartum, we planned for limiting family support after the first birth.  We thought we could do it all ourselves.  We did not have any food delivery.  I returned to work at 12 weeks postpartum and Beck started full day day care.

 

The second time around we signed up for meal delivery from friends and family.  We had more visitors checking in with us and visiting to keep us company.  We still thought we could handle the housework and child care of the older child ourselves.  I decided to stay home with the two kids but thought that I would be responsible for all day everyday child care as well as household tasks.

 

This time we held a party before the birth to have friends and family bring food.  We hired postpartum doulas to help with dishes, meals, laundry and cleaning.  We asked family to watch our children full time during the day for the first 20 days while I was in bed and for half days the first two weeks I was out of bed.  Beck goes to preschool 4 mornings a week and Bri goes to her grandpa's house or to a church daycare 3 mornings a week.  My husband is in charge of 2-3 dinners and cares for all three kids 2 nights a week and one weekend afternoon.

 

What worked for me

  • Self forgiveness when I could not do something the way I wanted to or the way I used to.

  • Tuning into my emotions and feeling them, admitting I was sad or mad, and then finding a way to cope or change them.

  • Talking to a therapist, sometimes it is good to get an outside perspective on things.

  • Engaging in mentally challenging games such as word finds, sudoku or logic puzzles.

  • Avoiding all caffeine, my body doesn't process it well and it just makes me more tired.  It is also not good for my babies through my milk.

  • Setting limits for myself with going to bed on time and having a good bedtime routine so I can get restful sleep.

  • Resting in bed for as long as possible.

  • Planned rest as much as I could get and forcing myself to rest at the slightest feeling of overwhelm or fatigue, resting with my eyes closed while either listening to something or in silence.

  • Hiring a postpartum doula to help my husband and I adjust slowly to home management and parenting 3 kids.

  • Asking others for help even when I could do it myself.

  • Supporting my body ergonomically by setting up a changing station at waist height on each level of the house to avoid bending.

  • Lots of bodywork, your body needs gentle touch and adjustments after the work of carrying and birthing a baby.

  • PELVIC FLOOR THERAPY!!  The pelvic floor holds up all the organs and is integral in healthy core strength.  An assessment should be routine for all women pre and post birth.

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