Wilberthe Pilate – Lactation Consultant
Hi! I’m Wilberthe Pilate, I’m a nurse, doula, and lactation consultant (IBCLC) based in the greater Boston area in the USA. I’ve been working with birthing/postpartum/breastfeeding families for almost 10 years in various roles; currently I split my time between being an IBCLC in the hospital, and in my own private practice Quiet Moon Postpartum Care. I am also a mother to a 4 year old and I’m excited to share my perspective here both as a care provider in this work, and as someone who experienced this process myself.
What are common physical changes that someone may experience in the postpartum period, and what are some ways to manage these changes?
The postpartum time is one of dramatic shifting and transformation for the body! I and many other birth workers love referring to the first few months postpartum as “the fourth trimester” to really reflect the fact that this time is a continuation of the process started in pregnancy, and that you and baby are still closely physically linked and transitioning through together.
There may have been stitches from a vaginal tear or of a c-section incision, and those areas may feel sore, sensitive, and itchy as they heal. Sitz baths are amazing for increasing blood circulation to the vaginal area and assisting in healing, and they feel very nice and soothing. In the case of a c-section you might find that allowing regular air circulation to the incision feels good, especially after a shower. This could look like laying back, lifting up your shirt or nightgown and allowing your incision to be open to the air for a little while. Your care provider may have more specific instructions on incision care they’ll recommend.
Stretch marks are incredibly common on the belly and breasts during pregnancy for obvious reasons, they are growing and expanding quickly to make room for your growing baby and to prepare for breastfeeding! Stretch marks are largely related to genetics and how elastic your skin naturally is. There’s no fool proof way to prevent them, and I think accepting and even celebrating them can be a great practice. Consider what it would be like to embrace your new normal. I love to think of the stretch marks on my lower belly as a natural tattoo commemorating the time my daughter spent growing inside me. Some people do find new stretch marks itchy or sensitive; keeping your skin well moisturized with a body oil or butter applied when the skin is damp after a shower can be soothing; jojoba oil and pure cocoa butter are my personal favorites.
During pregnancy, the growing uterus would have been shifting and compressing the abdominal organs, as well as stretching and taxing the abdominal and pelvic floor muscles. For many people this can result in a feeling of core weakness after birth, and in some cases can result in diastasis recti, a persistent separation of the abdominal muscles. Some people report a feeling of heaviness in the pelvic floor or may be experiencing problematic symptoms. Seeing a pelvic floor therapist is crucial after birth, to get proper evaluation and guidance on exercises and treatment options for these issues. I firmly believe that every postpartum person should be able to work with a pelvic floor therapist in the early weeks and months after birth!
What are potential changes that happen in the breasts during and after pregnancy, and what are some ways to manage discomfort or pain?
The breasts are busy producing milk and in the early days and weeks you may experience breast tenderness, fullness, engorgement, or sore nipples. Some mild nipple tenderness can be common while you and baby are learning to latch and figuring out your nursing dance together. Applying some expressed milk to the nipples after feedings can allow the healing properties in breast milk to work their magic on the skin there. Some people may find applying nipple balm soothes minor irritation as well.
For breast fullness and the discomfort that can result from that, the number one remedy is nursing baby frequently through the day, based on their hunger cues. This is also important for preventing engorgement, which is when the breasts become painfully swollen, hard, and inflamed. Cold compresses and very gentle breast massage can be good options to help with breast drainage and alleviating inflammation. Wearing a soft, breathable, non-compressive bra can also feel good and supportive.
If at any point you’re having pain while breastfeeding, you’re persistently engorged, your nipples are sore and/or damaged (cracked, bleeding, bruised, etc), or you’re having any other issues or concerns, reaching out for lactation assistance is crucial to figuring out the underlying cause of what’s going on. If you give birth in a hospital you may work with a lactation consultant there, or once you’re home you can arrange an office or home visit with an IBCLC or other lactation professional in your community.
What are some potential hormonal changes during and after pregnancy, and how can these changes affect overall health and wellbeing?
There are many different hormones at play to establish, maintain, and accommodate a pregnancy, and they may all cause various types of effects and symptoms. For example, a hormone called relaxin does exactly what its name suggests and causes the muscles in the pelvic floor to loosen in preparation for baby to move through the birth canal. However, the effects of relaxin aren’t just limited to the pelvic floor and can result in laxity in the ligaments and other areas of the body. So you may experience joint and muscle instability or pain especially in your back, shoulders, or hips. The effects of relaxin continue during the first few weeks postpartum so you may continue to feel this discomfort even after baby is born. This is another thing that a pelvic floor physical therapist can help address!
For another example, estrogen and progesterone are two key pregnancy hormones that are present in very high levels for the duration of pregnancy. There is a very abrupt drop in the levels of these hormones when the placenta leaves the body after birth, and the postpartum time is marked by the effects of the rapid shifting of these and other hormones. This can result in some mental and emotional effects such as tearfulness and feeling destabilized in the early postpartum weeks. This can often be a common part of the postpartum transition, but feeling things like persistent or severe sadness, anxiety, or hopelessness is never normal. For any mental health concerns at all, reaching out to a trusted care provider is key, as perinatal mood disorders are heartbreakingly common and no one should have to suffer through them with no support.
Got tips for managing postpartum fatigue and exhaustion, getting rest, and meeting your own needs while also caring for a newborn?
Before birth, figuring out a sleep configuration that safely meets the needs of baby and parent(s) can go a long way towards helping everyone get the rest they need! It’s safest for baby to sleep in your room for at least the first several months of their life, and this arrangement also makes middle of the night feedings more convenient.
After nighttime breastfeeding sessions, having your co-parent or other support person take baby and settle them back down can allow you to get back to sleep more quickly. You might also consider going to bed much earlier than you did pre-baby, to help make up for the interruptions in sleep that will happen through the night.
Trying to get some rest during the day can also go a long way towards helping you to feel more rested overall. Keep in mind “resting” doesn’t necessarily mean sleep. If it’s difficult or impossible for you to sleep during the day, just taking time to recline your body, rest your eyes, do some breathwork, and be still for a while can feel very restorative.
Also, having supportive people around you can be critical to getting your needs met. Good community helps us feel held and safe, which is so important when going through a time of upheaval and transition. Many of us may find it difficult to ask for or receive help, but the postpartum time gives us a beautiful opportunity to practice this. If you have friends or family members offering support, accept it and tell them exactly what you think you need! Help with meals, chores, and errands can make it easier for you to focus on nurturing yourself, connecting with your partner if you have one, and engaging in self-care however it may look for you during this time.
Speaking of meals, you may also feel much more hungry or thirsty during this time, especially if you’re breastfeeding. The body needs at least 500 extra calories a day to support the milk production process (and at least twice that number if you have twins). And good nutrition is important to support overall postpartum recovery; in particular, nutrients such as protein and vitamin C are very important for tissue healing. Having regular, nutritious meals throughout the day, as well as some snacks in between, can give you the nourishment and energy you need to feel sturdier and more stable while you ride the waves of the fourth trimester. Setting up a meal train (or better yet, having a support person set one up for you!) can be a great way to have meals on hand without the labor of prepping and cooking. Having some snacks around that are easy to eat one-handed can be helpful. And as breast milk is largely made of water, it’s important to make sure you’re well hydrated; keeping your water bottle filled is a great task for any visitors or support people in your home!
Lastly, if you don’t have friends or family readily available to call on (and honestly, even if you do), a postpartum doula can be an amazing addition to your circle of support in the fourth trimester. Postpartum doulas are knowledgeable sources of support, care, and information during the postpartum time.
Unfortunately, fatigue, exhaustion, and depletion are commonly experienced by many parents in the postpartum time. An underlying reason for this is an overall lack of support available to parents during the fourth trimester in our society (speaking from my perspective as someone in the United States). That is a bigger discussion about the structures and policies that affect families’ access to essential resources and care such as: adequate, accessible, comprehensive, and respectful prenatal and postpartum healthcare (including mental health, lactation, and pelvic floor care); universal paid parental leave; accessible and affordable childcare; and affordable access to doula support.
We can celebrate mothers by advocating that they receive the support they deserve.