The First 40 Days After Birth

I recently hosted a lunch & learn on the evolution of postpartum and how to support new moms after childbirth, otherwise known as the 4th Trimester.  I presented with Lauren Dissinger, a local Postpartum Doula | Postpartum Yoga expert.  What follows is a synopsis of our presentation along with a history lesson of postpartum treatment of women around the world.  It is so important to understand how far we have come in caring for women after childbirth and what more we can do going forward.  A special thanks to Lauren for all of her help & research.

HISTORY

Prior to the industrial revolution, families generally stayed in the same community they were born and raised. Because of this, generations of families were around to support new mothers and babies. In addition to family, the community women were there to support the laboring woman during birth and then care for her after the baby arrived. Birth and postpartum were women-only events.

During the 18th century there was a major shift.  Young adults moved into cities to look for new jobs so when they then had babies, they were often alone in their new homes. It was the first time there weren’t villages helping to raise babies and care for the mothers.  During this time, we saw men entering the birthing space as male midwives.  This became the beginning of medicalizing birth and eventually the push to move birth into hospitals. Within just one century, because of demographic and geographic changes, increases between the rich and poor, rising popularity of the male-midwife, many postpartum experiences went from fully supported by a village of women to what we can relate to here in the US, an isolated postpartum time.

While we may have lost the villages in Europe that helped raise new babies and new mothers, today, the government in many countries have stepped in to encourage care for postpartum women.

Netherlands:   Families have an average of 49 hours of in-home help from a home maternity nurse covered by insurance, available up to 10 days after birth.

Switzerland:  56 days after birth a midwife is available for home visits covered by insurance.

Germany:  German law forbids a new mother for lifting a finger to do anything for 8 weeks. This period is called “wochenbett” – week’s bed – and most midwives will insist a new mother stay in bed resting, eating chicken soup and spending time recovering and with the baby.

Africa:  Postpartum traditions are not government focused in Africa as we see in Europe, but rather unique to each tribe. One tribe in Kenya sacrifices and roasts a piece of livestock to celebrate the new baby and mother. The idea is to fatten the mother up to breastfeed. For weeks, all the women in her life come to cook, clean, do laundry, and visit. Regardless of the tribe, the overall theme in Africa is the same, the birthing woman is supported by the other women in her life for an extended period, sometimes weeks, sometimes years. It is literally a village of women that help raise the mother and baby, thus the Africa proverb “it takes a village to raise a baby.”

An interesting fact is that Africa views the US as successful since it is so highly developed, so there currently is a strong desire from the African government to Westernize the birth experience, now offering incentives to birth in a hospital or to have a cesarean. Therefore, there is the same vilifying of midwives we saw in the west in the 19th and 20th centuries in Africa today.

China:  Some of the most well-known postpartum traditions comes from Asia. While China is most notorious for their “sitting month,” almost all cultures in Asia have some form of this tradition. Often the mother or mother-in-law will come over every day or even move in with the new parents to help take care of the mother.  New mothers are not allowed to shower or wash their hair during this time. There should be no wind, no going outside, no fans and in some cases no AC.  All of this is to protect her from things like catching a cold.

Japan:  In Japan, a mother and baby will remain indoors for 100 days and traditionally, move in her with parents for three weeks after the baby is born.  Again, bathing discouraged for a period of time. Traditionally in these areas, only warm meals are provided to help encourage healing within the mother and each culture has customary foods and drinks.

Postpartum Treatment 0 – 6 Weeks

It should not surprise anyone that most mothers in the United States do not feel supported by our government, cultural traditions, or large villages of women.  Women often feel isolated like they are the only ones experiencing something, not realizing that most new mothers feel the same way.  It not until women get the courage to ask someone if what they are feeling is normal that they realize they are part of this secret postpartum mother’s club.  It’s important that women find others to validate what you are going through and help you be better prepared.

So, what are the ways to improve the postpartum experience and recover quicker?  It’s important to reconnect with your deep core, do safe movements, skin inspection, and return to exercise.

You need to cue your pelvic floor muscles to regain normal function which includes organ support, sphincteric function, core support, sexual function, and circulation.  There is a relationship between deep breathing the pelvic floor, movement, and healing.  Below is a breakdown of exercises that can be done starting the week after birth and progress through the next 6 weeks.

Weeks 0 – 2

In the hook position which means lying on your back with your knees bent and your feet flat on the floor do the following exercises:

Diaphragmatic Breathing:

In the hook position keeping your chest still and keep your mouth closed and breathe in & out through your nose only.  As you breathe in your stomach should rise and when you breathe out your stomach should fall.  It may be helpful for you to feel the rise & fall if you place one hand lightly on your chest and the other more firmly on your stomach.

Sets:  1 (5 minute duration) |  Times Per Day:  2  | Times Per Week:  7

Pelvic Tilt Clocks:

In the hook position move your hip bones (pelvis) from 12:00 (your head) to 6:00(your feet).  Then move from 3:00 to 9:00.  Eventually work your way from each number to the opposite number on the clock and then move in full circles clockwise and counterclockwise.  This movement will be small and take focus.

Sets:  2 |  Reps:  2 | Times Per Day:  2  | Times Per Week:  7

Hook Lying Pelvic Floor Contraction

In the hook lying position inhale, exhale and contract your pelvic floor muscles (Kegel).  Hold for 1 second and relax.  Repeat

Sets:  2 |  Reps:  5 | Times Per Day:  2  | Times Per Week:  7

Weeks 3 – 4

Walking:

Take a walk on a level surface, at an easy pace.

Sets:  1 | Time:  10 – 15 minutes | Times Per Day:  1 – 2  | Times Per Week:  7

Transverse Abdominis Activation

Lie on your back with your feet flat on the floor.  Keep a natural spine(small space between your lower back and the floor).  Place your hands on your stomach so that your fingertips are just inside your hip bone.  Activate your transverse abdominus by drawing in your abdomen without moving your spine upon exhale – hold for 5 seconds. To activate your deep core, brace your stomach like you were about to be punched in the stomach.

Sets:  2 |  Reps:  10 | Times Per Day:  2  | Times Per Week:  7

Pelvic Floor Endurance Holds

In the hook position perform a pelvic floor contraction (Kegel) and sustain hold for 5 seconds and then relax.  Make sure you are no compensating with activation of your inner thighs, gluteus, or abdominal musculature.

Sets:  2 |  Reps:  10 | Times Per Day:  2  | Times Per Week:  7

Weeks 5 – 6

Walking:

Walk with a slight increase in pace or incline.  No jogging!

Sets:  1 | Time:  20 – 30 minutes | Times Per Day:  1 – 2  | Times Per Week:  7

Transverse Abdominis Bracing with Pelvic Floor Contractions

Lie on your back with your feet flat on the floor.  Keep a natural spine(small space between your lower back and the floor).  Place your hands on your stomach so that your fingertips are just inside your hip bone.  Inhale, exhale and contract your pelvic floor muscles (Kegel).  Then activate your transverse abdominus by drawing in your abdomen without moving your spine upon exhale – hold for 5 seconds. To activate your deep core, brace your stomach like you were about to be punched in the stomach.

Sets:  2 |  Reps:  10 | Times Per Day:  2  | Times Per Week:  7

Pelvic Floor Endurance Holds

In the hook position perform a pelvic floor contraction (Kegel) and sustain hold for 10 seconds and then relax.  Make sure you are no compensating with activation of your inner thighs, gluteus, or abdominal musculature.

Sets:  2 |  Reps:  10 | Times Per Day:  2  | Times Per Week:  7

Every postpartum experience is different and it’s not about “bouncing back,” but adapting to a new body.  It is a process and being “cleared” is medical, not an indication of pelvic floor or core readiness.

There is support out there for new moms and pairing of a few of the suggestions below can make a huge impact.

• Physical therapy:  An appointment with a Pelvic Floor PT referral is typically given after 6 the week follow-up with a medical provider.  Mothers may attend PT sooner for pain management with Direct Access meaning no physician’s referral is needed.
• Postpartum Doula – : https://www.laurendissinger.com/
• Mother’s Circle – find a local group where you will have a safe, shared space where you can talk about your feelings and experiences without feeling judged.  Friendships will be created, and support will be at the ready.  Look on Facebook for groups like Lancaster PA Moms.

Mothers face MANY changes throughout the postpartum journey, but a Pelvic Floor physical therapist can improve the quality of life throughout the entire pregnancy experience, especially postpartum.  You can check out our Pelvic Health page HERE or if you have questions, please call me in our Mount Joy office for a FREE phone consultation at 717.492.8708 or email me at efranze@hartzpt.com.