Fourth Trimester Pelvic Floor Healing

Expectations... not met

One of the hardest parts of the fourth trimester is that you may not even know there is one. As expecting moms, we often give a lot of attention and do a lot of preparation for pregnancy and childbirth, but often do very little preparation is done for after the birth. One week after the birth of my son, I found myself lying down with a heating pad under my back, an ice pack over my vagina, and hooked up to my breast pump for several hours of the day. I was not sure what to expect after childbirth, but this certainly was not the picture I had in my head.

Mamas transition, too

The fourth trimester is considered a time of transition for a baby from the womb to the world. However, it is also a time of transition for the mother. Her body is healing and recovering from the past 10 months of pregnancy and childbirth while also navigating the waters of life with a newborn. There are a lot of changes taking place and yet new moms receive very little guidance on physical recovery, breastfeeding and pumping, and transitioning back into day-to-day life. There were so many times I thought, “I wish someone would have told me this sooner!” Well mommas, wait no longer, because here ya go!


It’s hard, y’all. Like really hard. I saw my twin sister pop her days-old baby on her boob like it was no big deal, and I thought that's how breastfeeding worked. Well, not so, friends. It was not intuitive or comfortable for me and the lack of support in the hospital and once home had me scouring the internet at all hours of the night unsure of what to do. 

So my advice is to get informed before baby arrives! 

  1. Two great books are Ina May’s Guide to Breastfeeding and The Womanly Art of Breastfeeding. Having an idea of what to expect can be helpful so once baby arrives you have some education and background about when to start breastfeeding, how it should feel, and when to get more support. 

  2. Work with a lactation consultant to guide you through latching, feeding, milk supply issues, and using a breast pump to help minimize stress and help you focus on your physical recovery and snuggling with your new baby. Ashland Breast Pumps provides support in-home consults with board certified lactation consultants through their Lactation Network! I had no idea if my son was getting enough milk, how often to feed him, should I wake him to feed, when to start pumping, or even what breast pump was the best for me.

  3. Pick the best breast pump for you! Ashland Breast Pumps can also connect new and expectant mothers all over the country with free insurance covered breast pumps. They help you select which breast pump is right for your lifestyle, deliver it directly to your doorstep, and work with your insurance provider to secure breast pumps, parts and accessories.  There are different pumps, different suctions, different size flanges depending on your breast size… who knew?! Ashland Breast Pumps can help you navigate these questions.  

  4. Hang in there. Know when to keep going and know when it’s not serving you. This is not always clear! There is so much pressure that “breast is best” and I really feel “fed is best.” So be gentle with yourself, know you are doing the best you can, and if there comes a time when you feel it might be time to stop (whether that's at two days or two months or two years) don't feel guilty about it. We have a long road of motherhood ahead of us and we cant be beating ourselves up at the very start of the journey. 

Baby your lady bits!

During the fourth trimester, your pelvic floor and abdominal muscles are healing. Take the first few weeks to rest and recover before rushing back into day to day life.  Below are some strategies to help early recovery.

  1. Trauma to the pelvic floor from pushing for a prolonged period, use of forceps or vacuum, or a perineal tear or episiotomy can cause pain. For the first several days, ice is your best friend. Use an ice pack, bag of frozen peas, or a pad-sicle (a frozen witch hazel soaked maxi-pad) over your vaginal area for 20-30 minutes several times a day. After using ice for the first 3-5 days, switch to taking a sitz bath to promote circulation and healing.

  2. Start performing kegels 2-4 weeks post-delivery. This may be the last thing on your mind, but performing these exercises early on and can promote blood flow to the pelvic floor area to promote healing and re-engage with deconditioned muscles.

  3. Following a perineal tear or episiotomy, you can begin gently massaging your scar massage once its completely healed. Get confirmation from your doctor or midwife that scar is healed and work with a pelvic health PT or do an online session with one of our therapists. 

  4. To learn more about how breastfeeding/pumping can affect your pelvic floor healing, read our blog post here

The 411 on peeing

Peeing may be difficult and painful initially due to the anesthesia, healing tissue, and shock to your pelvic floor muscles. 

  1. Drinking plenty of water! Walking around, running water, or soaking in a warm bath can help relax your muscles and initiate your stream, too.  

  2. Use a peri-bottle to spray warm water or witch hazel on your vulvar area during and after urination. Pat dry with tissue instead of wiping as tissues may be sensitive. 

  3. Urinary leakage may occur immediately after delivery as well. This should gradually improve but if leakage or urinary issues persists after 6 weeks, see a pelvic health PT or do an online session with one of our therapists. 

The 411 on pooping

Constipation immediately postpartum is super common due to pain medication and dehydration.

  1. Drinking plenty of fluids will help get you back to pooping normally. Like gobs of water! Due to blood loss, medication and your breast milk coming in, you need plenty of fluid to replenish yourself.

  2. Avoid straining when you poop. Use optimal positioning to relax your pelvic floor by placing your feet on a stool or squatty potty, lean forward, and exhale like you are blowing out a candle as you gently bear down. This helps relax your pelvic floor muscles to avoid straining, hemorrhoids, prolapse, or damage to incisions. 

  3. Take stool softeners or Magnesium powder in the hospital to be proactive in preventing constipation, especially if you had any anesthesia or pain medication.

The 411 on c-sections

Following a cesarean section, you are recovering from major surgery. The first few weeks are focused on recovery. 

  1. Wear pants with a soft waistband and use ice over the incision site for the first week postpartum. You can also place a small pillow over the incision when you are riding in a car, coughing, or having a bowel movement. Finding a comfortable position to breastfeed may also be a challenge. Make sure to check in with Ashland Breast Pumps for an in-home consult with a board certified lactation consultant through their Lactation Network.

  2. Start getting out of bed to walk every day. Making sure you stand upright and avoid slouching to allow your abdominals muscles to elongate and not get restricted at your incision site. Make sure to roll over onto your side to get in and out of bed instead of sitting straight up. 

  3. Perform gentle belly breathing when you are lying down to relax your abdomen. Progress to performing gentle pelvic floor muscle/kegel contractions to initiate regaining muscle strength and function. 

  4. Massage your Cesarean incision after its completely healed to decrease scar tissue restriction that can lead to bladder and bowel issues and pain. Get confirmation from your doctor that scar is healed and work with a pelvic health PT or do an online session with one of our therapists to learn how to massage your scar. 

Focus on your baby (and you!)

The 3 months following the birth of your child can be exhilarating, exhausting, adventurous, and overwhelming. So much focus is rightfully put on your tiny beautiful baby, but as the mom you also need nourishment, care and support. 

The focus should be on healing, breastfeeding and bonding with your baby.  

All postpartum moms should check in with a pelvic health PT around 4-6 weeks postpartum. Want to chat one on one about YOUR specific needs postpartum? Schedule an online session to chat today!

Sara Reardon PT, DPT, WCS is the owner of NOLA Pelvic Health and founder of The Vagina Whisperer, a resource for online pelvic health education and therapy to help women worldwide with pelvic health conditions. She is a board certified women’s health physical therapist with a special interest in treating pelvic pain and pregnancy and postpartum conditions. She is a mom, wife, Saints fan and wanna be yogi.

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