You matter. Your body matters.
Pregnancy and birth may be everyday occurrences, but they are not easy, and the after-affects can be wide-ranging and sometimes difficult to live with.
Taking care of your physical and mental health is paramount, not only because a healthy, happy you will be more able to cope with the demands of parenthood, but because you are still the whole human being you were before you conceived, and you deserve to recover and thrive.
With proper care postnatally, we can strengthen and support our bodies to recover – and maintain optimal physical health for life.
This book aims to hold your hand and lift you up as you navigate your new body, giving you information to help you to relish motherhood, not just survive it. It deals comprehensively with the common bodily changes you may experience after birth, explaining what is normal and what may need attention.
Research and interviews with health experts are complemented by women’s experiences of how they overcame a range of physical challenges postpartum, including stories that often go untold. The book does not shy away from tackling the hardest aspects of postnatal recovery, but aims to be hopeful and genuinely helpful.
Not only will you understand your body better, but you’ll also gain confidence that you can and will get back to optimum health. Your Postnatal Body is relevant for everyone who’s given birth, whether you are a brand-new first-time mum or already a few years (or decades!) into motherhood.
THE FIRST SIX WEEKS
It’s six weeks after another human exited your body – woo hoo, time to zip up your old jeans, put your disco dancing shoes on and go partay. No? I don’t bloody (pun intended) blame you. There is an accepted view that six weeks postpartum is when you should be back to ‘your old self’ and resuming your ‘normal activity’. Inexplicably, this can mean many of us that were otherwise previously averse to exercise suddenly donning funky athleisure wear and going to a park to be shouted out as we squat and plank with 11 other bewildered, redfaced mothers. Although some things should have ‘calmed down’ by six weeks after the birth (blood loss, swelling and so on) – the six week ‘marker’ is a bit of an arbitrary milestone. It is a hangover from when maternal mortality rates were very high, as a large percentage of mothers may not have even lasted to six weeks. While maternal mortality is thankfully very low in the West, we still have a little way to go to improve these figures, including paying particular attention to the higher rates of mortality in black and ethnic minority communities. More on this later.
A maternal postnatal check has to happen at some point, but there is no magic switch at six weeks which means you are no longer as ‘postnatal’ as you were at, say, five weeks or will be at 10 weeks. There is, therefore, no reason not to go to your GP, midwife or health visitor earlier with any queries or worries about your health. If you need to see a GP at two weeks postpartum, then book in to see them; there is no reason to wait until this ‘six-week finishing line’. Equally, if you felt fine at six weeks postpartum or, if, like me, you were still in a ‘fug’ at this point and didn’t really actively participate in the discussion around your health, then you can book to see your GP much later on about ‘postnatal’ issues. They really don’t just surface at six weeks and then disappear; it isn’t as simple as that.
THE SIX-WEEK CHECK – WHAT TO ASK FOR AND HELPING YOUR GP TO HELP YOU
In 2018 myself and other campaigners and groups called on government and policymakers to reinstate funding which had been ‘pulled’ for the maternal postnatal check. For around a decade GPs did not have it in their contract to provide a postnatal check for mothers. To their credit, many still did it – tagging it on to the 6–8 week check for the baby. However, this likely made the majority of appointments feel rushed and positioning your health as an ‘add on’ really doesn’t cut it. I’ll say it again for those at the back – YOU are important. In the five years between having my first son and my second, I can’t say that there have been great leaps forward in assessing women at the postnatal check – for either physical or mental health issues, unfortunately. This is the perfect moment to ‘catch’ women who are struggling and also to prepare women for the road ahead. With time, hopefully this service will improve.
When you go and see your GP, try, if you can, to leave the baby with your partner or a trusted friend/family member (even if it means they are there in the waiting room) so that you can really focus on you. Despite my incessant drum-beating on all things postpartum and self-care, I still managed to rush through my own 6–8 week check as my baby was crying and I felt desperate to just get home. This was a mistake. I should have asked for my caesarean stitches to be checked and also for the women’s health physiotherapy referral that I knew I was entitled to.
I hope you get a great GP who is genned up on postnatal health and will guide you through your check-up. If not, and you feel uncomfortable in any way, then perhaps call the practice manager and ask to see a different GP.
Your GP will check that your uterus is shrinking back, and they should check your stitches. There are things your GP should also ask you, such as how you found the birth, how you are healing, how you are feeling, whether you are experiencing any mood issues and they should talk to you about your bladder and bowel health (weeing, pooing, passing gas), and, finally, about contraception options. If they don’t, I have added some prompts below – which hopefully you will feel comfortable using. I am not immune to feeling underconfident around medical professionals, so I do recognise it can be uncomfortable asserting yourself – particularly at this vulnerable time and when some areas are either emotive, embarrassing, or both. If you feel more comfortable with a female doctor, you can request this.
I worked with a fabulous GP, called Dr Stephanie di Giorgio, midwives, colorectal surgeons and a national charity to put together a comprehensive checklist for GPs to go through with postnatal mothers and I know that another pelvic health campaign group worked on something similar. Whether either of these went further, I am not sure, although both GPs I spoke with, Dr Eloise Elphinstone and Dr Meera Sood, did seem to have something along these lines. However, if your GP appointment is more in the realm of ‘how is your mood and have you thought about contraception?’ – as mine was – then the below prompts may help.
I found the birth difficult, is there a debrief service you can signpost me to?
I haven’t been feeling myself. I think I need to talk to someone about the birth/my mood/intrusive thoughts. Can you refer me?
I am not sure whether I am exhausted or depressed. Is there someone I can speak to, to get more clarity on my feelings?
I’m struggling with sleep; I watch my baby all night instead of sleeping. This doesn’t feel normal.
I’d feel reassured if someone could check my stitches/my scar.
I’m struggling with breastfeeding; can you signpost me to more breastfeeding support?
I’m not sure my pain/blood loss is normal.
I think I might need help with my pelvic floor function. Please refer me to a women’s health physiotherapist.
I don’t feel in full control of my bladder/bowels. Please refer me to a women’s health physiotherapist.
Sex is painful. Please refer me to a women’s health physiotherapist.
I’m having back/hip/pelvic pain that is unmanageable. Could you please refer me for physiotherapy or osteopathy?
Things are not okay at home; I need to speak with someone who can help me.
I would like to know my options for contraception.
Or, alternatively…
I am not ready to talk about contraception yet. Could we speak about it at my next appointment?
It can be frustrating that GPs want to talk to you about contraception, often at a time when it’s not really top of your list, but do bear in mind that you can be a real Fertile Myrtle just weeks after giving birth, after your ovaries being ‘dormant’ for so long. It is best to try to give your body a break between pregnancies, even if you are raring to go again. (For more on birth spacing, see p144).
Be wary of the term ‘That’s normal if you have just had a baby’ in response to any physical or mental complaint you have… this is still often used to dismiss women’s pain and discomfort. You deserve a full recovery.
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