After 24 hours of labor, I thought the hard part was over.
Then my nurse showed up with a small diaper filled with ice. And it wasn’t for the baby.
“This is one of our tricks to reduce the swelling,” she said, while carefully positioning it under my hospital gown.
My recovery, I suddenly realized, wasn’t going to be as simple as I had envisioned.
And neither was breast-feeding.
It began with a nipple blister — yes, you read that right. It’s a common complication that happens when milk gets trapped under the skin. The pain was second only to labor — and the difficulty I had in “establishing a proper latch,” or getting the baby to get a good mouthful of my breast.
I will spare you the details about popping a stitch during recovery. Or the time, a few weeks later, when my gynecologist discovered a polyp that required silver nitrate cauterization to chemically burn the tissue.
(“This will sting a little” turned out to be an understatement.)
Some women endure far worse. But we don’t tend to talk about it, except, perhaps, with our closest friends and family members.
That is starting to change. Several recent books, such as “The Fourth Trimester” (a road map for healing) and “The Fifth Trimester” (a guide for women returning to the workplace after childbirth), have begun to address the mother’s needs during the postpartum period.
Unflinching portrayals of early motherhood are showing up onscreen, too, in “The Letdown,” an Australian series now on Netflix; the movie “Tully,” which explores postpartum depression; and, on the opposite end of the spectrum, Ali Wong’s popular comedy specials about pregnancy and childbirth, “Baby Cobra,” and “Hard Knock Wife.”
And in May, the American College of Obstetricians and Gynecologists issued new recommendations for postpartum care, including the suggestion that women develop a postpartum care plan during pregnancy. Women should have contact with a maternal care provider within the first three weeks after childbirth, the recommendations say, rather than waiting six weeks, and women with chronic medical conditions, including mood disorders, should be counseled about scheduling timely follow-up visits to address those illnesses.
Certainly, it is healthful and helpful to raise awareness of the challenges of motherhood and the risk of postpartum depression.
But even so, many women — myself included — have felt unprepared for the physical trials of the postpartum period. With that in mind, I spoke with doctors, doulas, pelvic floor specialists and researchers to compile a short list of practical suggestions for women entering the first three months after childbirth, a momentous phase of a woman’s life that has often been eclipsed by the baby.
Stock up on supplies. For yourself.
Granted, it’s much more fun to pick out onesies than adult diapers — but you’ll be much more comfortable if you have items like a sitz bath, witch hazel pads and numbing spray, readily available at home.
Lucie’s List, a website full of helpful information for new moms, details the various things you’ll need while recovering from a vaginal delivery or a C-section.
Find a physical therapist.
If you’re wondering whether or not to visit a pelvic floor specialist, the answer is yes.
“Anyone who has had a baby should get some kind of rehab,” said Ronit Sukenick, a physical therapist who established the Pelvic Floor Rehabilitation Program at NewYork-Presbyterian Hospital at Columbia University.
It’s especially important for women experiencing incontinence, back pain and feelings of instability — or if you are no longer able to do the things you used to do, she added.
Many women assume that pelvic health begins and ends with Kegel exercises, but it’s much more than that, said Lindsey Vestal, owner of the Functional Pelvis, a practice that educates and treats women who are either pre- or postnatal.
“It’s not just about the lift and the squeeze,” Ms. Vestal said — any tightening needs to be followed by a full release.
Scar massage can also go a long way toward helping the pelvic floor heal, Ms. Vestal said, by improving circulation and providing nourishment for the nerve bed. She includes a video on how to perform the massage on her website.
Evaluate your core.
During pregnancy, the abdominal muscles stretch to make room for the baby. In the weeks after delivery, the tissue at the midline of the abdomen will usually close, but sometimes a separation remains. This is called diastasis recti and results in a protruding belly.
If you still look pregnant several months after delivery, even after you stop breast-feeding and hormone levels return to normal, it might be diastasis.
A pelvic floor therapist can check the width of the separation and suggest exercises to strengthen the transverse abdominis muscle and the other muscles that help support your core.
Seek breast-feeding support.
Some women don’t have trouble breast-feeding. But those who had difficult pregnancies or deliveries, or who are over the age of 40, are more likely to need help, said Freda Rosenfeld, a lactation consultant in New York City who sees about 400 to 500 women each year.
Mothers should speak with a lactation consultant if after two or three days they are in a lot of pain or if the baby isn’t gaining weight, she added.
Ms. Rosenfeld suggested finding someone who is certified by the International Board of Lactation Consultant Examiners. When seeking referrals, look to other mothers or a care provider such as your child’s pediatrician.
Some mothers simply cannot produce sufficient breast milk, or have trouble breast-feeding for other reasons.
Do what is best for your family, and don’t put unnecessary pressure on yourself to exclusively breast-feed. Consider supplementing with formula or donated breast milk.
“I’m not going to tell a woman who’s struggling with milk production not to use formula,” Ms. Rosenfeld said. “A kid has to gain weight.”
Sleep as much as possible. No, really.
I know, I know. Newborns and sleep do not go hand in hand.
Sleep deprivation is “pretty much inevitable” and one of the biggest sources of stress during the postpartum period, said Dr. Alexandra Sacks, a New York City psychiatrist and author of a forthcoming book about pregnancy and the first year of motherhood.
But finding ways to get a little extra sleep — even if only temporarily — can make a big difference, not only in helping you heal physically but also in your mental state.
“For many people, one or two nights of good sleep totally changes their emotional assessment of their relationship with their child and their relationship to parenthood,” Dr. Sacks said.
Lauren Smith Brody, author of “The Fifth Trimester,” a book offering practical suggestions for women returning to the work force, said there is often a hesitation among mothers to enlist their partner to share in the nighttime feedings or wakings.
“If you can trade off four hours at a time or better yet two nights at a time, you will sort of reset your focus and your capabilities and your sleep,” she said. “A lot of women don’t see their partners as a resource, and that’s a mistake.”
Some people hire night nurses for a brief time, others enlist the help of relatives or try to nap when the baby is sleeping, letting other tasks slide.
“Eat, sleep and feed the baby,” said Dr. Alison Stuebe, the medical director of lactation services at UNC Health Care and a member of the task force that helped create the new A.C.O.G. recommendations.
“If you’ve done all that, you’ve won the game.”