Postpartum Health and Wellness | YMyHealth

What did nature intend for us when it comes to pregnancy? The answer might surprise you.

This includes the fourth trimester—that up to three-month period of recovery after delivery—a period of time which does not receive the press that it should. At YMyHealth, we are changing that.

As important as it is to understand the many physical changes that happen during pregnancy, it’s equally as important to understand what changes can occur in our bodies afterwards. While some can be permanent, others are not.

Also, what may seem like a problem or cause for worry, may simply be a part of the natural biology and evolution of humans in pregnancy, not a cause for concern.

Fellow millennial and OBGYN, Megan Bunnell, MD, breaks down the common postpartum issues millennial women face, including impacts on our pelvic floor function and changes to our bowel habits.

She shares how your history of healthy habits like exercise and diet, and management any pre-existing conditions play major roles in pregnancy and recovery; and that when it comes to pregnancy age really is ‘just a number,’ one that is far less significant than most of us realize.

Physical Changes to Expect After Pregnancy

The journey of childbirth doesn’t end at delivery; it transitions to what many refer to as the fourth trimester. It’s a time when new mother’s experience several physical changes as their bodies recover and adjust to not being pregnant anymore.

Ligament laxity and pelvic floor impact

Many of these changes result from a hormone named relaxin.

“One big thing that happens to your body while you're pregnant is that most ligaments are relaxed by the hormone, relaxin” Bunnell said.

This hormone plays a key role in opening the ligaments in your pelvis and pelvic floor in order to accommodate a baby, she explained. This relaxation of your ligaments affects your knees and your hips. It’s also why people’s feet grow when they’re pregnant.

“You rapidly gain this flexibility while pregnancy- but with this comes instability,” Bunnell said. This can make you more prone to running injuries and overuse/overextension injuries while doing exercises like squatting.

After pregnancy, the relaxed pelvic floor can lead to potential pelvic floor disorders like incontinence (the loss of bladder control or urine leakage).

“Every single woman who has a vaginal delivery has some sort of insult to their pelvic floor,” Bunnell said. However, she reassures us that this is natural process and not necessarily a permanent one.

“I think that we are generation of people who are so unforgiving to our bodies in the time of social media telling us we are supposed to be able to bounce right back to the person we were before. Fifty years ago, people did not worry about that stuff,” Bunnell pointed out. “I think it is important to remind people that this is what nature intended to have happen and just because your body is different after a baby does not mean that something is wrong.”

If incontinence does become a true and continual problem for you in the months beyond delivery, there are treatment options ranging from pelvic floor physical therapy to surgical correction that can help, Bunnell shared.

Megan Bunnell, MD, MS, MA, is a board-certified OBGYN. She has a background in Genetic Counseling, in which prior to medical school she earned her MS/MA in Clinical Genetic Counseling/Medical Humanities and Bioethics from Northwestern University. She earned her MD at the Geisel School of Medicine at Dartmouth.

Bowel/GI changes

Pregnancy can also shift your bowel habits, such as having constipation and an increased or decreased number of bowel movements a day compared to what they were used to.

“Pregnancy is kind of a test of what things are going to bother you in your 60s. Hemorrhoids are a great example. If you don't have hemorrhoids while you're pregnant, you’re unlikely to have hemorrhoids when you're old. But if you had hemorrhoids while you're pregnant, you’re far more likely to deal with hemorrhoids in the future,” Bunnell explained.

“Everybody finds out something new about their body when they are pregnant,” she emphasized.

Other potential issues

Women may also experience hair loss or skin changes during pregnancy, but it's crucial to remember these alterations are often temporary. As Bunnell explained, understanding that the definition of what is “normal” varies depending on the stage of your pregnancy, your hormone levels, and your age is important to keep in mind. “There is bell curve,” she said, “and you’re probably somewhere on it.” That doesn’t mean you cannot reach out for help, but keep in mind the answer might be “that is normal!”

Impact of Exercise History on Postpartum Recovery

While there are many physical changes that we do not have control over, exercise is one thing we do. By engaging in regular physical activity, you prepare your body for the demands of pregnancy and the postpartum period.

Your history with exercise before and after pregnancy plays a significant role in your recovery after childbirth. It can even determine what type of and how much exercise you can continue and safely do (and your doctor can recommend).

“If you were running five miles a day before you got pregnant, then I as your obstetrician would, in most cases, say, it is absolutely fine for you to keep running five miles a day while you're pregnant,” Bunnell explained. “But if you want to start an exercise plan like running five miles a day during pregnancy and you were not a runner before, you’d need to have a longer discussion with your physician about the best choices for your body.”

Benefits of being physically active before/during pregnancy

When we make the choice to exercise before, during, and after pregnancy, the benefits add up. Exercise benefits us during these time periods as it:

Boosts mood and supports good mental health
Improves muscle tone and posture
Improves strength and endurance
Increases energy levels
Alleviates some of the changes to the body in pregnancy (such as constipation)
Lowers the risk of high blood pressure (preeclampsia)
Promotes healthy weight gain
Promotes better sleep
Speeds up recovery after delivery
Can help prevent postpartum depression

Difficulty levels by age - misconceptions around "geriatric" pregnancy

There are many misconceptions surrounding the idea of a “geriatric” pregnancy (a term that I find offensive, and many others do), especially when it comes to bouncing back postpartum.

To start with, a “geriatric” pregnancy refers to women, who are 35 years old and older when pregnant. Bunnell explained that age of 35 was chosen many years ago when the risk of amniocentesis (a procedure done to take amniotic fluid and cells from the uterus to test the baby’s health) basically equated with the risk of you having a baby with Down syndrome. This risk and the number 35 are irrelevant now for two reasons, Bunnell shared:

Amniocentesis is a much less risky procedure now in the way that its performed with ultrasound, etc.
There are so many other things besides Down syndrome that we now know to care about—some of which are age related and some of which aren't.

“Somehow this number 35, which was chosen for this very arbitrary, not even relevant reason anymore, has taken on this life of its own where we’ve created this divide, in all areas of obstetrics between the under age 35 versus over 35 population,” Bunnell said. “The number doesn't mean anything physiologic, other than its history as this really specific indication for prenatal testing 25 years ago.”

“I think that as we get older, we just tend to accumulate minor medical problems and sometimes major ones, but those minor medical issues—all of them—can be exacerbated by pregnancy and harder to take care of if they are not controlled beforehand,” Bunnell said.

She finds that while younger women sometimes have an easier time getting pregnant physically in their 20s let’s say because they do not have 30-plus-year-old problems like blood pressure that is a little higher or underlying thyroid disease, that does not mean women who are in their 30s and 40s are too old to conceive. And that word “geriatric” as many of us well know, truly depends upon a person’s lifestyle history—healthy or not.

Resuming exercise routines after delivery

You might be surprised, but the best way to return to your exercise routine is not defined by a certain number of weeks. Ultimately, it’s the way that feels best for you.

The recommendation for returning to exercise after delivery is to wait six weeks. But Bunnell says that amount of time is not based on any strong evidence.

“I think it drives people to feel like either they can't do those things until six weeks even if they feel up to it or that at six weeks, they should feel up to it,” Bunnell explained. Instead, she recommends that people listen to their own bodies and let that be their guide to resuming exercise post-delivery.

For example, if someone goes for a run at four weeks after delivery and it hurts, Bunnell would say to stop. However, if it feels fine and has benefits for your mental and/or physical health then you should continue to slowly increase your activity. If it starts to hurt at any point, stop and reassess.

Pelvic floor physical therapists say otherwise. She has heard them recommend waiting until 14 weeks after delivery or later to give the ligaments and everything in the pelvis a chance to come back together. The biology behind their reasoning makes sense, but, again, there is not a lot of strong evidence to say exactly when our bodies are ready.

Preventive Steps to Consider

Taking preventive steps before and after pregnancy can help ensure a healthier and smoother transition to motherhood.

Pelvic floor physical therapy

In an ideal world, every woman would have access to pelvic floor physical therapy in the weeks and months following their delivery. It’s a non-invasive approach to reducing or eliminating symptoms of pelvic floor dysfunction that many women develop in some form after delivery.

Bunnell says obstetricians are starting to mention it more as part of the post-delivery plan, but that they should be far more helpful in connecting patients with pelvic floor physical therapists. That’s one of the biggest challenges: it’s very hard to get into see one. The other barriers are the cost and having access to childcare while getting therapy.

“I have no doubt that no matter what kind of delivery you have, like you can benefit from connecting with a pelvic floor physical therapist,” Bunnell said. “I think there are a lot of patients who would be very interested in pelvic floor physical therapy, but you've got a four-week-old at home, so doing anything is hard.”

Benefits of pelvic floor physical therapy include:

Increasing pelvic floor muscle strength and endurance
Reducing symptoms of incontinence
Reducing pelvic organ prolapse (*when one or more of the pelvic floor organs slips down from its normal position and bulges into the vagina because the pelvic floor becomes too weak to hold one or more organs in place)
Reducing sexual dysfunction

Preconception prep

Preconception preparations can play a pivotal role in the health of your future pregnancy.

Two things that should be in your preparation toolbox long before pregnancy: management of any pre-existing conditions and genetic carrier screening.

“I tell people if you're on psychiatric medications, thyroid medication, are almost hypertensive, or have high cholesterol, it is time to talk to your primary care doctor or your OBGYN about the fact that you are thinking about being pregnant in two years,” Bunnell recommended.

Unfortunately, there are many blood pressure, anti-seizure, and antidepressant medications that are not safe for people who are pregnant, so patients have to be switched to other medications that are safe to use.

“It is a lot easier to do and allow your body time to adjust to a new medication when you're not yet pregnant, than if you’re in the thick of it. I think having a whole year to do that rather than a couple of weeks that is very volatile is the way to go,” she said.

There are also some medications that we just do not know a lot about. Currently, the use of statins in pregnant patients is a very controversial topic with some practitioners saying they are helpful while others think they are unsafe.

Bunnell also highly recommends getting genetic screening for carrier conditions like cystic fibrosis two years before you think you want to start having a baby, if you already have a partner who you know that you are eventually going to have children with.

“I would say 99% of the time people have that testing when they're already pregnant and there's no worse time to do it than when you're already pregnant,” Bunnell said. “In this day and age especially, your options are limited if you do find out that the pregnancy, you’re carrying is affected with one of these inherited genetic diseases. So, finding this out ahead of time is incredibly helpful for people to process emotionally and to make decisions about what they want to do with that information.”

Lifestyle factors

As members of Generation Y, we are and can be better prepared because of the healthy lifestyle many of us have and work hard to engage in.

For example, runners and spinners who have been doing those activities long before pregnancy as their normal routine tend to have a healthy pregnancy experience and can continue working out.

Even our plant-based or mainly plant-based diets are okay during pregnancy, Bunnell said, long as we pay attention to mineral deficiencies and combat those appropriately.

“The fact of the matter is when you're 20 or early in your 30s and not pregnant, you can be missing all kinds of vitamins and minerals in your diet, and you probably won't have any side effects from it. But when you're pregnant and you're trying to grow a baby, these deficiencies can be more significant.

This can be especially problematic when it comes to iron deficiency. When it comes to protein intake, while always helpful, it is especially important in patients with multiples (twins or more).

“As you're thinking about getting pregnant, you should figure out how much iron you are already eating and if it’s enough, which for many people it’s not. If not, find out what kind of iron supplementation can you handle. Trying out those different things and seeing how they agree with you before can be very helpful instead of at the same time as your nauseous in early pregnancy,” Bunnell said. It can be hard to adjust to taking an iron supplement in the first trimester.”

Also, make sure you have your checkups at your primary care doctor, dentist, dermatologist, and other preventive care screenings ahead of getting pregnant. It’s important to have things like your blood pressure well-managed and in the normal range from the start.

As more millennials become pregnant in their 30s and early 40s, remember this: The state of health you come to pregnancy in is a far greater predictor of the kind of pregnancy and recovery you will have.

“Those health habits that we start and stick with in our pre-pregnancy lives, all of those no matter how old you are, will go into having a healthier pregnancy,” Bunnell shared.

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