Seattle's Child

Your guide to a kid-friendly city

Recovery after birth

Photo by Jacob Lund, iStock.

Recovery after birth: A prescription for healthy mom and baby 

Why "lying in" is a part indigenous cultures across the globe

“You need to get in bed and stay in bed,” this is my memory of my grandmother’s voice two days after the birth of my first child. She had arrived at my house to find me standing by the washing machine, knee-deep in dirty laundry, overwhelmed, tired, and crying.

“In my day, that was the rule! Two weeks in bed just feeding the baby,” she said, or something close to it, as she ushered me to the couch. And then words I’ll never forget: “If you get up too soon, your uterus might fall out.” 

Oh, the power of an old wives’ tale, I thought. 

Later, when I became a childbirth professional, I learned my grandma’s push to lay low after birth was valid. Not only that, but it is also the custom in cultures across the planet for good reason: it leads to healthier moms and babies.

For the record, uterine prolapse (pelvic organ prolapse or POP) is fairly common after birth. That was the “falling out” my grandmother was alluding to. But while there are things you can do to help prevent it (pelvic floor exercises, keeping a healthy weight), laying in bed after a baby arrives isn’t one of them. If this happens to you, make a beeline to your provider.

That clarified, some amount of activity after delivering a baby is, in fact,  necessary for maintaining a birth parent’s strength, returning to family normalcy, and, well, going to the bathroom.

Still, my grandmother’s notion that birthing parents should “lie-in” by laying very low after birth has its merits. The early postpartum period can be full of surprises and challenges, and both parents and babies need time to move through it healthfully.

Why lying in is important

Multiple studies, including research published in the International Journal of Sports Physical Therapy in 2022, show that a multiweek postpartum recovery period helps women recover and return most healthfully to pre-pregnancy activities. 

Specifically, they point to the benefits of a two-to-six-week lying-in period in which a parent who gives birth does little or no other work than bonding with and feeding the baby. Lying in::    

  • Promotes swift healing of the perineum after vaginal birth and strong healing of the incision after a Cesarean. 
  • Promotes the release of oxytocin (often called the “love hormone”), which helps to bring the birthing parent’s milk in and reduce levels of baby jaundice. 
  • Promotes birthing parent-infant bonding, significantly reducing the chances of postpartum depression.
  • Helps the birthing parent and baby get maximum rest.

Big benefit to babies

Years ago, I saw a presentation through DONA International that stuck with me through the next 20 years of my practice. In it, nurse midwife Bridget Lynch, RN, MA, offered even more reason to adhere to some amount of lying in. Doing so allows a baby time to settle in and acclimate to their new environment.

“Babies come into this world ready to bond; their central nervous systems are open and ready for new experiences. With too much activity, babies become over-stimulated and do not have the ability to calm themselves,” Lynch said. “The social demands of entertaining well-meaning visitors deprive both mother and baby of much-needed rest. Babies sense their mothers’ fatigue and anxiety. They become increasingly irritable and difficult to console. However, babies of mothers who observe a lying-in period have a lower incidence of colic. The mother’s familiar presence, adequate rest, and limited stimuli allow the baby time to integrate into his or her new environment.”

Why don’t more parents do it?

If stepping back, laying low, lying in, and allowing friends and family to step it up in the cooking, cleaning, and shopping departments is the prescription to reduce postpartum depression, promote healing, and enhance the mother-baby bond, why don’t more new moms take this medicine?

Here’s what I most often hear from new moms: Someone’s got to do it (“it” being the grocery shopping, housekeeping, cooking, errand running, older kid drop off, etc. With the advent of ‘virtual’ work, I’ve worked with a whole lot of birth parents who feel compelled to continue to work even during their formal family leave.

As one of my clients aptly put the problem: “Multitasking has become second nature. To put the brakes on that drive all of a sudden is hard to do.”

The “Costco incident”

I’ve worked with thousands of parents in Seattle and Los Angeles. Almost all of the parents who gave birth did too much too soon, despite my admonition to lie in. Within days or a few weeks of giving birth, I saw clients cleaning, taking miles-long walks, working virtually at home while their babies napped instead of sleeping themselves, and entertaining waves of family and friends. 

I once visited a Renton mom just two days after she gave birth by Cesarean at Valley Medical Center and found her hoisting a large box of Cosco purchases out of her car. She could barely lift the box and stood wincing in pain.

“It seemed silly to ask someone to do my shopping,” she told me, hugging her belly as we walked into the house (I carried the box). Three days later, she was back at her doctor’s office, bleeding both vaginally (the number one sign of a birth parent doing too much too soon) and from torn stitches. 

Exposing the myth

Unfortunately, there is ample misinformation and hearsay that perpetuates the problem of American women over-exerting themselves after a baby arrives. The myth of women birthing in fields and going right back to work does not hold up when you look at postpartum traditions from other cultures.

As Anne Hirsch, a homebirth midwife, pointed out to me: “In Bali, for example, women folk come over, do all the cooking, and give mama and baby a massage every day. Sometimes, I think if women in our county hear about other cultures where (lying in) is OK, they can relate to how out-of-control busy our culture is and can begin to allow themselves to slow down.” 

China, most Latin American countries, and India all have strong traditions of lying in. They each encourage specific foods to help the birthing parent regain strength. They each enjoy a sense of community around caring for a newborn parent and baby. In fact, “every indigenous culture does this,” Hirsch pointed out.

Becoming a preacher doula

After the “Costco incident,” I got a little more doula-pushy with my clients about the importance of a three–or-more-week lying-in period after’ their babies arrived. 

“I really took your advice,” one of those moms shared in the months following her labor and delivery. “It made such a difference in allowing me the time to rest. I was better able to cope mentally with the demands of a newborn because I allowed myself to rest and not worry about housework. I had my husband, mother-in-law, and mother to help so I could sleep when I needed to during most of the first six weeks. I believe this helped prevent postpartum depression. I was better able to care for my child, which made both of us happier and calmer.”

Here is what I and countless midwives and doulas have seen: When the birthing parent takes time off from all work, heavy lifting, and household chores to recover their body, bond with their baby, and relax into new parenthood, they will likely be fully recovered in four to six weeks.

If they don’t take the time, they are more likely to crash, physically and emotionally, around week three postpartum. 

A postpartum recovery ‘prescription’

Here’s what I and many other birth professionals recommend to birthing parents and new families:

Rather than surround yourselves with visitors, especially those you may feel the need to take care of and who simply want to hold their baby, befriend the words “no thank you” or “not yet.” Here’s a simple, true, statement to help:

“I am still recovering from my birth, and we are yet ready for visitors. We’ll let you know when we are, but my providers have suggested we wait about six weeks.”

Say yes only to those family members or friends who will actually take over everyday jobs–cooking, cleaning, shopping, mowing, and other tasks that will allow you to rest, be with your baby, and, after a week or so, take short walks that will help in birth parent recovery. Follow this postpartum “prescription” written by many midwives and doulas in and around Puget Sound: 

Week 1: The birth parent is in bed. Pajamas are a physical reminder to the parent who gave birth and offer a sort of “permission” to rest and enjoy their newborn. They also remind those visitors who are taking care of your household needs that the birth parent is recovering and needs rest, not entertainment.

Week 2: The birth parent heads to the couch in pajamas – again a subliminal message to them that they are taking it easy. Freely move between bedroom and living room, but avoid stairs if possible and limit up and down to once a day if not.

Week 3: Time for the birth parent to get dressed, move around the house, and go on short walks (start with one to three city blocks). No major outings.

Week 4: The parent who gave birth can return to doing light chores—still no heavy lifting.

Week 5: Increase your walking up to a mile daily and return to moderate and shared housework.

Week 6: Resume regular activities, including returning slowly to your pre-pregnancy exercise level.

Other providers suggest the 5-5-5 rule: five days in the bed, five days on the bed, five days near the bed, followed by weeks three to six above. 

When do you know you’ve done too much?

The postpartum body offers a signal to help the person who has given birth know when they are doing too much or not resting enough: lochia. In the weeks after birth, the blood continues to bleed for up to six weeks. The bleeding may start out heavy, but it should lighten as the days progress forward. If, at any time, bleeding increases or the color changes from a lighter pit to a darker color, your body is holding up a stop sign:

Slow down, lay down a little more, lift less, rest.

Consider this: the average placenta is round. It is about 10 inches long in any direction and one inch thick. It separates from the wall of the uterus after birth, leaving an equally shaped and sized wound. That is where the lochia comes from. Imagine having a 10-inch wound outside your body. It takes four to six weeks to heal an external wound of that size.  Take that time to support and protect the wound left by your placenta.

What I want for every parent after they give birth

A visit with one of my postpartum mothers offers the perfect example of what I hope for every birth parent at three weeks following birth:

  • When I arrived, her sister greeted me at the door and led me to the new mother’s room, where she lay in bed cooing at her baby girl. 
  • On the table was a breakfast tray. She was relaxed, smiling, and rested. 
  • She had not done housework since the baby arrived. Instead, she was letting her family and friends rotate into the home to take care of her.
  • She’d just started doing 30 minutes of gentle yoga each day, and she and her husband took a short stroll with the baby in the evening. 

The significant perineum tear this mother experienced at birth was completely healed. Her mood was buoyant. Her baby was well latched, well attached, and thriving. I asked her how she felt about the baby, her body, and her new life as a mom.

“I am so in love,” she told me. “I love this baby! I love my body! I love all these people who have surrounded us. I’ve never let go in my life – and now I just don’t know why I didn’t.”

She began to set up her support system after I gave her the postpartum prescription. The commitment was sealed when she watched an “über independent” friend struggle through the postpartum period, overwhelmed, depressed, and unable to accept help from anyone.

“What I saw there was suffering,” my beaming mama said. “All I could think of was how hard that was on the baby.”

 

 

About the Author

Cheryl Murfin

Cheryl Murfin is managing editor at Seattle's Child. She is also a certified doula, lactation educator for NestingInstinctsSeattle.com and a certified AWA writing workshop facilitator at Compasswriters.com.