Transcript: Postpartum Care – Self Care Tips to Heal Birth Tearing

This is a text transcript from The First Time Mum’s Chat podcast. The episode is called Postpartum Care – Self Care Tips to Heal Birth Tearing and you can click on the link to view the full episode page, listen to the episode and view the show notes.

Many of the moms I speak with find their postpartum care and recovery a difficult time, with often a lack of resources and information readily available to them. This is even more of an issue when they’ve experienced birth tearing.

For many, this is a scary, uncertain time and there’s no instruction manual or welcome package to help you along with your postpartum care is there?

Getting used to the new normal is hard and there are so often questions you need answers to, right!

This week’s guest knows where you’re coming from and has some excellent tips to help you. Leslie Abraham is a perinatal osteopath who is originally from France where she did her training and has lived in the USA since 2016.

When Leslie moved there, she noticed a lack of help and information available to women on postpartum care and decided to offer her wealth of knowledge to them.

In today’s episode you’ll hear from Leslie on postpartum care topics such as how to help heal birth tearing. Be sure to listen to the end of the interview so you don’t miss any of Leslie’s excellent tips.

Helen Thompson: Hi, Leslie and welcome to First Time Mum’s Chat. I’ve been so excited about having you here.

Leslie Abraham: Thank you, Helen. Thank you for having me. I’m so glad to be able to talk with you on the podcast.

Helen Thompson: So I thought we’d start with the six week check area but before we go into that, I’d love you to tell us a bit about you, what you’re passionate about and what your business is all about.

Leslie Abraham: Yes, yeah, and I love that topic, so I’m excited to be able to dive in. So I’m Leslie, I’m a perinatal osteopath. I’m French, as you can hear. I can’t really hide it. But I live in the US since 2016 and so my experience really sits with women postpartum and during their pregnancy. And so when I came to the US, I really, saw the need for a more, I will say, accurate care of postpartum women. That is really lacking from my own experience, in other countries, I was able to work in France and in Canada where postpartum care is very different.

So when I came to the US and I was confronted to postpartum care through friends, and then clients, I was a bit puzzled from the lack of help that they may receive. The lack of information as well. And so as an expert into that field, I found it really disappointing in a way. So I wanted to be able to bring more information, more resources, and more accurate expertise to that field and to these women. So that’s why Bonjour Baby was born in the first place, just to be able to bring more resources and more information. Everything that all these new mom deserve to know in the first weeks, in the first month, but also in the first years of a postpartum life.

So that’s what I do now. I focus on postpartum recovery. So abdominal and pelvic floor recovery through my own signature program. And yeah, I mean, so far so good and I’m just super happy to be able to work with those women and help them feel better from the inside out and be able to find that identity as a mom and embrace, new chapter that is motherhood.

Helen Thompson: Yeah, that’s a huge new chapter, motherhood, especially if it’s your first time. Yes. It’s a huge new chapter because you know, you’ve had your own life for so long and suddenly this beautiful little baby comes along and it cries for the first time and you think, what am I going to do?

Leslie Abraham: We all have so many questions when that happened about, all the changes that we are experiencing, all the challenges that we face for ourselves, for our baby, for our relationship. And so this is where we don’t find all the answers. It’s hard to have access to everything and nobody, send us home with a welcome package or a how to, or, something like that, you don’t really have that. So this is where you get confused. This is where you are disappointed. This is where you kind of, you lose hope at one point too, because you feel like, okay, that’s just what it is now. And it’s my new normal, which I hear a lot because you know, friends are experiencing the same.

My mom was experiencing the same, so I guess that’s what I have to go through. And it’s not the case. It’s really not the case. Postpartum life doesn’t have to be super hard. It doesn’t have to be very painful. There are ways to improve all of that, definitely.

Helen Thompson: Yeah. One of the things is the tearing after birth and I know that can be really hard for moms, especially if they’ve had stitches and whatever else, and they come home and they’re thinking, how do I cope with this? What do I need to tell my doctor after my six week check and everything. And I know you did a podcast on that. So I just thought I’d ask you what your experience of that is and how can a mother manage that kind of thing and what should they say to the doctor.

Leslie Abraham: Yeah and that’s actually a very good question because that’s one of the things that, you don’t have really instruction for that. So, a lot of women experiencing tearing during childbirth. At least in the US, it’s really something that they let do. In Europe and in France, especially, it’s very different. We go with episiotomy a lot. They really let women tear naturally because it’s better for recovery, so that’s very different. And so it has been shown that 90% of women who give birth will experience tearing.

So that’s really something that is very frequent. And so you have four different types of tearing. So the first thing is to really understand what type of tearing you had during your childbirth, because it will give you a tip, a hint of what kind of tissues has been damaged and what you can do for your own recovery.

So the four degrees, the first degree, it’s the easiest one. And usually it’s just the tissues around the vagina. So this one is the least severe one. Then you have the second degree. So that’s the one that we see the most after giving birth. So this one extends bigger and it goes deeper as well into the tissues, into the skin, the muscular tissues of the vagina itself and into the perineal.

So now here we are in the perineum. So the pelvic floor is torn. On the third degree, so this one goes from your vagina to your anus. So if you can picture it, you have those two outlet here and so the tear really goes from the vagina to the anus, so it’s a pretty big one. And so it goes through the skin, into the muscular tissue and it can damage us as well, the anal sphincter muscle.

So if you go to the restroom, that can be really, really painful. And these muscles, the anal sphincter muscles, those are the ones that are controlling your bowel movements. As I said, when you go to the restroom, it can be painful. And so here, the pelvic floor muscles are also down here and it goes deeper into the pelvic floor layers.

The first degree that’s the one that we see the least thank goodness. And so this one goes from the vagina through the perineum as well to the anal sphincter muscle and into the rectum. The rectum is like the last part of your colon that ends up into the anus. So this one is really the most painful and the most severe, but so for childbirth, as I just said, the one that we see the most is the second degree.

Okay, so at your six weeks checkup, they will check on the healing process. They will just see how are the scar tissues, if you’re healing well, give you any advice on that. And from there, they can clear you out for having sex again with your partner, even for exercise, all that kind of things.

So, what I recommend to you, even though when you are at your six weeks checkup and they tell you that everything is looking good and the healing process is perfectly on track and that you’re okay for whatever. Ask for a pelvic floor PT (physiotherapy) referral. It’s very important and you have to ask for it because most of the OB GYN (obstetrician gynaecologist), they won’t tell you right away. Okay, this is healing good, but still you need to do a bit of pelvic floor recovery. So ask for it. That’s really something that I tell all of my clients, even though we work together on the pelvic floor recovery, I like them to also see, PT because that’s a different kind of work. And so with the PT, there is a lot of work to do because they will ensure a proper mobility of the tissues, making sure that there are any adhesions that will be left because that can translate into movement restrictions.

So we are talking about pain during sex. Heat pain, lower back pain in the future. That’s not something, especially for the hip pain and lower back pain that you would feel right away. But that’s something that can develop in the months and years after giving birth. If that wasn’t a rehab and recovered properly with the help of some PT exercises.

Something else that I like to think my clients as well is to perform some self-massage. So you do it on your own. You don’t need to go anywhere. You just need a mirror because it helps to visualize the place, but you don’t need to use any fancy oils. just your hand, your fingers and contacting the area where you feel the scar tissues and just doing some gentle massage on it.

You want to try and feel if you feel any bumps. Any dryness of the area. So it’s like tissues that are feeling very hard and losing their mobility. The elasticity of the skin is not the same as some place just above or beneath the tearing. And so you want to gently massage the area. You are looking for a kind of butter melting sensation.

So you will feel like the more you massage this area, the tissues underneath your fingers will begin to melt. So if you feel any bumps or whatever, that would feel more mobile. I don’t mean to say that you do it the first time and it will be A okay and you’re done for life. It takes, you know, several sessions for it to really feel better.

But when you massage it, because you are really kind of warming up the tissues here, you will bring some more fluids and some more blood to the area. And so you will have this kind of heating sensation of the tissues, but it’s also this kind of melting sensation. So yeah, at first it’s hard to feel, but the more you do it, the more you will have that sensation at this place.

And so if you don’t really feel anything at first, don’t get discouraged because like everything, it takes practice, but just by doing it and touching the area and gently massaging the area, you already have a lot of benefits. Because one thing that we see also with tearing and it’s also the case for C-section but I think we’re going to speak about that after, is that these areas, usually they have some, they feel numb. We don’t really feel anything after, a tearing or and I saw that with a lot of patients in my osteopathic practice. So just touching this area by gently massaging it, can help to reappropriate this part of your body.

And that’s something extremely important, especially when we speak about the pelvic floor, because that’s a beautiful part of your body and we don’t give it any love because it’s kind of taboo or I don’t know why, but it needs as much love as your skin on your face, needs. It’s as important and it’s very important for your future health as well. And so it will help you also, if there are any fear about the thought of having sex, again, with your partner. Being able to be in control of that part of your body by gently massaging it, will help to decrease the fear as well, because you will know what feels weird, what feels comfortable or what area needs maybe a bit more work. So those are my advice and what you should ask for at your six week check up.

Helen Thompson: When you have that tear, how do you know what kind of tear you’ve had? Do the doctors or the nurses or the midwife actually tell you what kind of tear you’ve had?

Leslie Abraham: Yeah, so usually they tell you. They don’t tell you right away, but it’s more around the six week checkup that they tell you. Some doctors are telling you before, it before, it depends on your doctor, but I always encourage moms to advocate for their own health. Ask all the questions you want. I mean, you deserve it, it’s your health. There’s no secrets to be kept from you. It’s not even really legal to do that. So you should have access to all the information. So if they don’t tell you, and if it’s what you want to know from the moment you leave the hospital, if you gave birth at a hospital or even at a birth center or even at home, ask the person who was here to help you give birth. Okay, did the I tear and what is the degree? If they are not able to answer you, maybe you will have the answer at your six weeks checkup, but usually it’s around the six week checkup that they tell you that.

Helen Thompson: Yeah, cause I know some mums might tear and after you’ve said that they might just think, oh gosh, which tear did I have?

Leslie Abraham: It’s very important to know, because as I said, it will drive your pelvic floor recovery and for you to understand what’s going on with your body, especially in those first weeks, why is it so painful when I go to the restroom? So, if you have a third degree tear, that’s going all the way to your rectum, so you can understand that, it can be super painful, so yeah.

Helen Thompson: Yeah, thank you, and some moms don’t want to go through that. They don’t want to have the tears. They think, okay, I don’t want to have the tears so that therefore they have a C-section, but then again, they might have a C-section for health reasons as well. So when you have a C-section I know you’ve got scarring on there as well and you were talking about the scarring from the tear. So is there something you can do with the scarring from a C-section?

Leslie Abraham: Absolutely, there are plenty of things that you can do from your C-section. And so the first thing to know if you had a C-section is how to move around, because I feel like I just had a surgery a few months ago, they took out a pretty big system, my ovary, so the scar that you have is exactly at the place of the C-section. It’s smaller, but still it’s the same kind of scar and it’s the same kind of intervention. So when you move around, when you have that, at first, it is painful. It is painful to twist, it is painful to to hold someone, you have a baby.

So remember that you have to hold your baby around. So just prepare yourself for ways to be able to move around with less pain. So you will have a lot of pulling sensation, as I said, especially in those twisting motions. But also when you nurse, you feed your baby, when you get your baby out of the crib or out of the changing mat or that kind of thing, this is where you will feel pain.

And especially in the middle of the night, when you’re still, half awake, frustrated and this is where we get hurt. So to get out of bed, the easiest thing to do is to rolling on the side first, then moving back the shoulders, then bringing the knees forward, letting your feet touch the ground.

Bringing yourself onto the bed and then pushing yourself up. So you stand up, okay. If you want to take it a step further, you can add some breath that, so every time you are kind of twisting, you want to breathe out and gently pull up the pelvic floor. It will definitely help to secure the area. You can do the same thing when you’re lifting up your baby from her crib, the bass or whatever, you always breathe out on the movement that is working.

So when you’re taking your baby from the changing mat up, for instance, you breathe out and you engage the pelvic floor as you do so to avoid putting too much pressure in that area. When you’re sneezing or when you’re coughing, that’s something that is very painful.

Helen Thompson: I can imagine.

Leslie Abraham: I experienced it and I can tell you it is super painful. So you want to protect the tissues. So place a hand on your scar and you’re kind of pushing inside gently and up just to protect the area. When you feel that the sneeze is coming up, do that, and it will help you to decrease the pain. Okay. I won’t say that it’s not painful at all, but at least it helps you to protect yourself and to decrease any pain.

Same thing when going to the restroom. If, if you feel it’s really, really pulling same thing, you put a hand on your scar here and you put it up a tiny bit and pushing up towards your belly and it does help as well. And so talking about going to the restroom, if you were prescribed the medication to go to the restroom more easily, I want you to take it because it’s really helping.

It can be, being gassy or constipated is one of the worst thing with a C-section, but there are natural ways also to support a healthy bowel movement. So I want you to pile up on insoluble fibers from your food. Yeah, so not too much raw veggies or fruits, mostly cooked because otherwise it can create gassiness and distension of the stomach.

Same thing with beans. You know, some people don’t really tolerate beans. It makes them gassy. So that’s something that you might want to avoid for the time being. And yeah, and as well as any food, sensitivities or allergies that you have that, can create some gut health issues.

 In the longterm, what we see with C-section, if you don’t really recover from it properly. We see a hip pain, pelvic pain, lower back pain and pain during sex. And so same thing with the tearing, that’s something that can happen, in the months and years following giving birth. So it’s also important here to advocate for yourself and to ask for pelvic floor recovery session, even after a C-section and I really place some emphasis here because most of the time, lots of women think that because they didn’t give birth through the vagina canal, there’s no need for pelvic floor recovery, but there is because your pelvic floor has to adapt to birth, but to the nine months before during your pregnancy, whatever contractions happen during your pregnancy, the weight gain that goes with pregnancy.

So everything, all of that, those nine months, we have to do something to help you recover from that as well. It’s not only birth. And sometimes, it depends, if it was a planned C-section, you don’t really have to go through all the stages of labor and everything, but when it’s an emergency C-section you have to go through all the stages of labor. What I want to say is that you don’t have to try and push, you know what I mean for a certain time. Yes. And at one point they’re like, okay, it’s taking too long, we do an emergency C-section, so that’s not the case. So if you had an emergency C-section because you tried and pushed for so long, you can bet that your pelvic floor had some work to do during birth as well.

So that’s why it’s important as well. Do you want to go into the healing process?

Helen Thompson: I think it’s so important for moms to know this because they’re not told all this, and this is why I think it’s so important. So yes please go ahead.

Leslie Abraham: So I, I keep going. So as we say for the tearing there is a healing process for your scar of the C-section. Of course it takes weeks and weeks and months for the scars to fully heal. It’s not just six weeks, it’s more than that for the full process. And so we need to make sure as with the perineal tearing that the tissues that were cut and the tissue surrounding staying mobile and that there’s no fascia and tissue lesions that are being created.

When you have that, usually this is where you have a lot of pulling sensation. And just in one spot on your scar or you feel bumps, you know, on your scar or you feel like when you look at it, it’s all red and you have this small bump and you feel like there are a lot of tissues intertwined here.

And that’s usually when you have adhesions here. So, and when you develop adhesions and so fascia restriction, this is where we will have issues with mobility at your other joints. So hip joints but also the joints around your sacrum and your hip bones that we call the sacroiliac joints, your lower back spine, your pelvic floor muscles also because they will have to compensate all of that and it can have consequences on how you feel when you move, when you stand, when you sneeze, when you cough, like all of that good stuff. So it’s really important to make sure that the tissues around the scar stay mobile. And as I said, it’s true for even years after giving birth. I remember I had patients in my osteopathic practice that were coming to me. One of them was a pain during sex and plenty of other ones.

And so they had children, but years ago, and it was at the very beginning of my years as an osteopath. And so I was trying to fix the pelvis and everything. And so as osteopath, we also do visceral manipulation. So we do manipulation on the organs and so coming to the pelvic area, this is where I see the scar, because they didn’t mention it was a C-section and I was like, oh, okay, so, let’s try and see how the, the scar is moving here. And so there was no movement. They had complete numbness around the scar. They didn’t have any feeling anymore and just me touching it was a discomfort for them because it was really loaded with emotions and that’s one part of their body they chose to neglect kind of, because it was linked to a trauma or something that they don’t want to remember.

So unconsciously, they completely neglected it. And so just by working on the C-section scar, we had tremendous results. Way more than if I was just working on the mobility of the joints. Doing the two together was where we really had something happening for them. Less hip pain, better pelvic floor mobility, so less pain during sex, that kind of thing.

So, same thing here. You want to ask for a fascia therapist referral in the U S that’s something pretty big. You can find someone pretty much easily or a PT referral. And it’s very important. I really liked when they see a fascia therapist for that kind of matter, because this is where we spend the time to work on the scar and the tissues around it.

Yeah and at home you can also do some self massage. There are some things that you can do by yourself. Doing gentle rotating movement around the scar up and down, a gentle pulling of the tissues around the scar. Same thing up and down to kind of try to break up any adhesions. And one thing that you can do as well, to help with any kind of numbness or lack of sensation is to play around with different types of fabrics on your scar. So let’s say you try cotton, then you try wool, that kind of thing to stimulate also the different nerve that helps with sensation around the area. And all of that can be done around week four to week six and up to several months after giving birth.

Once they have seen your C-section scar and they tell you that everything is okay, everything is on track. You can definitely begin your self massage and do all of the things that we just talked about.

Helen Thompson: So I was just thinking what you were saying about the material. I’m assuming you do that after the stitches were out or disintegrated, I don’t know how it works.

Leslie Abraham: No, of course you do that after and I think today, they do more with kind of glue. You know, they glue the tissues, so it’s easier because the glue, in a few days it’s its own skin, you don’t have really glue anymore. In one week or two weeks you don’t see anything anymore. So that’s the beauty of that new kind of intervention and how they are sealing the skin now, but if you had stitches, yes, definitely.

Helen Thompson: And you mentioned a couple of times and this is something which includes the tearing and the C-section, having sex afterwards. And I know husbands might want to have sex, but to me it’s more respecting your own body and saying to your partner and having that trust and communication with your partner and saying, look, yes, I still love you, yes. I still want to have this, but I need some time to recover. I just thought of this when you were saying it, maybe he could help with this sort of massaging of what you were saying with the tearing and also the scar, because that’s also intimacy and everything as well.

Would you agree with that?

Leslie Abraham: I completely agree with that. And what you just said is, is exactly what it is. It is so important to respect our boundaries, the boundaries that we choose for ourselves. And because from my experience, I feel like, and I see that pretty much every day on, you know, mum’s groups and everything that’s a question that comes up a lot. Like, my doctor has cleared me for having sex with my partner again, but I’m fearing it, what are you tips for that? And I feel very sad every time I see that, because I feel like they are being pressured into something that they don’t desire yet.

And because, you know, the doctor is telling them that, the society is telling them that, they kind of feel they have to rush. And I’m sure if they speak with their partner, their partner will completely understand, and be able to wait or maybe find other ways to have fun together and still find that connection and intimacy that doesn’t require you know, penetration or anything that is not comfortable for you at that very moment of your life.

So it’s very sad. And I think we need to do a better job at reframing the conversation around sex in postpartum. But at the same time, this is something that is needed, but what is needed the most is communication and open communication in a relationship. So social pressure is unacceptable and it’s not acceptable in your relationship as well.

It has no place. I mean, it’s up to what you and your partner want, but that’s all. I mean, it’s not because your doctor is telling you, okay, now it’s time to have sex again that you should do it., I mean, if you’re not ready for that, you’re not ready for that. Maybe you’re battling with postpartum depression, maybe you have postpartum anxiety, maybe you’re just completely exhausted. Like, most moms and that’s the last thing on your list and you really don’t want that. And when there is fear around it, I really want to encourage you to talk about that with your partner, because your partner didn’t give birth.

And so it’s important to explain them what it was looking like, what you feel physically and, and what you feel you are ready for right now. Maybe it’s just foreplay or maybe it’s just, them at first, helping you with the various massage that we just talked about. Decide what you want to do as a couple, not what the doctor and the society wants you to do.

I mean, to me, clear communication, setting expectations, both sides because the partner has his or her words to say as well and explaining why and sharing how you feel about that and why you don’t want it is what matters the most. Really not because friends told you, oh my God, you had your six month checkup and it’s time now.

Oh God, you guys didn’t have sex yet. No, I mean, it’s up to you. So, and as we said, for a physio to me or perineal tears this is exactly why self-massage is so important. We just say that, but being able to touch this area first, just by yourself, and so reconnecting to that part of your body, it is the first step to be ready also for that, and it will decrease any fear that is linked to intimacy after giving birth.

If you are not at ease yourself with providing these massage on this area. I mean, it’s hard to, to picture that you will be ready for your partner and you to be intimate again. You really have to be able to own your body again and having this intimacy and this connection with your partner.

Helen Thompson: And you’ve got to build it up gradually again so that you will enjoy it and you will like it and I think your partner’s got to understand that. Cause as you’ve said, men don’t understand what it’s like to go through that but they don’t understand the aftermath of it. And I think, if some husbands or partners go to the births and actually see you going through it, I think they may understand it a lot more.

Leslie Abraham: Yeah, I agree with you. And that’s why it’s important to explain to your partner if he was in the room, what really happened physically, what you felt. How were the contractions for you? How you felt, what kind of physical sensation you had. So your partner can picture that and how it feels after every time you’re walking, every time you’re holding your baby, what you feel inside going on. So they can understand that, okay, maybe she needs a bit more time. And it’s very, very important to do that. And if you’re ready to, do the self massage of your perineum, as we said, you can ask your partner, to come and join you and do that.

And so he or she will be implied into that recovery process, which I love by the way, because I feel it’s more a couple thing than just a one person recovery after birth. So, that’s totally something that you can do as well and so gradually it will help you to be more confident to share that intimacy again.

And he, or she will know what is a discomfort for you, what feels better for you, that kind of thing, because maybe sex will be different now that you have a baby in that you went through childbirth for the first month, postpartum, then it was just before having a baby all during pregnancy as well.

So that’s important for them to understand that. Something that can help as well is using any lube for sure that can really, really help especially if you are dealing with any kind of hormonal imbalances. You can have dryness and it can be painful as well. So that’s something that you want to keep in mind as well is to work with any kind of nutritional deficiencies that you can have as well, that can increase the hormonal imbalances that, you know, the first six to nine months are a bit of a roller coaster.

So you can have like any different sensation as well, like dryness or all that kind of thing.

Helen Thompson: Gosh, we’ve talked about so much in this podcast. So I think it’s about time for me to ask you how can people get in touch with you?

Leslie Abraham: So it’s pretty easy. You don’t have, you just have to go to, this is my website. So you can check what I do. If you’re up for a little chat, you can book your free consultation with me. So that’s pretty easy. I also have my social media and my free Facebook group. This is where everything is happening. This is where I share the most content. And of course there is the Bonjour Baby podcast.

Helen Thompson: Thank you. I will just say, I highly recommend your Bonjour Baby podcast, because I’ve actually listened to the podcasts and there are a lot of really, really valuable tips in your podcast. I think you’ve covered a lot of amazing topics in there, so just wanted to pass that on to mums.

Leslie Abraham: Thank you. I appreciate it. I really, I really love and enjoy doing that podcast and it’s it’s it’s really to be able to share, you know, all of the resources that we have on hand and that can help all moms.

Helen Thompson: That definitely shows when you talk. So just one last thing out of everything we’ve said what two magical tips would you give to a first time mum who’s going through what we’ve just talked about.

Leslie Abraham: To trust herself. It’s the first one, because she knows she has the answers to all of her challenges as a new mom. She knows deep inside what to do. She doesn’t need to be told what to do with her baby.

She knows deep inside. She is a good mom and she needs to trust herself more. So that’s my first tip. And the second is to listen to her body. It’s very important. Your body knows what he needs. So in terms of recovery, it’s very important. I always say that to all of my clients to really pay attention to the cues of the body and to listen to what’s going on because every discomfort that you feel, every pain, even if it’s not something that is kind of a burden on your life, then your body’s trying to tell you some things. So listen closely to it and seek the help of other experts to help you. It is so important. I promise you that’s really what matters and especially in women’s life at that time.

So in order to be able to take care of our little ones and to be present for our families, we need to put ourself in the first-line as well.

So that’s my two tips.

Helen Thompson: Thank you, they’re beautiful tips. And thank you so much for being on the podcast. I’ve really, really enjoyed talking to you, so thank you so much.