Birth Recovery with Sarah Spivey, DPT

Being pregnant sucks. Yes it’s a miracle, it takes some of us a very long time to get there, some of us haven’t gotten there and we should all do nothing but appreciate it. But, everything hurts, moves weird and you think, I can’t wait to not be pregnant because everything will go back to normal. And then… it doesn’t. Many of those aches and pains persist, new ones develop, you’re a mess. But being in pain slows you down, and Mama ain’t got no time for that! Insert Sarah Spivey, doctor of physical therapy and experienced people-person, to teach me that recovery is possible! I have worked with Sarah on my own pelvic floor strength and general physical recovery from birthing three beautiful, but large, babies. She joins me today to share her top tips for pregnant and postpartum moms everywhere.

First thing’s first. Tell us a little about yourself and your career.

Thanks Patricia! My name is Sarah Spivey, and I am a Doctor of Physical Therapy and a Board Certified Clinical Specialist in Women’s Health Physical Therapy. I’m also a mom of two great kids, Sam and Cooper, who are 13 and 10 and I’ve been married to my exceedingly patient husband for 17 years. Before becoming a PT, I taught Pilates for about 10 years, so I have been working with people for a long time to help them achieve their goals. When my youngest was 2, I decided I wanted to go to PT school – which was probably nuts, but I’m so glad I did it! Since graduating in 2020, I have specialized in pelvic health and am passionate about normalizing the discussion about things like incontinence and sexual health. This includes educating pregnant and postpartum folks about what is “normal” versus what is “common.” What I mean by this is, it is common to experience a little leakage of urine with coughing or sneezing during or after pregnancy, but it isn’t normal! Oh, and moms should definitely be able to jump on the trampoline with their littles!

What is the most common reason pregnant and postpartum moms come to you for help?

Usually pregnant and postpartum moms come to see me because they are having symptoms of some kind. This might include things like leakage or urine or feces, constipation, pelvic pressure or pain with intercourse. I also see a lot of patients who have back or hip pain due to increased physical demands of pregnancy. Over the past several months, however, I have started seeing patients who have heard about the benefits of pelvic floor physical therapy (PFPT) and they are coming in for preventative care. This type of treatment is usually very focused on education about normal changes during pregnancy, how to prepare for delivery and what to expect during the immediate postpartum period. I always recommend patients see me around six weeks postpartum for an assessment to develop a personalized approach to help them achieve their goals.

Fitness instructors are always talking about pelvic floor, from the perspective of a medical professional, what do they often get wrong? 

I have to confess, when I was a fitness instructor, I had the idea that women’s pelvic floors are inherently weak, and everyone could benefit from strengthening. This is not only untrue but could have been increasing dysfunction in a certain group of people. For those with increased tone or tension in their pelvic floor, performing unnecessary pelvic floor exercises – or Kegels – can lead to an increase in symptoms like trouble starting the flow of urine, pain with intercourse or even hemorrhoids! I encourage fitness instructors to focus on the relationship of the pelvic floor to the deep core and the idea of stability rather than the idea that everyone needs Kegels.

Sarah’s Top Tips for Pregnancy and Postpartum moms

Pregnancy aches and pains

• Motion is lotion! Exercise during pregnancy is crucial for reducing aches and pains. If you have not exercised prior to pregnancy, chat with your provider about their recommendations. It is important to maintain great cardiovascular health via things like walking or swimming, but don’t forget about strength training! This can help mitigate the impact of your growing baby and reduce stress on your hips and lower back. Core strength is another key. However, if you notice your abdominals doming when you work out, this is a sign of diastasis recti and you need to consult a PT for safe exercises.
• Take time to stretch. Inevitably, some muscles are going to tighten up as your body changes. Pay close attention to your hip flexors (in the groin region), inner thighs, glutes and lower back.
• Consider your posture – perfect posture doesn’t exist, but if you find your back hurts while sitting, you may need to use things like a foot stool or a small towel roll behind your lower back for increased support.
• Take some time for self-care. Before you know it, that little nugget will be here so now is the time to take care of yourself. Schedule a massage, take a yoga class, go out for a walk or anything else that helps manage stress.

Hospital Stay

No one loves being in the hospital. The bed is different, the temperature may not be quite right. Oh, and you are caring for a new little human too!

• Comfortable Pajamas Another must is a pair of comfortable pajamas – if you have had a cesarean section you may want to think about a higher waisted option so the pants don’t press on your incision site. You may also want an option that is conducive to breastfeeding if that is your preference.
• Adult Diapers After delivery, you will have some bleeding that may be heavy at times. While the mesh panties the hospital provides are cute, they are less than cozy. I suggest an adult brief that you have tried on ahead of time and find comfortable.
• Step Stool For that first post-baby poop, you may want to have a step stool to prop your feet on to reduce straining. C-section mamas may also want a small pillow to apply pressure to their incision.
• Peppermint Oil After a vaginal delivery, you may have a hard time initiating the flow of urine, and a few drops of peppermint essential oil in the commode can help as well.

Labor Recovery

• Everyone recovers differently after delivery, but here are some things to keep in mind.
• Pain is normal. You are a rockstar and just had a baby, but your body also went through quite a bit. It is normal to have vulvar pain, especially if you have any stitches. You may want to use a cushion to reduce pressure on your stitches. I also recommend cold compresses. My favorite tip is wearing two pairs of underwear and slipping the compress between them so you can still get up and move around if you need to – hello diaper changes!
• You need time to heal. Seriously. Just rest. There is so much pressure to get back to “normal” after having a baby and for those who deliver vaginally, I think the pressure is greater. For the first 7-10 days, focus on rest and baby care. After that, if you are feeling up to it, maybe take a walk around the block, or do a bit more around the house. There is NO NEED to start exercising too quickly. If it hurts, DON’T DO IT!
• Perfect Your Feeding Set Up Taking care of a newborn is physically demanding. You may have increased low or mid back pain. It is important to use props to help when feeding the baby, whether breast or bottle feeding. Here are my top tips:
  • Sit in a place with support – beds are not ideal as they lead to lots of slumping.
  • Make sure your feet can touch the floor – you may need a foot stool to make this happen.
  • Use a folded hand towel behind your lower back for a bit of support.
  • Sit back against the seat back, take the load off your spine.
  • Use props or pillows under the baby to bring them to the level of the breast, or a height that you don’t need to slump forward to hold a bottle.
  • Use a pillow under your arms to relieve pressure in your neck and shoulders.
  • Try not to watch the whole time! I know baby is cute, but this places a lot of strain on your neck. Look up every now and then.

C-Section Recovery

As a c-section mama myself, I felt like all the guidance for new moms revolved around those who have delivered vaginally. Here are some things to consider after a cesarean:

• Be kind to yourself. You just had major abdominal surgery! 
• Try to avoid twisting – getting in and out of bed in the first days will be challenging. Roll to one side first and then push up to get out of bed. This will reduce pull on your incision.
• Take some deep breaths. This will help get the abdomen moving again as you focus on gently letting your belly rise as you inhale.
• Use a cushion. When you cough, sneeze or have a bowel movement, you increase the pressure in your abdomen, and this can be painful. Place a small pillow over your incision and apply gentle pressure to reduce pain. This is also helpful on the ride home from the hospital when you go over any bumps or, heaven forbid, train tracks.
• Keep an eye on your incision. Look for signs of infection such as redness, warmth to the touch or any funky looking discharge.
• Consider setting up “stations” If you have stairs, you may want to consider setting up “stations” on all levels of your house as stairs can be tricky initially. You may want to have a diapering station on the main level instead of having to walk up to your room.
• Healing takes time. The movement guidelines from above apply here as well but may take a little longer if you have had a c-section. This is normal. It takes about 6 weeks to achieve 80% healing.

General tips for all new moms:

• Stay hydrated! If you are breastfeeding, you will need a lot of water to help maintain your supply. I usually recommend 80-100 ounces in most situations. If you are not breastfeeding, you still want to stay hydrated to make sure your stool stays soft and you don’t increase your changes of a UTI.
• Consider your nutrition. Protein is very important as our bodies heal. Make sure you are getting enough of this vital macronutrient.
• Clearance for exercise and sex is just that – clearance. This means it is physically ok to resume these activities. When it comes to sex, you may need more time. THIS IS NORMAL! As far as exercise goes, this means you are cleared to begin exercise. You have taken time off, no matter who you are, and will need to work into exercise slowly. Walk before you jog, jog before you run and run before you sprint. The same applies for strength training.
• Maternal instinct can take time. Everyone is different. For some, bonding and maternal instinct comes instantly. For others it takes time. You are doing great!
• If you need more support, reach out. If you are feeling overwhelmed, please speak to your provider about your options for help.
• Ask for help. Patricia can help you here – she is the master!