Ali Heppell Pregnant Woman Leaning On Rock By The Water

Honest realities of the 4th trimester

Honest conversations and evidence-based information about the practical realities of early postpartum are essential for all birthing people. 

There are real physiological needs in postpartum. 

Your tissues have expanded, the placenta leaves behind a wound the size of a dinner plate inside your uterus, your uterus is contracting back down to its pre pregnancy size, your pelvic floor has stretched.

It is huge work preparing for, birthing and caring for your baby, physically, emotionally, spiritually. 

In the days, weeks and months post birth your body is doing a lot. 

Your internal organs are returning to their normal place, connective tissue and ligaments are slowly repairing and recovering. You will have swelling and bruising and maybe some itchiness in the places where wounds are healing. 

Your breasts will feel sore, tight and uncomfortable as the milk comes in. If you haven’t breastfed before the sensation and sometimes pain that can accompany the first time your baby attaches to the nipple can feel, to put simply, foreign. You’ll be super hungry, with the high nutritional requirements needed for physical recovery and breastfeeding. You will cry, you will get little sleep, you will be on one of the steepest learning curves of your life. 

Postpartum doulas are trained in the knowledge to support those in postpartum and to teach them how to care for themselves in this fragile and tender time.

Not only are we there to be by your side, hold space while you unravel, listen without judgment, care for you and feed you healing and nourishing food. We also educate you, support you and help you physically and emotional move through early motherhood. 

You will be amazed, looking back, at the way your body can go from being painful, tender, swollen to repair and recovery. But when you are in the thick of it you need to know how to support yourself and move through this time with ease.

Below are some of the practical honest realities of postpartum and general suggestions to move through them with greater ease. 

Every postpartum is individual, you may experience all or just some of the things outlined below. 

Remember, postpartum support is available you do not have to do this alone, you do not have to wait until you are really struggling to ask for help and you do not have to spend hours in the middle of the night google-ing. Postpartum doulas are an amazing wealth of knowledge reach out to someone in your local area or reach out, I am always available to answer your questions.

This advice is general in nature, I am not a medical professional. If you need medical support please contact your local GP, maternal health nurse, obstetrician, midwife or qualified health professional.

Vaginal healing

Your vagina, vulva, perineum, and rectum have sustained immense pressure, bearing down and pushing and stretching to get your baby out.


  • Use ice packs for up to a week after birth. This will help with reducing swelling and bruising to the vagina, vulva and perineum. 
  • After ice comes warmth. Use a warm heat pack or a pop into a warm bath to bring warmth and blood flow to this area to support healing and recovery. 
  • Add epsom salts (magnesium sulphate) to your bath to promote healing and reduce swelling and infection. 
  • You can have a sitz bath – This is a shallow bath with about 10cm of warm water. You can just do this in the a bath or you can buy attachments to the toilet. Sitz baths help to soothe, cleanse and heal.
  • Use a ‘peri bottle’  – Short for perineum bottle this is a little bottle with a bent nozzle, essentially a portable bidet, used to spray water up onto your perineum and surrounds to relieve some of the stinging and discomfort that can occur from tears and stitches.

Caesarean healing

Belly birth is major abdominal surgery. Hospital stay and recovery tends to take longer than vaginal birth. 

You will be given through supports around the wound healing and physically recovery from your medical professionals. 


  • Brace your belly. Hold onto and support your wound when you laugh, cough, sneeze and go to the toilet. 
  • Once to incision is fully healed touch and massage your scar to promote deep tissue healing

You will bleed

In the days after your birth you will have vaginal discharge that contains blood and other tissues and fluid called lochia. Heavy lochia will generally last up to five days and then slowly reduces, generally ceasing by the six week mark. You will need to be changing pads very regularly in the beginning. Often when breastfeeding your uterus will contract and continue to shrink back down to size, you will release more blood/lochia, generally, at these times.


  • Maternity pads, a lots of them
  • Postpartum disposable undies 

Haemorrhoids are common

Uncomfortable, painful pains in the arse! They are common during pregnancy and postpartum because of the amount of pressure pleased on the vein in your rectum. Haemorrhoids can shrink and disappear without the correct support. 


  • Soak in a sitz bath (see description in vaginal healing section) 
  • Eat fibre rich foods
  • Hydrate
  • Use Witch Hazel. Soak a cotton ball with witch hazel and apply directly to your haemorrhoids after each bowel movement. 

The sweats 

Know that if you are experiencing night sweats, you are not alone and they are short lived!

During pregnancy we retain water due to the increase in blood volume. After birth your body then flushes out the excess fluid through sweat (and wee). 


  • Sleep on towels
  • Hydrate, hydrate, hydrate! Drink lots of water, always. Water support you in so many ways throughout the postpartum period. 
  • Wear light, breathable clothing to bed

Going to the toilet can be scary

You will be stretched, sore and bruised. You may have stitches or have given birth via caesarean, either way your body will feel sore and the last thing you want to do is create more movement down there. 


  • Use a stool to elevate your feet and move into an optimal pooing position. 
  • Support your perineum and any stitches by holding a pad against the area while doing your poo.
  • Learn how to breathe out your poo, not strain or push. 
  • Hydrate 
  • Eat fibre rich foods. 

The tears will flow

Progesterone and Oestrogen are in abundance during pregnancy. In the days following the birth of your baby and placenta there is a drop in these hormones. This along with the many other hormonal changes that occur in birth and in the production of breastmilk will leave you feeling all the feels. 


  • Lean in, cry if you need to, feel and move through the feelings as they arise.
  • Share your feelings with trusted people
  • Know that it is hard because it is hard. You are learning and doing so much right now. 

Phantom crying 

Having a baby changes your brain. Hearing crying when your baby is not crying – maybe when you’re in the shower and buns is asleep and after with another carer is not uncommon. 

Essential for the survival of our baby (and the species!) we are wired to listen out and be tuned in to all our babies needs. We are also in the thick of sleep deprivation influencing our sensitivities and reactions. 


  • Try using a baby monitor
  • Reassure yourself using compassionate language – “It’s okay, the baby is safe.”
  • Ask another caregiver to watch the baby

Rest and manage your pain

You have just birthed a baby – whether vaginally or through the belly – this is major and the discomfort and pain is real. 


  • Lay down, rest, keep horizontal. 
  • Ask for help. 
  • The only movement you should be doing in the first days and weeks is going to the bathroom and feeding your baby. 
  • Move gently. 
  • People can come to you. 
  • Eat in bed, sleep in bed, rest in bed, feed your baby in bed, rest in bed. 
  • Take the prescribed pain medications. 
  • Try not to overdo it, you don’t need to put a load of washing on, you don’t need to go for a 2km walk. 
  • Start off small.