Birth and Bowel Movements: Tips for the first BM after delivery

Bowel movements?!?  Really?!?  You want to talk about bowel movements?  

Yes. Yes, I do.  

This is one thing I certainly never expected or cared to research when I was having kids.  I was just focused on gearing up to get the baby out - I didn’t think so much about after the fact!  One would think that a bowel movement would be nothing in comparison to pushing out an 8 pound baby, no?!? Well…

Many women don’t anticipate this being an issue after delivery, especially if you’ve never had issues with constipation before.  However, a multitude of factors can throw things off and leave you feeling all “backed-up”.  Medications, prolonged sedentary positions and/or an altered diet are just a couple of potential culprits. Regardless of the reason(s), it makes for a less than ideal experience when the time comes to void those bowels.  Your healthcare provider will most likely be asking you and keeping track of how this process is going.  However, if you are having trouble in this department after giving birth, don’t be afraid to ask for help so they can set you up with a variety of resources like stool softeners and enemas to help move things along.  

Here are some additional tips that you can do yourself should you find you’re in the situation of dreading bowel movements after giving birth.  (These tips also work great for general constipation too).  

  1. Relax - Way easier said than done especially if you’ve had any type of tearing, an episiotomy, a C-Section or are just dreading having to “push” one more time! Pelvic floor muscles relax and open much more easily when you are not stressing about it or anticipating pain. How do you relax the pelvic floor specifically? One way is to use your breathing - inhale and simultaneously visualize opening the anus. Sometimes it works well for people to visualize widening the SITs bones away from each other as you inhale (the “SITZ bones” are the two boney points you feel in your backside when sitting in a chair). This relaxing or opening should NOT feel like you are pushing downwards, it’s simply a reflexive response to the breath. If you’re having trouble getting this down, ask for some help from one of our amazing physiotherapists.

  2. Don’t clench your jaw - Also, if you’re having trouble relaxing the pelvic floor, check and make sure you aren’t clenching your teeth. Strangely enough, keeping this area relaxed can also help relax the pelvic floor.

  3. Knees higher than hips - Those fancy commodes are handy so you don’t have to squat down so low, but sitting high doesn’t do much for optimizing the position of the rectum when trying to void those bowels. Grab a stool or improvise with a garbage can (preferably empty!) tipped on its side. Place feet up on something secure so your knees are higher than your hips and legs are supported and relaxed. This can help align things more optimally for faecal evacuation.

  4. Position some more - Lean forward and rest elbows on your knees. This allows for further relaxation. Let the tailbone untuck slightly to allow for easier passage of stool pass this area.

  5. C-Section? Splint lower abdomen - If you’ve had a C-section, place a towel or your hands between thighs and lower abdomen for added support at the incision site. Try not to block your belly totally however as forward movement of the abdomen can further help the muscles surrounding the anus to relax. I know it’s going to feel like things will burst wide open if you strain too hard, but keep in mind that the surgeon stitches you up with the goal of keeping you closed. If they thought the forces generated by pooping were going to be a hazard, they would tell you not to poop for 6 weeks or something crazy like that until things are all healed up. Plus, after reading this article, you now have some strategies to minimize that horrible feeling of pain/pressure/pulling at the incision site! Ready for some more awkward suggestions?? I’m just warming up!

  6. “Moo”, “Grr”, “Hiss” or pretend to “Blow through a very small straw” - Ummm, WHAT?!??! If you didn’t already think I was crazy, I realize I just tipped the scale. Please, bear with me (no pun intended). Using your breath or vocalizations on the exhale can help modulate intra-abdominal pressure and act as an effective tool for assisting with a less strenuous bowel movement. It can help you avoid the Valsalva Maneuvre (breath holding) that can increase downward pressure on the pelvic floor and/or the outward pressure on the C-Section incision site (if you have one). Try all four sounds out - see which one feels like it opens the anus the most. Generally speaking, half of these vocalizations will feel like they make you tighten at the anus, and the other half will create an opening effect. However, which one is most effective will vary from person to person. When you find one that feels like it creates the greatest opening effect (eg. “Moo”), use that as your go-to vocalization when on the toilet. If you are having trouble finding one that works, make sure you try again using a low-pitched voice versus a high-pitched voice. In attempts to try and redeem myself, I’m going to throw in here that you don’t actually have to make the sound so they can hear you at the nurses’ station (although that would be entertaining). Simply causing that air movement with a whispered “Moo” can be just as helpful.

Strange tips, I know, but these simple things can make a huge difference in keeping that first bowel movement or two after delivery a much less torturous experience.

If you have any questions about pelvic floor physiotherapy or preparing for birth, please call Rebirth Wellness Centre at, 226-663-3243, or email us at info@rebirthwellness.ca.

Jaclyn Seebach, PT ~ Certified Pelvic Health Physiotherapist


Feeding Positions After Cesarean

Tips for minimizing pain

So, Cesarean birth was the way you got to meet your precious baby!  It may or may not have been the journey you expected.  The pain afterwards may also not have been what you expected.  Regardless, here you are, things hurt like hell and you’ve got to feed your baby.   Below are a few suggestions that I hope will make things more comfortable for you as you nourish your little one after having undergone a Cesarean birth.  These tips apply to women who are breast-feeding OR bottle-feeding.  

 1)    Have baby brought to you.  As much as possible, have someone bring baby to you when it’s time for them to be nourished!  This could be a partner, family member, neighbour, friend or postpartum doula. Early on in your recovery, limit how often you are up & down, in & out of bed as well as lifting & lowering baby from the bassinet/crib.  Trust me, your body will thank you in those first few days after surgery!    

 2)  Stay on top of your pain medication.  If breast-feeding or pumping, many women are nervous about taking pain medication for fear that it will get passed on to baby through the breast milk. Please note that most pain medications are safe to take while breastfeeding.  Conservatively stated, less than 1% of NSAIDS transfer to baby (when taken orally…as most of you will be doing).  This remains well below any dosage that would be prescribed for your child.1

“Orally administered NSAIDs are excreted into breast milk in low concentrations. Ibuprofen has a short half-life with a relative infant dose that ranges from 0.6% in colostrum to less than 0.38% in mature milk, equivalent to approximately 0.2% of the pediatric dose. Given the very low concentrations in breast milk, ibuprofen use is acceptable and the likely preferred first-line agent for postpartum pain.” ~ American College of Obstetricians and Gynegologists, 2018Initially, many women require more help for pain relieve.  Opiods (such as codeine or tramadol) may be used in the first couple of days in combination with other medications.  Opiods can be a useful tool for treating what we call “breakthrough pain”, severe pain that shows up even when on other pain medications.  However, in order to implement them in the safest way we know, it is recommended that you be on this form of medication for a short amount of time only (no longer than 4 days) and that baby is monitored for signs of sedation.  Infant sedation may show up as being difficult to wake for feedings, as having difficulty feeding or showing signs of limpness.  Keep in mind that this happens in only ~2% of infants.3

Something else to consider, however, is that staying on top of medications can also impact breastfeeding in a more helpful way.  Did you know that pain can inhibit the release of oxytocin, a hormone important for encouraging milk flow?2  So, staying on top of pain medication can have a positive impact on milk flow.2  

 If you are still adamant that you don’t want to take pain meds, at the very least, make sure you don’t overdo things!Yes, I’m looking at you “productive”, driven and antsy momma!Gentle movement and short walks within your pain tolerance can be helpful in mitigating pain, releasing endorphins (one of your body’s natural, internal pain fighters) and increasing circulation to help with healing.2 However, if you over-do things pain will most likely increase.  You should never be more sore than ~3-4/10 pain for longer than 30-45 minutes after completing approved forms of exercise. 

 I am by no means a medication master.  Please speak to your doctor or pharmacist for more thorough and individualized advice or if you have questions/concerns about pain control postpartum.

 3)  Try different feeding positions Whether you are bottle-feeding or breast-feeding your precious babe, the following positions can be helpful to limit aggravation of the healing tissue.  If you have an active baby, these positions will also limit the probability of getting kicked in the guts and that awful feeling that your incision is  going to burst open at any moment (been there, felt that!).  Keep in mind that some of these positions might not feel great to you - that’s ok!  Stick only with the ones that are helpful! 

 a) Sitting upright with a nursing pillow:  The pillow helps brace the site and protects from squirming feet and legs.  If you have a long torso, you may require a second pillow  to elevate baby up to the breast - resist the temptation to slouch and bring the breast down to baby! Slouching down can put uncomfortable pressure at the incision site. 

b) Sitting upright - Football hold: This positions baby off to the side of your body.  Their head is cradled in your hand and their body is elevated with pillows to a comfortable height at the breast.  Again, don’t slouch!

c) Side-lying:  Once it feels comfortable to lay on your side, you can nurse with baby accessing either the bottom or the top breast.

d) Laid-back: Hold baby in a cradle or cross-cradle position up away from the incision site.  Use a pillow over the incision for further protection.For babies with an established latch, you can also try placing the baby vertical along your torso (instead of across it) - for this position you’ll want to watch feet and knee kicks to the lower abs (pillow!).Letting baby nurse in this laid-back position may allow both you and baby to make us of many different nursing reflexes.AND it takes the work and discomfort out of holding yourself in an upright position for hours of the day.While in hospital, simply elevate the head of the bed.At home, use pillows to prop yourself up.This article from La Leche has a great summary if you wish to know more about the benefits of this particular position: https://lllusa.org/lie-back-and-relax-a-look-at-laid-back-breastfeeding/ .

4) Be patient with yourself If you are breastfeeding, keep in mind that having a Cesarean birth may make it more difficult to establish breastfeeding, impact milk supply and throw off an infant’s receptivity to breastfeeding.4 

 If breastfeeding is your goal, know that it’s not something you’re doing wrong.  Give yourself a little bit more time knowing that the biological processes that get naturally set off through vaginal birth may not have been stimulated in the same way with a Cesarean birth.  Stick with it and get professional assistance from a Registered Lactation Consultant or Breastfeeding Counsellor if you are struggling.

 Some simple things you can try to limit these potential impacts are to breastfeed as soon as possible after your Cesarean (ideally within the first hour) and have lots of skin-to-skin contact with your baby.  Assuming your infant doesn’t require immediate medical attention, many surgeons are allowing this to happen right in the operating room.  If you haven’t yet had your Cesarean and are reading this as a way to prepare, be sure to let your healthcare provider know if this is something you’d like to have happen. 

Hope you find these tips helpful in your recovery!  For more information or to book a spot in our Cesarean Birth Recovery Workshop, check out rebirthwellness.ca.

 References

1. Sachs, H. C., & DRUGS, C. O. (2013). The Transfer of Drugs and Therapeutics Into Human Breast Milk: An Update on Selected Topics. Paediatrics. do: 10.1542/peds.2013-1985, [https://pediatrics.aappublications.org/content/108/3/776]. Accessed online July 24, 2019.

2. “Breastfeeding After Cesarean Delivery.” HealthyChildren.Org, [https://www.healthychildren.org/English/ages-stages/baby/breastfeeding/Pages/Breastfeeding-After-Cesarean-Delivery.aspx.] Accessed online July 24, 2019.

 3. Postpartum pain management. ACOG Committee Opinion. No. 742. American College of Obstetricians and Gynecologists. Obstet Gynecol 2018; 132. DOI: 10.1097/AOG.0000000000002683. Epub 2018 May 18. [ https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Postpartum-Pain-Management?IsMobileSet=false]. Accessed online July 24, 2019.

 4. Hobbs, AJ, Mannion, CA, McDonald SW, Brockway, M, Tough, SC. (2016). The impact of cesarean section on breastfeeding initiation, duration, and difficulties in the first four months postpartum.  BMC Pregnancy Childbirth. 16: 90.