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fourth trimester, Postpartum, self-care

5 Ways to Reduce the Stress of Returning to Work after Baby


Integrating your new mom-life with work-life after maternity leave can seem incredibly insurmountable. Managing a new schedule, embracing new responsibilities and processing emotions are but three of the most common tasks we all encounter when returning to work after having a baby.  It is overwhelming to think about, but it can be done successfully.  It is important to recognize that the path to a successful integration of work and life looks different for everyone. It is not a one size fits all plan. Through trial and error, you will come up with a plan that works best for you and your family.

Be prepared that the first day back at work will be emotionally and possibly physically difficult for you.  More than likely, you will find yourself crying no matter how prepared you feel about returning to work.  Know that you are not alone. Grant yourself the grace to feel the emotions that wash over you that first day back, and then allow yourself time to process each emotion before you press on.  It is ok to feel sad, angry, anxious, worried, disappointed, frustrated, mad, excited, relieved, overwhelmed.  You name the emotion and a mom out there has felt it upon returning to work after maternity leave.

So, what can you do to make the transition back to work as seamless as possible?  Ideally, you want to start doing your research and planning several weeks prior to returning to work to reduce the stress of the first day back.  Here are a few ways to make the transition back to work less formidable.


  1. Take inventory of your new identity

Be realistic with your own expectations of yourself.  Acknowledge that work life will be different.  You have two jobs now instead of just one.  You have a responsibility to your family and to your work that at times will conflict.   Your priorities may sit differently than they did before and different from your coworkers.  You will have to define for yourself what is most important, what you are willing to fight for and what you are willing to sacrifice.


  1. Identify your individual needs

Identify your individual needs as a working mother.   It will look different for every mom.  Are you going to need breaks to pump or breast feed?  Will you be responsible for childcare?  Will you need a flexible schedule?  Will you need to reduce your travel days initially?  Will you need to work remotely?  Have a deliberate discussion with your life partner about their needs and the needs of the family.  Keep a running list of your needs as you process the idea of returning to work.


  1. Consider the needs of your employer or business partner

After you have come up with a list of your needs, consider the needs of your employer or business partners.  How can the needs of each co-exist?  Be willing to consider creative options and solutions.  Document your ideas so that they become cohesive and presentable.


  1. Voice your needs to your employer or business partners:

After you have a list of your needs, present these clearly to your employer or business partners.  Ideally, presenting these needs will be done prior to returning to work so that the expectations are well known when you return for your first day.  Communicate your creative solutions clearly with your employer or business partners. Be sure that they are in agreement that these solutions will work for both you and them.


  1. Find reliable child-care

Reliable child-care is paramount.  I don’t have to tell you how hard it is to trust a stranger with your new baby.  Consider all of your options: facility day-care, in-home daycare, nanny, au pair, family or friends are all great options.  Do your research and make a decision based on what works best for your individual needs.  In addition, identify a back-up plan.  If you chose a day-care facility or in-home daycare you will need a back-up when baby is sick.  If you chose nanny, friends, or family you will need a back-up plan in case the chosen caregiver no shows or calls in sick.  Mentally prepare for a day like that so you have a step-by-step plan in place if the need ever arises.


Dear momma, don’t despair.   I know that as that day looms closer, it seems scary and overwhelming.  Have faith that you will find a new normal that will work best for you and your family. I promise as the days pass by, the emotions won’t be so raw.   Talk to other moms who have gone before you.  Ask for help when you need it.  Believe it or not, this experience will make you a stronger momma and working professional.  You’ve got this momma!


fourth trimester, Postpartum, self-care

The Truth about Self-Care after Birth


I stare at the clock as the hour approaches.  The baby is still feeding, for some reason he has chosen to take longer this time.  I still have to move the clothes from the washer to the dryer, fold the laundry that is in the dryer and cut up some vegetables for dinner.  But, first I have to figure out how I can get this baby off the breast so that I can make my appointment for my pedicure, my chosen weekly self-care activity.   Ugh this is stressful.  There is so much to do and not enough time.  Self-care has become more stressful than relaxing because I have to do time gymnastics to fit it in to my schedule.  Not only am I having a hard time fitting self-care into my routine, but I also feel guilty when I can’t check it off my to do list. Self-care has left me more frazzled than emboldened.

The fourth trimester is emotionally, mentally and physically challenging. Too often, extraordinary demands are placed on a mom leaving her exhausted and empty. Women lose themselves to the daily obligations of caring for a newborn. Moms feel the pressure to be everything to everyone all while keeping the house clean and organized, cooking healthy meals and taking care of themselves. The quest to keep your cup full while filling every one else’s around you was promised to be solved by the addition of self-care as a routine part of your life. Moms have been preached to about the importance of self-care activities in maintaining a connection with one’s self.

The push for self-care is well intended, but the definition of self-care should be clarified.

Most women think of facials, pedicures and coffee with friends when they think self-care.


While these activities are great and can help recharge a mom struggling to make it through the day, without a change in mindset these self-care activities will become another box to check off the forever-growing to-do list.

Self-care is so much more than pedicures, hair appointments and exercising with a friend.


Self-care is:

  1. Embodying an understanding of your self worth and finding ways to respect it. Self-care involves caring about yourself by accepting your limits.
  2. It is about having the strength to recognize your limits, set boundaries in line with your limits and having a willingness to say “no” even when it means disappointing someone.
  3. It is about letting go of the pride of being busy and the constant struggle for improved efficiency as a mom.
  4. It means removing some of the unnecessary (but often perceived as necessary) items on your to do list.
  5. Self-care is respecting your feelings, thoughts, and personal needs.
  6. It is accepting that letting down others is not failure, but preservation of your self. We all have our limits that are as individual as we are.

We all reach our limits, leaving us exhausted, overwhelmed and empty.

Setting boundaries and saying no may be uncomfortable at first, but as you free up quality time for yourself and family, you will come to realize that boundaries are empowering. Your time will become your own and will be of greater quality. When you are able to accomplish this you will feel fuller than you ever have.

When you take the step to create boundaries and regard your needs as a priority, you will be a better mom, partner, colleague, and friend. That is true self-care.




When having a baby isn’t all sunshine and rainbows: What you need to know about postpartum depression.

Having a baby will be the greatest and most rewarding adventure you will ever encounter, but it is not without bumps and bruises, heartache and stress, fatigue and worry. Much to our detriment, we have been conditioned to believe that after baby is born we all will just bounce back to our pre-pregnancy selves on our way out the hospital door.   I mean after all, look at the pictures of Kate Middleton on her way out of the hospital, gorgeous, right.  Those pictures are unrealistic and the media fails to provide the full picture of these women who look like they were never pregnant two days after giving birth.  While the fourth trimester is a beautiful time for the mother-baby unit to bond and learn about each other, it is hard work, it is emotional and it is exhausting.  For many women the postpartum period is not all sunshine and rainbows.


Postpartum depression can be difficult to recognize because many of the symptoms are similar to the normal experiences of the postpartum period, such as fatigue, sleeping difficulties, irritability, or change in appetite.  Frequently women will ignore symptoms of postpartum depression thinking it will go away.  Many women are reluctant to discuss any symptoms of depression for fear of judgment or recourse.  However, it is vital to recognize postpartum depression and seek help from a physician when it is suspected.


The exact incidence of postpartum depression is uncertain, but it is estimated to affect around 10-15% of women.  Postpartum depression can begin during pregnancy but more frequently occurs after delivery.  Approximately 50% of women with postpartum depression will develop it during the first four weeks after delivery, another 40% of women with postpartum depression will develop it two to four months after delivery.  Approximately 6% of women who develop postpartum depression will have an onset of symptoms five to twelve months after delivery.


Some of the typical symptoms of postpartum depression include:

  1. Depressed Mood – feeling sad, hopeless, “blue”, “blah”, having no feelings at all.
  2. Loss of interest in previously pleasurable activities – for example loss of interest in a hobby that used to bring joy.
  3. Change in weight and/or appetite – increase or decrease in weight or new onset change in appetite.
  4. Sleep disturbances – this can be difficulty falling asleep (ok, I know everyone will raise their hand for this one, but this means even if you have time to fall asleep, you are unable) or staying asleep (ie. midnight awakenings, not for the sake of feeding or tending to the baby), prolonged sleeping at night, or daytime sleeping (ie finding it difficult to get out of bed).
  5. Lack of energy – just can’t get motivated to do anything, some women will describe that their limbs or body feels heavy.
  6. Feelings of worthlessness
  7. Excessive guilt
  8. Difficulties with concentration and memory
  9. Anxiety – excessive worry, feeling unsettled, having recurring thoughts, ruminating.


Who is at risk for postpartum depression?  While anyone can develop postpartum depression, there are risk factors that are more commonly associated with postpartum depression.  These risk factors include:

  1. Young age at delivery (less than 25 years old)
  2. Single marital status
  3. Family history of postpartum depression or psychiatric diseases
  4. History of intimate partner violence
  5. Negative view of pregnancy
  6. Unwanted or unintended pregnancy
  7. Poor health prior to pregnancy or during pregnancy (ie diabetes, hypertension)
  8. Personal history of anxiety or depression prior to pregnancy
  9. Breastfeeding difficulties
  10. History of postpartum depression in a previous pregnancy


There are multiple consequences of untreated postpartum depression.  Women who develop postpartum depression are more likely not to breastfeed or breastfeed for a shorter duration of time.  Postpartum depression can result in poor bonding between the mother and her newborn.  There is literature demonstrating babies of women with untreated postpartum depression have a higher incidence of impaired development as a result of inattentiveness and poor infant healthcare.  In addition, postpartum depression strains marital relationships and friendships.  The risks for suicide and infanticide although extremely rare in the postpartum period, are higher in women with untreated postpartum depression than the general public.


Treatment options for postpartum depression include behavioral therapy with a psychologist or licensed mental health counselor, antidepressant medications, or a combination of both. It is generally believed that the risks of untreated postpartum depression outweigh the risks of anti-depressant medication use in breastfeeding women.  There are mental health therapists, psychologist and psychiatrist who specialize in treating women during and after pregnancy.


Postpartum depression affects the entire family, not just mom.  It is a complication of the fourth trimester that cannot necessarily be prevented and does not usually go away without some form of therapy.  If you are concerned that you may have symptoms of postpartum depression then please seek care with a physician.  If you have risk factors for postpartum depression please talk to your doctor or midwife prior to delivery so that you can be better prepared for your postpartum experience.  You are your best advocate!


You got this momma!

body image, Postpartum, self-care

The Struggle of Postpartum Body Image

What do you see when you look in the mirror? Do you see a beautiful, strong, courageous woman, or do you see cellulite, dark circles, stretch marks and wrinkles?


Do you hate what you see, or can you find the good qualities that outshine the flaws? Body image is an individual’s perception of her physical appearance. It is not how the world perceives your body but how you view your external self from within. Body image can be distorted by a variety of internal struggles such as early life experiences, mood, stress, fatigue, and societal “norms” to list a few. A healthy body image does not mean that you believe that your body is perfect; it means that you are comfortable with your body as it is, flaws and all. A negative body image can have deleterious effects on a woman that can range from distressing to life altering including difficulties in relationships, low self-esteem, eating disorders, anxiety, and depression.


Pregnancy and postpartum marks a monumental transformation in a woman’s life. The changes are physical, mental and emotional. Our bodies make an incredible transition while pregnant. The miracle of life is held within our ever-growing womb. The physical changes of pregnancy are beautiful and warmly accepted. But then the baby is born and the beauty of pregnancy is gone and you are left with a deflated abdomen, loose skin and stretch marks. The culture in the United States will tell you that this body that created and held life for 10 months is no longer beautiful unless it is nipped, tucked, worked out, and dieted back into a size 0. Our perception of the postpartum body is tainted by unrealistic expectations. There is beauty in the postpartum body. There is strength, there is courage, and there is love in that beautiful body that just carried and delivered a precious new

Let’s have a reality check. It is EXTREMELY rare for a woman to leave the hospital after giving birth (whether it was a cesarean section or a vaginal delivery) looking like Kate Middleton. Very few of us will be able to wear their pre-pregnancy skinny jeans as their “going home outfit”.   Your body has changed. Your hips are a little fuller, you have extra weight (that is not all lost immediately upon delivery) and your chest is fuller. This is what postpartum looks like and it is ok.


When the world tells you that your make up should be flawless and your hair should be on point all while fitting in to your pre-pregnancy clothes within 2 weeks after delivery, it is difficult to accept your postpartum body.   How do we go about accepting our new bodies? Here are some suggestions to help in the struggle with postpartum body image:

  1. Speak kindly to yourself. Talk to yourself as if you were talking to your newborn. Imagine yourself as a child and speak kind and supportive words to your child self.
  2. Highlight the qualities you perceive as positive. If your mind starts to ruminate on negative thoughts, attempt to make a conscious switch to focus your thoughts on your positive qualities.
  3. Find your mom tribe. You will discover that you are not so different from all the other postpartum women out there. We all struggle with postpartum body changes.
  4. Get outside and move. Walking outside improves mood by increasing endorphins. Activity is not just about weight loss.
  5. Take a social media break. We naturally tend to compare ourselves to others. Avoid the trap of comparing yourself to women on social media. Life is always sunshine and rainbows on social media. Photographs can be deceiving.
  6. Let go and accept change. Give your self a break. Focus your energy on something you find enjoyable.
  7. Accept compliments by others graciously and believe them.


For some of us it will not be easy to accept our postpartum bodies. Acceptance may require help through therapy with a psychologist or licensed mental health counselor. A woman should seek help from their physician if body image concerns are causing eating habit changes, anxiety, depression, or thoughts of suicide.

Be kind to your self, momma. Pay close attention to your internal self-talk. Speak kindness and truth to your self. Your body is a temple, it is beautiful and it is strong. Believe this!


You got this momma!

fourth trimester, Postpartum, self-care

Finding Your Village


Being a new mom can be isolating. We tend to hole ourselves up in our homes just trying to survive on a daily basis. After several weeks of this “survival” behavior, it becomes a bad habit, and the idea of going out to meet someone seems like a mountain of a hurdle to jump. We feel the pressure of balancing house chores with taking care of a newborn all while being attentive to our partners and trying to feel “normal” ourselves. It does not leave much for anyone or anything else. While some women thrive on being alone, I would argue that a majority of women need stimulus from other women. We need a mom village! While you may already have your tribe prior to having a baby, after baby arrives, sometimes those people change as you begin to identify with other women who have children or are soon to be mothers. This is normal. I would even venture to suggest that it is necessary. I encourage women to get out and meet other new moms to share stories, concerns and help provide support. There is strength and healing in sitting with another mother and hearing “I get what you are going through.” When I had my son I was lost on how to find my mom village. The last time I sought out friends who were not work related was probably in college. I had no idea how to begin. What I failed to realize is that the struggles experienced during the first few weeks of new motherhood can be a uniting factor for women. Here are some tips to consider when you are seeking your mom village.


  1. Get out of the house and socialize. Go to a park, walk around the mall, go to the gym or head to a coffee shop.
  2. Meet women in person. Research local mom groups on-line, but plan meet-ups in person. You are more authentic self when you are face to face. It is easier to project only successes on social media and avoid failures.
  3.  Keep your mom village local. You will find that it is difficult to meet up with women who do not live in the same proximity as you. Keep the logistics simple to improve the chances of being able to spend time together.
  4. Be vulnerable. Be willing to share your experiences of motherhood (the good, the bad, the ugly) with other new moms.
  5. Listen. Most women aren’t looking for a fix, they are just looking for someone who will listen and commiserate.
  6. Ask for help when you need it. Offer help when you can.
  7. Include family in your village such as aunts, cousins, sisters, mothers and even grandmothers.
  8. Ask for support and share support.
  9. Spend your time building each other up and avoid talking about other women, which will only serve to bring you down.
  10. Be open to learning to mom together.

hands-2847508__340.jpg                     mom-1508902__340.png

Sharing in the experience of new motherhood with other women, being authentic and vulnerable can lead to some of the tightest, longest lasting bonds you can forge. Your new mom village can lead to life long friendships that you will share the highs and lows of life with. You will find joy and comfort sharing in your struggles together. You will learn how to mom together. Your village will help you to thrive as a new mom. It takes a village to raise a mom!

You got this momma!


body image, fourth trimester, Postpartum, self-care

Postpartum Hair Loss is REAL!


I knew it was an inevitable part of the fourth trimester, but for some reason I was still alarmed when it started. Hair loss, ladies, that is what I am talking about. Lots and lots of hair everywhere! Hair in the shower, on the bathroom floor, in the brush, on the baby! Ugh, so gross. I thought for sure I was going bald! How can this be normal? Well, thankfully, it is.

Postpartum telogen effluvium also known as postpartum hair loss is completely normal. Ninety percent of mothers will experience some degree of hair loss during the postpartum period. It usually begins one to four months after delivery. It is self-limited, so by six to fifteen months after delivery your normal hair growth/loss pattern will usually return.

What is the cause you ask? During pregnancy, the change in the hormonal milieu results in the ratio of hair follicles that are in the growth phase (called anogen phase) relative to the hair follicles in the resting phase (called telogen phase) increases drastically. The result of this change is lusciously full locks by the third trimester. Then once you have had your sweet little nugget, those same hormones change abruptly which affects your entire body, to include your hair. After delivery, the ratio of hair in the growth phase (anogen phase) compared with the hair in the resting phase (telogen phase) reverses resulting in more obvious hair loss. As the hormones balance out over time you will notice that your hair growth and loss returns to its original pattern usually by about 15 months after delivery.

brushing-350089__340.jpg                        adult-19230__340.jpg

What can you do to encourage healthy hair growth and reduce further damage?

  1. Eat a healthy diet full of fruits, vegetables and lean meats (such as eggs, chicken, fish).
  2. Avoid over styling your hair with heat (blow dryer, curling iron, flat iron) or chemicals (improper coloring techniques).
  3. Avoid wearing your hair up in tight ponytails or buns.
  4. Get plenty of sleep.
  5. Continue your prenatal vitamin – especially if you are breastfeeding.
  6. Reduce stress.
  7. Gentle scalp massage – encourages blood flow to the hair follicles.

Because postpartum telogen effluvium is self – limited there are no medications that are FDA approved to treat this condition. Your normal hair growth and loss pattern will return on its own. I get a lot of questions about Rogaine. Rogaine for women is not appropriate for postpartum hair loss.

What if your hair loss seems excessive? If you feel like your hair loss is excessive, you are noticing bald spots, or your hair is not re-growing over time, you may have an underlying medical condition that should be evaluated. A dermatologist would be able to evaluate your symptoms, medical history and perform testing to determine the source of hair loss. A few of the common medical conditions that can be associated with hair loss include:

  1. Anemia
  2. Thyroid disease
  3. Diabetes
  4. Polycystic ovarian syndrome
  5. Lupus
  6. Skin conditions such as seborrheic dermatitis or psoriasis


You got this momma!

fourth trimester, Postpartum, self-care

Surviving with “Mom Brain”


It is pouring rain outside as the car window fogs, I forgot the umbrella (of course), and now I have to run back into the grocery store because I forgot to grab diapers during my first grocery run. How did I forget to grab diapers? I had a living reminder staring at me from the shopping cart. As I plan my strategy to dodge the raindrops and run back into the grocery store for the second time with my little guy in tow (fun), I wonder what has happened to my brain. I am more forgetful, my brain feels foggy, and I have the emotional lability of a toddler. What is happening to me??

I think most new moms can relate to this (please say yes!). If you are a mom then you have probably heard of, or experienced “mom brain”.   Most women complain of increased forgetfulness, lapses in judgment, and/or emotional instability after baby is born. So what is up? Is this normal? Are we all losing our minds?


Well, the answer is not so simple, but I can assure you that you are not losing your mind. The brain is a complex organ that we in the medical field have yet to completely understand. It truly is the final frontier. Pregnant and postpartum brains have been even more elusive because up until recently there has been very little research to evaluate the changes that may occur in the brain as a result of pregnancy.   A new research paper published in 2016 describes visible changes in the brain in women during pregnancy and lasting up to two years after delivery. A group of researchers from Barcelona scanned the brains of women during pregnancy and again at intervals postpartum. These researchers demonstrated definite changes in the grey matter of the brain in the areas associated with social cognition. These changes are believed to help women understand the needs and emotions of their babies. While this change is extremely helpful for new moms to connect to their new babies, it also can explain why postpartum women have more intense emotional responses in general. This may explain why I now can no longer watch movies, TV shows, and commercials that have anything to do with children in distress.


As far as cognition and judgment… “Mom brain” really should be called “a preoccupied, hyperemotional, sleep deprived woman”. I know it feels like you are getting dumber by the second, but there is no research at this time to suggest that memory, cognition and overall judgment is affected by physical changes in the brain as a result of pregnancy or postpartum. Rather, the foggy feeling many women describe as “mom brain” is more likely a result of a combination of sleep deprivation, preoccupation with other tasks and thoughts, and distraction. A new mom goes from just thinking of herself, her partner and her job to suddenly thinking of a new mini person with all of the associated necessities that this little peanut comes with on little to no sleep and a hyperemotional brain. Sounds like fun! Let a man try to remember anything under those conditions!


Unfortunately, the causes of “mom brain” are difficult to avoid, but we can learn to manage symptoms. Here are some tips on how to function in the world with “mom brain”:

  1. Be patient with yourself. Remember there are physical changes your brain has undergone to make you the best mom you can be, but it does have other effects. So don’t cringe when you start crying at the Hallmark commercials. Give yourself room to be emotional and don’t judge. However, if your emotions are affecting your daily living or your ability to care for yourself or your family, then you should seek help from your physician or midwife.
  2. Make lists, lots and lots of lists. Find a good app on your phone for lists or do it the old fashion way with pen and paper. Just don’t leave home without it!
  3. Give yourself time to get tasks done. Rushing intensifies the feelings of fatigue and absentmindedness.
  4. Plan ahead. In my pre-baby life, I was accustomed to doing everything very last minute and in general flying by the seat of my pants. I have found out the hard way that the more I do it the old way, the more I forget. I have invested in a good calendar that I can share with my husband. I have made it a habit to prepare for the day the night before.
  5. Engage your partner with tasks to help you throughout the day.
  6. Get as much sleep as possible, even if it means frequent naps when baby naps.
  7. Make time for yourself daily, even if it is only thirty minutes. Make it a time to relax, decompress and allow your mind to wander.

You’ve Got this Momma!!!

fourth trimester, Postpartum, self-care

Prioritizing Sleep as a New Mom


I don’t know about you, but I require 8 to 9 hours of sleep daily to feel rested. Sleep requirements differ between individuals, but studies show that most people require 6 to 8 hours of sleep daily to feel rested and function at their highest capacity. Sleep is imperative for our bodies to heal, recover and rejuvenate.

Sleep in the fourth trimester can be quite elusive. I am pretty sure I didn’t sleep for the first two weeks my little guy came home, and I have very little memory of those days with him. I was so exhausted. I was trying to do it all…visit with friends when they wanted to stop in, cook, clean and take care of my little peanut. I felt guilty for wanting to sleep. It gives me the heebie-jeebies just thinking it about it now! If I could go back and tell my new mom self one thing, it would be sleep, make it a priority. Lack of sleep affects the body in such a profound way. You may not feel the results of fatigue immediately, but believe me it will hit you eventually.


Here are 5 ways sleep deprivation affects your body:

  1. Your body produces stress hormones causing you to be in a constant state of flight of fight.
  2. It increases your heart rate and blood pressure.
  3. It increases your risk for depression and anxiety.
  4. It depresses your immune system so your body has a harder time fighting off infections.
  5. It distorts your judgment depressing your ability to make sound decisions.


I encourage every momma out there living through the fourth trimester to take control of your health and well being by making sleep a priority every day. A well- rested momma is a more effective, loving, nurturing momma.


Here are some quick tips to help you prioritize and improve sleep:

  1. Sleep when baby sleeps. I know this seems obvious, but it is very tempting to spend baby’s nap times cooking, cleaning, doing laundry, visiting with guests, watching TV, interacting with social media, etc. All of these activities are fine as long as you are not sacrificing sleep to do them. Nap times are a precious commodity especially when baby is not yet sleeping through the night, so use this time to your advantage and get some rest.
  2. Ask for help and don’t turn down help. Let other people do chores for the first few weeks, until you and baby get the hang of each other. This frees up time for you to rest.
  3. Maximize your room for comfortable sleep. Make sure your room is quiet, dark and cool.
  4. Invest in a white noise machine or app.
  5. Avoid feeling guilty for sleeping.
  6. Avoid TV, computers, smart-phones within 30 minutes of sleeping. These devices will actually stimulate your brain making it more difficult to fall asleep.


Sleep will change your fourth trimester experience. It is vital to self-care during the fourth trimester. Prioritize sleep and you will be better prepared to care for your new baby, your family and yourself.

Postpartum, vaginal delivery

Vaginal Lacerations: The low down on a tear down there during delivery

Vaginal lacerations are extremely common during delivery. Not to be graphic, but you did just fit a cantaloupe through a hole the size of a tennis ball. Fortunately, the vaginal tissue is forgiving and stretches significantly during the vaginal birthing process. However, the vagina still does tear. There are four main categories of tears that occur during delivery based on the depth of the tear: first-degree laceration, second-degree laceration, third-degree laceration, and fourth-degree laceration. First and second-degree vaginal lacerations are the most common tears that occur during a vaginal delivery. Third-degree vaginal lacerations are less common, and fourth-degree vaginal lacerations are the least common of the types of tears; only occurring in about 1-2% of non-instrumented (forceps or vacuum) vaginal births. Unfortunately there is no fail proof way to prevent vaginal tearing. Most of it is dependent on your anatomy, the size of the baby, length of labor and use of instruments to aid in delivery (forceps or a vacuum).

First-degree lacerations are the most shallow of the four types of tears involving the outer most surface layer of vaginal tissue. First-degree tears usually heal quickly without complication. In general, first-degree tears will require some stitches to repair the tissue so that it heals correctly. Your physician or midwife places those stitches immediately after delivery. The stitches will dissolve in 6-8 weeks.

Second-degree lacerations involve slightly more tissue than the first degree, but only involve vaginal tissue and do not extend any deeper. Just like first-degree tears, second-degree tears heal quickly without any major complications. Stitches are required to bring the vaginal tissue back together to allow for healing. The stitches will dissolve in 6-8 weeks.

Third-degree vaginal lacerations involve the vaginal tissue and the anal sphincter, which is the ring of muscle that prevents you from leaking stool. These tears require stitches to repair the muscle as well as the vaginal tissue. The stitches will dissolve in 6-8 weeks. These tears have a higher risk of poor healing. Women with third degree vaginal tears can experience incontinence of stool and flatus (uncontrolled passing of stool and gas) even after repair. Many women will require pelvic floor physical therapy and a few women will require additional surgery in the future.

Fourth-degree vaginal lacerations involve the vaginal tissue, the anal sphincter and the rectum. These tears require a great deal of stitches to repair all of the torn tissue. These tears often do not heal well. Women who have fourth-degree tears are at high risk of developing a fistula (connection) between the vagina and the rectum. It is common after a fourth degree laceration to have incontinence of stool and flatus. Frequently these tears require multiple surgeries after delivery to correct the injury. Women with fourth degree tears will need pelvic floor physical therapy.

Postpartum, preeclampsia, self-care

What every new mom needs to know about postpartum preeclampsia:

Preeclampsia is generally thought of as a complication diagnosed during pregnancy. However, preeclampsia can occur after pregnancy too. Preeclampsia during the fourth trimester can be devastating because it is often overlooked and under diagnosed.   Preeclampsia (whether it is diagnosed during pregnancy or postpartum) puts women at risk for seizures, strokes, liver damage, kidney damage and even death. It is imperative for all women to be aware of the signs and symptoms of preeclampsia so that they can seek help immediately.


Here are signs and symptoms you need to look for after delivery:

  1. Unrelenting headache that is not relieved with Tylenol or ibuprofen.
  2. High blood pressures. Your blood pressure is considered high when the top number is 140 or higher and/or the bottom number is 90 or higher. If you don’t have a blood pressure cuff at home, you can check your blood pressure at a drug store, grocery store, or local fire station.
  3. Right upper quadrant abdominal pain.  Pain whether it is sharp, gnawing or burning pain in the right upper abdomen, just under the right rib cage.
  4. Intractable nausea/vomiting.
  5. Visual disturbances such as difficulty seeing in all visual fields, or experiencing “squiggly lines” in your visual field.
  6. Chest pain and/or shortness of breath.


If you experience any one of these signs/symptoms listed above, you need to be evaluated by your physician. Contact your physician immediately, these symptoms cannot wait until tomorrow. If your physician is unable to see you, then you should go to the hospital for evaluation.