THE SIX WEEK GAP: Doulas, Postpartum Recovery and Self-Care

Any woman who has birthed a child at a hospital or a birth center in the United States has likely experienced a gap in care during the several weeks between delivery and her first postpartum office visit with a midwife or doctor, typically 6 weeks after birth.

The Early Postpartum Period

This early postpartum period is an intense, all-consuming time of adjustment for mom and baby as they establish their relationship while recovering physically and emotionally from the birth experience. While often joyful, it is a stressful time of transition for the entire family. Even the healthiest pregnancy and most empowered birth depletes a woman’s body, so rest and replenishment are crucial during those first weeks. Sadly, many women feel overwhelmed, isolated, alone and fearful in early days and and weeks post-childbirth.

To address this, I’ve partnered with an experienced and amazing postpartum doula, Esther Gallagher, to share practical resources and tips to support mothers during the first 6 weeks after birth. In fact, I got so excited about the wonderful service Esther provides to women and families, that I hired her to support me during the early postpartum period I will be entering very soon as I anticipate welcoming my second child in a few short weeks.

While a postpartum doula is a wonderful resource if you have access to one where you live, there are also many practical ways that friends, family and partners can support new mothers during the early postpartum weeks. Keep reading to learn how you can guide your loved ones to best support you, or to glean tips about how to provide support to a special person in your life who is welcoming a new a baby. We begin with words of wisdom from Esther:

Covering the Six Week Gap

You may have heard the term Doula. You may even have met and hired your Birth Doula. But did you know that originally Doula was the name for a woman who helped new mothers during their long period of healing and recovery AFTER BIRTH?

Since midwives and their apprentices would have, and DO,  lovingly and skillfully attend to women’s labors and babies births there would not necessarily have been a designated labor-doula. Once the midwives’ job is done, the Postpartum Doula arrives to relieve the midwives and attend to the ongoing needs of the mother and family.  In the U.S. women are discharged from the hospital after two days and unless there is an “issue”, not seen again for six weeks (aka the Six Week Gap).

If they do need to be seen they are expected to leave their homes and travel and wait for care, while also taking care of their baby. This is not good healthcare policy or expectation.  Even otherwise-healthy moms need to be resting and not doing inappropriate movements (getting in and out of cars, sitting in uncomfortable chairs, trying to breastfeed without adequate support) and having access to nourishment, none of which is provided in medical settings.

The Postpartum Doula is someone with education, training and skills to focus her supportive presence in service to new families. She understands the parents’ general and specific needs. These include:

Healing Birth Wounds

SITZ BATH AND REST IN THE FIRST WEEK. Your postpartum Doula or a knowledgeable friend or relative can prepare your sitz bath during a time that makes most sense for you to enjoy its benefits.  

Step by step directions can be found in our Postpartum Sitz Bath Guide.

Gentle, gradual, slow increase in activity once postpartum bleeding subsides is very important for both physical and emotional well-being, but taken at a pace that does not induce stress, pain or a feeling of being drained of all energy. See below* for excellent advice from Leah on activities that are best for new moms.

Sleeping, Eating, Breastfeeding

Restorative rest/sleep appropriate to the postpartum recovery – SLEEP WHEN BABY SLEEPS Yes, that’s short increments throughout the night AND daytime.  Be sure that those who want to visit are clear that short visits once a day are all you may be able to handle in the first several weeks.  

When we say short, we mean 15 minutes. The time it takes to feed the baby may be the longest you’ll be awake during the day, so if they can bring you your snack, sit with you while you feed, clean up the kitchen and let themselves out while you get back to sleep, it’s all good! For guidance on how to communicate boundaries for visitors and guests that feel comfortable to you, this episode of the Fourth Trimester podcast that I present with Sarah Trott provides valuable insight and suggestions.

Nourishment tailored to this period of transition – EAT WHEN BABY EATS. Yes, that’s 10-12 times a day. Eat protein- and fat-rich foods along with root vegetables and greens. Small plates with a variety of healthy bite-sized offerings are best for new parents who need nourishment while feeding their baby.  Preparing these “snack-plates” is a way that those who’d like to be helpful can really dial it in!! You need about 6 of these stacked in your fridge each day.

Breastfeeding or alternative-feeding  support – FOCUSED ATTENTION TO GOOD LATCHES AND COMFORTABLE POSITIONS. This takes practice and encouragement! While you are sorting this all out with your new little person, it’s best to have no distractions. This is a reason why visitors who aren’t schooled in baby-feeding support might be saved for a later time when you have this stuff well in hand.

Social-Emotional + Practical Support

The Doula understands the physiological changes occurring for mom and baby and close family members, as well as the social-emotional implications for the family.  She may be well-schooled in the birth-experience, whether home or hospital, normal or surgical, and knows how to support the family, both physically and emotionally, as they unwind from recent events, integrate what’s happening now, and move forward into and through the developmental changes as they occur.

MOST IMPORTANTLY, she is someone who not only can educate her clients during their postpartum recovery, she is a can-do, hands-on, pro-active healer and wonderful nourishing meal- and snack-maker, who encourages health and well-being on all levels, and can refrain from judgement.  

How Friends and Family can Support Parents of Newborns

Friends and family who wish to be helpful might consider the following:

  • Be self-sufficient when in the home of new parents.  Do not expect them to wait on you.
  • Look for tasks that you can do without asking for direction or help. If you cannot throw in the laundry without assistance, don’t offer to do so.
  • Do laundry, dishes, bathroom cleanup (especially tub cleaning after sitzbath) and tidying. Don’t ask where things go.
  • When preparing food, don’t ask where to find items. They are in the kitchen somewhere and you can find them. If not, make do.  But DO bring a beverage and a snack to new parents while they feed the baby.
  • Listen when they have anything to say about their experience, but don’t ask for their story. This may seem like exciting information, but for the parents it may feel very special, private and/or possibly distressing to remember. They need peace more than they need to talk.
  • Prepare a sitzbath if mom is available and ready to enjoy it:  Postpartum Sitz Bath Guide
  • For more great tips on how to be a helpful visitor to a family who is welcoming a newborn, listen to this excellent episode of the Fourth Trimester podcast.

Physical Recovery During the Six Week Gap

In terms of self-care, what can mothers do with minimal time and effort to support their physical recovery during those first 6 weeks after delivery?

Healthy, restorative movement during the first 6 weeks after birth

The most important and healing activities to embrace during those early days post-birth include rest, sleep, and replenishment. Your body is recovering from the physiological demands of both pregnancy and birth while establishing milk supply and responding to the 24-hour demands of caring for a newborn. This is not the time to dive into a workout routine – that can and should wait (and I’m writing this as a personal trainer and exercise enthusiast!). When you feel up to incorporating gentle activity (this timing varies from person to person), the most appropriate, restorative movements to support healthy postnatal recovery include the following:

Light, brief walks

This simple activity is wonderfully restorative physically, and walking (especially outdoors) supports emotional, mental and spiritual health. Walking facilitates healthy circulation and tissue recovery, helps reduce swelling, and generally feels good – except for when it doesn’t. Even with something as natural and accessible as walking, listen to your body and don’t rush into too much too soon. If you experience pain, discomfort or bleeding, stop and contact your doctor or midwife. Rest is still your top priority.

Begin with brief walks (a few minutes is plenty at first) within the hospital corridor or inside your home, and then rest. Avoid standing for prolonged periods, and keep walking brief, light and occasional. When you feel stronger and more energetic, you can venture outside for perhaps a 10-20 minute walk. Bring the baby in a stroller or carrier, or better yet bring your partner or a friend and let him or her carry the baby in a carrier. Fresh air and the movement of walking is soothing to infants, and they will often sleep better after (or during) a walk outside. Remember to dress both you and your little one appropriately for the weather, and keep your route short and sweet.

Gentle Kegels

These exercises bring healthy circulation to the pelvic floor and initiate the recovery of muscle control, strength and healthy function. Try performing a gentle Kegel while in a comfortable position – you might be lying in fetal position, on your back with knees bent, reclining with support or possibly sitting upright (although this is a more challenging position at first because it requires greater effort to resist gravity).

Envision your pelvic floor as a hammock of muscle, and try gently lifting and squeezing the center of the hammock in an upward direction towards your spine as you exhale. Make this a slow, controlled muscle contraction. After each squeeze, fully relax and release the pelvic floor as you inhale. Envision a gentle lowering and opening of the pelvic floor as you soften your core and take a full, diaphragmatic breath.

Repeat the pattern of engaging the pelvic floor in an upward squeeze while exhaling, followed by relaxing and softening the pelvic floor as you take another full breath. In the early postpartum days, just a few cycles of engagement/relaxation are sufficient. As you feel stronger and more connected to your deep core muscles, you might perform 1-2 minutes of these slow, controlled Kegels.

Remember to fully relax the pelvic floor after each contraction. Of course listen to your body, and stop if you experience bleeding, discomfort, pelvic pressure, or if it simply doesn’t feel right. Note: if you have a history or current diagnosis of a hypertonic (overly tight) pelvic floor, schedule a consultation with a physical therapist who specializes in pelvic floor rehabilitation before incorporating Kegel exercises into your personal recovery plan.

Core Compressions™

These exercises target the transverse abdominis, your natural corset and deepest abdominal muscle, to restore core strength, muscle balance and function. Core Compressions protect your back and help close any abdominal separation that occurred during pregnancy as your belly stretched to make room for your growing baby.

What is a Core Compression? In a nutshell, a Core Compression involves performing a Kegel as described above, while simultaneously engaging your abdominal muscles up and in toward the spine. Remember “E on E” – always exhale on engagement. Exhale as you lift and squeeze both your abs and your pelvic floor toward the spine. Then take a breath as you soften and relax the muscles. Repeat, keeping the muscle action slow and controlled. It’s important to breathe as directed, and never hold your breath.  

As you get stronger, you will be able to perform Core Compressions in more efficient sets, and in a variety of body positions. For complete video coaching and step-by-step guidance, including a library of variations and tips to get the most out of these profoundly healing exercises, check out our Reclaim program at Wait until you’ve received medical clearance by your doctor or midwife to begin any full body workouts, but you may engage in therapeutic Core Compressions as soon as as early as you feel comfortable doing so postnatally.

Once postpartum bleeding has subsided, you may begin to incorporate light, restorative movement like gentle stretches that simply feel good and relieve some of the postural stresses of caring for a newborn. During those early postpartum days, celebrate each little moment you manage to set aside for your healing as an act of self-love, a moment to pause and breathe as you marvel at the wonder and gift of this new life and your own powerful, resilient body.

About the authors of this article:

Esther Gallagher is a birth and postpartum Doula in the Bay Area since 1992. She is co-host with Sarah Trott of the Fourth Trimester Podcast. She enjoys time with her parents, her grown children and her grandson whenever her work allows.

Leah Keller is a certified personal trainer and Creator of the EMbody Program™ by Every Mother (formerly The Dia Method). She lives in San Francisco with her husband, 4-year-old daughter, and baby boy due to arrive this fall!