March Knowledge Drop
Each month for our newsletter, the Lady Blurb, we'll share answers to some questions you've submitted. The questions below were taken directly from you! To submit a question for next month, comment below or email us at contact@ladybirdpt.com.
**The answers to these questions are not meant to be used as medical advice. These answers are not meant to take the place of a skilled physical therapist or discussion with your medical provider. If you are experiencing concerning symptoms, please contact your physician.**
This month, we’re answering:
How does lactation impact estrogen and your pelvic health?
Should I wear a belly band after childbirth?
How do I reduce my risk of perineal tearing during vaginal birth?
1. How does lactation impact estrogen and your pelvic health?
During pregnancy, estrogen levels rise. Following the birth of the placenta, estrogen levels plummet to below pre-pregnancy levels. Your estrogen levels do not return to baseline until you are no longer producing milk and this hormonal fluctuation can have a major impact on your pelvic health.
The tissue at the vaginal opening, known as the vestibule, is hormonally dependent. This tissue is the same kind of tissue that lines the inside of your urethra. Estrogen helps keep this tissue healthy, plump and happy. Without enough estrogen, the tissue at the vaginal opening can become sensitive, frail and thin. These tissue changes can lead to a number of symptoms including pain with penetration (specifically at the vaginal opening), urinary urgency and frequency and can even contribute to urinary incontinence and symptoms of prolapse. Oftentimes when milk production ends, estrogen levels begin to return to baseline and it’s common for people to report an improvement in some of these symptoms.
Some signs that you’re estrogen deficient include:
vaginal dryness
burning and sensitivity at the vaginal opening during penetration
bladder irritation
One common recommendation for getting through this period of estrogen deficiency is to use lubrication during sex. If that’s enough to help manage your symptoms - great! I recommend Slippery Stuff for a water based lubricant and Uber Lube for a silicone based lube. But lube isn’t always enough.
Another option for managing symptoms of estrogen deficiency is using a topical estrogen prescribed by your obgyn or midwife. Topical estrogen has been found to be safe to use while lactating and an effective means of managing symptoms. Topical estrogen has also been found to help perineal tear healing postpartum. While we have no research that topical estrogen impacts milk production, there are anecdotal reports of impact on supply.
If you’re interested in learning more about the benefits of topical estrogen, contact your provider.
2. Should I wear a belly band after childbirth?
This is one of the most common questions I get from patients during pregnancy. My answer to whether or not someone should wear a belly band is that it depends. It depends on your goals, your symptoms, your priorities, birth and concerns. Belly binding and belly bands have been used by various cultures for support through the early postpartum period with reported benefits. As far as western literature, evidence is limited on the impact of belly bands.
The research we do have is focused on belly bands following cesarean birth, with findings indicating that belly binding in the first 24 hours after childbirth can reduce the severity of abdominal pain following cesarean and can help reduce pain during childcare related tasks.
Belly bands are essentially a brace meant to help support your core when it is weakened following childbirth. If belly bands feel good, I recommend wearing them when you feel you need the extra support (like going to the grocery store, going on a walk, doing work around the house) and taking them off when you’re doing lower intensity tasks or resting. If belly bands don’t feel good on your belly or pelvis, I recommend holding off on wearing them.
A couple words of caution around belly bands:
You always want to make sure your belly band does not restrict your breathing. It should never be so tight that you feel like it limits your ability to take a full breath into your abdomen.
If you experience increased heaviness or pressure in your pelvis, vagina or anus, the band may be too tight or may be causing increased pressure through the pelvis. This can be a sign that banding is stressing your body rather than supporting it.
3. How do I reduce my risk of perineal tearing during vaginal birth?
Perineal tearing during vaginal birth occurs in an estimated ~85% of vaginal births according to the American College of Gynecology. Other forms of tearing that are less likely to occur include vaginal or sulcus tears, periurethral tears, periclitoral tears and labial tears. Though tearing is common, there are things we can do prenatally and during labor to reduce the likelihood and severity of tearing. To learn more about tear risk reduction, check out our birth prep course.
Here are 6 ways to reduce the risk and severity of perineal tearing during vaginal birth:
Perineal massage beginning at 34-36 weeks pregnant. Click here for a video tutorial and download our free perineal massage handout to learn more.
Practice pelvic floor relaxation exercises during pregnancy
See a pelvic floor PT during pregnancy to help assess your pushing technique and pelvic floor muscle tone
Use a warm compress at your perineum between pushes during labor
Push when you feel like you need to rather than when you’re directed to (this can be harder with an epidural)
Slow your pushing while baby crowns
Working with a pelvic floor physical therapist prenatally and postpartum can help you manage pregnancy pains, prepare for birth and recovery postpartum. If you’re interested in working with us in Austin, TX or virtually, contact us here.
This post was written by Dr. Rebecca Maidansky, PT, DPT, owner and founder of Lady Bird Physical Therapy. Rebecca is a pelvic floor physical therapist in Austin, TX and founded Lady Bird Physical Therapy in 2019. She is the creator of Birth Preparation and Postpartum Planning, Baby Steps Fitness and the head writer and editor of The Pelvic Press.
Rebecca is a passionate writer and vocal advocate for pelvic health and the importance of improving access to perinatal care. She believes strongly that many common pregnancy pains and postpartum symptoms can be eased or even prevented with basic education and care.
She created this blog to help all birthing people manage common pregnancy pains, prepare for birth and recover postpartum.