Physical Recovery After Birth — How Partners Can Help

A vaginal delivery is often framed as the 'easier' option, but the physical aftermath is substantial. Up to 90% of first-time mothers experience some degree of perineal tearing. First-degree tears involve skin only and heal quickly. Second-degree tears extend into muscle and require stitches. Third and fourth-degree tears reach the anal sphincter and can cause long-term issues with bowel control if not properly repaired and rehabilitated. Even without significant tearing, the pelvic floor muscles have stretched enormously. These muscles support the bladder, uterus, and rectum — and when they're weakened or damaged, urinary incontinence, pelvic organ prolapse, and sexual pain can follow. The uterus, which expanded to the size of a watermelon, contracts back to its pre-pregnancy size over about 6 weeks, a process accompanied by painful cramping (afterpains) that can be as intense as labor contractions, especially during breastfeeding. She's bleeding — postpartum bleeding (lochia) continues for 4–6 weeks. She may have hemorrhoids from pushing. Her joints are still loose from relaxin hormone, making her more prone to injury. She's simultaneously processing the physical event of birth while launching into the most demanding caregiving role imaginable. The disconnect between how she looks on the outside and how she feels on the inside is enormous — she may seem functional while managing significant pain and limitation.

A cesarean section is major abdominal surgery. The surgeon cuts through seven layers of tissue to reach the uterus, and recovery involves healing from the inside out while caring for a newborn. In the first 24–48 hours, she may need help getting out of bed, walking to the bathroom, and holding the baby. Coughing, laughing, and sneezing are painful — holding a pillow against the incision helps. She'll have a catheter initially and may have difficulty with bowel movements for several days (gas pain after C-section is notoriously uncomfortable). Driving restrictions typically last 2–6 weeks depending on the provider. She shouldn't lift anything heavier than the baby for at least 6 weeks. Bending, stretching, and reaching are limited. She can't do laundry, vacuum, carry car seats, or manage groceries. These aren't suggestions — they're medical restrictions designed to prevent incision complications and internal damage. The incision itself takes 6–8 weeks for the external wound to close, but internal healing of the uterine scar and abdominal fascia continues for months. Adhesions (internal scar tissue) can cause pain and pulling sensations for a year or more. Numbness around the incision is common and may be permanent. Emotionally, C-section recovery can carry additional weight. If the cesarean was unplanned or emergency, she may be processing disappointment, fear, or trauma alongside physical recovery. Even a planned C-section carries the unique experience of being awake during surgery and meeting her baby while numb from the chest down.

The pelvic floor is a group of muscles that form a hammock-like structure at the base of the pelvis, supporting the bladder, uterus, and rectum. During pregnancy and vaginal delivery, these muscles stretch, weaken, and sometimes sustain direct injury. Even cesarean deliveries involve 9 months of increased pelvic floor load from pregnancy itself. Pelvic floor dysfunction after birth can manifest as: stress urinary incontinence (leaking urine when coughing, sneezing, laughing, or exercising), urge incontinence (sudden need to urinate with inability to hold it), pelvic organ prolapse (feeling of heaviness, pressure, or bulging in the vagina), fecal incontinence or urgency, and pain during sexual intercourse. These issues affect up to 35% of women in the first year postpartum, and many persist long-term if untreated. The tragedy is that most of these conditions are highly treatable with pelvic floor physical therapy — a specialized form of physiotherapy that assesses and rehabilitates these muscles. Studies show that pelvic floor PT is as effective as surgery for many types of incontinence and prolapse. In many European countries, postpartum pelvic floor rehabilitation is standard of care. In the US, it's rarely offered proactively. She may not bring these symptoms up because she's been told 'leaking is normal after having a baby.' It is common, but it is not something she should just accept. If she's experiencing any pelvic floor symptoms, a referral to a pelvic floor PT is the single most important step.

The practical load during postpartum recovery is enormous, and the degree to which you absorb it directly correlates with her healing. This isn't about 'helping' — it's about co-owning the work of keeping the household and family functioning while she heals. Meals: plan, prepare, or arrange meals for the household. Accept every meal train offer. Stock easy, nutritious snacks (protein, fruit, cheese, nuts) that she can eat one-handed while feeding the baby. Hydration is critical, especially if she's breastfeeding — keep water accessible everywhere. Cleaning: maintain a functional home without expecting perfection. Dishes, laundry (there's SO much laundry with a newborn), basic tidying, and trash removal. If you can afford it, hire a cleaning service for the first months. Baby care: learn to change diapers, give baths, dress the baby, soothe the baby, and handle wake-ups independently. Don't hand the baby back every time it cries. She needs you to be a parent, not a babysitter who summons her for the hard parts. Logistics: manage appointment scheduling (for the baby and for her), handle insurance and medical billing, coordinate with family, respond to messages people send asking about the baby, and manage household admin. This is the invisible work that continues regardless of a new baby and someone needs to handle it. The mental load — remembering, tracking, planning — is as exhausting as the physical work. Take ownership of tasks rather than waiting to be assigned them.

The standard medical guidance is to wait until after the 6-week postpartum checkup, but this timeline is about minimum wound healing, not readiness. Most women are not physically or emotionally ready for penetrative sex at 6 weeks, and many aren't for months longer. Here's what's going on: perineal tears may still be tender. C-section incisions may still be healing internally. Vaginal tissue is estrogen-depleted (especially if breastfeeding), making it dryer and thinner. Pelvic floor muscles may be weak or in spasm. She may be terrified that sex will hurt — and that fear alone can cause pelvic floor guarding that makes penetration painful. Emotionally, she may feel 'touched out' from constant physical contact with the baby. Body image concerns, sleep deprivation, hormonal changes, and the identity shift of new motherhood all affect desire. Breastfeeding suppresses estrogen, which directly reduces libido and vaginal lubrication. The timeline for resuming sex should be set by her readiness, not a calendar. When she is ready, go extremely slowly. Use generous amounts of lubricant. Start with non-penetrative intimacy. Check in frequently during any sexual activity. And if she says something hurts, stop immediately. The first postpartum sexual experience sets the tone for months to come — making it safe, gentle, and pressure-free protects your sexual relationship long-term.