During pregnancy, tissues stretch, hormones change, muscles and bones shift, and even the heart and lungs are altered. Access to postpartum health care, however, can be inconsistent, and there has been little evidence-based information available to help guide people in their own recovery, according to a new book aimed at providing just that—a book for “every postpartum human,” including transgender and nonbinary people and people whose pregnancies did not end in parenthood.
Courtney Naliboff, co-author with Ruth Macy of Your Postpartum Body: The Complete Guide to Healing After Pregnancy (Avery), said in an interview that “almost everything that exists for you to read after you have a baby is about the baby, and about your relationship to the baby as a parent.” This book, in contrast, is “about the person who has been pregnant.”
The idea for the volume began when Naliboff, a full-time teacher and journalist in Maine, sought a book to explain the “weird stuff” happening in her body after pregnancy. She found nothing, and turned to Macy, a long-time friend and a licensed pelvic floor therapist with 17 years of experience.
Macy said her own postpartum patients had been asking her, “Why doesn’t anybody talk about this? Why isn’t this information out there for everyone?” She said the idea for the book also “coincided with the social movement to pay more attention to the health of people with uteruses and to advocate for them and their general health. It’s such a necessary thing, and it’s odd to think that there’s not a reputable medical book out there already.”
They were intentional from the start about making the book inclusive of all pregnant people, in language and content. Macy said their attitude was, “This book doesn’t exist at all, so can we just make it exist for everyone who has the capacity for birth? I think we both feel passionate about: start with inclusive, don’t start female-forward, cis/hetero only, and then back pedal.”
Nabiloff was also inspired by author and educator Trystan Reese, a transgender man, whom she heard speak on a podcast a number of years ago about becoming a gestational parent. Reese had become a sought-after expert on transgender fertility and pregnancy, and they consulted him for the book.
For both transgender and cisgender people, “Lots of things needed to work together” to support pregnancy, Macy said, “but those things don’t realistically, in almost any case, just bounce back, and you may have lasting changes,” whether you had a cesarean section or vaginal birth.
“There is this perception that if you just do your Kegels, which is a pelvic floor tightening contraction, then everything’s going to get better, but the research does not support that,” she added. “It says maybe 30% of people are going to get better, so there are still 70% of people who are being underserved even with that simple recommendation.”
Your Postpartum Body therefore provides detailed information on the many physical and mental changes one might experience after pregnancy, and offers advice on pelvic floor recovery, nutrition and hydration, lactation (and how to end it, when desired), reducing pain, reclaiming fitness and sexual activity, finding support, when to resume hormone therapy, and much more.
“We’re trying to give people stuff that’s very pragmatic and ask questions of them that they can ask themselves to help steer them in the right direction,” she explained. The book suggests things to look out for; ways to advocate for yourself; how to get the most out of your doctor visits, and when you should rush to the doctor or emergency care.
“There are things that are commonly experienced that you can also heal from,” Naliboff added. For example, she said, just because an older generation says that “sneeze-peeing” (bladder leakage when sneezing) is “something you have to live with,” it’s possible that, “You maybe can improve with some of the things that we have in the book.”
At the same time, she said, sometimes the body will change, but in ways that can be lived with, like going up a pants size. The book, therefore, as Macy put it, is “trying to ride the line between changing what’s changeable and accepting what needs to be accepted.”
While the volume draws on evidence-based recommendations and Macy’s professional experience, Naliboff noted that “The reason that a book like this needs to exist is that a lot of times there are not recommendations made across the board that are based on any sort of meaningful research. And if that’s true for cisgender women, that is doubly true for anybody outside of that category who is going through a pregnancy.”
Macy agreed, “Most folks who have been pregnant are underserved from the start, because we’re not investing and being curious and answering these questions that people ask me in my office every week,” she observed.
Naliboff said the volume also ties into larger conversations about reproductive healthcare. “If we don’t turn the lens back onto the body that was pregnant and all of the things that happened to that body and validate those experiences, I think that we’re going to continue to have maternal mortality crises and maternal mental health crises,” she asserted. “I think that everything we can do to acknowledge and support the person who was pregnant is going to be a real benefit to society at large and to every single person that we can reach.”
Your Postpartum Body comes out on June 4, but is available for preorder.
Originally published as my Mombian newspaper column.