What Actually Happens After Birth and How to Heal
By Dr. Sarah Mickeler, Oona Wellness Group | Toronto & Newmarket
Oona Wellness Group provides comprehensive postpartum recovery care in Toronto and Newmarket, including pelvic floor physiotherapy, chiropractic care, diastasis recti rehabilitation, caesarean scar treatment, registered massage therapy, naturopathic medicine, and perinatal mental health support.
The fourth trimester is often the greatest omission of the parenting conversation. We spend months preparing for birth, researching strollers, perfecting swaddle techniques, reading every account of labour we can find. And then the baby arrives, and the conversation about what happens to the mother or birthing person essentially stops.
You may be handed a six-week follow-up appointment and a pamphlet, and somehow that is supposed to be enough. The entire focus shifts, as it should in many ways, to the new person who has just arrived. But you are also a new person in almost every way. Your body has just done something extraordinary, and it is going to need considerably more than six weeks and a pamphlet to truly recover.
This is not a complaint, and it is not an alarm. It is an honest accounting of what postpartum recovery actually involves, and an invitation to take it seriously in a way that our culture has been slow to embrace.
Your body just grew a human, delivered them, and is learning how to be itself again. That deserves more than a routine check-in. We built Oona so you could have that.
What Is Actually Happening in the Fourth Trimester
The term fourth trimester, which refers specifically to the first twelve weeks after birth, has gained some traction in recent years and we are glad for it. But recovery does not necessarily wrap up at the twelve-week mark. For many women, the full arc of postpartum healing, physical, hormonal, and emotional, extends well into the first year and often beyond.
In the weeks immediately following birth, your body is managing a staggering amount simultaneously. Your uterus is contracting back toward its pre-pregnancy size, a process that causes the cramping many women notice in those first days. Your hormones undergo a precipitous drop as estrogen and progesterone, which were elevated throughout pregnancy, fall sharply after delivery. Your pelvic floor has experienced significant strain – regardless of whether you had a vaginal or a caesarean birth. Your core muscles have been stretched and altered in ways that may not simply reverse on their own. If you delivered by caesarean section, you are also recovering from major abdominal surgery, a reality that is frequently underacknowledged, given how routinely this surgery is performed.
Layered over all of this is the extraordinary physical demand of caring for a newborn. The feeding, the lifting, the carrying, the repetitive positioning, the broken sleep, the perpetual alertness that new parenthood requires. This is not a recuperative environment. It is an intensely demanding one, which is precisely why intentional recovery support matters so much.
The Symptoms That Deserve More Than Tolerance
We want to name some of the things we hear most often from postpartum clients at our Toronto and Newmarket clinics. We think it is important for you to know that these experiences are common, they are not permanent, and they are not simply the price of having had a baby.
Pelvic Floor Symptoms
Perhaps you have noticed leaking when you cough, sneeze, laugh, or jump. There may be a heaviness or pressure in your pelvis that you cannot quite name. Maybe your bladder or bowels do not empty the way they used to. Sex may be painful in ways it never was before. We hear versions of this from our patients every week. And none of them are things you simply have to accept. Simply because something is common does not make it normal, and it certainly doesn’t mean that it can’t be treated. This distinction matters. Pelvic floor physiotherapy is the evidence-based first-line response to these symptoms, and the sooner it is initiated, the more effectively the pelvic floor can be rehabilitated before the body learns to compensate in ways that feel normal but arenāt actually helping. And if you are reading this months or even years after giving birth, wondering if it is too late to start, it is not. Your body has been waiting for you to be ready, and we will meet you exactly where you are.
Diastasis Recti: What That Gap in Your Core Is Telling You
Diastasis recti refers to the widening of the two vertical muscles of the abdomen along the midline, which occurs to varying degrees in most pregnancies as the uterus expands. You may notice this as a doming or coning along the midline when you try to sit up, or as a persistent gap that you can feel when you press along the centre of your abdomen. You may also notice it as a feeling of core weakness or instability that does not seem to improve no matter how much you move. Diastasis recti responds well to targeted physiotherapy and guided rehabilitation, but the generic advice to simply do more core work can sometimes worsen it before it improves. Proper assessment is the starting point.
Lower Back, Hip, and Pelvic Pain: Why Your Body Aches in Ways It Never Did Before
The ligaments and joints of the pelvis, loosened during pregnancy under the influence of relaxin, do not immediately return to their pre-pregnancy state after birth. This, combined with the postural demands of feeding, carrying, and bending over a crib or change table for hours each day, creates a predictable pattern of lower back, hip, and pelvic discomfort. This is where chiropractic care makes such a meaningful difference. Gentle, targeted adjustments and soft tissue work support spinal and pelvic alignment, while practical guidance on positioning and movement helps protect your joints through the demanding physical work of early parenthood.
Neck, Shoulder, and Upper Back Tension: The Hidden Cost of Hours Spent Feeding
Whether you are breastfeeding, bottle feeding, or doing both, the hours you will spend in a forward-rounded feeding position each day create significant and cumulative tension in the neck, shoulders, and upper back. We often call it the dreaded “feeding hunchback”. Registered massage therapy offers direct therapeutic relief from this tension, working with the specific anatomy of postpartum muscle patterns rather than providing generic relaxation massage. Many of our clients describe the relief after a postpartum massage as genuinely transformative! Not because a massage is a luxury but because releasing that level of chronic muscular holding has a meaningful effect on how the body feels and functions.
Postpartum Fatigue Beyond Normal Tiredness
Every new parent is tired. That is simply true. But there is a category of postpartum fatigue that goes beyond the expected tiredness of broken sleep. It is worth knowing how to recognise it, because it is not just in your head. Postpartum thyroid dysfunction affects approximately ten percent of women in the year following birth. It is frequently missed because its symptoms: fatigue, mood changes, difficulty concentrating, and weight changes are attributed to the general demands of new parenthood. Iron deficiency, which can be significant after blood loss during delivery, compounds fatigue considerably. Our naturopathic doctors assess both of these, along with other nutritional and hormonal factors that influence energy and recovery, and provide targeted support that goes well beyond the reassurance that this is just the new normal.
Postpartum Mood and Emotional Experience: When It Feels Like More Than the Baby Blues
The way you feel after having a baby is rarely single-faceted. It is layered, and it shifts, and it does not always match what you expected. That is not a failing. It is part of the territory. The baby blues in the first two to six weeks, driven by the sharp hormonal drop that follows delivery, are extremely common and typically resolve on their own. Postpartum depression and postpartum anxiety are also common, affecting roughly one in five new mothers, and they are treatable with the right support. What we want you to know is that the threshold for reaching out is low. You do not need to be in crisis. You do not need to have a diagnosis. You need only to feel that you are not quite yourself, that the anxiety is loud, that the enjoyment is muted, or that you are struggling in a way that is hard to articulate. That is enough. Our mental health practitioners in the perinatal space are here for all of it, including the ambiguous middle ground that does not fit neatly into clinical categories.
Just because something is common doesn’t mean it’s normal, and it certainly doesn’t mean it can’t be treated. This distinction matters.
When to Reach Out Sooner
Some discomfort is part of healing. But certain symptoms deserve attention sooner rather than later.
Call your healthcare provider if:
- You have heavy bleeding that soaks through a pad in an hour
- You have a fever over 38°C (100.4°F)
- You have chest pain or difficulty breathing
- You have thoughts of harming yourself or your baby
Book a postpartum assessment if:
- Leaking continues beyond the first few weeks
- You feel persistent heaviness or pressure in the pelvis
- Pain with sex does not improve as healing progresses
- You notice a gap or doming in your abdomen when you sit up
- Back, hip, or neck pain is affecting your daily function
- Fatigue feels unmanageable even when you rest
- You are not enjoying things the way you expected to
You do not need to have a clear diagnosis to book, and in fact you don’t even need a referral. You just need to know that something feels off.
How Oona Approaches Postpartum Recovery
The reason we built Oona the way we built it, as a community where multiple disciplines live under one roof and within one philosophy, is precisely for moments like this one. Postpartum recovery is not a single-discipline problem. It is a whole-person experience that benefits from practitioners who communicate with each other, who understand the interconnection between the physical and the emotional, and who can adjust the plan as recovery unfolds.
Your postpartum care at Oona might begin with a pelvic floor physiotherapy assessment, where your physiotherapist takes a thorough history of your pregnancy and birth and conducts an internal and external assessment of your pelvic floor. From there, the picture expands. Your physiotherapist might refer you to our chiropractor for additional treatments, or recommend that you speak with our naturopath about fatigue and nutritional support, or suggest that our registered massage therapist can help with the shoulder tension that is affecting your sleep.
You do not need to arrive with a plan. You need only to arrive.
When to Start
This is the question we hear most often, and the answer is: earlier than you might think, and with much more gentleness than you might expect.
- Massage therapy and chiropractic care can begin within a few weeks of a vaginal birth, once you are comfortable moving and travelling.
- Pelvic floor physiotherapy is typically initiated from six weeks postpartum, and itās never too late to start.
- Naturopathic and mental health support have no minimum waiting period. If you need them, you need them now.
One of the things we want to challenge is the idea that postpartum care is something you can only access once the acute phase has passed, once you are sleeping a bit better, once the baby is on some kind of routine, once things are more settled. The first three months are often the period of greatest need, and they are also the period in which women are most likely to put their own care at the bottom of the list. We understand why. We are asking you to consider a different approach.
At a glance: Massage + chiropractic within weeks | Pelvic floor physio from 6 weeks | Naturopathic + mental health: no waiting period
While You Wait: Small Things That Help
If you are reading this and not quite ready to book, or if you are waiting for your first appointment, there are gentle things you can do that support your recovery without risking further strain.
Breathe. It sounds so simple, but connecting to your breath is the foundation of core and pelvic floor rehabilitation. Lie on your back with knees bent, place your hands on your lower ribs, and breathe so that your ribs expand sideways into your hands. This is diaphragmatic/box breathing, and it gently mobilizes the pelvic floor and core in a way that is safe even in the early weeks.
Support your scar. If you had a caesarean section, once your incision is fully healed and your doctor has cleared you, you can begin very gentle scar massage. Using your fingertips, make small circles along the length of the scar, spending a few minutes each day. This helps prevent adhesions from forming and desensitises the tissue. Our physiotherapists like Praja work with women recovering from caesarean sections, starting with gentle desensitisation of the scar and progressing to manual work that restores normal tissue mobility.
Adjust your feeding station. Look at where you spend the most time feeding your baby. Is your back supported? Are your feet flat on the floor? Is the baby at a height that allows you to relax your shoulders? Small adjustments to your setup can significantly reduce neck, shoulder, and back tension.
Rest when you can. This is not helpful advice in the way it is usually offered, because rest is not always possible. Accepting help isnāt always easy, but we would encourage you do your best to allow those around to assist in whatever way they can. Your body is doing more than anyone can see.
The Caesarean Recovery Conversation We Need to Have
Caesarean section is one of the most commonly performed surgeries in the world, and it is also one of the most neglected in terms of recovery support. Women who have delivered by caesarean have typically had a major surgery that involved cutting through multiple layers of abdominal tissue, yet the standard recovery guidance is often limited and the expectation to simply resume normal functioning within a few weeks is deeply unrealistic. We often compare this recovery to a knee or shoulder (or really any other) surgery. When you have any other kind of surgery, you are sent home with instructions for rehabilitation/physio/whatnot. This is just simply not the case after Caesarian section.
Caesarean scar tissue, if not addressed, can create adhesions that affect the function of the surrounding structures, including the bladder, the bowel, the pelvic floor, and the abdominal muscles. Our physiotherapists, chiropractors, and registered massage therapists are all trained in caesarean scar release and rehabilitation. They start with gentle desensitisation of the scar once it has healed, then work to restore normal mobility to the tissue underneath. All the practitioners, including our naturopaths, offer Dolphin Neurostim. This is a microcurrent therapy that targets the deeper layers of scar tissue. This work often surprises clients, not just in how it changes the way their scar feels, but in how it shifts the way their whole body moves. Clients frequently express surprise at the profound impact of this work, noting that it addresses not only the physical aspects but also the often-complex emotional connection to the scar.
What We Want You to Remember
Your recovery matters. Not because you’re expected to “bounce back” like nothing happened, even though that pressure is very real. It matters because you’re a human being who has just done something extraordinary. Growing and delivering a baby is a big deal, and you deserve thoughtful, skilled, compassionate care as a given, not a luxury.
At Oona, this belief is not a tagline. It is the reason our Toronto and Newmarket clinics exist. It is the reason our practitioners chose to specialise in perinatal care. And it is the reason we are glad you found your way here.
Postpartum recovery is not a straight line. It takes longer than anyone tells you, it is more nuanced than most people acknowledge, and it is far more possible than you might feel in your most depleted moments. We have seen it, again and again, in the clients who walk through our doors and walk out, eventually, feeling like themselves again.
You can get there. And we would be honoured to be part of that journey.
Book online (Toronto or Newmarket), call our Toronto clinic at 416-960-5656, or reach our Newmarket team at 905-427-1166. Direct insurance billing is available wherever possible, and our Wellness Fund is here for those navigating financial barriers to care. You do not have to do this alone.
Frequently Asked Questions About Postpartum Recovery
How long does postpartum recovery actually take?
Healing is not linear. Most women feel significantly better by six to eight weeks, but full recovery of core and pelvic floor function can take six months to a year. Every body is different, and comparison is rarely helpful.
What is diastasis recti and how is it treated?
Diastasis recti is the widening of the two vertical abdominal muscles along the midline. It is effectively treated with targeted physiotherapy that focuses on reconnecting the deep core and restoring function, not generic core work that can sometimes worsen the condition.
When can I start pelvic floor physio after birth?
Pelvic floor physiotherapy is typically recommended from six weeks postpartum – but it’s never too late to start.
What is the fourth trimester?
The fourth trimester refers to the first twelve weeks after birth, a period of intense physical and emotional transition for both parent and baby. It is a time when recovery support matters most.
What help is available for postpartum recovery in Toronto?
Oona Wellness Group provides comprehensive postpartum recovery care in Toronto and Newmarket, including pelvic floor physiotherapy, chiropractic care, diastasis recti rehabilitation, caesarean scar treatment, registered massage therapy, naturopathic medicine, and perinatal mental health support.
How do I know if I have postpartum depression?
If you are feeling persistently sad, anxious, overwhelmed, or disconnected, or if you are not enjoying things the way you expected to, it is worth reaching out. You do not need to be in crisis to seek support.
When can I see a chiropractor after a caesarean section?
Chiropractic care can begin really any time that you feel ready for it. Your chiropractor will work gently within your recovery timeline.
Ready to Start Your Postpartum Recovery Journey?
If anything in this guide sounded familiar, the next step is simple. Book an appointment at Oona Toronto or Newmarket. You will be welcomed, you will be listened to, and you will leave with a clear understanding of what is happening in your body and a plan for what comes next.
Book an appointment at Oona Toronto or Newmarket ā
About the Author
Dr. Sarah Mickeler founded Oona Wellness Group in Toronto and Newmarket because she believed families deserved a different kind of care. One that is integrated, honest, and grounded in evidence. One where practitioners actually talk to each other, and where you are never made to feel like your concerns are too small or too complicated. She writes the way she practices: warm, clear, and without shame.
