See Postpartum Bleeding: Real World Expectations for Part 1
See Postpartum Bleeding: Speed It Up by Slowing Down for Part 2
When do I start the process of getting to the mikvah? At a certain number of weeks? After my postpartum check up?
I want to start with three stories (identitites protected, of course, and shared with permission) –
Efrat came to me last month for a bedikah. Her Rav told her that from the shaylah she sent in, it looked like she might have a petzah (small wound in the vagina/on the cervix). Spotting a teeny baby in the bassinet she’d brought along, I asked her how many weeks she was postpartum, and she said she was three weeks after her 1st birth. Instead of proceeding with a speculum exam, we sat down for a chat. We talked about the average number of weeks it takes for women to get clean (4-6), the ways the uterus and vagina have to recover/heal after birth, and how with a little patience she beH would not need a bodeket at all! And, I’m happy to report, I got a phone call a couple of weeks later that Efrat didn’t have any problems getting to the mikvah when she waited just a bit longer.
Gitty had a long hard labor that ended with a c section and a NICU admission for her baby. After a rough few weeks, she was relieved to get clean with record speed, but then she was faced with a dilemma. On one hand, she could really use a hug. On the other hand, her doctor did not feel she’d healed enough from surgery to be with her husband. After clarifying with their Rav (and another Rav for extra reassurance), Gitty went to the mikvah as soon as she was able, and just delayed intercourse until she was ready.
Sarah had a really difficult vaginal delivery while still in Shanah Rishona that resulted in extensive tearing. She wasn’t able to get to the mikvah until 12 weeks postpartum while her physician treated scarring and complications from her stitches. Looking back a few years later, Sarah realizes that if she’d felt more comfortable bringing her questions to a Rav or bodeket, she likely could have gotten clean before or even during treatment, despite the fact that it was a number of weeks before standard bedikahs were possible.
Why do I think those stories are so important? They represent a nice cross section of experiences and raise a few important points.
- There’s no exact time when a woman should be going to the mikvah postpartum. For some women it happens really quickly, for others more slowly. In many cases, just a bit of patience removes a great deal of stress. Many women prefer to wait for a couple clean days in a row to start their count, because it’s super common for bleeding to happen off and on as it tapers off. If you’ve given your body enough weeks to heal, you’re less likely to be running around looking for a non-uterine source of bleeding.
- Ideally, we live married life in a state of Taharah. Especially postpartum (though it can come up at other times in life as well), it’s recommended that you go to the mikvah when you are able to get clean, and this does not mean that you are required to resume all aspects of physical intimacy right away. Some women will need a bit more time physically or emotionally and that’s ok. Consult with your understanding LOR with any additional questions.
- Seeking out advice from an experienced Rav, kallah teacher, bodeket, etc., may reveal solutions that you hadn’t considered. They can help you discern “normal” from “not normal” and can point you towards help for some of the more common issues that arise.
**It’s not strictly necessary to go to your post partum check up before going to the mikvah and/or resuming physical intimacy. Even if you’re planning to use birth control, many options such as the minipill and IUDs are best started after a frum woman gets to the mikvah (using spermicide as needed until the birth control is effective) because of concerns about spotting. Check up timing ranges from 2-6 weeks postpartum, and I definitely think the visit is worthwhile (planning another post on the subject sometime soon). But generally speaking, if a woman can get to the mikvah and is interested in resuming physical intimacy, she doesn’t need to wait until she’s gotten a physician go-ahead.
I thought my bleeding was done but I’m still getting problematic bedikahs – why?
After postpartum uterine bleeding has finished, there are a number of things that can lead to problems with bedikahs.
Mostly common is cervical changes. After pregnancy, the cervix never again looks like it did before you ever became pregnant. The changes are more pronounced after the cervix has fully dilated for birth. What sometimes happens is that more sensitive cells from the inside of the cervix end up on the outside of the cervix, facing into the vagina. This isn’t a medical probem, but it can lead to bedikah troubles. (See more in this post about cervical ectropions.)
Another issue is that postpartum, especially if a woman is breastfeeding, the vagina can be quite dry. For some women, doing bedikahs twice a day, or even trying a hefsek a few days in a row, can create very small tears in the vaginal wall.
Very rarely, a woman will have a tear on her cervix, in her vagina, or on her perineum from the birth that’s not healing correctly (most will heal completely within the first 2-3 weeks). In that case, she’ll need to go back to her doctor to take care of the issue.
A bodeket can check for all of the above issues and obtain a clean bedikah with her exam. When you take that information back to your Rav, he can advise on whether changes in bedikah frequency or depth, or slightly wetting the bedikah cloth, would be appropriate for your situation.
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