One day I will write a movie or stand-up comedy routine about the first few days after giving birth. Here are a few things no one tells you:
- Your rectum will probably hurt more than your vagina
- The first bowel movement after birth is not as bad as it seems but still scary as….
- You will be leaking from every orifice
- People will ask you when the baby is due even though you are holding a 1 week old
- You will lose hair….in clumps….that looks like a small animal in the drain around 4-months postpartum
- You start to sweat like a man (if you didn’t already)
- Your feet grow in pregnancy due to the weight gain and not only may you not fit into your skinny jeans, you may have to buy all new shoes
- Mothering can be isolating
- You just have to laugh and see the bright side. Talk about, seek out other new mom’s, be gentle to yourself and the people that love you!
Cramping or after-birth pains
Really, there has to be after-birth pains?! Well, yes there does. It actually is lifesaving. When the baby latches it releases Oxytocin in your body that causes your uterus to contract. This in turn, slows the bleeding from the placental site, which is lifesaving in that it prevents hemorrhage Just as you had contractions in labor, which led to birth, you will have contractions afterward which prevent excessive bleeding and eventually help your uterus return to its normal size. If this is your first baby, you may not even notice these contractions, but if you feel your uterus soon after birth, it will be about the size of a grapefruit in the middle of your abdomen, and should stay firm. The more babies you have, however, the more likely you are to feel afterbirth contractions as strong cramping which can be quite painful. After birth pains are caused by the alternate tightening and relaxation of your uterus. They are usually the worst in the first hours after birth, or during breastfeeding, though if you have had several babies, you may experience discomfort for the first few days. The pains are made worse by a full bladder, and may feel stronger when you breastfeed.
Comfort Measures: Rest and keep your bladder empty. Apply hot packs to your abdomen, especially when you breastfeed. Try 600- 800mg. Ibuprofen (same as Motrin or Advil) every 6-8 hrs. Lie face down with a pillow under your abdomen to supply firm pressure against your uterus. Initially, this may hurt worse, but relief follows as your uterus is forced to stay contracted. Helpful herbs: Raspberry tea- can be sipped throughout the day.A dropper full of Blue Cohosh tincture in water several times a day.Mix 1oz. Cramp Bark, 1/2oz. Blue Cohosh, and 1/4oz. Hops and brew in one-quart water. Sip this mixture to relieve cramps and promote sleep.
You will have a discharge similar to a menstrual period after birth. This flow is called lochia. It will be heaviest in the first 3 days after birth, but lightens up after that. At first, you may gush when you stand up after lying down a while, and may even pass a few clots. Golf ball and quarter size are normal. If it starts to become egg or hamburger size you need to call your midwife. Your flow will change from bright red right after the birth to a darker or brownish red to a lighter pinkish color by the end of the first week. By two or three weeks, you may only have occasional spotting, or a whitish yellow tinge. If you over exert yourself, your flow will probably pick up temporarily, but should decrease with rest. It should smell no worse than an old period.
Comfort Measures: Use incontinence pads (such as Attends or Serenity) or a baby diaper for the first several hours following the birth– they are larger and tend to catch gushes better.Use a towel on the bed over a disposable blue pad. This will keep you from having to change the whole bed should you leak while lying down.Slide a towel or chux under you to use like a diaper when you first get up after lying down for a long time. Danger Signs: Foul smelling flow (that persists even after bathing)Passing large clots (the size of an orange or larger).Your flow stays bright red or changes back after several days (not relieved by rest). Soaking more than one pad in one hour. Temperature higher than 100.4 degrees, chills, or flu-like symptoms
You need to keep your bladder empty after birth for your own comfort. A full bladder can cause excess bleeding and painful cramping. Some ladies find that they have decreased sensation, which makes it hard to urinate at first. If this occurs, try going to the bathroom at regular intervals rather than waiting to feel the urge. Also, listen to water run in the sink, run warm water over your hands, or use a peri-bottle to squeeze warm water over your perineal area. You may feel that you are “peeing quarts” in the first several days after birth. Your body rids itself of excess fluids retained in pregnancy at this time. Some ladies have stinging or burning of the labial skin in the first few days after birth due to tiny abrasions. Drink plenty of fluids to dilute urine, and squirt water from a peri-bottle over your labia as you urinate. Some women will find that they are prone to suddenly passing small amounts of urine when they cough or sneeze. These symptoms reflect relaxation of the normal tone in the bladder sphincter and pelvic floor muscles. Kegel exercises (deliberate tightening and release of these muscles, learned by stopping the flow of urine midstream) often can help correct this problem if done several times per day regularly.
Danger Signs: Urgency, cloudy or bad smelling urine. Severe backache, chills, fever, or general feelings of unwellness.
Many ladies do experience some perineal discomfort after birth. Types of discomfort including burning and stinging of the vulva after birth, swelling, pain or tenderness from a tear or episiotomy, or from hemorrhoids. Burning and stinging around the vaginal area is related to stretching from birth—it will subside in a few hours, though it may return with urination. Swelling of the tissues can be caused by the pressure of the baby’s head. Stitches from an episiotomy or laceration may cause tenderness. Sensations range from mild pulling to deep aching. Most acute discomfort passes within hours to days. An episiotomy may remain slightly tender for weeks, and stitches generally dissolve within two to three weeks.
Comfort Measures: Apply ice to reduce the pain and swelling in the first 24 hours. Ibuprofen: 600-800 every 6-8 hours can decrease inflammation and pain. Try an anesthetic spray after going to the bathroom. This needs to dry on your skin before you replace your pad. Witch hazel compresses (Tucks) are helpful for pain from stitches or hemorrhoids. These compresses can be used in your sanitary pad, used over an ice pack, or placed directly on hemorrhoids. Tub or sitz baths after 24 hrs. can feel heavenly. The tub needs to be very clean. A strong brew of comfrey tea can be added to the bath to promote healing. If you use the tub, be sure someone stays nearby to help you in and out in case of dizziness. Avoid constipation by eating plenty of fiber, and drinking lots of water. Sit on a hard chair, and wear loose clothing. Don’t strain with bowel movements. It will make hemorrhoids worse. Reduce hemorrhoids by using a little lubricant on your finger and pushing them back inside.
Breast Care and Comfort for Nursing Moms
Breastfeeding is the easiest and healthiest way to feed babies but some common problems can occur in the early days. Nipple pain or discomfort with feeding may occur in the first days after birth and breastfeeding mothers also may become engorged. These problems are usually preventable and if they occur, can be handled with simple measures in most cases. Preventing nipple pain: Sore cracked nipples are not supposed to be part of the breastfeeding experience, but unfortunately, too many ladies experience this problem and quit because of it. A little bit of tenderness at the start of a feeding can be normal after the first day or so. There should be no pain beyond the first few seconds of the feeding, and the tenderness at the start of feedings should disappear within the first week. If it feels like the baby is pinching you during the feeding, gently break the suction and reposition the baby. DO NOT tolerate pain as this is generally a signal that something is not working as it should. If you continually feel pain during feedings, or if repositioning does not help, please do not delay in calling for help from your midwives.
Positioning: Whether you are sitting up or lying down, turn the baby so that his/her body completely faces you from nose to toes, belly to belly. Baby needs to be at breast level. Cup your breast with your thumb on top and your other fingers below so that your hand forms a “C”. Press slightly toward the center to make a wedge of tissue your baby can grasp but keep your fingers well behind the nipple by one or two inches. Tickle your baby’s mouth wide open by stroking the bottom lip with your nipple till baby opens wide like a yawn. When the baby opens wide, quickly bring him to the breast so that he takes in a good part of the dark area (areola) behind the nipple. This should feel comfortable. Pull the baby’s bottom on close to your body or press your breast down slightly toward the baby’s mouth if you think breathing space is needed. Use pillows to support your arms and baby’s body so that you can nurse as long as the baby needs to and be comfortable. If your nipples become tender, air dry them after feedings. Don’t use breast pads which contain plastic. Pure lanolin (such as Lansinoh) can be used between feedings.
Danger signs: Hot, red areas in the breast that are painful. Breast pain accompanied by fever (above 100.4 degrees). Flu-like symptoms.
Hair and Skin
Once you have given birth, you may be surprised at how much you perspire in the days following. You may feel hot, or have night sweats. This is normal and is one way in which your body gets rid of excess fluids retained in pregnancy. It peaks around 2 to 5 days after birth. Ladies often notice changes in skin pigmentation during pregnancy. Skin changes like darkening of the nipples, the appearance of a line or hair growing down the middle of your belly, or blotchiness across your face are related to the high amount of estrogen circulating in your body. It can take several weeks to months for these changes to fade. Stretch marks are usually bright pink-purple or red in pregnancy and fade to white in the following weeks. Some ladies lose a great deal of hair in the months following the birth and this can occur as late as six months after birth. This, too, is related to changes in the hair growth cycle triggered by pregnancy. Don’t be alarmed, you won’t go bald, and this will pass.
Comfort Measures: For excess perspiration, take one or more showers per day, change bedding daily, drink lots of fluid, and avoid becoming chilled. If you developed the mask of pregnancy (blotchy pigmentation across the face), use sunscreen and avoid sun tanning. Also, you may want to avoid oral contraceptives that contain estrogen as this problem can occur with the pills and be permanent. For hair loss, there is nothing you can do to reverse the hair loss, but getting your hair trimmed or choosing a new style may make it look fuller. Normal growth patterns will resume in a few months.
General Aches and Pains
The stress of labor is hard physical work so don’t be surprised to have some soreness in your back, across your shoulders, or in other places. You can develop sore tight muscles from the work of constantly lifting and carrying the baby in the early weeks after birth or from poor body mechanics.
Comfort Measures: Hot showers or a soothing bath. Herbal baths can promote healing and make you feel very pampered. Treat yourself to a massage. Use a warm pack or heating pad if one area is particularly sore. See a chiropractor. Sit up straight and support your arms with pillows when feeding the baby. If you use a front pack or baby carrier, make sure that the straps fit properly and distribute weight evenly across your body. Rest, relax and enjoy your baby.
I’m so tired…
When you gave birth, your body went through a major change in a relatively short time, and continues to change rapidly to restore itself to the non-pregnant state. The physical work of labor often involves loss of sleep and takes time to recuperate. The uterus involutes in a few short weeks, breast changes occur to facilitate lactation; the body rids itself of fluids retained in pregnancy. On top of it all, you have a brand new baby to care, for whose sleep needs are probably not much different than yours! You may be expecting some sort of return to “normal” after pregnancy, which of course, is not likely with a new family member in your life. You will have to establish a new “normal” for yourself. Of course, you are tired. However, this won’t last forever, your energy will return. What you need to know though is that the bulk of your recovery after birth occurs in the early weeks. The way you care for yourself in those early weeks will influence how well you feel in the future. So take time and rest… and nest. Don’t do a lot of entertaining, and allow others to care for you in those early weeks after the birth. It can take weeks or months before you feel able to function fully in all areas after a birth. Don’t feel bad about it; a new baby is a full time job.
Helpful Strategies: Sleep deprivation can figure heavily in how tired you feel – so try to sleep whenever the baby sleeps rather than using the time to “get things done”. Don’t count on 8 or 10 hours of uninterrupted sleep anytime soon. Keep your baby close to you at night to simplify care. Keep lights low or off, if possible, when feeding and caring for the newborn. Avoid middle of the night diaper changes by using a thicker diaper at bedtime unless there are problems with diaper rash. Keep middle of the night care as low as possible so baby understands you are available, but that it is not party time. Enlist help from your family and friends or your partner for shopping, meals, housework, and assistance with older children. Lower your housekeeping standards. In 25 years, it is unlikely if you will remember or care whether the floor got vacuumed today. When you are alone, or without much support, keep the room you spend the most time in picked up so that it is tolerable, and ignore the rest as much as possible. If you have other small children, it may be helpful to camp out in one room that is childproof where they can’t get hurt or do much damage while you rest or feed the baby. If older children are old enough to be entertained by TV or by music or story tapes, you may be able to rest while they watch a favorite program or listen to a tape by lying down on the floor on a blanket with the baby, or the sofa in the same room. If you can afford to do so, hire a responsible teenager to watch the children or to do a few chores in the afternoon while you rest. Keep life simple! Turn off the phone when you need to rest, and put a sign on the door for visitors. Don’t try to make fancy meals or keep your house spotless.
Weight loss and body image
You will probably lose around 14 to 20 pounds by two weeks postpartum. After birth, your abdomen will be smaller, but you will probably still look pregnant when you stand up. By the end of two weeks, you should no longer be able to feel your uterus over your pubic bone, and your abdomen may still be soft and doughy but will be quite a lot smaller. You may have lost much of your weight by the end of six weeks, but it can take months to lose all of the weight. Younger, physically active women tend to lose weight faster than older women or less active women. If you had puffiness or edema during pregnancy, it may take a few days to resolve depending on the degree of edema. Even if you lose most of your pregnancy weight gain in the first two months postpartum, you may find that your clothes fit differently than they did before. Your breasts may be larger in the days following the birth. This is due to fullness that comes with milk production. This change may persist for several weeks, then breasts slowly become smaller and softer even with breastfeeding. Sometimes when the breasts become smaller and softer, women think they have lost their milk. This is not true. Your breasts have simply adapted to the task of producing milk efficiently. While your breasts are larger, a well-fitted supportive bra may help you be more comfortable.
Survival Strategies: Line up some “in between” clothes for your early post-partum days. Friends and thrift shops or creative shopping elsewhere may yield some useful finds. Two piece outfits such as pants/skirts and tops are very practical for breastfeeding mothers. However, if you can afford it, there are some specialty shops which carry dresses and clothing especially for breastfeeding mothers. Choose easy care fabrics that do not stain easily. Dark colors, knits and patterned fabrics are better at hiding wet spots from leaking milk or leaking babies. Be kind to yourself. Treat your body with love and care. Eat well. Take naps. Take time to smell the roses.