IN THIS CHAPTER
Getting better after delivery
Recovering from cesarean delivery
Looking at postpartum changes
Resuming your normal activities
According to the old adage, it takes nine months for a woman to make a baby and nine months for her body to return to normal afterward. In reality, the time it takes to recover from childbirth varies widely from woman to woman. But most of the changes that your body goes through during pregnancy revert to normal during the postpartum period — sometimes called the puerperium — which begins immediately after delivery of the placenta and lasts for six to eight weeks.
As you go through this period of change, you’re likely to have many questions about what you can do to make the postpartum transition as easy as possible. In this chapter, you find out what life may be like as your body gets back into its old shape, as you begin to have sex again, and as you deal with all the physical and psychological challenges of new motherhood.
Recuperating from Delivery
The average hospital stay after an uncomplicated vaginal delivery is 24 to 48 hours. After a cesarean, you may stay in the hospital for two to four days. In some hospitals, you spend this recovery period in the same room in which you delivered. In others, you move to a separate postpartum unit. The nurses continue to monitor your vital signs (blood pressure, pulse, temperature, and breathing) and check your uterus to make sure that it’s firm and well-contracted. Nurses (often the same ones taking care of you) also monitor your baby’s vital signs. Your nurses can provide you with pain medication that your practitioner has prescribed, if you need it, and help you care for your tear or episiotomy if you have either one.
The following sections outline the ways your body begins to recuperate after a delivery and what you can expect.
Looking and feeling like a new mom
Only in movies and on TV do women throw on a sassy pre-pregnancy outfit and leave the hospital looking like they did before they even considered having a baby. Delivery takes a toll, and although most of the changes are fleeting, you’ll notice that you look and feel different.
After delivery, your face may be swollen, very red, and possibly splotchy. Some women even have black marks under the eyes or broken blood vessels around their eyes and, all in all, look as though they’ve just been in a prize fight. All these characteristics are to be expected; pushing causes the rupture of tiny blood vessels in your face. Don’t be alarmed. You’ll look like your old self again in a few days. Also keep in mind that many women still look pregnant when they leave the hospital. Patients are often disappointed that they still have an enlarged abdomen after delivery.
You’ll feel like yourself before long, but you’re likely to experience afterpains, or contractions that persist sporadically after delivery. These pains are similar to the contractions you experienced during labor and delivery, and they gradually fade away within a few days. You may find the afterpains are more noticeable while you’re breastfeeding.
Understanding postpartum bleeding
Experiencing vaginal bleeding after delivery is completely normal, even if you had a cesarean delivery. Average blood loss after a vaginal delivery is about 500 cc, or 1 pint. After a cesarean, the average blood loss is twice that — about a liter, or a quart. In order to limit blood loss, many practitioners give medications to help keep the uterus contracted. When the uterus contracts, it squeezes shut the blood vessels from the placental bed to reduce bleeding. If your uterus doesn’t seem to be contracting well, your doctor or nurse may massage your uterus, through your abdomen, to promote contractions.
The blood coming from your vagina, called lochia, may initially appear bright red and contain clots. Over time, it takes on a pinkish and later a brownish color. It gradually diminishes in volume, but the flow may persist for three to four weeks after delivery. You may notice that the amount of bleeding increases each time you breastfeed. This increase happens because the hormones that help produce breast milk also cause your uterus to contract, and this contraction squeezes out any blood or lochia in the uterus. For many women, the bleeding is heavier when they stand up after being in bed for a while. This extra bleeding happens simply because the blood pools in the uterus and vagina while you’re lying down, and when you stand up, gravity draws it out. It’s perfectly normal.
The best way to deal with postpartum bleeding is to use sanitary napkins, which come in varying thicknesses to accommodate whatever amount of bleeding you have. Don’t use tampons, because they may promote infection during the time that your uterus is still recovering. Although the bleeding usually subsides after two weeks, some women experience bleeding for six to eight weeks. Occasionally, fragments of placental tissue stay within the uterus, and this condition can lead to extensive bleeding.
Traditionally, doctors told women not to take deep tub baths after delivery if they were still bleeding. Today, many practitioners say that tub baths are okay, and most feel that shallow baths — called sitz baths — are perfectly acceptable. If your practitioner says to avoid tub baths until your bleeding has subsided, she may be concerned that full baths will increase the chance of developing some infection inside your uterus. The trouble is that doctors really have no data on this topic — no studies demonstrate a risk from taking full baths. Ask your practitioner what she thinks you should do.
Call the doctor in these instances:
· If you have very heavy bleeding with clots that lasts for several weeks after your delivery
· If your lochia takes on a foul odor, which may be a sign of infection
Dealing with perineal pain
The amount of pain or soreness you feel in your perineum (the area between the vagina and the rectum) depends largely on how difficult your delivery was. If your baby came out easily after only a couple of pushes and you have no episiotomy or lacerations, you probably feel little pain. If, on the other hand, you pushed for three hours and delivered a 10-pound budding linebacker, you’re more likely to have perineal discomfort.
The pain you feel has several causes: The progression of the baby through the birth canal causes stretching and swelling of the surrounding tissues. Also, an episiotomy or tears in the perineum naturally hurt, just as an injury to any other part of your body would. The pain is worse during the first two days after delivery. After that, it rapidly improves and is usually nearly gone within a week.
Your perineum may be swollen, and if you had an episiotomy, you have stitches closing it up. Sometimes these stitches are visible on the outside, and sometimes they’re buried underneath the skin.
Many women are concerned about the stitches used to sew up their episiotomy or lacerations. These sutures aren’t meant to be removed. They gradually dissolve over the next one to two weeks. They’re strong enough to handle most activities, so don’t worry that a sneeze, a difficult bowel movement, or lifting your 10-pound baby will cause the stitches to tear open.
It’s important to keep the perineal area clean to prevent an infection from developing. Such an infection is a rare complication, but call your doctor if you notice a foul-smelling discharge or increasing pain and tenderness in the area, especially if you have a fever higher than 100.4 degrees Fahrenheit.
Here are the best ways to care for your perineum as it recovers from your delivery:
· Keep the perineal area clean. You may want to use a squirt bottle filled with warm water to help clean places that are difficult to reach.
· Some women get relief from pain by taking a sitz bath. A sitz bath consists of soaking your bottom in a small amount of warm water. If you have a lot of swelling in the area, putting Epsom salts in the water may give you added relief.
· You can buy various kinds of anesthetic sprays and pads that you can apply to the perineum to help ease the pain. Or you can soak gauze pads in witch hazel and apply them to the area. Some women find that chilling the witch hazel increases its effectiveness. Other women find that ointment or petroleum jelly is soothing, too. It keeps the skin moist and soft and prevents it from sticking to sanitary pads.
· An ice pack applied to the perineum during the first 24 hours after delivery helps minimize swelling and discomfort.
· Over-the-counter pain relievers — such as acetaminophen (Tylenol is a well-known example) or ibuprofen (such as Motrin or Advil) — or some prescribed pain medications further ease the pain. Taking these medications isn’t a problem if you’re breastfeeding.
· Avoid standing for long periods of time, which can make the pain worse.
You can relieve the gravitational pressure on your perineum from time to time by getting off your feet and lying down for a short while.
· After a bowel movement, try not to contaminate the area with the toilet tissue you use to wipe yourself. Clean the area around the anus with a separate toilet tissue, and don’t wipe from back to front. If the areas around the anus or the perineum are tender, try to just pat the area dry, instead of wiping. You may find that using baby wipes is really helpful, because they clean the area very well, don’t shred, and are gentle on healing tissues.
· Don’t insert anything into your vagina (such as a tampon) for six weeks and don’t douche.
· Avoid intercourse for six weeks after delivery. Your doctor will see you for a routine postpartum checkup at the six-week mark. As long as you are well healed, sex should be okay at that time!
If you’re extremely uncomfortable, you may want to ask your doctor to prescribe pain medications. If you notice that your perineal area is very red or purple and tender, if you run a fever, or if you notice a foul-smelling discharge, let your practitioner know.
If you had any lacerations that extended near your rectum, you may want to take a stool softener (such as Colace), not a laxative, so that bowel movements aren’t too terribly painful. At least make sure that you drink extra fluids and consume extra fiber in your diet so that your stool is soft. When you anticipate having a bowel movement, you may want to take a pain reliever ahead of time — acetaminophen (Tylenol), perhaps, or some other nonsteroidal anti-inflammatory agent, such as ibuprofen (Motrin or Advil).
Surviving swelling
Immediately after delivery, especially after a vaginal delivery, you may discover that your entire body looks swollen. Don’t freak out — this is normal. Many women develop swelling during the last few weeks of pregnancy, and this swelling often persists for a few days to a few weeks into the postpartum period. The intense pushing efforts required to deliver the baby may further cause your face and neck to swell, but this also goes away a few days after delivery. In general, it can take up to two weeks for the swelling to completely disappear.
Don’t step on the scale the day after you deliver. You may find that you’ve actually gained weight from all the water you retain during delivery.
Many patients ask, “Isn’t there something you can give me to help relieve the swelling, like a diuretic or something?” Prescribing medication usually isn’t necessary because the swelling goes away on its own in a few days, when you’re back up and around. Just be patient. You will have ankles again.
Coping with your bladder
When you were pregnant, you probably felt like all you did was pee, right? Now, after you’ve given birth, you may actually find urinating difficult immediately after delivery, or you may feel discomfort when you do urinate. This discomfort is a result of the way the bladder and urethra were compressed when the baby’s head and body came through the vagina. The tissues around the opening to the urethra are often swollen after delivery, and this swelling can add to the discomfort.
Some women may need to be catheterized (a thin, flexible plastic tube is inserted through the urethra into the bladder) after delivery to help empty the bladder. The problem is sometimes worse if you have an epidural because the anesthesia can hang around in your system for several hours and temporarily make the bladder more difficult to empty. But your bladder regains its normal tone a few hours after delivery, so urinary discomfort is usually a short-lived problem.
If you feel a burning sensation primarily during urination, let your doctor or nurse know because it may be a sign that you’re developing a urinary tract infection.
Some women experience the opposite problem: They find that they don’t have good control over their bladder function — that they leak a little urine when they stand up or laugh or they have to run like a cheetah to make it to the john in time. If this incontinence happens to you, don’t worry too much, because time usually solves the problem. In some cases, it may take a number of weeks to get things under control.
Kegel exercises may be useful if the problem persists (see the “Doing Kegel exercises” sidebar later in this chapter). Another good strategy is to make a conscious effort to go to the bathroom at regular intervals to empty your bladder before it becomes an emergency!
Battling the hemorrhoid blues
Most of your pushing efforts during delivery are focused toward the rectum, a fact that causes many women to develop hemorrhoids — dilated veins that pop out from the rectum. Unfortunately, having no problems with hemorrhoids before you go into labor is no guarantee that they won’t appear after delivery. If you develop hemorrhoids during the last part of your pregnancy, they may get worse after delivery. At times, hemorrhoids can be more uncomfortable than an episiotomy, and they last a little longer. Turn to Book 2, Chapter 3 for tips on dealing with hemorrhoids.
The good news is that the problem is usually temporary. Postpartum hemorrhoids typically go away within a few weeks. Sometimes they don’t go away completely, but for the most part they aren’t bothersome. They may not trouble you at all for a few months, and then they may be uncomfortable again for a few days and then get better again.
Consider taking a stool softener (such as Colace), and make sure you consume plenty of fluids and fiber. This way, bowel movements won’t hurt so much and you won’t have to push too hard (which makes hemorrhoids worse). Your hemorrhoids are likely to go away within one to two weeks.
Understanding postpartum bowel function
Many women find that they don’t have a bowel movement for a few days after delivery. This lack of bowel function may be because you haven’t eaten much or because epidurals and some other pain medications sometimes slow down the bowels a little. Your system may take a few days to return to normal.
Many women are afraid of bearing down because they don’t want to tear the stitches used to repair their episiotomy, so they try to avoid having a bowel movement altogether. But avoiding a bowel movement isn’t a great idea. You have no reason to be afraid of tearing the stitches. Your episiotomy is repaired in several layers with strong sutures. Tearing the sutures is extremely difficult, especially by having a bowel movement.
Here are a few ways to make having a bowel movement easier:
· Walk around the postpartum ward as much as you can. Walking improves circulation to the bowels and can help to eliminate any residual effects of the epidural.
· Take a stool softener, such as Colace.
· Try not to think about it too much. Things happen in time.
If you have hemorrhoids or a laceration that reaches back to the rectal area (see Book 2, Chapter 3), a bowel movement may be painful. You can reduce the discomfort by using a local anesthetic cream and by using a stool softener. Also, you may want to take a pain reliever shortly before you anticipate having a bowel movement.
Continuing to recover at home
By the time you’re discharged from the hospital after a vaginal delivery, most of the acute pain is gone. After you get home, however, you can still expect some soreness. The main area of discomfort is around your perineum. No matter how easy your delivery may have been, this part of your body has undergone some real trauma, and it simply needs time to heal.
Try not to let the lingering discomfort associated with having just given birth frustrate you. Keep in mind what an amazing miracle your body has just been through. In addition to dealing with the soreness from delivery, you need to adjust to a new lifestyle — getting up at all hours of the night, changing diapers, and feeding your new baby.
Recovering from a Cesarean Delivery
The hospital stay after a cesarean delivery is generally a few days longer than after a vaginal delivery — usually three to four days in total. If you have a cesarean delivery, you’re put on a stretcher immediately afterward and transported to the recovery room. You may even feel up to holding your baby during the trip. Just like any surgery, the first few days can be uncomfortable. Don’t worry, though, because after the initial few days, most people recover quite easily.
Going to the recovery room
When you’re in the recovery room, your nurse and anesthesiologist monitor your vital signs. The nurse periodically checks your abdomen to make sure that the uterus is firm and that the dressing over the incision is dry. Your nurse also checks for signs of excessive bleeding from the uterus. More than likely, you have a catheter in your bladder, and it stays in place for the first night so that you don’t have to worry about getting up to go to the bathroom. You also have an intravenous (IV) line in place to receive fluids and any medications your doctor prescribes. If you had an epidural or spinal anesthetic, your legs may still seem a little numb or heavy. This feeling wears off in a few hours. If you had general anesthesia (that is, if you were put to sleep), you may feel a little groggy when you get to the recovery room. Just as with a vaginal delivery, you may experience some shaking (see Book 2, Chapter 5). If you’re up to it and if you want to, you can breastfeed your baby while you’re in the recovery room.
Most likely, you received pain medication in the operating room, and you may not need any more while you’re in the recovery room. In some hospitals, if you have an epidural or spinal, your anesthesiologist injects a long-lasting medication into the catheter that keeps you almost pain-free for about 24 hours. If, however, your pain medication doesn’t seem to be working, by all means, let your nurse know.
Taking it one step at a time
When your nurse and anesthesiologist are confident that your vital signs are stable and that you’re recovering normally from the anesthesia, you’re discharged from the recovery room — generally about one to three hours after delivery. You’re transported on a stretcher to a hospital room, where you spend the rest of your recovery time.
The day of delivery
On the day of your cesarean, you should plan on just staying in bed. Thanks to your catheter, you don’t need to worry about getting up to go to the bathroom. If you had your surgery early in the morning, you may feel like getting up later in the evening, if only to sit in a chair. Just be sure to check with your nurse first to see whether getting up is okay. When you get up the first time, make sure someone is there to help you.
Although some doctors still prefer that patients not have any food immediately after a cesarean, many doctors now allow women to eat and drink shortly after the surgery. If you feel queasy and nauseous, you’re better off not eating. But if you feel hungry, drinking liquids and having small amounts of solid food is probably fine.
Like women who have had a vaginal delivery, expect some vaginal bleeding (lochia) after a cesarean. The bleeding may be quite heavy during the first few days after your surgery (see the earlier section “Understanding postpartum bleeding”).
As far as care for the incision goes, many practitioners will remove the dressing on the first or second day after the cesarean. After the dressing is removed, you’re usually able to shower. During the shower, don’t rub the incision; just let the water run over it and pat it dry immediately after the shower. Some women’s incisions are closed by sutures that will be reabsorbed over time with no need for removal, while others may be closed by staples, which do need to be removed.
Most women who have a cesarean delivery and have staples in their skin worry that removing the staples will hurt, but don’t worry. Staple removal is a quick and painless procedure.
The day after
The first day after your surgery, your doctor is likely to encourage you to get out of bed and start to walk around. The first couple of times you get up to walk may be pretty uncomfortable — you may feel pain around the incision in your abdomen — so you may want to ask for a top-up dose of pain medication 20 minutes or so before getting up.
Make sure someone is with you the first few times you get up to make sure you don’t fall.
Depending on your fluid needs, your doctor may also discontinue your IV line. Most of the time, you’re able to drink liquids on the first day, and many doctors also let you eat solid food.
Most likely, you have a bandage over your abdominal incision. Sometimes this bandage comes off on day one, but other times doctors prefer to leave it on longer.
Many women ask about rooming in — that is, having the baby stay in the room with them — after a cesarean delivery, especially after they’ve had a day or so to recover a bit from the procedure. Having the baby in the room with you is certainly fine if you feel up to it. But by no means should you feel that you have to. Keep in mind that you just had abdominal surgery, and you may not be physically able to attend to every single one of your baby’s needs during the first few days afterward. The hospital nurses are there to help, so during this time, devote as much energy as possible to your own recovery. You’ll be that much better able to care for your baby after you get home.
Understanding post-cesarean pain
You may feel a kind of burning pain at the site of your abdominal skin incision. This pain is worse when you get out of bed or change positions. Eventually, the burning diminishes to a sort of tingling sensation and is much improved within a week or two after surgery.
You may also feel pain from post-delivery uterine contractions — just as women who deliver vaginally do. Your doctor is likely to give you oxytocin (Pitocin) for the first few hours after your surgery to encourage contractions and thus minimize blood loss. Pain from contractions diminishes by the second day, although it may recur when you breastfeed because breastfeeding can trigger more contractions.
You may feel pain in tissues deep beneath your skin. In a cesarean, the physician must cut through several layers of tissue to reach the uterus. Each layer must then be repaired. And every one of the repaired incisions can generate pain. This pain usually takes one to two weeks to fade away. Many women say that they feel more pain on one side or the other, possibly because the stitches are a little tighter on one side. Whatever the reason, uneven pain is very common and nothing to worry about.
Many women say the worst pain of all is gas pain. The intestines accumulate a large amount of gas after a cesarean delivery, in part because of the way the intestines are manipulated during the surgery but also as a result of the medications — the anesthetics used during the operation and the painkillers given afterward. Gas pains typically begin on the second or third day after delivery and improve when you start to pass gas. Get up and walk around as much as possible, because doing so gets the gastrointestinal tract moving again.
If you have a cesarean delivery after going through labor for hours, you may have perineal pain — from pushing and from any number of internal exams — on top of everything else. This pain disappears soon after delivery.
Dealing with post-op pain
The amount of pain or discomfort experienced after a cesarean delivery varies from woman to woman, depending on the circumstances of her delivery and on her tolerance for pain. Your practitioner can prescribe pain medication, but she probably will specify that the medication shouldn’t be given unless you ask for it. (Sometimes this is hospital policy.) So if you want the pain relief, ask for it — before your pain becomes excruciating.
Some hospitals offer a PCA (patient-controlled analgesia) pump, which is attached to your IV line. When you feel your pain increasing, you simply press a button on the pump to release a small amount of pain medication into your IV line. Because you receive the medication intravenously, you can feel its effects quickly, and by using the medication only when you feel you need it, you can often get by with much less medication in total. Don’t worry about overdosing, because the pump has special settings that prevent you from getting too much medication.
Getting ready to go home
After surgery, you find that each day is noticeably easier and more comfortable than the one before. Over the course of three days, you gradually find it easier to get out of bed and walk around. You start to eat normally again. You’re also able to shower — and many women find that first shower a truly big relief. But please keep in mind that you have just been through not only major surgery but also nine months of pregnancy! And you must recover from both.
The length of your hospital stay may be determined to some extent by what your insurance plan allows and what individual state laws mandate. And occasionally, a post-operative infection or some other complication necessitates a longer-than-usual hospital stay. But typically, you’re ready to go home after about three days. Here are some indications that you may be ready to go home:
· You tolerate food and liquids without any problem.
· You urinate normally and without difficulty.
· Your bowels are on their way to recovering normal function.
· You have no signs of infection.
Continuing to recover at home
When you’re discharged from the hospital after a cesarean delivery, you’re well on your way down the road to recovery. However, getting back on your feet after a cesarean delivery takes longer than after a vaginal delivery, so take it easy for the first week or two after you return home. Keep the following pointers in mind as you recover.
Taking good care of yourself
Get the help you need from family and friends, if possible. If you can afford it, consider hiring a baby nurse for the first few weeks. (A baby nurse can be quite helpful for women who’ve had vaginal births, too.) Make sure, however, that any caregivers you recruit to help you have all their vaccinations up to date. Specifically, make sure that they’ve had a Tdap vaccine booster within the past ten years (see Book 1, Chapter 2). When you’re on your own, try to keep the household chores you do to a minimum. Avoid running up and down stairs a lot. Devote your energy to taking care of your new baby and taking care of yourself. Pay attention, and your body will clearly let you know how much activity you can handle.
Some doctors recommend that you not drive a car for the first week or two. This restriction isn’t because of the anesthesia you may have had — the anesthesia really doesn’t affect your reflexes for more than a day or two after delivery. The problem is simply that any leftover pain you may be experiencing after delivery may make it difficult for you to quickly move your foot to the brake if you need to stop suddenly. When your pain is gone, you can safely resume driving.
Most doctors also advise you to postpone any abdominal exercises until after your six-week checkup so that the incisions in all the layers of your abdomen have time to heal completely.
Most women feel pretty much back to normal by the six-week point, but some need as long as three months to fully recover.
By the time you’re home from the hospital, you should be able to eat normally. If you lost a great deal of blood during your surgery, however, you may want to ask your doctor whether you should take extra iron supplements.
Noticing changes in your scar
At first, the scar from your cesarean delivery looks reddish or pinkish. In time, it may turn a darker shade of purple or brown, depending to some extent on your skin color. Over the course of a year, the scar will fade and, eventually, assume a very pale color. If you have dark skin, it may be brownish. Most of the time, a cesarean scar is pencil-thin or even thinner. A scar from a cesarean delivery may look prominent immediately after the procedure, when the staples are still in place, but after they’re removed and the scar has had several weeks to heal, you’ll observe how it begins to fade into something far less obvious.
Many factors can affect the healing process and thus determine what the scar ultimately looks like. Some women are naturally prone to forming a thick type of scar, called a keloid. In these cases, doctors really can’t do much to change the situation. Some over-the-counter products claim to help wounds heal, but none have proven to be beneficial.
You may notice that the area around your incision becomes numb. This numbness occurs because in making the incision, your doctor cut through some of the nerves that transmit sensation in that area. The nerves do grow back, however, and in time the numbness turns into a mild tingling sensation and then returns to normal.
Some women notice a blood-tinged fluid discharge coming from the center or side of their incision. This drainage sometimes happens when blood and other fluids accumulate under the incision and then seep out. If only a small amount oozes out and the drainage then stops, it’s okay. Applying a little pressure to this area with a clean bandage is a good idea.
If you notice persistent blood-tinged or yellowish discharge from your incision, let your doctor know. Occasionally, the incision may open at the point where the drainage occurs. If so, your doctor may want you to take special measures to keep the opening clean so that it heals on its own.
Recognizing causes for concern
Most women who have cesarean deliveries recover without any problems. In some cases, however, you may not heal quickly and smoothly. Call your doctor if you notice any of the following:
· If pain from your incision or from your abdomen increases rather than decreases
· If large amounts of blood or blood-tinged fluid drain from your incision
· If you have a fever higher than 100.4 degrees Fahrenheit
· If your incision begins to open up
· If you notice any odor associated with the discharge from your incision
Going through More Postpartum Changes
Many aspects of postpartum life are the same whether you had a vaginal or a cesarean delivery. Now that you’re no longer pregnant, your body begins shifting back to its pre-pregnancy state, and you’re in for a number of changes. This section describes many of the common changes you may experience.
Sweating like a … new mom
If you’re managing to get any sleep at night despite having a new baby in the house, you may find that you wake up drenched in sweat. Even during the daytime, you may notice that you perspire significantly more than usual. This sweating is very common and is thought to have something to do with fluctuations in hormone levels that occur as your body returns to a nonpregnant state. It’s very similar to the night sweats and hot flashes that menopausal women get due to a drop in estrogen levels. As long as the sweating isn’t associated with a fever, it’s not a problem. It will go away over the course of the next month or so.
Dealing with breast engorgement
A woman’s breasts typically begin to engorge, or fill with milk, three to five days after she delivers her baby. You may be amazed to see how huge your breasts can really be! If you’re breastfeeding, your baby lessens the problem for you as she gets the hang of nursing, figures out how to take in more milk, and establishes a pattern of feeding. (See Book 5 for more information about breastfeeding.)
If you’re not breastfeeding, you may find that your breasts stay engorged for 24 to 48 hours (which can be quite painful), and then you begin to feel better. Wearing a tight-fitting supportive bra may make the process a little more comfortable. Applying ice packs or bags of frozen peas to your breasts helps the milk to “dry up,” as does taking cold showers. Cold temperature causes the blood vessels in the breasts to constrict, lessening milk production, whereas warmth causes the blood vessels to dilate, promoting milk production. (Doctors no longer prescribe a medication to help a woman’s milk dry up, because the drug they once used has been associated with some significant complications.)
Understanding hair loss
One of the stranger aspects of the postpartum return to normalcy is hair loss. A few weeks or months after delivery, most women notice that they’re shedding like crazy. This shedding is normal, and it doesn’t last long. Your hair is usually back to normal by nine months after delivery.
All hair follicles go through three phases of development: a resting phase, a so-called transitional phase, and a shedding phase. The elevated levels of estrogen that are present during pregnancy essentially freeze your hair in the resting phase. Within a few months after delivery, all that hair proceeds to the shedding phase. Suddenly, you notice large amounts of hair sticking in your brush or washing down the drain.
Chasing away the baby blues
Studies show that the vast majority of women — as many as 80 percent — suffer a bout of the blues during the first days and weeks after they deliver. Typically, you begin to feel a little down a few days after the birth, and you may continue to feel vague sadness, uncertainty, disappointment, and emotional discontent for a few weeks. Many women are surprised at the feeling; after all, they’ve looked forward to motherhood, and they feel sure that they’re really thrilled about it.
No one knows for sure why women get the blues postpartum, but a few explanations are plausible. First, the shift in hormone levels that comes after delivery can affect mood. Also, when pregnancy ends, a mother must change her whole focus. After focusing on the birth for so many months, she suddenly finds that the big event is over, and she may feel almost a sense of loss. And face it — parenthood brings tremendous anxiety, especially for a first-time mother. Feeling overwhelmed by all the responsibility and all she needs to figure out about caring for a baby isn’t unusual for a woman. Add in the physical discomfort — episiotomy repair, breast tenderness, hemorrhoids, fatigue, and the rest — and you begin to wonder how any new mother can avoid feeling a little blue.
Fortunately, postpartum blues tend to fade away rather quickly, usually by about two to four weeks after the birth. Keep in mind that what you’re feeling is extremely common and that it doesn’t mean you don’t love your child or that you won’t be a fabulous parent.
If you find yourself suffering from the baby blues, remember that the feeling is as normal as pregnancy itself. And take heart: Those who have already grappled with the problem have found a number of ways to ease the blues. Consider this list of some of the best strategies:
· Try to get more sleep. If the baby is napping, try to lie down and snooze. Lack of sleep compounds the problem of the baby blues. Everything is worse when you’re physically fatigued. The amount of stress that you can handle when you’ve had your rest is much greater than if you hadn’t slept enough.
· Accept other people’s offers of help. In most cases, you don’t have to take care of your baby entirely by yourself. You’re a great mom, even if you do let Aunt Suzie or Grandma Melba change a diaper or burp the baby.
· Talk about how you feel with other mothers, close family members, and friends. Be open about it; let your partner, family members, and friends know how you feel, because you need love and support at this time. You’re likely to find that they felt exactly as you do now. They can empathize with you and offer suggestions for how to cope.
· If possible, try to get some time to yourself. Often, new parents are overwhelmed by the realization that their time is no longer their own. Get out of the house, if you can. Take a walk, read, watch a movie, or get some exercise. Have dinner with your partner or with a friend.
· Pamper yourself. Try a manicure or pedicure, a trip to the hair salon, or a massage. Often the blues are exacerbated by the fact that your body still isn’t back to what it used to be, and doing something that makes you feel beautiful may help.
If you don’t begin to feel better in three or four weeks, let your practitioner know. Some women go beyond the blues into full-blown postpartum depression. Check out the next section for information.
Recognizing postpartum depression
True postpartum depression isn’t nearly as common as the blues, but it does affect more women than you may imagine. Between 10 and 15 percent of women develop depression within six months after they deliver. Symptoms include the following:
· Severe unhappiness
· Inability to enjoy being with the baby (or to enjoy life in general)
· Lack of interest in caring for the baby
· Insomnia
· Weak appetite
· Inability to function from day to day
· Extreme anxiety or panic attacks
· Thoughts of harming the baby or yourself
Although postpartum blues are usually mild and transient, full-blown depression can be severe and lasting. Despite the severity of the symptoms, postpartum depression often goes unrecognized, or the mother may attribute the problem to something else.
No one knows exactly why postpartum depression occurs, but certain characteristics put a woman at higher than normal risk. These risk factors include
· History of postpartum depression
· History of depression in general
· Experience of anxiety before the birth
· Life stress
· Lack of a good support system
· Marital dissatisfaction
· An unplanned pregnancy
· Unhappiness about the labor and delivery process
If you have postpartum blues and it doesn’t go away after three or four weeks, if the feeling seems to be getting worse, or if you develop the blues more than two months after your delivery, discuss the situation with your doctor.
Treatment for postpartum depression includes counseling (group or individual psychotherapy), antidepressant medications, and, rarely, hospitalization. Recent studies have suggested that in some cases, taking small doses of estrogen under the tongue can help. Of course, follow this treatment only under your doctor’s supervision. Your doctor may want to check to see whether you have postpartum thyroid disease, which can mask itself as depression or make your depression worse. Discuss all these with your doctor.
To get further information about how to handle postpartum depression, you may want to get in touch with one of the following resources:
· Postpartum Support International: www.postpartum.net or call 1-800-944-4PPD.
· PPDMOMS.ORG: www.1800ppdmoms.org or call 1-800-PPD-MOMS.
· March of Dimes: Go to www.marchofdimes.com. Enter “postpartum depression” in the search field. There are numerous links to help you find the information that applies to your particular situation.
Checking your progress: The first postpartum doctor visit
Most practitioners ask their patients to come in for a checkup about six weeks after delivery if both the pregnancy and the birth were uncomplicated. If you had a cesarean or some complication, you may be asked to come in earlier.
During a postpartum checkup, your practitioner performs a complete exam (including a breast and vaginal exam) and obtains a PAP smear, if needed. In most cases, the six-week checkup suffices for your annual gynecological exam. Your practitioner probably also talks with you about your birth control options. Discuss the “spacing” of future children and other precautions before conceiving again — such as taking folic acid a few months beforehand and, if this pregnancy had complications, getting whatever special blood tests your practitioner may advise.
FOR PARTNERS: CHIPPING IN DURING THE RECOVERY PHASE
While your partner recovers, gets her hormones back together, and works into her new routine as a mom, she needs you to pick up the scut work around the house without being told what to do. Taking over the following list of chores makes for a happy mom, which means a happy baby — and a happy next six months for your new family:
· Keep the house in order. Because your partner is limited to lifting nothing heavier than a baby for the next six weeks, cleaning has just become your full responsibility. If you don’t have time to clean every part of the house every day, ask your partner point-blank what tasks are most important to her, and then carry out her requests word for word. For example, if she wants the bathroom cleaned every day, then grab your toilet brush and get scrubbing. And when well-wishers come bearing a lot of stuff, try to keep the clutter under control. Mom is trapped indoors with a baby who’s feeding around the clock, and feeling suffocated by balloons, flowers, and stuffed animals may only increase her anxiety. Make sure to find a new home for everything that comes into the house.
· Assume laundry duty. Laundering baby’s things is a bit different from laundering your things. Wash brand-new infant clothes prior to first use to remove any chemicals or germs in the fabric. To avoid exposing your baby to dyes and chemicals that can irritate her delicate skin, wash baby clothes in dye- and chemical-free detergent. Be sure to treat stains. Rinse away or wipe off any detritus from the article of clothing or blanket, and spray on the treatment of your choice — prior to washing.
· Become the gopher. Grab the keys and get rolling, because driving duties are up to you for a while. Doctors recommend that women who have a vaginal birth don’t drive for two weeks following delivery. That time could increase for a cesarean delivery; follow your partner’s practitioner’s instructions. Some suggest that she be able to pick up her foot and stomp on the ground without any abdominal pain before driving.
· Take care of meals. Whether you’re the guy who likes to take charge in the kitchen or the type who routinely forgets to add the cheese packet to macaroni and cheese, making sure you and your partner are well-nourished is one of your most important roles. Breastfeeding women need to consume an additional 400 to 600 calories more than they would when eating a normal diet. New moms need to eat energy-packed, nutritious foods to help their bodies recover from labor and delivery. And with all the extra work you’re doing on reduced sleep, you need these same foods too!
Tip: Because you’ll be getting less sleep and doing more work around the house, you may not be eager to strap on the apron three times a day. To make the task easier on yourself, cook meals that you can eat multiple times or freeze for future consumption, such as easy-to-assemble casseroles or pots of soup. If time allows, this cooking can be a great nesting activity with your partner prior to delivery, too. And if friends and family ask you what they can do to help, ask them to bring you a meal in a freezer-safe storage container in lieu of flowers. Having prepared homemade meals on hand helps you avoid the temptation to order takeout or fast food, which is high in sodium and fat and not the most nutritious for mom and baby.
· Call in backup, if necessary. If you can’t be home to help out during the early stages of parenthood, talk to your partner about the needs and desires she has while you’re at work, and help her find the appropriate support from friends, family, and neighbors. Make chore lists for daytime helpers so your partner doesn’t feel burdened by having to ask for help. If financially viable, hire a cleaning service. It will be the best gift you can give to your partner … and yourself.
Before you gratefully accept your parents’ and your partner’s parents’ offers to visit and help, make sure your partner wants them around. All the advice and constant companionship from a parental figure may cause her more stress.
Returning to “Normal” Life
Your body typically needs six to eight weeks for the changes that you experience during pregnancy to disappear. After delivery, your body needs some time to get back in shape for your day-to-day activities, let alone for vigorous exercise or sex. This section focuses on what you can do to help make the transition easier.
Getting fit all over again
Making exercise a priority after delivery is important for every new mom. Fitness has many benefits for both your physical and emotional well-being. It can help your body recover from the stress of pregnancy, and it helps you feel more even-tempered and better about yourself. Resume your sports and workouts gradually. Over the course of two weeks, depending on how you feel, you can gradually increase your exercising until you’re fully active again. Naturally, the amount of exercise you can handle depends on what kind of shape you were in before and during your pregnancy. Head to Book 4, Chapter 5 for information on how to get your body back.
After pregnancy, restoring strength to your abdominal muscles is especially important. In some women, pregnancy causes the abdominal or rectus muscles to separate a little, as shown in Figure 7-1. The medical term for this separation is diastasis. Do abdominal exercises to restore their strength and draw them together.
Illustration by Kathryn Born, MA
FIGURE 7-1: After pregnancy, your abdominal muscles may be separated a bit, one side from the other.
Walking is great exercise for just about everyone. During the first two weeks after delivery, take it slow. But after that, you may find that long or brisk walks are enjoyable for both you and your baby — and a great form of exercise.
Losing the weight
You may feel like jumping onto a scale right after delivery to see how much weight you’ve lost. But take caution. Some women do lose a lot of weight quickly after delivery, but some actually gain weight from all the fluid retention. Rest assured that you’ll soon weigh less than you did before you delivered — probably about 15 pounds less — but the loss may not register until a week or two after delivery. Most women need two to three months to get back to their normal weight, but, of course, the time varies according to how much weight you gain during pregnancy. If you gain 50 pounds (and have just one baby), don’t expect to look fabulous in a bikini six weeks after you deliver. Sometimes a woman needs an entire year to get back into shape. A healthy diet and regular exercise help the weight come off.
Try to get as close to your pre-pregnancy weight — or your ideal body weight — as soon as is reasonably possible. You don’t have to let a pregnancy turn into a permanent weight gain. If you let each successive pregnancy cause a little more accumulation, your health may suffer in the long run.
Pondering your postpartum diet
Any woman who’s just had a baby needs to once again examine her diet. If you’re breastfeeding, you want to ensure, as you did when you were pregnant, that you’re eating a healthy combination of foods that provides both you and your baby with good nutrition and that you’re also getting enough fluid. (For information about how to follow a balanced, nutritious diet, see Book 3.) Remember, the best approach to weight loss involves exercise plus a well-balanced diet that’s low in fat and includes a mix of protein, carbs, fruits, and vegetables.
You may find that a program such as Weight Watchers (www.weightwatchers.com) offers the motivation and support you need to get your diet on track. Avoid diets that focus on rapid weight loss; instead look for ones designed to change your way of eating so you discover how to eat healthily and still lose weight.
Taking your vitamins
Regardless of whether you breastfeed, continue taking your prenatal vitamins for at least six to eight weeks after you deliver. If you do breastfeed, keep taking vitamins until you stop breastfeeding. Taking care of a new baby may make it hard for you to eat properly, and the childbirth experience may have left you anemic. If you lost a particularly large amount of blood during your delivery, your practitioner may suggest that you take iron supplements to help restore your blood count. Calcium is also very important for any woman, especially one who’s breastfeeding, in order to maintain strong bones. A calcium supplement or extra calcium in your diet is a good idea.
DOING KEGEL EXERCISES
Kegel exercises are squeezing motions aimed at strengthening the muscles of the pelvic floor that surround the vagina and rectum. These muscles give support to the bladder, rectum, uterus, and vagina. Keeping them strong is key to reducing the adverse effects that pregnancy and delivery can have on this part of the body. If the pelvic floor muscles are very weak, your chances are greater of developing urinary stress incontinence (a leakage of urine when you cough, sneeze, laugh, or jump) or prolapse or protrusion of the rectum, vagina, and uterus (in which these organs begin to sag below the pelvic floor).
To perform these exercises, tighten the muscles around your vagina and rectum. When you’re first doing Kegels, squeeze the muscles for as long as ten seconds and then release. Squeeze five to ten times per session, and try to do three to four sessions a day. Ultimately, you can build up to the point where you hold each squeeze for ten seconds and do 25 squeezes per session. Continue to do the Kegels four times a day. You can do them while you’re sitting, standing, or lying down, and you can do them while you’re doing something else — bathing, cooking, talking on the phone, watching television, driving your car, or standing in line at the grocery store.
Tip: Here’s a simple way to find out what it feels like to do the exercises correctly: Sometime when you’re urinating, try to stop the flow of urine midstream. Or insert a finger in your vagina and try to tighten the muscles around your finger. If you’re doing Kegels correctly, your finger feels the squeeze. (Both of these techniques are simply ways of figuring out how to squeeze the muscles, not the way you normally practice the exercise.)
Having sex again
If you’re like most postpartum women, sex is the last thing on your mind. Many women find that their interest in sex declines considerably during the first weeks and months after pregnancy. But at some point, the fatigue and emotional stress of childbirth ease up, and your thoughts are likely to be more amorous again. For some women (and their lucky partners), the rebound occurs fairly quickly. For others, it may take 6 to 12 months.
The drastic hormonal shifts that occur after delivery directly affect your sex organs. The precipitous drop in estrogen leads to a loss of lubrication for your vagina and less engorgement of blood vessels as well. (Increased blood flow to the vagina is a key aspect of sexual arousal and orgasm.) For these reasons, intercourse after childbirth can be painful and sometimes not all that satisfying. With time, as hormone levels return to their pre-pregnancy norm, the problem tends to correct itself. In the meantime, using a lubricant sold specifically for this purpose helps.
The exhaustion and stress of caring for an infant further reduces the desire for sex in some women. Your attention, and your partner’s, too, is likely to be focused more on the baby than on the relationship between the parents. Set aside some time for the two of you to be alone together. This time together need not even include sex — just holding, hugging, and expressing feelings for each other.
Most doctors recommend that women refrain from intercourse for four to six weeks after the baby is born in order to give the vagina, uterus, and perineum time to heal and for the bleeding to subside. At your six-week follow-up doctor visit, you can ask your practitioner about resuming sex.
Choosing contraception
Many people believe that breastfeeding prevents a woman from becoming pregnant. Although breastfeeding usually delays the return of ovulation (and, thus, periods), some women who are nursing do ovulate — and do conceive again. You may not ovulate the entire time that you breastfeed, or you may start again as early as two months after delivery. And if you don’t breastfeed, ovulation begins, on the average, ten weeks after delivery, although it has been reported to occur as early as four weeks. If you breastfeed for less than 28 days, your ovulation returns at the same time as it does for non-nursing women.
It’s important to consider your options for birth control before you have sex again. Most women have a wide range of birth-control options regardless of whether they’re breastfeeding. But some women have medical conditions that prevent them from using certain methods. Discuss your options with your practitioner at a postpartum visit.