Postpartum Health Issues
If you took any medication before or during pregnancy, ask your doctor about continuing it or resuming it after delivery.If you have a chronic illness, such as diabetes or asthma, it may affect your recovery. You may need to watch for specific problems or to make particular adjustments. You may need to take medications or to adjust your activities; check with your doctor about your particular situation.
For example, if you had gestational diabetes during pregnancy, your blood-sugar level may need to be tested after delivery. Discuss results with your doctor. If your blood-sugar level is normal, you're OK. If it isn't, you may be referred to a doctor who specializes in treating diabetes. He or she can help you plan a program to deal with your problem. Most of the time delivery cures gestational diabetes, and you are fine until you are pregnant again, when it may recur. Gestational diabetes may also indicate a tendency in a woman for diabetes to occur later in life, so you may wish to ask your doctor about warning signs to watch for.
Changes in the Uterus
After delivery, the uterus shrinks from the size of a watermelon to the size of an orange in 6 weeks!
After baby's birth, your uterus slowly returns to its original shape. Just before birth, the uterus was large enough to accommodate the baby, placenta and amniotic fluid. Immediately after delivery, you should feel your uterus around your navel; it should be very hard. You are checked frequently to make sure it remains hard after delivery. If it feels soft, you or a nurse can massage it so it becomes firm.
The uterus shrinks about a finger's width every day; this is called involution. You will be checked daily while you're in the hospital to ensure that your uterus is shrinking normally. This exam can be a little uncomfortable, but it is necessary for normal control of bleeding.
Afterpains
Afterpains are just what they sound like—pains you experience after the birth of your baby. They are normal; expect to feel them for several days after birth as your uterus contracts. Contractions occur to prevent heavy bleeding and to enable the uterus to return to its normal size. Cramps can be eased by lying on your stomach and by taking mild pain relievers, such as acetaminophen or ibuprofen.
If you breastfeed, your afterpains may intensify when you nurse. The baby's sucking stimulates the pituitary gland to release oxytocin, which makes the uterus contract. These extra contractions are good for you because they help control bleeding, but they can be uncomfortable. Mild pain medication can offer relief.
Perineum Pain
Stretching, cutting or tearing in the area between the vagina and anus during labor and delivery can cause pain in the perineum. An episiotomy can add to this discomfort. Pain doesn't last too long; soreness should diminish daily and disappear in about 3 weeks or by the time you see your doctor for your 6-week checkup.
If you experience severe discomfort, use ice packs, which may offer some relief in the first 24 hours after delivery. Ice numbs the area and helps reduce swelling. After 24 hours, a warm bath or soaking in a sitz tub several times a day can help.
Other remedies for pain include numbing sprays, witch-hazel compresses, walking to stimulate circulation and practicing your Kegel exercises. Pads soaked in hemorrhoid medication (sold over the counter) can be kept in the freezer, then placed on the sore area—they provide excellent relief.
Urinating may be painful because urine can sting the cut area. This burning is not an indication of a UTI or bladder infection. It is caused by the chemicals in the urine that cause stinging along the cut. You may find it less painful to urinate standing or in the shower with running water washing over the area.
It may seem like you're bleeding a lot during and after delivery, but remember, your blood volume increased 50% during pregnancy, so you have extra blood in your body.
Bleeding After Delivery
It's common to lose some blood during labor and delivery. However, heavy bleeding after the baby is born can be a concern. A loss of more than 17 ounces (500ml) in the first 24 hours after your baby's birth is called postpartum hemorrhage.
The most common causes of heavy bleeding include the following:
- when your uterus doesn't contract
- a large or bleeding episiotomy
- clotting or coagulation problems
- failure of blood vessels inside the uterus to compress
- retained placental tissue or retained blood clots in the uterus
- rips or tears in the vagina or cervix from the birth
- a tear, rupture or hole in the uterus (rare)
If bleeding suddenly becomes heavy after a few days or weeks, contact your doctor. He or she may want to see you to prescribe medication.
Your Changing Bowel Habits
Your bowel habits will probably change for a few days after your baby's birth. Your digestive system slows down during labor and after delivery because of medications, such as pain pills, because of changes in your activity level or because you sit or lie in bed. You may have had an enema, or the lower part of your bowel (the rectum) may have emptied while you pushed during labor and delivery. These factors can all contribute to bowel-habit changes.
Many women don't want to have to deal with having a bowel movement for the first 4 or 5 days after delivery because it hurts. Some new mothers have said that their first bowel movement after delivery felt like they were delivering another baby.
If you had an episiotomy or if you have hemorrhoids, your bowel movements may be more difficult or more painful. You may be apprehensive about having one. Now is not the time to be constipated. To avoid constipation, eat a high-fiber diet and drink lots of fluids to keep your system working efficiently.
Prune juice and bran are natural laxatives; include them in your diet. Over-the-counter stool softeners may also be beneficial. Many stool softeners and laxatives are safe to use if you breastfeed. If you don't have a bowel movement within a week or if you become uncomfortable, contact your doctor.
When you do have a bowel movement, try not to strain. This can aggravate hemorrhoids or make an episiotomy incision or the area of a laceration hurt or bleed. Hemorrhoids eventually shrink on their own, although they may not go away completely. A witch-hazel compress or a commercial compress can offer relief. Over-the-counter creams and ointments and mild pain medication and anti-inflammatories, such as ibuprofen, can also offer some relief. Ice packs may help. More serious measures are usually unnecessary.
Changes in Your Breasts
Whether you breastfeed or bottlefeed, sore breasts are fairly common after delivery. In the natural course of pregnancy and delivery, your body has prepared you to breastfeed, so your breasts will fill with milk.
The fullness of milk in your breasts, called engorgement, usually lasts a few days and may be uncomfortable. If you breastfeed, you can empty your breasts when the baby nurses, and the situation resolves itself in a few days. It's a little more difficult for a woman who chooses not to breastfeed because breast milk still comes in. Medication is no longer given to stop the production of breast milk. You can ease discomfort by wearing a support bra or binding your breasts with an Ace® bandage or a towel. Ice packs also help milk dry up.
If you find your breasts are engorged, and you are not breastfeeding, try not to empty your breasts. This may be difficult; emptying your breasts may be the only way to get relief. However, when you empty your breasts, your body replaces the expressed breast milk with more milk! Avoid nipple stimulation and warm water on the breasts because these practices also stimulate milk production. Hearing a baby cry—yours or someone else's—may also make you lose milk.
A mild fever with engorgement is not uncommon. Acetaminophen can help with both the fever and the discomfort from engorgement.
Urinary Incontinence
Bladder function or voiding urine may be different after delivery for many reasons. During labor and afterward, fluids are often given by I.V. for various reasons. Oxytocin (Pitocin), given during or after labor, has an "antidiurectic" effect; it causes a decrease in urine production. Once this effect has passed, you have a lot of fluid to get rid of—you'll need to urinate a lot! Bladder sensation can also be affected by pain from delivery, a tear in the birth canal or anesthesia, such as an epidural.
Some women have trouble controlling their urine after birth; this condition is called urinary incontinence. This may last briefly, or it can last a few weeks or longer. Most women report that the more pregnancies and deliveries they have, the greater their problem with incontinence. There are several factors that contribute to this, including the size of the baby, the number of deliveries, the size of the uterus, your age and whether you had a vaginal delivery or a C-section.
For a baby's head and shoulders to fit through the birth canal, your muscles and connective tissues stretch a great deal. Your bladder lies in front of the uterus, and the lower part of the bladder wall is stretched during birth. After delivery, this area is weaker than before pregnancy, which can contribute to incontinence. Each delivery stretches the birth canal. Tissues that support the bladder are also stretched with each delivery, causing some incontinence.
It takes a few weeks or more for your uterus to return to normal size. In the weeks immediately after delivery, the uterus gradually contracts and grows smaller, and it lies directly on the bladder. This compresses your bladder so it won't hold as much urine. It might be harder for you to control urine loss.
You can help yourself regain bladder and urine control by practicing Kegel exercises. Do not hold your urine; empty your bladder fairly often. It takes time for things to get better. Chances are that your bladder control may not be the same as before you became pregnant.
Let your doctor know if a urinary incontinence problem continues or worsens. Improvement may not come for weeks after delivery, until you begin to get back in shape. Surgery may help, but most doctors prefer to perform this kind of surgery only when you are finished having children. Any further pregnancies may undo the benefits of the surgery.
Varicose Veins
Varicose veins, blood vessels that are dilated or enlarged, are a fairly common result of pregnancy. They are also called varicosities. You may have an inherited predisposition to varicose veins—if your mother had them, you have a greater chance of having them, too.
Varicose veins occur most often in the legs, but they may also occur in the vulva and vagina. Varicosities will not disappear immediately after delivery. Follow the tips you were given during pregnancy to help deal with varicose veins after your baby is born. Some of these tips include the following:
- Lie on your side (left is best) as much as possible.
- Elevate your legs above the level of your heart when you can.
- Don't wear restrictive clothing.
- Get up and walk throughout the day.
- Don't cross your legs.
- Get regular exercise.
- Don't stand for long periods.
In severe cases, varicose veins may require treatment, including injection, ligation, stripping and laser treatment. It is rare to perform any of these procedures until you are finished childbearing.
Swelling and Water Retention
Swelling and water retention are a normal part of pregnancy. Water retention occurs because of hormonal changes and the blockage of blood flow by the enlarging uterus. Because it takes weeks for your uterus to return to its prepregnancy size, it takes some time to get rid of this extra water.
To help lessen swelling, do the same things you were advised to do during pregnancy. Lie on your side several times during the day and at night when you sleep. Get up and get moving; if you just sit in bed, it'll take longer to get rid of extra fluid. Elevating your legs above the level of your heart can help, but lying on your side is better. Exercise regularly.
Headaches
Headaches can be a problem for some women after delivery. They don't usually indicate a problem, but they can make you miserable. Headaches can be caused or influenced by many factors—for example, a long labor, having to push for a while or if you have not slept in 24 to 36 hours. If you had pre-eclampsia or pregnancy-induced hypertension, either could cause a headache.
Epidural anesthesia or a spinal anesthetic for labor or a C-section can result in a headache called a spinal headache. It doesn't happen often—once in every 100 deliveries—and is treated with bed rest and fluids. Sometimes an epidural blood patch is used to seal the area of leakage from the spinal canal. With this procedure, blood is withdrawn from your arm and introduced into the spinal canal. You are advised to lie flat on your back for 2 to 3 hours, so the blood placed in the spinal area can clot and seal off any opening that may be causing the leakage. This procedure often helps stop the headache.
Occasionally, dealing with visitors and your new baby may contribute to a headache. If you have headaches, discuss the situation with your doctor. He or she can recommend a course of treatment for you. Usually rest, fluids and mild pain medicine offer relief. It's important to tell your doctor if you have a headache that doesn't go away or doesn't get better, especially if a headache is severe or is accompanied by blurred vision, headache or nausea.
Emotions May Change
You may experience many emotional changes after your baby is born. Mood swings, mild distress or bouts of crying are not uncommon. Changes in moods are often a result of hormonal changes you experience after birth, just as they were when you were pregnant. A lack of sleep may play a part in how you feel. Many women are surprised by how tired they are emotionally and physically in the first few months after their baby's birth. Make sure you take time for yourself. You'll have a period of adjustment.
Sleep and rest can help you deal with mood shifts, which seem to occur more often when a woman is exhausted. Taking care of yourself is very important. See Getting Enough Sleep and Rest After Pregnancy and Postpartum Distress Syndrome.
Copyright © 2002 by Glade B. Curtis and Judith Schuler. Excerpted from Bouncing Back After Your Pregnancy with permission of its publisher, Perseus Books Group, Inc. All rights reserved.
To order this book visit perseusbooksgroup.com.