You can't help but marvel at all your body has endured in the past nine months. Now that the pregnancy is (finally) over, you've been rewarded with a living, breathing wonder -- and a new title: Mom. Coming to terms with your new role, while learning how to care for your baby, can be overwhelming for any woman.
Like just about everything else in your life, your body faces significant changes in the weeks and months following your baby's birth. In this postpartum period, which begins immediately after delivery, your body will heal from childbirth, rebuild its strength and begin to regain its pre-pregnancy shape.
The more you know about what to expect, the better prepared you'll be to cope with the physical and emotional changes that come post-pregnancy.
Women may experience a wide range of postpartum problems, some more serious than others and each with its own symptoms. Some of the more common problems include:
- Postpartum infections, (including uterine, bladder, or kidney infections)
- Excessive bleeding after delivery
- Pain in the perineal area (between the vagina and the rectum)
- Vaginal discharge
- Breast problems, such as swollen breasts, infection and clogged ducts
- Stretch marks
- Hemorrhoids and constipation
- Urinary or fecal (stool) incontinence
- Hair loss
- Postpartum depression
- Discomfort during sex
- Difficulty regaining your pre-pregnancy shape
Causes and Treatment
Although some bleeding is normal immediately after delivery, heavy bleeding or hemorrhage occurs in just 2% of births, most often after long labors, multiple births or when the uterus has become infected.
Postpartum hemorrhage is the third most common cause of maternal death in childbirth. It usually happens because the uterus fails to properly contract after the placenta has been delivered, or because of tears in the uterus, cervix or vagina. Soon after the baby and placenta have been delivered, you will be monitored to make sure the uterus is contracting as it should. If bleeding is severe, your midwife or doctor may massage your uterus to help it contract, or you may be given a synthetic hormone called oxytocin to help stimulate contractions. He or she will likely perform a pelvic exam to find the cause of the hemorrhage, and your blood may be tested for infection and anemia. If the blood loss is excessive, a blood transfusion may be recommended.
If hemorrhage begins a week or two after delivery, it may be caused by a piece of the placenta that has remained in the uterus. If so, the tissue will be removed surgically. Once you are home, report any heavy bleeding to your doctor immediately.
Normally, the placenta separates from the uterine wall during delivery and is expelled from the vagina within 20 minutes after giving birth. If pieces of the placenta remain in the uterus (called retained placenta), it can lead to infection.
An infection of the amniotic sac (the bag of water surrounding the baby) during labor may lead to a postpartum infection of the uterus. Flu-like symptoms accompanied by a high fever; rapid heart rate; abnormally high white blood-cell count; swollen, tender uterus; and foul-smelling discharge usually indicate uterine infection. When the tissues surrounding the uterus also are infected, pain and fever can be severe. Uterine infections usually can be treated with a course of intravenous antibiotics, which are used to prevent potentially dangerous complications such as toxic shock.
Infection of C-section Incision
Follow your health-care provider's instructions about caring for your C-section incision. Consult your doctor if you see signs of infection, such as red, swollen skin or draining pus. Resist the urge to scratch. Try lotion to ease itching.
A kidney infection, which can occur if bacteria spread from the bladder, includes symptoms such as urinary frequency, a strong urge to urinate, high fever, a generally sick feeling, pain in the lower back or side, constipation and painful urination. Once a kidney infection is diagnosed, a course of antibiotics -- either intravenous or oral -- usually is prescribed. Patients are instructed to drink plenty of fluids, and are asked to give urine samples at the beginning and end of treatment to screen for any remaining bacteria.
Be sure to report any unexplained fever that develops in the early weeks after delivery to your doctor. This could be a sign of postpartum infection.
For women who delivered vaginally, pain in the perineum (the area between the rectum and vagina) is quite common. These tender tissues may have stretched or torn during delivery, causing them to feel swollen, bruised and sore. This discomfort may also be aggravated by an episiotomy, an incision sometimes made in the perineum during delivery to keep the vagina from ripping.
As your body heals in the weeks following childbirth, the discomfort should lessen. Sitz baths, cold packs or warm water applied to the area with a squirt bottle or sponge can help avoid infection and reduce tenderness. It's also important to wipe yourself from front to back after a bowel movement to avoid infecting the perineum with germs from the rectum.
If sitting is uncomfortable, you may want to purchase a doughnut-shaped pillow at your local drugstore to help ease the pressure on your perineum. A prescription or over-the-counter pain reliever (non-aspirin, if you're breast-feeding) also can help.
When you feel up to it, pelvic floor exercises (often called Kegel exercises) can help restore strength to your vaginal muscles and help the healing process along. If you have increasing or persistent pain in the vaginal area, however, discontinue the exercise and alert your doctor.
Vaginal Discharge (Lochia)
A bloody, initially heavy, discharge from the vagina is common for the first several weeks after delivery. This discharge, which consists of blood and the remains of the placenta, is called lochia. For the first few days after childbirth, the discharge is bright red and may include clots of blood. The flow will eventually lighten, as will its color -- gradually turning pink, then white or yellow before stopping altogether. The bright red discharge may return at times, such as after breast-feeding or too-vigorous exercise, but its volume generally slows considerably in about 10 to 14 days.
Swollen (Engorged) Breasts
When your milk comes in (about two to four days after delivery), your breasts may become very large, hard and sore. This engorgement will ease once you establish a breast-feeding pattern or, if you're not breast-feeding, once your body stops producing milk (usually less than three days if your baby is not suckling).
You can ease the discomfort of engorgement by wearing a well-fitting support bra and applying ice packs to your breasts. If you are breast-feeding, you can relieve some of the pressure by expressing -- either manually or with a breast pump -- small amounts of milk. If you are not nursing your baby, avoid hot showers and expressing any milk. This will only confuse your body into producing more milk to compensate. Oral pain relievers can help you endure the discomfort until your milk supply dries up.
Mastitis, or breast infection, usually is indicated by a tender, reddened area on the breast (the entire breast may also be involved). Breast infections -- which can be brought on by bacteria and lowered defenses resulting from stress, exhaustion or cracked nipples -- may be accompanied by fever, chills, fatigue, headache and/or nausea and vomiting. Any of these symptoms should be reported to your doctor, who may recommend treatment with antibiotics.
If you have a breast infection, you may continue to nurse from both breasts. Mastitis does not affect your breast milk. It's also important to rest and drink plenty of fluids. Warm, wet towels applied to the affected area may help alleviate discomfort; and cold compresses applied after nursing can help reduce congestion in your breast. You may also want to avoid constricting bras and clothing.
Clogged milk ducts, which can cause redness, pain, swelling or a lump in the breast, can mimic mastitis. However, unlike breast infections, caked, clogged or plugged ducts are not accompanied by flu-like symptoms.
Breast massage; frequent nursing until the breast is emptied; and warm, moist packs applied to the sore area several times a day may solve the problem. However, if you have a lump that does not respond quickly to home treatment, consult your doctor.
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Stretch marks are the striations that appear on many women's breasts, thighs, hips and abdomen during pregnancy. These reddish marks, which are caused by hormonal changes and stretching skin, may become more noticeable after delivery. Although they may never disappear completely, they will fade considerably over time. While many women purchase special creams, lotions and oils to help prevent and erase stretch marks, there is little evidence that they work. About half of women develop stretch marks during pregnancy, regardless of whether or not they have used any topical ointments.
Hemorrhoids and constipation, which can be aggravated by the pressure of the enlarged uterus and fetus on the lower abdomen veins, are both quite common in pregnant and postpartum women. Over-the-counter ointments and sprays, accompanied by a diet rich in fiber and fluids, usually can help reduce constipation and the swelling of hemorrhoids. Warm sitz baths followed by a cold compress also can offer some relief. An inflatable, donut-shaped pillow, which can be purchased at any drugstore, can help ease discomfort caused by sitting.
Do not use laxatives, suppositories or enemas without asking your doctor, especially if you've had an episiotomy or have stitches in the perineal area.
Urinary and Fecal Incontinence
The inadvertent passage of urine, especially when laughing, coughing or straining, usually is caused by the stretching of the base of the bladder during pregnancy and delivery. Usually, time is all that's needed to return your muscle tone to normal. You may hasten the process by doing Kegel exercises.
In the meantime, wear protective undergarments or sanitary napkins. If the problem persists, talk to your doctor, who may be able to prescribe medication to relieve the problem. If you experience pain or burning, or have an uncomfortable urgency to urinate, tell your doctor. This could be a sign of a bladder infection.
Lack of bowel control often is attributed to the stretching and weakening of pelvic muscles, tearing of the perineum, and nerve injury to the sphincter muscles around the anus during delivery. It is most common in women who have had a prolonged labor followed by a vaginal birth.
Although fecal incontinence usually disappears after several months, talk with your doctor about exercises to help you regain control of your bowels. Fecal incontinence that does not resolve itself over time may require surgical repair.
That lustrous sheen that pregnancy brought to your hair may fade by the time your baby is 6 months old. You'll likely notice hair loss as well. During pregnancy, skyrocketing hormones prevent the normal, almost imperceptible daily loss of hair. Several months after delivery (or when breast-feeding slows or ceases), many women begin to fear the worst as they watch their hair fall out at an alarming rate. Rest assured, the hair you're losing is only equivalent to the hair you would have shed during pregnancy had your hormones not stepped in. Generally, the sudden change in hair volume is temporary and not noticeable to others.
Most women experience a case of the "baby blues" after the birth of their child. Changes in hormone levels, combined with the new responsibility of caring for a newborn, make many new mothers feel anxious, overwhelmed or angry. For most, this moodiness and mild depression go away within several days or weeks.
Longer lasting or more severe depression is classified as postpartum depression (PPD), a condition that affects 10% to 20% of women who have just given birth. PPD, which usually becomes apparent two weeks to three months after delivery, is characterized by intense feelings of anxiety or despair. Lack of sleep, shifts in hormone levels and physical pain after childbirth can all contribute to PPD, making it difficult for some women to cope with their new role and overcome their sense of loneliness, fear or even guilt.
The first step in treating postpartum depression is enlisting the support of family and close friends. Share your feelings with them, and get their help in caring for your infant. Be sure to discuss any PPD symptoms with your doctor, who can prescribe medication or recommend support groups to help you better cope with these new and unfamiliar emotions.
If your depression is combined with lack of interest in the baby, suicidal or violent thoughts, hallucinations or abnormal behavior, get immediate medical attention. These symptoms could indicate a more serious condition called postpartum psychosis.
Discomfort During Sex
You can resume sexual activity once you feel comfortable -- both physically and emotionally. After a vaginal birth, it's best to postpone intercourse until the vaginal tissue heals completely, usually four to six weeks (less if you didn't have an episiotomy). After a cesarean birth, you doctor will probably advise you to wait six weeks.
You may find sex to be physically uncomfortable, even painful, for up to three months after delivery, particularly if you are breast-feeding. Because breast-feeding reduces levels of the hormone estrogen in the body, your vagina may be unusually dry during the postpartum period. A water-based lubricant can help relieve some of the discomfort. Tenderness at the location of an episiotomy also is not uncommon for weeks or months after giving birth.
Even after your body heals, you may find that you are less interested in sex than you were before your baby arrived. Physical exhaustion accompanied by new distractions and emotional changes can take their toll on your libido. Many women battle feelings of unattractiveness in the postpartum period, and some find it more difficult to achieve orgasm. Breast-feeding can also change how you and your partner perceive sexual intimacy. Sharing your feelings with your partner and recognizing that these issues usually are temporary may help you deal with them more easily.
Regaining your pre-pregnancy shape
Exercise is one of the best ways to lose post-pregnancy weight, regain your energy level, relieve stress, and restore your muscle strength. Unless you've had a cesarean delivery, difficult birth or pregnancy complications (in which case, you should talk with your doctor), you can usually resume moderate exercise once you feel up to it. If you exercised before and during pregnancy, you have a head start on postpartum fitness, but don't expect to jump immediately back into a vigorous exercise program.
Brisk walking and swimming are excellent exercise and good ways to build up to more intense activities. Because of the risk of bacteria entering the healing tissue of the vagina, however, you should not swim for the first three weeks after delivery.
Toning and strengthening exercises, such as sit ups or leg lifts, are one of the best ways to jumpstart your postpartum program. Light, repetitive weight lifting also can help your body get back into pre-pregnancy shape. But remember, take it slow and focus more on long-term health than on short-term results.
Many health and fitness clubs, hospitals and local community colleges also offer postpartum exercise classes. In addition to providing specially designed exercises, these classes can be a great way to network with other new mothers and get the support you need to stick with an exercise program.
Call Your Doctor If:
Continue to be aware of any unusual changes in your body in the days and weeks after delivery. Call your doctor immediately if you experience any of the following symptoms. They could indicate a serious postpartum complication.
- Vaginal bleeding heavier than your normal period.
- Increasing or persistent pain in the vaginal or perineal area.
- Fever over 100.4 degrees F.
- Sore breasts that are hot to the touch.
- Pain, swelling or tenderness in your legs.
- Cough or chest pain.
- Pain or burning when urinating, or a persistent and sudden urge to urinate.
- Nausea and/or vomiting.
- You feel depressed, have a lack of interest in your baby, or have suicidal or violent thoughts or hallucinations.
Originally published March 2000