Terms for childbirth, like having or delivering a baby, make the whole affair sound like a catered lunch. As you may already know, the experience is more like running a marathon for 12 to 60 hours, then donating blood. And if you had a c-section, you’ve also experienced major organ surgery.
The end of pregnancy and the delivery of your baby out into the world set off powerful changes in your body. Here’s a list of some of the physical symptoms you are apt to experience right after giving birth and during the days that follow:
SWEATINESS AND HOT AND COLD FLASHES
You may get a shaking chill immediately after delivery, and fluctuating hormone and blood levels may also give you hot and cold flashes in the days that follow.
Immediately after birth your uterus starts the process of contracting back into shape and shedding all of the various baby-building byproducts. As this happens you will probably feel cramps for the first few days, particularly when you nurse (breastfeeding releases a hormone that helps the uterus contract). Amazingly, your uterus will return to pre-pregnancy size in about 10 days. Even after a c-section, you can bleed for up to four weeks. The first week you may go through 30 to 70 pads (no kidding)! When you send someone to buy pads, be sure to specify to them that you need “extra super” or “overnight.”
You’ll need to change those giant pads every couple of hours. What looks like blood and discharge is not a period, exactly, but is called lochia or postnatal bleeding. The fluid contains blood, and also old tissue from around where the placenta was attached to the uterine wall. After your initial bleeding slows down and your uterus continues to heal, the lochia will turn from bright red to pink, and eventually to a white discharge as your uterus recovers.
Your first period may appear about two months after pregnancy, or it may take longer if you’re breastfeeding day and night.
Your first postpregnancy period will last longer than your pre-baby cycle, probably about 7 to 8 days, and it will be heavier than usual, especially if you had a c-section.
Then there’s the issue of going to the bathroom—something you probably took for granted until this point. Especially if you’ve had stitches, that first trip to the toilet can be an intimidating experience. Take your time and take it easy. Try propping your feet up on a foot stool. If you’re really scared, ask your care provider to recommend a stool softener. Avoid taking opiate-based pain relief medications since these may constipate you and make matters worse.
Constipation, hemorrhoids, and incontinence
You may not have your first postpartum bowel movement until the third or fourth day after delivery, and hemorrhoids, stitches, and sore muscles may make it painful to go to the bathroom. Hemorrhoids, which are swollen blood vessels around your rectum, should eventually shrink. Apply cold packs, take warm baths, and ask your care provider or a nurse for a stool softener. Drink plenty of fluids and eat fruits and vegetables for fiber. Don’t try any laxatives, suppositories, or enemas unless directed to do so by your healthcare provider. If your hemorrhoids are uncomfortable, ask your care provider to recommend an over-the-counter cream or ointment, or pads containing witch hazel or topical anti-inflammatory agents.
“One morning you’ll wake up and discover that both you and the baby are clean, clothed, fed, and happy, and then you’ll know you’re finally moving out of one of the hardest stages in your entire life.”
It’s possible that you may have even more bad news downstairs: Urinary or fecal incontinence. More than 50 percent of first-time pregnant moms and up to 85 percent of second-timers develop temporary bladder weakness, usually during the third trimester of pregnancy as the baby’s weight puts constant pressure on the bladder.
Then, after the baby’s born, you may find that you still leak a little urine when you laugh or cough. And, in some cases, if your pelvis was injured during childbirth, you may also be experiencing fecal incontinence. Talk to your care provider if you find that you’re unable to control your bowels and the problem doesn’t appear to be going away. Meanwhile, practice Kegel exercises. The contracting and releasing of your pelvic floor muscles can help to alleviate incontinence.
Tip
You’ll always be able to see where your c-section incision was, but episiotomy scars will usually be undetectable by the untrained eye within 6 months to a year after birth, and your sexual functioning can be expected to return to normal.
Stitches and tears
We’re sure it comes as no surprise that your perineum (the area between your vagina and rectum) will probably be really sore from what it’s been through. You may have stitches if you had an episiotomy, or your tissues may have torn slightly. The tears are usually minor and heal quickly unless your doctor gave you an episiotomy to assist with delivery using a vacuum extractor or forceps, then the tears may be deeper.
A postpartum nurse will pack your underwear with pads and ice packs, and you can request pain medication. If you had stitches, the nurse will also show you how to care for them once you get home.
You’ll probably be given a spray bottle of perineal cleanser to use after you go to the bathroom, and if you have dissolving stitches you may be advised to avoid baths until your stitches heal. You may also be given a plastic toilet-seat basin, called a sitz bath, to take home. Ask for instructions on how to use it to keep your stitches clean.
As you recover, you’ll also have to deal with your breasts, and it will seem like they have a life of their own these days. They’ll be swollen and they may hurt. The first 3 to 14 days after birth is extra hard on them as they start making milk, especially if this is your first baby.
If you nurse your baby, your nipples may also become sore and chafed from the baby’s day-and-night nursing and sometimes from the baby nursing in an awkward position that causes him to suck on the outer tip of your nipple rather than taking in the entire areola.
It takes some doing to shut the milk factory down if you decide that you’re not going to nurse. If you choose not to breastfeed and to bottle-feed instead, your breasts will be painful and extremely hard until milk production slows. You can expect the complete shutdown process to take about 10 to 14 days.
In the meantime, bind your breasts with an elastic bandage, and when you shower, point them away from the water to avoid stimulating milk production. (For more information on breastfeeding and weaning, see in 3. Your Baby Maintenance Guide.)
Broken blood vessels
Tiny dots or spidery veins may have appeared on your cheeks, caused by the effort of pushing, and you may also have bruising from IV or injection sites. These should fade in the three months after delivery.
Skin discolorations
You moles may have darkened, and you may still have a line down the middle of your abdomen. These will also fade in about 3 months after delivery.
Stretch marks
Stretch marks occur when the collagen and elastin fibers in your skin thin and break from weight and pressure. They look red or purple at first because more blood vessels are visible through the skin. Non-pregnant people may develop stretch marks as a result of rapid weight gain, but pregnant women are especially vulnerable to them because pregnancy hormones soften connective tissue.
To avoid getting stretch marks, it helps to be young, not overweight before you got pregnant, to not gain too much weight during pregnancy, and to be blessed with a good set of genes, since some women appear to inherit more elastic skin than others. But even then, no promises.
The good news, though, is that stretch marks do fade over time. Your skin will never look the way it did before, but, eventually, as your body returns to its prebirth dimensions, the blood vessels heal and contract and the stretch marks fade to white or silver. Cosmetic laser surgery may make stretch marks turn from red to silver more quickly, but it won’t have much effect in the long term.
Comfort items
Here’s a list of some of the items your health-care provider may recommend to help you during your post-birth recovery.
• Pain medications such as acetaminophen.
• An anesthetic spray for painful stitches and tearing.
• An ice pack for perineal swelling.
• A sitz bath for soaking your sore vaginal area.
• A spray bottle for cleaning stitches.
• Witch hazel pads or medication for anal swelling and hemorrhoids.
• A stool softener.
Tip
Acetaminophen (such as Tylenol®) is the painkiller of choice for relieving the pain of stitches or a cesarean section. While the drug is considered extremely safe, it’s important to follow the instructions about how much and how often to take it, since overdosing has been associated with liver damage. Aspirin is not recommended because of its effects on blood clotting. Prescription pain-relief medications containing opiates (such as codeine) can cause constipation, which may make bowel movements difficult and painful, especially if you’ve had stitches.
Varicose veins and spider veins
Varicose veins are dark purple or blue tangles of veins under the skin, and spider veins are small, red, and closer to the surface of the skin. Within three months after delivery, varicose and spider veins will usually improve. However, more are likely to develop and remain after additional pregnancies.
DON’T IGNORE THESE POSTPARTUM SYMPTOMS
The following are signs that you need to contact your health-care provider. When you call, describe your symptoms, and call again if you don’t get a response within half an hour—even if it’s on the weekend or the middle of the night. If your doctor or midwife has a telephone code or number to push in case of emergency, use it.
• A fever of 100.4° F (38° C) or higher. In the first 2 weeks after delivery this could be a sign of a uterine, breast, or strep infection.
• Serious bleeding. You soak more than one pad an hour after the first 2 days, or the amount of blood seems to be increasing.
• Foul-smelling vaginal discharge. This could be a sign of infection, or that you have not entirely expelled the placenta.
• Severe pain in the vaginal or rectal area. This could signal infection or damage.
• Swollen, hot incision. If you had an incision and stitches following an episiotomy or c-section and the area becomes swollen, the incision reopens, or there is discharge from the wound.
• New pain, swelling, tenderness, or hardening in your legs. This could be a symptom of an inflamed leg vein or a forming blood clot.
• Problems urinating. Pain or burning during urination or an intense need to urinate with nothing coming out could all be signs that your urinary tract was damaged during delivery or that you have an infection.
• Increased vaginal pain. This may be a sign that your stitches or tears aren’t healing properly.
• Coughing, severe chest or abdominal pain, nausea, or vomiting. These could signal a serious complication, a glandular problem, or an allergic reaction to a medication.
• Swelling in your face and hands, a headache, and/or blurred vision. Rarely, preeclampsia can strike in the week after birth. (For a definition of preeclampsia, go to 8. Parent’s Dictionary.)
These symptoms don’t signal an immediate emergency, but you should report them to your healthcare provider during normal office hours:
• Breast pain or inflammation. If your breasts feel hot to the touch, lumpy, or look red, or if you have cracking or bleeding from your nipple area, you could have a plugged duct, mastitis, or a yeast infection.
• Depression. Talk to a professional if you experience weepiness, sadness, and feelings of helplessness that don’t go away in a few days. If you have the urge to harm yourself or your baby, seek help immediately. (For more on postpartum depression, see in this chapter.)