Thursday, April 21, 2011

Postpartum Recovery

When you are pregnant, you imagine what it's going to be like after the baby is born.  You have these visions in your head of maternal bliss. 

Then you get there. 

And it's not very much like you thought it would be.

You are sore, and you ache.  You are tired and emotional.  And you are overwhelmed.

Here's a practical guide of what to expect and how to get through the first few weeks.

Dizziness and Instability - Right after birth, you may feel dizzy and unstable.  Ask your partner or nurse to help (or stay close) when you get up to use the bathroom and shower for a few days.  You've lost a lot of blood and fluid.  It is very important to stay hydrated.

Sleepiness and/or Insomnia - Both are common.  You've just been through a tremendously exhausting experience, and the adrenaline keeps you going for a while.  After it wears off, it is common to be extremely sleepy. 

Bleeding and Discharge - You will bleed, whether you had a vaginal delivery or c-section.  The first few days will be heavier, bright red blood with occasional clots.  It is normal to pass small clots.  If you pass anything larger than a quarter, let your care provider know.  Usually, passing a lot of clots can be a sign that you are overdoing it.  Rest and let your body heal.  After a few days, the discharge will gradually change to what is referred to as lochia.  It can be pinkish, brownish or even white, and will last for a few more days to a couple weeks.    Before you are discharged from the hospital, ask for some of the large maternity pads to take home, as well as a spare pair or two of the mesh disposable panties.  They are so unattractive, but will be your best friend.

Cramping - You will experience cramping for weeks after birth, the most noticeable in the days right after.  The cramps will be stronger with nursing, and will continue until your uterus returns to it's pre-pregnancy size, about 6 weeks from birth.  You can use over the counter pain relievers to help manage the pain.

Muscle aches and pains - Some women come out of labor feeling a bit like they've been run over by a truck.  Labor is hard work.  Pushing is hard work.  It's common to feel soreness in areas you aren't expecting to, like your arms or back.

Headache - These are common after birth, often due to sleep deprivation and dehydration.  If you had an epidural (or spinal)  have a sudden very painful headache, it's possible it is a spinal headache.  Let your nurse know immediately, as there are specific treatments for those headaches.  One of the best ways to know if it is a spinal headache is if it resolves by laying completely flat.  If so, it's probably a spinal headache.  They can last a few days if not treated.

Incision pain - If you had a c-section, you will have a two-fold recovery.  In addition to the recovery from the pregnancy itself, you are recovering from major abdominal surgery too.  Resist the urge to just lay down and rest all the time, you are better off if you keep a low, but tolerable level of activity.  Check your incision daily for signs of infection.  Do not lift anything heavier than your baby for 6 weeks (this includes the car seat carrier - let someone else do that).   Let people help you.

Swelling - Many women experience significant swelling in the postpartum period, often even worse than the swelling at the end of pregnancy.  The best thing you can do is to continue to drink lots of fluids, and maintain a tolerable level of activity.  If your swelling continues to worsen, discuss it with your care provider. 

Fear of using the bathroom - This is very common.  Particularly if you experienced any vaginal tearing or hemorrhoids, it is common to resist the urge to have a bowel movement.  Don't.  Waiting will only make it worse.  Use stool softeners, and be sure to eat lots of fiber rich foods. 

Vaginal tears and swelling- Whether you had an episiotomy or not, many women have some degree of vaginal tearing after birth.  Immediately after birth, they will place on ice pack on your perineal area.  If this helps, you can ask for more ice packs while you are in the hospital.  Ask your nurse for a squirt bottle, and use it with warm water while urinating and defecating.  It will dilute the acidity of your urine so it stings less, and help cleanse the area as well.  In addition to the squirt bottle, witch hazel pads can help with swollen tender areas.  There is also a spray called "epi-foam" that works to numb the area temporarily.  Ask your nurse about these items as soon as you get into the recovery room.   Also, even the day of birth, start doing Kegel exercises.

Trouble urinating - This is also quite common, especially if you had a large baby or vaginal tears.  Using the squirt bottle can help trigger urination and make it less painful.  If you truly find that you cannot urinate, let your nurse know asap.

Hemorrhoids - These pesky veins make their appearance for some women toward the end of pregnancy or after pushing.  They can be internal or external, and can swell quite large and even bleed.  Ask your nurse for witch hazel pads, and be sure to use stool softeners until they are reduced.   Keep your activity level up, and try to avoid sitting in one position for too long while you have them.  If they get worse, contact your care provider.

Intense hunger - It's said that a woman in labor burns as many calories as a marathon runner, and I've found that to be the case.  You emerge from labor voraciously hungry.  Be sure to eat balanced meals, full of protein and fiber.  You need to ensure you are drinking enough water as well.  While nursing, you will need about 500 more calories to produce milk, make them count. 

Rapid weight loss - At the time of birth, you will lose about 10-15 pounds automatically between the baby, the amniotic fluid, the placenta and blood.  You will continue to lose weight over the next few weeks, from a decrease in blood volume and fluid.  Do not expect that your body will go back to the way it was before, though.  Your uterus doesn't even return to it's pre-pregnancy size for 6 weeks.  You can begin exercising around 6 weeks with your physician's advice. 

Roller coaster emotions - There will be some dramatic ups and downs in the days and weeks after labor.  This is common and expected.  If you feel, however, that you are spending more and more time feeling sad or detached from the baby, let your partner and care provider know.  The baby blues are very common and will pass, but post-partum depression is a more serious matter.  Do not be afraid to ask for help.

Hair loss and skin changes - It is very common to lose a lot of hair in the first few weeks postpartum.  Do not be alarmed.  Many women break out in acne after birth too.  If you developed stretch marks during pregnancy, they may begin to fade.  Eventually they will lighten to a whitish color, but the elasticity may never return.

Breast swelling, tenderness and warmth - Your breasts will swell in the first few days after birth.  Immediately after birth (and before as well), your body is producing pre-milk called colostrum.  It is nutrient rich and provides all kinds of benefits to newborns.  Just because there isn't a lot of it doesn't mean it isn't enough.  Healthy, term breastfed babies do not need supplemented in the first few days.  As your milk begins to come in, you may experience excessive swelling, referred to as engorgement.  This is temporary.  Expressing a little milk before each nursing session may reduce the swelling enough to help the baby latch.  Your breasts may feel heavy and warm and quite sore to the touch.  Ice packs can help some women, heat packs help others.  There are cooling gel packs you can place in your bra as well.  You should have some soft, stretchy bras to wear in the first weeks, as you will probably feel better with light support, even at night.

Leaky breasts - It is very common to experience leaking, especially with a first baby.  Your body is trying to figure out how much milk to make, and it's not a perfect system.  Often when nursing, the other side will leak.  There are disposable breast pads, but I found that washable cotton ones worked better. 

Sore nipples - The first few weeks of nursing are a time of trial and error.  I wish that it was always a natural, beautiful, easy thing.  It's not.  Work with your nurse and a lactation consultant before leaving to hospital to ensure that the baby is latching on correctly.  You may feel sharp stinging at first, but it should not last through the entire nursing session.  It will get better with time.  To ease nipple soreness, let them air dry as often as possible.  Lanolin creams help as well.  The best thing you can do is make sure your position is good, the latch is correct.  With time, your body will adjust. 

Overstimulated - After going through the birth process, it's common to feel touched out.  Too many people have seen too much, you have been too exposed, too many demands have been and are being placed on your body.  It's normal to feel this way.  Try to find time to relax and soothe your self, take long showers while someone else is watching the baby. 

Postpartum Check-up - If you had a c-section, your doctor will probably want to see you in a week or two.  If you had a vaginal delivery, it is more likely to be six weeks.  In the meantime, take care of yourself.  Rest when you can, don't over-do it.  If you have any of the following warning signs, contact your physician immediately:
  •     soaking more than a pad an hour
  •     vaginal discharge has a foul odor
  •     you have a fever over 100.4F
  •     you are passing large clots
  •     you develop a severe headache
  •     your incision is not healing properly
Good luck!  This is a short period of time, and it is completely worth it!  Relax, rest, recover.  And love on that baby.  :)

2 comments:

  1. FYI...forgo those bulky pads out of the hospital and buy yourself some depends before baby comes...you probably won't need a whole bag...but easier to just pull them up and on and more comfy at night...also easier than wearing underwear or having to worry that you might dirty them...like you need more laundry to do

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  2. All the information are really nice this is very valuable information for all. Thanks for sharing such amazing post.

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