What to expect in the first few weeks
There are many health care professionals, family and friends out there that may have helped prepare you for the birth and the first few weeks after giving birth. However only you will experience this amazing, life changing event.
Every single mother I see has a different birthing experience, determined by many factors. This early time : weeks 1-6 will without a doubt be the most challenging for you physically, mentally and emotionally.
Physically, you might experience:
Sore breasts. Your breasts may be painfully engorged for several days when your milk comes in at about day 3 for normal vaginal deliveries – NVD and 4-5 for C’ section mums. Your nipples may be sore – see info on breastfeeding!!
Constipation. The first postpartum bowel movement may be a few days after delivery, and sensitive hemorrhoids, healing episiotomies, and sore muscles can make it painful. You will be given a stool softener (probably Lactulose) to help with this. It is vital that you don’t get constipated now or in the future. It is really important that you don’t bear -down and strain when going to the toilet.
Episiotomy. If your perineum (the area of skin between the vagina and the anus) was cut by your doctor or if it was torn during the birth, the stitches may make it painful to sit or walk for a little while during healing.
Haemorrhoids. Although common, haemorrhoids (swollen blood vessels in the rectum) are frequently unexpected.
Hot and cold flashes. Your body’s adjustment to new hormone and blood flow levels can wreak havoc on your internal thermostat.
Urinary or faecal incontinence. The stretching of your muscles during delivery can cause you to inadvertently pass urine when you cough, laugh, or strain or may make it difficult to control your bowel movements, especially if a lengthy labor preceded a vaginal delivery.
“After pains.” After giving birth, your uterus will continue to have contractions for a few days. These are most noticeable when your baby nurses or when you are given medication to reduce bleeding. This can sometimes last longer than a few days. During your time in hospital and at home your early childhood nurse, or local doctor can check your tummy to see how well your uterus is shrinking back .
Vaginal discharge (lochia). Initially heavier than your period and often containing clots, vaginal discharge gradually fades to white or yellow and then stops within several weeks.
Weight. Your postpartum weight will probably be about 5 – 6 kilos (the weight of the baby, placenta, and amniotic fluid) below your full-term weight. Additional water weight drops off within the first week as your body regains its balance. and your blood volumes return to normal.
Try to involve family and friends around you for physical and emotional support . This is a time when you are not only learning to care for your baby, but when you need to protect, heal and re- strengthen your perineum and pelvic floor muscles.
Post Natal Early advice for comfort for 1st few days
• Rest and bond skin to skin with baby, suckle within 30 minutes after birth
• Ice 10 minutes x lots: pads –frozen sanitary pads, gel pads, ice pole in pad, frozen glove finger. Pat dry perineum and apply clean pad.
• Compression double pad with firm underwear for compression on perineum. Especially helpful when up and about in 1st weeks.
• Elevation On tummy 1pillow under head, 1 pillow under tummy, 2 pillows under hips.10 -20 minutes.
Diuresis : lots of going to the toilet
Expect to pass urine frequently, and in large quantities, in the 2nd and 3rd days after giving birth. This is one way your body will release the extra fluid needed for blood and tissues for baby. It’s completely normal.
Some of the drugs used in labour may have the effect of making you retain water. Synthetic Oxytocin may contribute to this. You may also be given fluids during your labour if you were ‘nil by mouth’. This ‘hydration’ may overload your body and give you swelling….you probably had some swelling in the last 2-3 weeks also.
It may cause you to leak on the way to the bathroom because your bladder may hold A LOT in these 1st 3 days.
Your nurse will want to know your urine volumes and if you have passed wind.
Urinary retention : not wanting to go to the toilet
After the birth of your baby you may have trouble completely emptying your bladder or even not have any real sensation to want to go!
Urinary retention can cause over stretching and damage to the bladder and may be caused by:
• pressure on the bladder and pelvic floor during delivery
• swelling, bruising and/or pain in the pelvic area, particularly around the urethra (tube passing urine).
It is important that you try and empty your bladder every 2-3 hours in these first few days and talk to your nurse about this.
especially after delivery, for many reasons,
• straining may damage perineal stitches,
• may impact on any pelvic trauma from assisted birth interventions
• can cause pain in the ‘C ’scar due to abdominal distension.
Supporting your perineum if you have had a tear or an episiotomy; folding some clean toilet paper and placing it gently on the perineum where the stitches are and holding it there while you go to the toilet, can splint the weakened perineum and help support the stitches when opening your bowels for about 4weeks. You can also support your C scar.
Use a stool softener – lactulose in hospital, then Movecol, or Normacol for combined fibre and colonic smooth muscle stimulant.
Correct sitting position on the toilet and allowing the pelvic floor to relax. You may need to support your ‘C’ scar to relax your tummy and let go.. How to go to the toilet !!
This is a surgical cut of the perineum, usually performed close to the ‘crowning’ of the baby’s head and may be used to ease / speed the delivery of the head and ?? reduces tearing.
The cut can range from 3 to 7 centimetres (average 5 cms) and is regarded as equivalent to a 2nd degree tear of the perineum. The cut divides some of the pelvic floor muscles and needs to be repaired with stitches (and possibly more local anaesthetic) after the baby is born.
Use two rolled up towels to sit on NOT a ring cushion.
Lean forward on the toilet and pour a jug or squeezy sauce bottle of water down over stitches when urinating. Use ‘Ural’ to reduce urine acidity and less stinging on stitches.
Perineal tears The late 2nd stage of pushing and then the ‘crowning ‘ of the baby’s head is when the perineum needs to have time to thin and stretch. . This may be when the caregiver instructs you to pant and not push….You will need to focus on opening, letting go and be prepared for the stinging, burning sensation of this stage.
Tears to the genital area are graded as follows:
1st degree tear
2nd degree tear
3rd and 4th degree tears
You can ask; and need to know if you have a tear & what degree it is. You also need to understand how to manage it. (large 2nd degree, 3rd and 4th degree tears –see me or send me an email firstname.lastname@example.org
Post ‘C’ section – extra info on drop down menu
The first 24 to 48 hours will involve having an intravenous drip in your arm (for fluids and often antibiotics) and a urinary catheter in place to keep your bladder empty. The epidural tube may be left in place to administer further pain relief for the first day or two. You will have a light diet until you start to pass wind.
Urinary catheter stays in for 24 -48 hours
Foot and ankle, pelvic floor squeezes and supported ‘huffing for 24 hours then assistance to get out of bed and walk –to reduce risk of leg DVT. Tall posture!!
Abdominal bracing at 4-5 days as you become more mobile, to support your spine
Pelvic floor muscle work
• Lots of small repetitive squeezes to help the local swelling- (use your own muscle pump)
• Every time you breast feed or use a breast pump
• Day 5 start deeper longer lifts. ….Yes just keep trying
• Both Vaginal and Caesarean births need to do PFM exercises
Diastasis Recti DRA : measurement and binders > 5cm into a binder see me ASAP
Breasts – Engorgement –see mastitis hand-out – Therapeutic Ultrasound can help this.
Post –natal check at 2 weeks – earlier if you have problems
copied from my “Secret Women’s Business – pre- natal workshop”
What to expect at your six week check up
Most women will have their post- natal check up with their Obstetrician, GP for shared ante- natal care, Midwife or doctor at the hospital.
During this visit your doctor will want to know about your health.
you will be weighed and can get weight loss advice if you need it (find out about healthy diet )
your urine will be tested to make sure your kidneys are working properly and that you haven’t got an infection
your blood pressure will be checked
you may be offered an examination to see if your stitches have healed (if you had any), and that all the muscles used during labour and delivery are returning to normal – you don’t need a referral to come and see me about your muscles!!
your breasts probably won’t be examined unless you have a particular concern about them
your doctor may discuss contraception. Even ‘fully’ breast feeding mums can get pregnant…..even if it took ages to fall pregnant with this baby.
you will be asked if you still have any vaginal discharge and whether you have had a period since the birth
Sex after a vaginal birth
When can you have sex after your vaginal delivery…the simple answer ; after you have stopped bleeding and had your post- natal check up. However it also has to be when you are both ready. I see so many women who say they are anxious about this; not ready; don’t feel like it and feel guilty etc…etc. The list goes on. There are many reasons why a woman may not be ready to have sex again after childbirth and each reason needs to be explored, explained; and if necessary help given.
Firstly click on to these links. They will help with some of the worries you may have;
After six weeks…Make an appointment to see me for a full understanding of where you are at with your recovery and progression to exercise.