Treating Aches and Wounds During Pregnancy

Pregnancy, delivery, and motherhood can be exciting, overwhelming -- and painful. As you focus attention and energy on your new baby, it's important not to neglect yourself. Knowing how to care for problems like foot blisters, cesarean section incisions, sore breasts, cracked nipples, and other unexpected discomforts can make this exciting time in life a little less painful.

Aches and Pains After Delivery

The pain of childbirth doesn’t always end with the final push at delivery. Here are some other painful problems you may experience, as well as tips on how to care for them and feel more comfortable.

Episiotomy or perineal tear

During a vaginal delivery, the area between the vagina and anus, called the perineum, can tear or may be cut by the doctor so that the baby can be delivered more easily. If the doctor cuts the area, the procedure is called an episiotomy.

After delivery, this area may be very sensitive for several days or weeks. It may hurt when you sit, walk, cough, or sneeze. To relieve swelling, pain and/or itching, try the following:

  • Ice. In the first 24 hours after delivery, try placing an ice pack on the area to help reduce swelling and pain.
  • Warm water. Stream warm water on the area while you are urinating to prevent stinging. When you’re discharged, the hospital may provide a squirt bottle especially for this purpose. If not, any clean bottle with a squirt top will work.
  • Anesthetic pads or ointments. Apply anesthetic spray, cream, or ointment with witch hazel pads to temporarily numb the area.
  • Sitz bath/Heat.No sooner than 24 hours after delivery, take warm sitz baths where only your hips and bottom are submerged. Taking these a few times each day and holding a warm compress against the area may help ease the pain.
  • Rest. Lie on your side as much as possible to relieve the pressure on the episiotomy site. Try not to sit or stand for too long. When you do sit, tense buttock muscles before you sit down and then relax them once you're seated. Sitting on a soft pillow may also help.
  • Kegel exercises. Perform exercises that strengthen the muscles near your incision or tear to help the area heal faster and feel better. To perform this exercise, tighten the area as if you were trying to stop your stream of urine. Hold that contraction for 10 seconds and then release. Try to repeat this 20 times daily. You can do these anytime.
  • Cleanliness. To keep the area dry and clean, pat the area with clean tissue or gauze, being careful to not rub. The more gentle you are, the less it will hurt. Change pads often, at least every four hours, and try to avoid touching the site.
  • Loose clothing. Avoid tight pants and tight underwear, which can cause friction and irritate the wound.
  • Fiber-rich diet. Eat plenty of fiber-rich foods and drink plenty of water to ensure that you have regular, soft bowel movements. Taking a stool softener may help as well.

With these self-care tips, the tear or incision should heal well. However, if you notice any of the following symptoms, call your doctor:

  • Signs of infection such as fever, chills, swelling, redness, pain that does not get better, or foul-smelling discharge or excessive bleeding from the episiotomy site
  • New or worsening pain
  • Problems with loss of urinary or bowel control

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Cesarean section (C-section) incision

If you deliver your baby by cesarean section, you will stay in the hospital two to four days, until you are healed enough to go home. In the hospital, you will be given pain medication as needed.

You will be given a prescription for pain medication to take at home if you need it. At home, you may find that you do not need the prescription. For many women, over-the-counter pain drugs such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) control the pain. Any stitches or staples will be removed after about a week.

Your doctor will provide instructions about how to care for a C-section wound. It is important to follow these instructions carefully. These instructions may include:

  • Keep the incision clean and dry. Wash the area with warm water (once a day is sufficient). Do not spray water directly into the wound
  • Change any bandages regularly.
  • Wear loose clothing. Avoid clothing that can rub against and irritate the incision. Pay particular attention to underwear bands.
  • Continue packing the wound at home, if needed. Some wounds may not close at first. If your doctor has recommended packing the incision, follow the directions carefully. Change the packing and wash the wound several times a day.
  • Know when to call the doctor. If you experience any of the following symptoms, call your doctor immediately:
    • Fever over 100.4 degrees
    • Persistent drainage or foul-smelling fluid from the incision
    • Increased tenderness at the incision site
    • Separating of the edges of the wound
    • Increased redness or swelling at the incision site

Sore breasts and nipples

Breastfeeding can be one of the joys of being a new mom. It can also be painful sometimes. For most women, there is a remedy for this discomfort, and there is no reason to stop nursing. In fact, nursing may even relieve the pain.

There may be many reasons why your nipples or breasts are sore, including the following:

  • Incorrect latching by your baby. The most common reason for sore nipples is that the baby is not latching onto nipples correctly. With a little practice, you can correct this at home. Your baby should open her mouth widely and take in a wide area of the areola, the circle of dark skin around your nipple. The nipple should be in the back of your baby’s mouth. If you're having problems breastfeeding, ask your doctor or staff at the hospital about talking to a lactation consultant.
  • Thrush. Thrush is a common infection caused by yeast, a candida fungus. Yeast thrives on milk and in warm, moist environments. Your baby may also have thrush. Check her mouth for white spots on the side of her cheek. Speak to your health care provider about over-the-counter medications. Some medications for yeast infections should NOT be used on breasts, so ask before you begin treatment.
  • Engorgement. Your breasts may become engorged and filled with milk and fluid. This usually occurs after delivery when milk is first coming in, but it can happen any time you delay breastfeeding. Nursing or pumping (if you cannot be with your baby) will usually relieve this discomfort.
  • Plugged or clogged milk ducts. Sometimes your milk does not drain completely and a duct can become clogged. Try applying moist heat to the area and gently massaging it. A warm shower can also relieve pain. Be sure to continue to nurse on that side.
  • Mastitis. Mastitis is an infection that may be caused by a persistent clogged milk duct. To resolve the pain, apply moist heat to the area, gently massage it, and continue to nurse on that side. If the pain persists or if you have a fever or chills, contact your doctor. You may need antibiotics.

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Aches and Pains of Pregnancy

Just as the pain of childbirth doesn't end with the final push, it doesn't start with labor. Here are some painful problems you may experience before having your first contraction.

Scrapes and bruises

Early in pregnancy, your body begins to prepare for all the energy and stretching it requires to grow and deliver a baby. Your joints begin to loosen as the body prepares for delivery. You may be feeling sleepy, nauseated, distracted, and overwhelmed. All of this can lead to more slips, falls, scrapes, or bruises. Treat these events just as you would if you were not pregnant. You should consult your doctor if there is a significant fall.

Clean minor cuts or scrapes with soap and water or an over-the-counter (OTC) antiseptic wash, and cover the wound with a bandage. Antibiotic or hydrocortisone ointment should be fine to use. If you notice unexplained bruising, talk to your doctor immediately.

Aching feet and blisters

During pregnancy your feet and ankles may swell. This typically occurs in the third trimester and is caused by several things. As your uterus grows, it begins to exert pressure on the veins in the lower body, and this slows the rate blood is circulated back to your heart. Also, the hormonal changes occurring inside your body can cause you to retain fluid when  blood vessels are dilated and increase blood volume. This extra fluid tends to collect in the feet and ankles. After you have your baby, the swelling should subside.

There are several things you can do to minimize the discomfort that comes with swelling:

  • Drink plenty of water. If you drink enough water, your body will not retain as much fluid.
  • Avoid salty foods. Junk food and salty foods cause the body to retain fluids.
  • Change positions every hour or so. If you are standing, try to sit for a few minutes. If you sit for a long period of time, stand and walk around for a few minutes.
  • Avoid crossing your legs. Crossing your legs can slow the blood flow.
  • Elevate your feet. Keep a stool, box, or stack of books under your desk so you can prop up your feet.
  • Wear maternity support stockings. Waist-high maternity hose may help prevent fluid from collecting in your feet and ankles. Put them on early in the morning.
  • Lie on your left side. If swelling persists, find a safe place and lie on your left side for a bit.

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When feet are swollen, forcing them into pre-pregnancy shoes (or sometimes any shoes) can cause friction that leads to blisters. If you develop blisters or sores on your feet because of the swelling, these suggestions may help:

  • Leave the blister undisturbed if possible. Do not pop or puncture the blister. The fluid inside is generally not infected and helps protect the skin beneath.
  • If the blister pops, leave the top skin in place. The top skin of a blister helps protect the skin beneath. It will eventually dry out and fall off on its own.
  • Apply a bandage. A bandage, sometimes called moleskin, may be cut to resemble a doughnut the size of your blister. This type of bandage protects the blister from contact and helps it heal faster. They are available at most drug stores and pharmacies.

It’s best to try to prevent blisters from forming in the first place. Try these ideas for avoiding blisters and foot sores:

  • Wear shoes that are large enough or that stretch to accommodate swollen feet. Shoes should be supportive and comfortable.
  • When possible, wear socks that are soft and absorbent.
  • Try rubbing petroleum jelly such as Vaseline on areas of the foot that seem to blister more often.

Ordinary Aches and Pains

During pregnancy, you may still suffer from everyday aches and pains. However, you may need to treat them differently now for your baby's sake. Speak with your doctor before using any OTC remedies (including pain relievers, supplements, vitamins, and herbal remedies). In general, avoid any drugs during the first trimester except those prescribed or recommended by your doctor.

Most doctors recommend regular-strength acetaminophen (Tylenol) to relieve minor aches and pains. OTC medications to avoid during pregnancy include:

  • Aspirin. Research has suggested that aspirin may cause birth defects, low birth weight, and delivery complications.
  • Ibuprofen (Advil, Motrin). These medications, including aspirin, are called nonsteroidal anti-inflammatory drugs (NSAIDs). They may cause heart defects and delivery problems, especially if taken during the third trimester.
  • Drugs labeled extra strength, maximum strength, or long-acting. As the label suggests, these are more potent per dose, and more is not always better, especially during pregnancy. These are generally fine as long maximum recommend dose is not exceeded. Ask your doctor.
  • Multi-symptom medicines. Ask your doctor and take the medication that treats only the symptom you have. Speak to your doctor if you feel like you need more than one medication.
WebMD Medical Reference Reviewed by Nivin Todd, MD on June 04, 2015

Sources

SOURCES:

Van Groenou, A. The Active Woman’s Guide to Pregnancy, Ten Speed Press, 2004.

KidsHealth.org, “Pregnancy Precautions: FAQs.”

American Academy of Family Physicians: “OTC Medicines and Pregnancy: What should women who are trying to get pregnant, are pregnant or are breastfeeding know?” “Recovering from Delivery.”

WebMD Medical Reference from Healthwise: “Pregnancy-related problems – Home Treatment.”

Murkoff, H. and Mazel, S. What to Expect When You’re Expecting, 4th Edition, Workman Publishing Co., 2008.

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