WebMD Parenting Guide - Baby's First Year

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Your Postpartum Body

WebMD Medical Reference from "The Mother of All Baby Books"

Your Postpartum Body

"I was on an emotional high after the birth something that allowed me to recover quite quickly. "
Dee, 32, mother of one

"I hadn't expected to be in such physical distress myself. That made the early days a lot harder than I had anticipated. I thought I'd be able to rebound quickly after giving birth and get used to this new mother thing. Despite my best efforts to do that, things just didn't work quite right. I was struggling against the tide. "
Mary, 35, mother of one

You'd think that your body would have earned a bit of time off after nine months of pregnancy and that marathon endurance test called labor. But, like it or not, your body still has a lot of work to do in order to return to its prepregnant state. (After all, you don't want to spend the rest of your life walking around with a uterus that's stretched out and a matching set of pregnancy hormones!)

In this chapter, were going to talk about the massive physical changes that you can expect during the first few weeks after the birth as your body begins to move from a pregnant to a non-pregnant state. Your uterus shrinks to a mere fraction of its former size, your blood volume drops significantly, your hormone levels change dramatically, and your breasts are transformed into milk factories and that's just for starters! Then we're going to tackle one of the biggest myths about having a baby: the whole idea that you should aim to have your old body by the time your postpartum checkup rolls around. (Unless you hired a body double to tackle the pregnancy and delivery thing for you, it ain't gonna happen, sister!) Finally, we'll wrap up the chapter by tackling two other important issues: the baby blues and sex after baby.

After the Birth

During the first moments after the birth, you may feel as if you've been hit by a freight train. Or you may feel so excited and euphoric that you swear you could hop off the birthing bed and go run a marathon. (Don't try it: the post-delivery adrenalin will only take you so far. And even if it did allow you to go the distance, you'd look more than a little silly dashing across the finish line with your hospital nightie flying open at the back.)

Regardless of how well you're feeling, you can expect to experience your fair share of poking and prodding during the first day or two postpartum as your health-care practitioner checks you over to make sure that your body is successfully making the shift from a pregnant to a nonpregnant state. He or she will be assessing:

your general wellness (your energy level, your responsiveness, whether you're experiencing a lot of pain and, if so, whether the pain relief measures that you've been receiving are proving to be adequate)
your emotional state (whether you're feeling depressed or weepy, how much family support you seem to have, how you're relating to your new baby)
your vital signs (pulse, blood pressure, temperature and breathing)
whether or not you are becoming dehydrated (a possibility if you endured a lengthy labor or threw up a lot when you were in transition)
whether you are having problems with hemorrhoids (how large they are and how much discomfort you are experiencing)
whether your bowels are functioning properly (whether you've had a bowel movement since the delivery or, in the case of a cesarean delivery, whether any bowel sounds can be detected something that may indicate that your bowels are getting ready to starting functioning again)
the consistency, location, and height of the fund us (the top of the uterus) and whether you are experiencing any tenderness that might indicate that you are developing a postpartum infection
your lochia (the character, color, and amount of postpartum bleeding, and whether or not any clots and/or any unusual odor are present)
your perineum (to check for signs of swelling, bruising, or other complications, and if you received a perineal tear or required an episiotomy, to see how well the incision or tear site is healing)
whether you're urinating regularly (to ensure that your bladder is functioning properly and that you aren't experiencing any delivery-related bladder problems caused by trauma to the area during the delivery, the effects of certain anaesthetics, and so on)
your breasts (to look for signs of any potential problems such as flat or inverted nipples, breast engorgement that may interfere with breastfeeding, nipple pain, and so on)
your incision site, if you had a cesarean (the nurse will want to see that the area is clean and dry and that the staples remain intact until they are removed approximately three days after the delivery)

Depending on your situation, you may need some additional care after the delivery. If, for example, you have Rh-negative blood and you give birth to an Rh-positive baby, you will need to receive a dose of Rh immune globulin (RhoGAM) within 72 hours of the birth to prevent problems in future pregnancies.

Your Postpartum Body: What to Expect

It's the stuff of which a pregnant womans fantasies are made: you'll give birth to your baby and immediately slip back into your prepregnancy jeans or, better yet, you'll be able to step straight into your bikini. (Hey, why not go for the bikini? After all you're not going to work stretch marks, a cesarean scar, a soggy abdomen, and leaky, cantaloupe-sized breasts into your fantasies now, are you?) If this is the fantasy that's running through your head as you come into the home stretch of pregnancy, I have bad news for you: it's a rare new mother indeed who can carry off the bikini look within hours of leaving the delivery room. It takes most of us much longer that sometimes even forever to get our old bodies back.

Heavy vaginal bleeding

The term "lochia" is used to describe the bleeding that occurs as your uterus sheds its lining after the birth you'll experience it whether you have a vaginal or cesarean birth. While women have traditionally been told to expect their lochia to last for 10 to 14 days, recent studies have indicated that most women experience lochia for at least a month after the delivery, and many for as long as six weeks. (Now you can understand why I suggested that you stock your home with truckloads of supersize maxipads.) Most women don't experience bright red bleeding this entire time, of course: lochia typically tapers down from a bright red, heavy flow (most common during the first three days postpartum) to a lighter pinkish discharge (from the third to tenth days postpartum) to an almost colorless or odorless discharge (from the tenth day onward). If your lochia has tapered off to a colorless or yellowish discharge but then suddenly becomes bright red again, call your doctor or midwife. Chances are you've simply been overdoing things a little which can increase the amount of postpartum bleeding you experience but it's always best to err on the side of caution in so far as your reproductive organs are concerned. (See Table 5.1 for some guidelines on other postpartum symptoms that warrant a call to your caregiver.)

TABLE 5.1
WHEN TO CALL YOUR CAREGIVER

You will need to get in touch with your caregiver immediately if you experience one or more of the following symptoms, which may indicate that you are experiencing a postpartum hemorrhage, a postpartum infection, or other postpartum complications:

sudden, heavy bleeding
a large number of blood clots
the return of bright red bleeding once your lochia has begun to subside
a foul-smelling vaginal discharge
severe pain or redness around, or discharge from, an episiotomy, tear, or cesarean-section incision
a fever over 100 degrees Fahrenheit
nausea or vomiting
pain, redness, hot spots, red streaks on breasts
painful, burning urination
painful, swollen, or tender legs
persistent perineal pain with increased tenderness
vaginal pain that worsens or lasts longer than a couple of weeks
severe pain in your lower abdomen

Try not to be alarmed by the amount of bleeding during the first day or two following the delivery. A woman can lose a cup or two of blood at birth without experiencing any undesirable effects, thanks to the increased blood volume during pregnancy. Still, it's very important to be alert to the possibility of early postpartum hemorrhage (excessive bleeding that occurs within 24 hours of to delivery something that happens in 4% of births) and late postpartum hemorrhage (excessive bleeding that occurs at any time after that point, but that typically becomes a problem between 7 and 14 days after the delivery something that happens in 1% of births). Postpartum hemorrhages can be caused by retained fragments of the placenta or the membranes, an infection of the uterine lining, or the failure of the uterus to contract properly and return to its normal size after the birth.

Don't immediately assume that you're experiencing a postpartum hemorrhage, however, if you feel a sudden gush of blood or fluid when you stand up (which causes the uterus to empty) or breastfeed your baby (which causes the uterus to contract). This is perfectly normal. There is generally only cause for concern if you are soaking more than one pad over the course of an hour, passing blood clots that are larger than lemons (yes, lemons!), or your lochia has developed an extremely unpleasant odor, a possible sign of a postpartum infection.

Perineal pain

You can expect your perineum to be sore and tender after a vaginal birth, even if you didn't have an episiotomy. After all, the tissues of your perineum got a bit of a workout as your babys head was being born. You can minimize your discomfort during the postpartum period by keeping these tips in mind:

Try to get in the habit of squeezing your buttocks together as you sit down and then relaxing your buttocks after you sit down. This will help to reduce a bit of the wear and tear on your perineum. If you still find that sitting down is pure torture, then you might want to send your significant other to the closest medical supply store in search of a hemorrhoid cushion. (For best results, only partially inflate the cushion.)
Experiment to find out whether heat or cold provides you with the greatest relief. If it's heat that does the trick, trying soaking your perineum in a warm bath (either a full-sized bathtub or a sitz bath) or carefully applying heat from a blow-dryer to your perineum. (Obviously you'll want to set your blow-dryer on the lowest possible setting and limit the amount of time you spend blow-drying your perineum in order to prevent burns. The same applies to sitting spread-eagled in front of a sunlamp something your mother or grandmother is sure to recommend but that generaly isn't recommended these days. This tender part of your body burns quickly, and getting a sunburn "down there" will add to your postpartum woes immeasurably.)
If cold brings you the greatest relief, try soaking some sanitary pads in water and freezing them in plastic bags (you'll want to mold them to the approximate shape you want) or filling a washcloth or rubber glove with ice and applying it to your perineum. Some women swear that there's no greater relief to be had than from chilled witch-hazel pads (an item you should be able to pick up at your local health-food store). You just tuck the frozen pads between your perineum and your sanitary pad and-voilá-relief is in sight.

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