15 things nobody tells you about recovering from childbirth
Top tips from a midwife on what to watch out for during your postnatal recovery.
Having a baby is one of the most profound transformations a woman will ever go through--physically, hormonally, emotionally, and even on a cellular level. You have just been through a major physical feat of labor and/or a major abdominal surgery in order to birth your baby. Now you are being sent home with a baby, and here in the UAE there will not be a midwife checking up on you or a health visitor knocking on your door to make sure that all is going well. Any postnatal care you receive you will have to organize yourself, so here are some basic health and recovery tips that a midwife would like you to know about, including when to call your caregiver or seek emergency medical care.
1. Rest, fluids, and good nutrition are essential to a speedy recovery, regardless of what type of delivery you had. Plan to nap when your baby is sleeping--which means leaving your house a mess, your social media accounts quiet, and your work email unanswered. Arrange for family members or house help to take care of laundry, cooking, shopping, cleaning and older sibling childcare for a week or so (at least) and try to stay in bed or on the couch for the first few days. Drink when you feel thirsty, keeping a bottle of water beside you when you begin a breastfeed. Continue taking antenatal vitamins if you have them. Limit visitors and if you do have them, greet them while wearing pyjamas so they know that you are not in entertaining mode. Consider this a time of rest, recovery and getting to know your baby.
2. Bleeding: In the first few days after birth, bleeding will be similar to a heavy menstrual period, both in color and amount. Clots may be passed, especially when you get up after you have been lying down, but shouldn’t be any larger than a golf ball. If you are bleeding heavily during the first 24 hours, empty your bladder and massage your uterus. Your uterus should feel like a grapefruit at or below the level of your belly button. Call your doctor or midwife if your uterus feels soft and does not get hard with massage or breastfeeding, or if you bleed enough to fill 2 pads in 1 hour. You should also call your doctor or midwife right away if the discharge from your vagina becomes foul-smelling. Bleeding (lochia) will turn a brownish color after a few days and decrease steadily, gradually turning yellowish-whitish or clear in color, until it stops at around 6 weeks. If fresh red bleeding persists or returns at any time, decrease your activity level and call your doctor or midwife.
3. Cramping or ‘After Pains’: Uterine contractions or 'After Pains' are normal in the first 3 days after birth, and they ensure that your uterus is returning to its normal size and reduce your blood loss. These uterine contractions will be felt most strongly during breastfeeding or expressing (when oxytocin levels peak.) Cramping can be uncomfortable, especially if this is not your first baby. Use a heating pad or hot water bottle as needed to relieve pain. Pain medication such as paracetamol (in the first 24 hours) and/or ibuprofen (after 24 hours) can be taken, every 4-6 hours, ideally just after a breastfeed. Take pain medication before the cramping becomes severe because it is easier to prevent the pain than to knock it out. There is no benefit to soldiering through pain at this stage of the game, and failing to relieve the pain can make breastfeeding and parenting your baby unnecessarily difficult.
4. Infection prevention: The postnatal period is a high risk time for infection. Wash your hands before you change your pad or handle your breasts. Check your temperature if you feel any flu-like symptoms. Uterine tenderness or pain and/or foul-smelling vaginal discharge with a fever are signs of uterine infection. A tender, swollen breast with body aches and fever may indicate mastitis. Normal body temp is 36 C/98.6 F. Call your doctor or midwife if you have fever over 37 C/100.4 F or any of the above symptoms.
5. Perineum: It is normal for the area around your vagina, or perineum, to be swollen and tender for several days, especially if you pushed for a long time and/or had an episiotomy or tear. Spray or pour water over your perineum while you urinate to reduce stinging and to clean the skin. Pat dry, but do not wipe. An ice pack can help with swelling (10 minutes on, 10 minutes off, as needed). One technique is to freeze a maternity pad or newborn pamper full of witch hazel or boiled and cooled water and place it inside your maternity pants. Sitting in a Sitz bath or a CLEAN tub of 10-12 cm of very warm water with sea salt several times a day helps healing. Homeopathic arnica can also help reduce swelling, pain and bruising. You can also start your kegel exercises right away to strengthen your pelvic floor muscles and increase blood flow to the area to promote healing. Stitches will dissolve on their own over time, but your doctor should check them at 6 weeks to make sure they have all dissolved and healing has been complete. If your pain increases rather than decreases at any point or isn't completely gone by the 6 week point, have your doctor or midwife take a look.
6. Bowel care and hemorrhoids: You probably will not have a bowel movement for 2-3 days after your birth. Be sure to drink at least 2 liters of water daily and eat plenty of fruit and veg and whole grains so you get enough fiber to avoid constipation. Prune juice (170 g twice daily) is helpful in relieving constipation, as are fresh-ground flaxseeds with lots of water. You may feel anxious about your first bowel movement, but don’t worry—most mothers do not find the first bowel movement after birth to be painful, despite lots of anxiety about it! If you are unable to have a bowel movement after 3 days, inform your doctor or midwife. Hemorrhoids (piles) are swollen blood vessels in and around the anus which can affect many mothers during pregnancy and especially after the pushing phase of vaginal delivery. Swelling of the hemorrhoids may occur and ice packs, witch hazel compresses or pads, and/or pain medication may be required. If you have discomfort and/or itching your doctor can prescribe ointment and/or stool softeners. Suffering unnecessarily can make breastfeeding, parenting and your postnatal recovery unnecessarily difficult--seek help from your care providers.
7. Cesarean incision care: After a cesarean birth, you should avoid lifting anything heavier than your baby and shower rather than bathe in a tub until your incision is well closed. If you have steri-strips, they can be removed after 7-10 days. Try moistening them in the shower and gently working them loose. You should not drive a car until the pain from your incision is mostly gone, usually at least 2 weeks. If your incision begins to bleed or ooze, feels hot, red, becomes suddenly more tender to the touch, or if you have fever of 37C/100.4 F or higher, call your doctor or midwife immediately.
8. Nursing and sore nipples: Sore nipples can almost always be corrected by fixing the baby’s latch, but sometimes a visit with a qualified lactation consultant is necessary. Having damaged nipples seriously increases your risk of bacteria entering the breast and causing mastitis, and a poor latch will also usually mean that your baby is not getting adequate amounts of milk. See our other blog post, “How to know when you need breastfeeding help” for more information.
9. Engorgement and plugged ducts: Around days 2-4 your milk supply increases significantly, and engorged or painfully full breasts can occur as your body stages an immune response to the milk itself. Cold compresses or cabbage leaves in the bra will reduce swelling and provide pain relief, while warm compresses, breast massage in the bath or shower and expressing milk just before feedings can help to get the milk flowing and soften the areola so baby can latch. Engorgement only lasts 1-2 days, but it is important to empty the breasts as often and as fully as possible to avoid mastitis and reduced milk supply. If you develop a lump anywhere in your breast, massage the area to remove it during feedings or in the bath/shower. This could be a plugged duct and can also lead to infection. If you have fever, body aches, flu-like symptoms and/or swelling, redness or pain in the breast, call your doctor or midwife immediately.
10. Danger signs: There are a couple very serious medical emergencies which can happen in the postpartum period. If you experience any of the following, contact your doctor or midwife immediately or call 999 for emergency medical assistance.
Sharp pains in your abdomen, chest or breast
blurred vision or dizziness, with or without headache
the worst headache of your life
pain in your legs, especially the calf muscles, when you extend your feet.
Any strong sense that "something is wrong."
11. Resumption of normal activity: The first weeks postpartum you may be very tired if you had a long labor or surgery. As your energy increases it is easy to overdo it and set your recovery back--a sign that you are overdoing it is if your bleeding turns bright red or increases in amount. If you notice your bleeding increasing, reduce your activity accordingly. In general, kegel exercises, gentle abdominal exercises, and walking should be your first exercise, with more vigorous exercise gradually resuming after your doctor or midwife has checked you and says it's okay. Intercourse can resume 4-6 weeks after birth (once the perineum is healed and bleeding has stopped), or when both partners desire it. Most women will need some added water-based lubricant because breastfeeding hormones can reduce natural lubrication. Be sure to discuss contraception with your doctor before you resume intercourse.
12. Pelvic, abdominal and spinal recovery: Pregnancy and birth can put a huge strain on the pelvic floor muscles, the abdominal muscles, and the spinal column and pelvic bones. If you are experiencing pain, pressure, muscle weakness, bulging or any other discomforts, see a physiotherapist, osteopath, and/or chiropractor who specializes in postnatal recovery. Early interventions can speed recovery and may enable you to avoid more serious future problems and possibly even the need for surgery one day. Your insurance may even cover some of these "alternative" therapies. Most mothers experience at least some of these discomforts and difficulties, so there is no shame in asking for help from skilled professionals. Have your doctor or midwife assess you and give you a referral.
13. Mood changes: Many new mothers experience a period of 3-10 days of “baby blues” in the first couple weeks after the birth. You may find that you feel moody, weepy or irritable. These feelings are the result of the rapid change in hormones and may be worsened by fatigue, discomfort, and feeling overwhelmed. With good self-care, appropriate support at home, and time to recuperate and adjust, these feelings should pass shortly. For about 10% of women these feelings escalate into postnatal depression. There are many resources to help with this, so talk to your doctor or midwife--too many women unnecessarily suffer for months and even years, and maternal depression can affect your baby's development as well. Don't be afraid to ask for help--both you and your baby are worth it! A wonderful group in Dubai is Out of the Blues--started by mothers who struggled with their own postnatal depression. A small number of mothers can experience very severe postnatal psychosis. If you ever have thoughts of harming yourself or your baby, this is a medical emergency--seek help immediately.
14. Birth Trauma: We now know that some mothers (and even fathers) suffer from PTSD (post traumatic stress disorder) after a traumatic birth. Generally this occurs when they believed that they or their baby were at risk of dying during or after the birth experience. Other factors which have been found to increase the likelihood of birth trauma include a sense of loss of control, loss of dignity, the hostile or difficult attitudes of the people around them during labor and birth, feelings of not being heard or the absence of informed consent to medical procedures. If you are experiencing recurrent intrusive memories, flashbacks and nightmares, if you feel distressed, anxious or panicky when exposed to things which remind you of your birth (including your baby), if you are experiencing difficulties with sleeping and concentrating or are feeling angry, irritable or jumpy and on your guard all the time, you might be suffering from birth trauma. Talking to your doctor or midwife about your birth experience may help, but sometimes specific counseling or other treatment is necessary. You can find out more here.
15. Postnatal check-ups: The World Health Organization recommends that all mothers should have at least 3 postnatal check-ups with a health care provider after leaving the hospital: on day 3 (48-72 hours), between days 7-14 after birth and 6 weeks after birth (more visits may be necessary if there are any complications.)
In addition to checking the baby and observing a breastfeed, during these visits mothers should be checked for general well-being; assessment of bladder comfort and control, bowel function, healing of any perineal or abdominal wound, headache, fatigue, back pain, perineal pain and perineal hygiene, breast pain, uterine tenderness and bleeding. Emotional well-being, family and social support, and mother’s coping strategies as she adjusts to life with her baby should also be discussed. At 10-14 days all mums should be assessed for postnatal depression and birth trauma and referred for appropriate treatment and follow-up if indicated.
In the UAE you will have to make your own arrangements for the first 2 postnatal visits with a doctor or midwife, and midwives are probably your best option as they have the expertise and the time to provide all the education and counseling which is required. In Dubai, Cooper Health Clinic, Healthbay Polyclinic and Babies and Beyond all offer midwifery home or clinic visits for both mother and baby and are highly recommended. In Abu Dhabi you can find similar care from BAYTI Baby home healthcare. Your pregnancy and birth package should include a 6-week postnatal check-up with your doctor, but not all OBs will actually examine you or check all these things as thoroughly as they could. Be persistent in requesting a thorough physical exam and complete assessment after the postnatal period--it's absolutely essential for your lifelong health and well-being.
My next post will cover what to look out for in your new baby in the early days and weeks after birth. What surprised you most about the postnatal period? I would love to hear about your experiences.
Good luck and Take Care!
Amy is a Licensed Midwife (Washington state, USA) and an International Board Certified Lactation Consultant. She currently works in Dubai as co-founder of Love Parenting UAE, teaching antenatal and parenting classes and workshops. For more information and tips like this plus lots of community and professional support, join our facebook groups Informed Pregnancy and Birth UAE and Love Parenting UAE support group.