New moms often feel they are leaking from every orifice – breastmilk, blood and tears. And it's true. Natural and caesar moms both experience postpartum bleeding called lochia when the body expels placental tissue and mucus.
This bleeding is usually heavier for normal vaginal delivery (NVD) moms than c-section moms and can include blood clots. The bleeding usually lasts 3 to 6 weeks, reducing in heaviness and colour over time. Use pads and avoid tampons – rather go back to them only after your 6-week check-up.
What's not normal?
"See your doctor if you feel itching, burning, smell a foul smell or have a fever," says gynaecologist/obstetrician and resident Your Pregnancy expert Dr Bronwyn Moore.
And if it's really gushing and you feel lightheaded, get yourself to your gynae immediately – a haemorrhage can be dangerous.
There's a myth that breastfeeding makes your boobs sag. But the American Society of Plastic Surgeons says it's pregnancy itself that causes sagging. Other factors are smoking, older age, larger pre-pregnancy bra size and number of pregnancies a woman has had.
But breastfeeding does temporarily affect the look and feel of your breasts. Your breasts fill up with milk on about day three of your baby's life (before then, she survives on colostrum).
By six weeks postpartum, your body will have figured out how to regulate the supply of milk tailored to your baby's appetite. Before then, engorged or overfull breasts are very common.
"Manage this with warm showers and by applying cabbage leaves," says Dr Moore, and feed your baby on demand rather than to a schedule. If a milk duct gets blocked, you might experience a painful lump in a breast. Learn to massage your breasts to nudge a blockage out and express milk to relieve the pressure on overfull breasts.
And lastly, your nipples can come in for a serious hammering in the early weeks: cracks, blisters, pain and bleeding from a little mouth that isn't latching correctly yet. So it's vital to get good breastfeeding advice from a lactation consultant as correct positioning can make all the difference. She might advise using silicone nipple shields to enable you to keep breastfeeding without as much pain.
What's not normal?
Mastitis is a name for inflamed breast tissue, and sometimes, especially if it's accompanied by an abscess (a collection of pus inside the breast tissue) it needs medical care.
"One area of the breast will be more tender than rest," says Dr Moore, "and physiotherapists can often perform breast drainage. If you have flu-like symptoms, you probably need to be treated with an antibiotic. As a very last resort an abscess can be drained by a fine needle aspiration."
3. Afterbirth pain
Your uterus begins shrinking back to pre-baby size (the size of a fist). Involution takes 4 to 6 weeks and can feel like period pains. Some women feel contractions while they're breastfeeding, because the nipple stimulation during breastfeeding releases the hormone oxytocin, which both contracts breast tissue to release milk and contracts the uterus.
So welcome this pain, it means you're on your way to losing (some of) that jelly belly.
Dr Moore emphasises that uterine contractions happen after NVDs as well as c-sections, and that a gush of bleeding during breastfeeding (from the uterus contracting) is also common.
Heat is a relaxant, so try taking warm showers or applying a hot water bottle to your abdomen just like you would with period pains. Pass urine often as this takes pressure off your uterus. Or lie on your tummy to apply counter-pressure to the area – this is safe even if you've had a c-section.
If you had a c-section, the incision in your abdomen will be sore. Gas and food movement in your intestines can also hurt, and some women feel referred pain under their rib cage or arms, typically their right shoulders, after a caesar.
"Your abdominal cavity has been opened and free air sits under your diaphragm, which your body interprets as pain," says Dr Moore. Take your prescribed painkillers, as they will be safe for breastfeeding.
For abdominal pain from gas, you basically need to fart. Try kneeling on your hands and knees and lifting your bum in the air to release air. Graceful? No. Effective? Yes.
What's not normal?
Watch out for seepage, separation of the scar tissue, and too much pain, says Dr Moore. "Some oozing from your wound onto the dressing is okay, but there shouldn't be lots of fluid. If the area surrounding the scar is red, raised, tender, or accompanied by fever, go to your doctor.
"And if you are bleeding actively from the vagina with clots, get it checked out. Although there may be a day or two of heavy bleeding it should not be ongoing beyond that and you shouldn't feel unwell," she says.
- Also read: I love my post-baby body
4. Vagina and perineum
Even if you didn't tear or have an episiotomy, you can't pass a baby with a 37cm head circumference through a vagina without some effects. So you will have swelling, bruising and stretching damage, and possibly stitches, which can itch, hurt or even tear. But the body has an amazing ability to heal, and will soon swell down back to pre-birth proportions.
You can help by applying ice packs or taking sitz baths (just immersing your buttocks and hips into water). Wipe front to back when you've gone to the loo (as usual). And to keep the area germ-free, change your pads often. If it hurts to sit, try a doughnut cushion until the swelling in your labia subsides, which should take about two weeks.
To restore pre-pregnancy muscle tone (important for continence and to enjoy lovemaking) Kegel exercises are recommended. To do this, pretend you are holding in your stream of urine – that's the muscles you want to be toning and contracting.
"There are now physios who specialise in women's health and who can do pelvic floor rehabilitation," says Dr Moore.
What's not normal?
Very few women report that their vaginas have stretched permanently after giving birth. "But a degree of urinary incontinence is extremely common in the first five to 10 days after birth," says Dr Moore, either from the birth or from the months of pelvic pressure the growing baby exerted on you.
"However, if you are having urine trouble and you had a catheter during delivery (for C-section or epidural), you need to do a urine test to see if you have contracted a bladder infection," she adds.
New moms dread one post-birth moment: your first poo!
Your organs are swollen from being jiggled around during the caesar, plus you've got a fresh new incision, so straining to push a stool can feel very uncomfortable.
For natural delivery moms, your rectal muscles will have swollen from the passage of the baby, and you might have episiotomy or tear stitches – so you'll also dread pushing.
Many new moms develop postpartum haemorrhoids (from pushing during labour) even if they were pile-free in pregnancy.
Dr Moore has a trick for making the perfect postpartum-piles ice pack:
Take a surgical glove, fill the fingers with water, tie them off and freeze them. Slice off a finger as needed, remove the glove part, and insert the now appropriately shaped ice into the area for relief.
And to compound the indignity, constipation is very common following both types of birth, from the trauma to the area and psychological inhibition (fear of pooing, basically).
"The pain meds can be constipating and hormonal changes also contribute," says Dr Moore. "Use a stool softener and watch your diet." Drink lots of water and eat lots of fibre, take sitz baths to soothe swelling, and when you do pass a stool, press a sanitary pad against your perineum as a support.
What's not normal?
If you find you are actually leaking poo (faecal incontinence), this may not be as drastic as it sounds: it may actually stem from constipation, where watery stool bypasses the blockage and leaks out (overflow).
Incontinence of solid stools is not common, says Dr Moore. "Incontinence usually settles, but if there is rectal incontinence and it hasn't settled within the postnatal period you must speak to your healthcare provider."
Haemorrhoids are also initially managed symptomatically, but they may never go away completely. "Haemorrhoids that don't resolve, or cause pain and bleeding can be surgically removed by a surgeon in a process called 'banding' where they are actually tied off," she says.
- Also read: Healing after birth
6. Baby blues and postnatal depression
If you suddenly find yourself sobbing (and sobbing, and sobbing), then welcome to the baby blues. A new mother can feel depressed, weepy, anxious or just confused for a few hours or days after having given birth.
The exact cause is unknown although the massive hormonal changes involved in transforming from a pregnant person into a mother are probably to blame. Add the responsibility of looking after a newborn, the fear, and the exhaustion, and it is surprising baby blues affect only half of all new mothers.
If your symptoms persist beyond a few days, though, be honest with yourself as you contemplate whether you might have postnatal depression (PND).
For baby blues, you can only rely on your support system until you feel stronger. Surround yourself with people who are good for you – send unwanted visitors home – and it may help to phone a friend who has experienced baby blues, so that she can reassure you that the symptoms are very temporary indeed.
- Also read: Postnatal depression quiz
What's not normal?
If your symptoms persist and you feel you may have PND, the kindest thing you can do for yourself, your partner and the health of your baby is to see a doctor immediately.
Depression is a disease, it is not your fault you've contracted it.
You should treat it like you would any other disease: with appropriate help, and medication if required.
For more information, go to the website of the Post-Natal Depression Support Association SA www.pndsa.co.za, or call their national helpline on 082 882 0072.
How have you been managing with all the changes your body's going through following the birth of your little one(s)? Share your experience along with any tips and advice by emailing email@example.com and we may publish your story. Should you wish to remain anonymous, please let us know.
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