What to Expect: Your Body After Birth

Published on: May 16, 2022

The first few weeks after delivery are a crucial period for both mother and baby, yet the excitement of preparing to give birth can leave our plans for postnatal care overlooked. Bumps & Babies coordinator Jo shares an overview of what a new mom can expect after pregnancy and labor.

By Jo Cox

Care and support for pregnant women often tends to focus on pregnancy and the birthing process. This leaves postnatal care often overlooked despite the WHO recognizing that failure to prioritize care at this time can have significant consequences, physically and emotionally. Consequently, they recommend women receive postnatal care on at least three occasions within the first 6 weeks of birth (WHO, 2022).

What is postnatal care?

Postnatal care is a collection of preventive care practices and assessments designed to detect and treat any complications for the mother and newborn within the first few weeks following birth. Defined by Romano (2010) as the stage immediately post birth up until six weeks, the postnatal period is one of major transition, and is ultimately critical for both the emotional and physical wellbeing of the mother, and the infant’s adaptation to its new environment. In this article, I will focus on postnatal care and its importance for new mothers.

The first seven days

The start of the parenting journey is usually marked by a flood of emotions—from fascination and relief to some apprehension and unease for the future. This is normal. Women birthing in hospitals are surrounded by healthcare specialists who closely observe the physical and psychological state of both mother and baby for at least the first 24 hours, ready to support and issue advice. A minimum two-night stay in hospital following birth is usually recommended in Bangkok hospitals. 

On being discharged from hospital, you will be given an appointment to see your obstetrician again for a postnatal review. This usually takes place at the hospital within the first six weeks of delivery, but timing depends on your doctor. Home visits by a trained support person are not routine in Bangkok but can be accessed independently.

The prospect of dealing with the transition to parenthood while being fully responsible for a new baby and managing your own physical recovery at home without professional support can feel somewhat daunting. The following paragraphs will provide a snapshot of the physical changes you can expect to experience following your pregnancy and labor, and some simple advice on how to manage them during your first week at home and beyond.

Initial feelings: exhausted, happy, and hungry!

Euphoria is a common emotion felt by most new mothers having made it through labor. It is normal to feel physically exhausted after giving birth, but many women find it impossible to sleep, fascinated by their new baby. Feeling extreme hunger after the physical and emotional exertion of labor is also common. However, medications used during delivery can cause nausea and vomiting, so you may need to wait a while before eating. After a C-section, eating and drinking is discouraged until your care staff have determined that your bowel is working properly. They can usually do this within a few hours of surgery. You may also pass a higher-than-normal volume of urine soon after giving birth as your body reduces the excess fluid accumulated during your pregnancy. This can continue for the first few days post birth (Chauhan, 2021). Nursing staff may record how much you pass initially to assess for any bladder damage or retention linked to the labor and delivery.

Breastfeeding 

Breastfeeding your baby for the first few times may leave your breasts feeling strange. It can feel like a suction pump has been applied—an unusual feeling for most new moms! Becoming familiar with attaching the baby and establishing breastfeeding are vital for those who opt to breastfeed. This should be a priority, with skin-to-skin contact as soon after delivery as is feasible. 

Although some babies are born naturals at breastfeeding, latching and sucking well, this is often not the case for all babies or indeed mothers. It takes perseverance, stamina, and practice, but once successfully established, it is so valuable for both and worth all the effort. Incorrect positioning and a poor latch can result in sore nipples and ineffective feeding, which can quickly start a negative downward spiral. Preserving your nipples is crucial, so if feeding is painful, seek support as quickly as possible. Advice from a professional is always available and will help you to feel more confident and competent. Ideally, you will have plenty of opportunities to practice before your milk ‘comes in’, which usually happens around day three.

It is also crucial to be aware of the symptoms of mastitis, which usually presents on one breast with swelling, heat, redness and pain. You may also experience lumpiness, a burning breast pain, discharge from the nipple, and flu-like symptoms including fever. There are a number of measures that you can take to relieve the discomfort of mastitis, which include gentle massage, warm compress, hand expression, taking either ibuprofen or paracetamol, and continued breastfeeding. Seek medical advice if the situation does not resolve within 24 hours (NHS, 2019). Midwives, doulas, and/or lactation consultants can also help.

Feeling low

Day three is typically when a number of factors combine, including hormone fluctuations, physical exhaustion and adjusting to the maternal role. It is also normally the time when the milk supply is initiating, filling the breasts and leaving them engorged and tender. Understandably, it can be overwhelming. Up to 80% of new mothers experience the ‘postnatal/baby blues’, which manifests in an extremely low mood, leaving the mother feeling tearful, anxious, and overwhelmed (Glavin, 2012). It is normal and not the same as postnatal depression. The timing of this low mood is usually a strong distinguishing factor as it tends to occur within days of the birth, and improves within the first few weeks. If the low mood persists or worsens, it is vital to reach out for advice to assess for postnatal depression. The BAMBI Bumps team can refer you to a professional who can offer you the right support.

Uterine cramps and bleeding

Within 14 days of giving birth, the uterus returns to its pre-pregnancy size and position. During this process, some women will experience cramps or ‘afterpains’ which resemble period pains. These happen following both vaginal and C-section births, and tend to be more intense with subsequent births. Experienced soon after delivery, these cramps are more noticeable while breastfeeding, triggered by oxytocin release. Painkillers can provide some relief.Another natural process is the shedding of the endometrial lining of the uterus, observed through vaginal blood loss known as lochia. This normally starts immediately after a vaginal birth and a little later after a C-section. It is initially heavy and dark in colour, gradually reducing as days pass, but experiencing a slight increase in amount as you become more active and mobile is normal. The hospital will provide you with maternity pads during your stay, but they can also be found in any international chemist should you require them. Using tampons or menstrual cups is not recommended until at least six weeks post birth, by which time the lochia is likely to have settled. If vaginal bleeding increases significantly (saturating pads or passing clots), it is important to seek urgent medical care (Thakur et al., 2016).

Wound pain after a C-section

After a C-section, it is important to manage your wound pain and get up and move around as soon as possible. Poorly-controlled pain and immobility may interfere with the breastfeeding process, and can result in serious complications, including the risk of blood clots. Your doctor will discourage you from lifting heavy items or driving for up to six weeks following your C-section.

Perineal trauma

The majority of women delivering vaginally will experience some degree of perineal trauma, either through a tear or an episiotomy. This can be painful and uncomfortable, both initially and as healing occurs, but it can be managed with paracetamol or ibuprofen, careful positioning, and if necessary, the use of cold packs to reduce swelling. However, any signs of infection such as increasing discomfort not resolved by pain medication, fever, or foul-smelling vaginal discharge will require immediate medical attention. To prevent infection and promote healing, careful hygiene, regular pad changes, and pelvic floor exercises as soon as sensation returns are strongly recommended (Webb, 2014).

Staying hydrated and nourished

Not drinking enough fluids will increase your risk of dehydration, urinary tract infections (UTIs) and constipation. If you are breastfeeding, you will likely experience an unquenchable thirst, so keeping a large bottle of water handy when you settle for a feed is sound advice. Consuming a healthy balanced diet is also imperative for milk production, and increasing your fiber intake will reduce the risk of having to strain or becoming constipated. The thought of your first bowel movement after delivery may fill you with fear and apprehension, but it will be fine. Be aware that constipation can occur as a side effect of some medications including painkillers and iron supplements. You may feel awkward talking to your doctor about experiencing urinary or bowel dysfunction, but they can only help if you share your problem.

Be kind and look after yourself during this period. Adjustment to parenthood is an enormous life change, especially while you are recovering. Accept assistance from friends and family, but remember there is also plenty of support available in Bangkok among the other parents and doulas, midwives, and lactation consultants. The Bumps team at BAMBI can advise and signpost you to the relevant resources—we are here to help.

Photos from Canva.


References

World Health Organization (2022) WHO recommendations on maternal and newborn care for a positive postnatal experience. Available online at: who.int/publications/i/item/9789240045989

Romano, M., Cacciatore, A., Giordano, R., & La Rosa, B. (2010). Postpartum period: three distinct but continuous phases. Journal of prenatal medicine, 4(2), 22–25.

Chauhan, G. & Tadi, P. (2021) Physiology, Postpartum Changes. Available online at: ncbi.nlm.nih.gov/books/NBK555904/ 

NHS (2019) Mastitis. nhs.uk/conditions/mastitis/ 

Glavin K (2012) Screening and Prevention of Postnatal Depression academia.edu/27993986/

Thakur, M., Adekola, H. O., Asaad, R., & Gonik, B. (2016). Secondary Postpartum Hemorrhage due to Spontaneous Uterine Artery Rupture after Normal Vaginal Delivery Managed by Selective Arterial Embolization. AJP reports, 6(4), e442–e444. doi.org/10.1055/s-0036-1597623 

Webb S, Sherburn M, Ismail KMK. (2014) Managing perineal trauma after childbirth The BMJ 349. bmj.com/content/349/bmj.g6829


About the Author

Jo Cox is a UK-trained nurse and midwife who has recently arrived in Bangkok. Over the past 20 years, she has spent significant periods of time overseas (Asia and Africa) with MSF and the Red Cross. Jo has taken on the Bumps & Babies Coordinator role for BAMBI and is keen to engage with the pregnant and new mums’ community to offer doula/midwifery care to anyone seeking support and advice.


The views expressed in the articles in this magazine are not necessarily those of BAMBI committee members and we assume no responsibility for them or their effects. BAMBI Magazine welcomes volunteer contributors to our magazine. Please contact editor@bambiweb.org.

 

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