Bumps, Bruises and Blues

The first few days after the birth, you may feel exhausted and have a case of the blues. If you had a Caesarean section you’d be recovering from the operation. If you’ve had stitches, the affected areas may be sore, and you might be worried about going to the toilet. Although you may have expected to feel great, feeling blue instead is not unusual.

Immediately after birth, your tummy will look saggy and soft. As your uterus shrinks back to its pre-pregnancy size in the few days after the birth, you may feel contractions known as ‘after pains’, especially if you’re breastfeeding. If you find these uncomfortable ask your midwife, GP or pharmacist what pain relief is safe to take.

Your breasts may swell and feel tender when your milk comes in. A well-fitted bra should help support your breasts and again you can take pain relief (recommended by your midwife, GP or pharmacist) if necessary.

After Birth Pains

You may experience cramping pain and discomfort following the birth of your baby as the uterus contracts and returns to its pre-pregnancy size. These after-pains are caused by involuntary contractions and usually last for two to three days after childbirth. After birth pains are more obvious for women who have previously had a baby. Heat packs and analgesia can be used to relieve pain and can be discussed with your health care professional (1).

Sore Bottom

It’s normal for the area between your vagina and anus (perineum) to feel sore and uncomfortable for a while after you have given birth. This area has stretched as your baby head (or bottom) entered the world.

Here are some self-help methods to relieve soreness (2):

• Lie down, so that you take the pressure off your bottom.
• Apply cold therapy example cold pads/crushed ice in a clean flannel, on your perineum.
• Rest when you feel the need, and allow yourself time to heal.
• Have a warm bath.
• Keep doing your pelvic floor exercises. This exercise helps to speed up the healing process and improve the flow of blood to the area.
• Pour a jug of warm water over the area while you do a wee. This will dilute your wee, reduce the sting and keep your perineal area clean.

The bruising and pain should feel better within a few days but can take a few weeks for the wound to heal. At your 6 weeks postpartum check you should be well on the road to recovery. Please speak with your health professional if pain/swelling increases. Uncontrolled pain can contribute to your baby blues.

Constipation

You may experience constipation during the postpartum period. Constipation is a concern to the new mother who is recovering from birth. A high fibre diet and increased fluid intake can prevent constipation in the postpartum period. Pain-relieving drugs and laxatives are common drugs in relieving constipation. If you are experiencing constipation discuss with your health care professional (3).

Lochia and bleeding

For the next three to four weeks, sometimes longer, you’ll have a discharge from your vagina, called ‘lochia’. Initially, this is a bit like having a heavy period. At first, it’s bright red, then pinkish brown, then cream. The lochia will be heavy at first and you’ll need lots of changes in sanitary towels (tampons aren’t suitable because of the risk of infection). The discharge should slow down after the first week.

Get medical advice if you experience any of the following (4):

• You start to lose fresh red blood or your discharge seems too heavy.
• The discharge gets smelly
• You have stomach pains or a temperature
• You pass clots after the first few days.

If you have any heavy bleeding at any time after the birth (soaking through pads) or have large clots of blood contact your midwife or maternity unit. Remember, some fresh red blood loss is normal after a breastfeed but only in the first few days. If the discharge hasn’t stopped after six weeks or so, speak to your health visitor or GP.

Caesarean section

A caesarean is major surgery, and it will hurt afterwards. You may feel you can’t do anything on your own. Even small movements, such as shifting up the bed, may require assistance. It will hurt to cough or laugh, but supporting your wound with your hands, or holding a pillow over your tummy, will help.

To help with your recovery eat and drink as soon as you feel hungry or thirsty. Drink plenty, and eat fibre-rich foods to help prevent constipation. Ask the nurses for peppermint water to soothe the pain of trapped wind, which often follows surgery. Wear loose clothes and cotton. Wear knickers that are a size bigger or borrow a pair of your partner’s boxer shorts. You’ll need to use sanitary pads after your caesarean because the bleeding from your uterus (lochia) is the same as after vaginal birth.

Your wound dressing should stay intact until reviewed by a health professional. Keep an eye on your wound for signs of infection, such as extra soreness, redness or discharge. Tell your health professional if you spot these signs, or if it looks like the wound is coming apart.

Your wound

Wash and dry your wound daily. It’s fine to have a shower or bath. You can use a face washer or clean chux cloth, as long as it’s freshly washed. Pat rather than rub the wound with a dry with a clean towel.

The scar is likely to be along your bikini line and will look very red at first. As the weeks and months go by it will gradually fade. While your scar heals it may be sensitive and itchy, particularly when your pubic hair re-grows.

Any numbness on or around your scar usually gets better a few months after the operation, though it can carry on for longer. If your scar becomes very sore, red or inflamed, you may have developed an infection. Tell your midwife or doctor if this happens.

A couple of years after the operation the scar will probably have faded to a faint line. It will always be a slightly different colour to your normal skin tone, but may eventually be almost invisible (5).

Care of your perineum

Your health care professional will ask whether you have any perineal pain or concerns about the healing process for the first 48 hours after birth. Severe pain and swelling to the perineal area or in the labia should be immediately reviewed by a health care professional.

It’s essential to keep the perineal area clean and dry. Undertake strict perineal hygiene strategies to help reduce the risk of infection (e.g. hand washing before and after toileting/changing sanitary pads and after nappy changes). Always wipe from the symphysis pubis towards the anus (front to back). The area should be washed with warm water and patted dry after showering, voiding and bowel movements. Sanitary pads should be changed at least every three hours.

We recommend topical cold therapy (cold packs) for the first 24-72 hours after the birth for relief of perineal pain. If you use cold packs, please apply them to the perineum for 10-20 minutes, and no more frequently than two hourly. Cold therapy is only of benefit in the initial 72 hours following birth (6).

Pelvic-floor exercises

Pelvic-floor muscles are important because they are the muscles that control your bladder. Weak pelvic floor muscles can result in stress incontinence (when you leak a few drops of urine when you cough, laugh or run). It’s common to feel you have no control over these muscles for a couple of days – maybe even weeks – after birth. A catheter (tube into your bladder) during your labour or an epidural can also affect your normal bladder sensation.

Pelvic floor exercises during your pregnancy are a great way to prevent any problems with stress incontinence. But if you didn’t get around to it then, now it is good to make them part of your daily routine. Try to use the muscles during everyday tasks such as washing the dishes. Remember – you can do them anywhere and no one will notice! You should aim to do them several times a day.

Exercise 1 – slow contractions:

Imagine you are trying to stop yourself passing wind, and that you are trying to stop the flow of urine. It will feel like squeezing shut and lifting the back and front passages.

• Start by trying to hold for three seconds.
• Rest for five seconds then repeat the exercise,
• Build up to holding for ten seconds.
• Repeat up to ten times.
• Do five sets per day.

Once you are able to hold for five seconds and repeat at least five times, then you can add…

Exercise 2 – fast contractions:

• Squeeze and lift as in exercise one
• Let go straight away
• repeat ten times.

Don’t:

• Tighten your buttocks
• Hold your breath
• Squeeze your thighs together.
• Stop the flow of urine midstream as an exercise – it may cause incomplete bladder emptying and increase risk of infection.

If your pelvic floor muscles are weak you may find exercising them quite difficult at first. With frequent practice though, you will soon improve. If you continue to have problems, mention it to your GP at your postnatal check and ask to be referred to a physiotherapist (7).

Baby Blues

You and your partner may experience a wide range of emotions during and following the birth of your baby, but it’s certainly not uncommon for women to experience the baby blues in the first few days.

Signs of baby blues include:

• Teary
• Irritable
• Overly sensitive in interactions with others
• Moody

The baby blues usually clear up after a few days with no other treatment except support and understanding from family and friends. If you have friends or family members who have also had the baby blues, they can be a great support during this time.

If the blues continue, you must seek help from a health care professional, as this can evolve into other issues such as postnatal depression. There are plenty of effective treatments for anxiety and depression, and the sooner you seek support, the faster you can recover.

If the blues continue, you must seek help from a health care professional, as this can evolve into other issues such as postnatal depression. There are plenty of effective treatments for anxiety and depression, and the sooner you seek support, the faster you can recover.

Click here to access support now.

Helping new mums

New mums need someone to listen to them, help with the baby and provide support and reassurance. There are lots of things you can do to help:

• Be ready to listen – and pass the tissues
• Remind her that the baby blues are common and will pass
• Make sure she isn’t overwhelmed by visitors
• Help with the baby
• Offer to do the cleaning, cooking and ironing
• Try and ensure she gets as much rest as possible.

Sophie Schipplock (BN, MMid) Registered Nurse, Registered Midwife
Photo by Lucky Business used under license from Shutterstock.com

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