A lot happens after you have a baby. When meeting with doula clients, I always end up talking about awkward topics like perineal massage, first bowel movement after birth, and night sweats. Because these things are awkward we have a tendency to avoid talking about them (they’re crucial postpartum care plan topics). But it does no one any good to pretend that they don’t happen, so let’s get real and talk about the cool, weird, gross, and uncomfortable stuff. Are you ready?
Ok, so a tiny human has somehow exited your body, either via your vagina or abdomen. Now, what happens?
Immediately after giving birth - Postpartum care kit & tips
In the minutes and hours after delivery a few things will happen, regardless of how your baby is born. There will be vaginal bleeding. This happens even with a cesarean birth. Vaginal bleeding, called lochia, will continue for up to 6 weeks with the intensity lessening after a week.
You will also experience contractions after birth as well. Your uterus uses these contractions to shrink back down to pre-pregnancy size. This also takes about 6 weeks and you may feel them during breastfeeding due to oxytocin stimulation.
In the hours after birth, your nurse or provider will perform a fundal massage. It’s a deep abdominal massage to encourage the uterus to contract, reduce excessive bleeding, and may feel uncomfortable. Occasionally when it is being performed you may feel a gush or pass a larger clot of blood.
Many people experience shaking immediately after giving birth. This happens due to a massive hormone shift and not due to being cold. If you’ve given birth via cesarean surgery, the medications given may also cause shaking and fatigue for a few hours afterward.
If you received an epidural or spinal block (with a cesarean birth), your legs will remain numb for up to several hours after delivery depending on the medications given and how fast your body metabolizes them. This may result in difficulty or inability to urinate and the catheter will remain in place until you are able to mobilize independently.
You may experience swelling in your limbs, particularly the feet, legs, and hands due to IV fluids. Over the following days, your body will work to rid itself of excess fluids through urination and sweat. If swelling persists, or worsens, please contact your healthcare provider immediately.
Your vulva will swell and may have already begun to change late in pregnancy due to hormones. During labor and particularly during the pushing stage the vulva will swell with the increase of blood and pressure in the area. This will dissipate in the hours and days postpartum.
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Some people find relief with postpartum care products like peripads or padsicles, frozen maxi pads with witch hazel and aloe, to soothe the area. It is not recommended to apply frozen compresses to broken skin due to the risk of adhesion and further damage to the area. Wait for perineal tearing or episiotomy incisions to begin healing before using peripads.
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Postpartum hemorrhage care plan: Hemorrhoids are another common occurrence during pregnancy and postpartum. Hemorrhoids can develop during pregnancy or the pushing stage due to the force from both pushing and the pressure of the baby’s head in the vaginal canal. So what’s the best postpartum hemorrhage care plan? Using medicated pads or wipes and a specialty cushion can help to relieve discomfort and be a great option to use postpartum.
Days/weeks after - Postpartum care
The days immediately after birth are full of shifts (new postpartum side effects). Hormonal changes, your internal organs begin shifting back, breasts begin to shift from producing colostrum to mature milk, the birth high begins to wear off, and you may be returning home from being in the hospital. Your body begins the process of returning to a pre-pregnancy state that can take weeks, months, and even years to complete.
The lochia, or vaginal bleeding, will continue during this time. It may begin to lessen but with increased activity may get heavier. This is due to the dinner plate-sized wound from where the placenta was attached to the uterus. It will take up to 6 weeks for the wound to heal and the uterus to shrink to pre-pregnancy size.
Fun fact! The uterus grows 200x in size during pregnancy. To help it continue the journey back down in size, you will feel mild contractions, particularly during breastfeeding or pumping.
Even if you do not breastfeed you will experience milk coming in and engorgement. As mature milk begins to come in around days 3-7, engorgement follows. Your body is attempting to regulate supply. To relieve engorgement and regulate milk supply, frequent and adequate removal of milk is important. If you experience pain or damage from breastfeeding, please seek professional support immediately.
Working with a skilled lactation professional (consultant or counselor) will help set you up for your best lactation experience. Even if you are not breastfeeding, working with a lactation professional can help you plan to reduce milk and have the least discomfort while doing so. Many can also support your formula feeding, combination feeding, or exclusively pumping journey.
Your vulva will continue to be swollen in the days immediately after birth but will lessen as the days progress. If you experienced perineal tearing or an episiotomy, you may notice discomfort around the stitches as the skin begins to heal.
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Sitz baths, peripads, peri bottles with warm water, and Dermoplast spray can all help to relieve discomfort and encourage healing for your postpartum perineal care. Using a peri bottle with either plain warm water or with the sitz tea water during and after urination can alleviate any discomfort. You may be too swollen or sore to use toilet paper comfortably at first. I recommend patting the vulva dry rather than wiping, or air dry.
This leads to one of the most often overlooked conversations about postpartum healing, the first bowel movement. It’s normal to be absolutely scared sh*tless of that first poop after you gave birth. The perineum is tender, may be damaged, and you likely haven’t pooped in a couple of days. Your pelvic floor might feel like everything is going to fall out if you push during pooping.
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It’s scary! But with these tips, you’ll make it through. Set yourself up to have time to relax. Hand a well-fed baby off to someone else and head to the bathroom when you feel the urge. Use a Squatty Potty, or stack of books/ boxes to prop your feet up and allow your pelvis to be in an optimal position as part of your postpartum self-care routine.
If you have perineal healing, use either a gloved hand or a folded stack of toilet paper to gently support your perineum. This will reduce any undue pressure on stitches, hemorrhoids, or healing parts.
Take deep, slow breaths and try not to bear down too hard during the bowel movement. Take time to support yourself both physically and mentally. Use a peri bottle with water to cleanse after (and with urination as well).
The bowel fun isn’t over quite yet in our conversation. “What?!” you may be saying. “We just spent 2 minutes discussing poop! What else could there be?”. Flatulence, or farting. It’s true.
There is so much shifting internally and hormonally as well as a weakened pelvic floor, farts are going to happen. Vaginal flatulence happens too. Working on pelvic floor engagement with core belly breathing will help strengthen these muscles.
Night sweats are commonly reported to soak the sheets. Your body is ridding itself of excess fluids and hormones and should reduce around 6 weeks postpartum. Along with excessive sweating comes an odor. Again, due to hormonal changes and sweat.
If you gave birth via cesarean section, your incision will need care during this period of healing. Your provider will discuss any special instructions with you prior to leaving the hospital. I recommend staying on top of pain medications. When you experience pain, your oxytocin levels drop, leading to lower milk supply and less connection with your baby, as well as a reduction in overall wellbeing.
When getting up from bed or in a seated position, be mindful to move with intention. Roll to your side and use your arms to list yourself rather than your abdominal muscles. Using a pillow against the incision site can help you feel more supported if you need to cough, laugh, sneeze, etc.
Regardless of how your baby was born, you may feel a physical shift of bones. Your body will still have an increase of the hormone relaxin until about 6 months after lactation has stopped. Relaxin is responsible for allowing the joints and bones to shift, making space in your body during pregnancy and birth.
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Support your body physically to feel your best. Some cultures practice belly binding while some people like postpartum support belts, I like BaoBei Support Leggings as they provide the right amount of hug without being excessive. If you feel pressure, heaviness, bulging, or can actually see or feel tissues bulging from your vagina, please seek care from your OB/Midwife and a pelvic floor PT/OT.
While urinary incontinence is common after birth, it is not normal and can be helped with simple pelvic floor exercises. Some people experience bowel incontinence as well during the postpartum period. It is important to get an individual assessment so your own body’s needs can be met properly.
Beyond the physical changes of postpartum are the emotional changes. These are often overlooked but important. Not only is your baby born, but you are born into this new season of life. The shift in identity can be as blissful as it can be challenging. It is a very real change in your life that deserves to be honored and respected. There’s even a term for it- matrescence.
Just like adolescence, motherhood brings a massive hormonal change and life change. Feelings of loneliness and isolation are just as common as feelings of joy and love. They do not contradict one another, just different parts of the parenthood pie.
Having a non-judgemental support network can help you feel connected and provide guidance if you need to seek more help. If the feelings of baby blue last beyond 2 weeks seek support for postpartum mood and anxiety disorders (PPMADS).
With knowledge, support, and a dash of humor you’ll get through the changes of the postpartum period! The more that we normalize and talk about the “things” that come along with pregnancy and postpartum, the better off we all will be.
SEEK IMMEDIATE MEDICAL ATTENTION
If any of the following symptoms persist in the postpartum period, please seek immediate emergency medical attention postpartum care.
- EXCESSIVE BLEEDING
- SEVERE HEADACHES
- DIFFICULTY SEEING
- SWOLLEN LEGS OR LIMBS
- NAUSEA/ VOMITING
- EXCESSIVE CRAMPING
- SHORTNESS OF BREATH
- CHEST PAIN
- SYMPTOMS OF POSTPARTUM PSYCHOSIS/ OCD
- SUICIDAL THOUGHTS
- THOUGHTS OF HARMING YOUR BABY OR YOURSELF
By: Erin Pasquet
Birth and Postpartum Doula
Certified Lactation Counselor
Pre/Post Natal Yoga Teacher