18 August 2003

Issues that affect women post-partum

The arrival of your new baby is an exciting event. However, with all this upheaval in your lives, the mother’s concerns can sometimes be overlooked. The mother may have many concerns and discomforts. Not to worry, this is quite normal as it may take quite some time for a new mother’s body to return to its pre-pregnant state.

The arrival of your new baby is an exciting event. However, with all this upheaval in your lives, the mother’s concerns can sometimes be overlooked. The mother may have many concerns and discomforts. Not to worry, this is quite normal as it may take quite some time for a new mother’s body to return to its pre-pregnant state.

After birth pains
The pain felt after childbirth is caused by the hormone called Oxytocin. Oxytocin is released during breastfeeding and it causes the uterus to contract, which in turn helps the uterus to return to its pre-pregnant state.

The discomfort or pain caused by the contractions is called After Birth pains. These pains are quite normal and there is no need for concern. In some instances, the increase in the number of births a woman experiences appears to be linked to more severe or stronger pain with each pregnancy.

Try breathing through the discomfort (big deep slow breaths in and longer out breaths).

The material eliminated from the uterus through the vagina after the completion of labour is known as lochia. The first discharge, lochia rubra, consists largely of blood. This is followed by lochia serosa, a brownish mixture of blood and mucus, and finally lochia alba, a yellowish or whitish discharge containing micro organisms and cell fragments. Each stage may last for several days. The various stages may even last as long as six weeks postnatally.

If your discharge has a foul odour or returns to red after having been white or even increases with bloody clots, there could be a more serious problem and you should report this to you doctor or midwife as soon as possible.

Menstrual cycle and conception
If breastfeeding exclusively, the mother may not menstruate for a couple of months. If this is not the case, four to six weeks after delivery, the mother may start menstruating again.

It is possible to ovulate and become pregnant before menstruating begins, especially when breastfeeding is reduced or the infant starts solids and takes less feeds.

Contraceptive precautions are available for breastfeeding moms and advice can be given by a health professional.

Breast care
For the first few days after birth, your breasts will secrete a yellow fluid known as colostrum. This precedes the onset of breast milk. Colostrum provides the huge nutritional requirements of the baby during this period. The production of milk will start any time between the second and fifth day and it is quite normal for the mother’s breasts to increase in size when this happens.

The following are good breast care tips whilst breastfeeding:

  • A daily shower with warm water is all the cleaning a mother needs
  • Avoid soap as this has a drying effect on the skin and also washes off the natural softeners
  • Nipples should be kept dry and clean
  • Avoid soggy or wet breast pads
  • Express a few drops of colostrum or milk to dry on the nipple (these have anti-bacterial and lubricating properties in them)
  • Prevent cracked nipples by correctly latching and fixing the baby on the breast
  • If a nipple cream is to be used make sure you do not have to wipe it off before feeds
  • Ask for advice from a breastfeeding consultant if nipples appear flat or inverted

Painful urination / bowel movements
The colon, rectum and anus undergo trauma during a natural delivery, causing pain while urinating or straining to have a bowel movement. Hence, bowel movements are often delayed, causing constipation.

Pouring warm water over the affected area as you urinate will alleviate any burning. Increasing your water intake also tends to make your urine less acid.

The bladder also can be traumatised by the baby's head passing through the birth canal or by a vacuum extraction or forceps delivery.

A lack of sensation may be experienced but all will return to normal within four to six weeks after delivery.

Be aware of urinary incontinence. You may urinate frequently in the first few days after delivery as you body gets rid of extra fluids that have accumulated in your blood and tissues during pregnancy.

NB: Remember to do your Kegels exercises!

Tips to avoid constipation:

  • Eat lots of fresh vegetables, fruit and foods with high fibre
  • Drink lots of water
  • Bowel movements should return within three days after delivery
  • A mild laxative may be given if needed

Your skin
As your hormones revert to normal, your skin will return to its pre-pregnant state. The pregnancy pigmentation is rarely permanent and will fade in time. However, it is advisable to continue wearing a sunblock as your skin is still vulnerable whilst your hormones are settling.

The development of stretch marks depends largely on the mother’s skin type. They are caused by the pregnancy hormones or fluctuations in weight. Stretch marks may fade and shrink after delivery to whitish lines that are often barely noticeable after the birth. Oils and wonder creams may be used but they seldom prevent or treat the marks. However, they may make the mother feel better and even help to relieve the itchiness.

A good fitting bra during pregnancy and breastfeeding will help to prevent stretch marks on the breasts. Specialists recommend that you wait at least three months before seeking serious treatment, to allow for adequate weight loss and your hormones to settle.

Treatments such as sclerotherapy or photoderm laser treatment are available for those needing to eliminate varicose veins, spider veins or sun spots.

Care of the perineum
The perineum can be very sore or tender after your delivery and care should be taken to assist in its recovery.

The following are tips in the care of your perineum:

  • Ice packs can be applied directly to the perineum if bruised or if the mother had to have an episiotomy.
  • The perineum must be swabbed from the front to the back passage (vagina to anus) and should be cleaned frequently with warm water or a diluted antiseptic (ask your doctor to recommend one), especially after a visit to the toilet.
  • Sanitary towels must be changed at every toilet visit and before feeding.
  • Salt or sitz baths can be taken to soothe a sore perineum.
  • The vaginal area must be kept dry and clean, a hairdryer may be used to help (cool or warm setting). Do not burn yourself.

Post Natal Depression
Between 10 and 30% of all mothers suffer from post natal depression. It can happen anytime after the baby is born, not only in the first few weeks after the birth. It can be mild or severe. Post natal depression is characterised by tearfulness, tiredness, feelings of helplessness and lack of self esteem or loss of libido. These feelings experienced in isolation are normal, but if felt simultaneously or for a prolonged period or time, it is important that you seek professional help.

You may need emotional support, professional counselling, medication or just simply help at home with your new baby. Do not suffer in silence - there is help available.

There is no single cause of depression. The mother’s hormones cannot be blamed as fathers may also suffer from post natal depression.

Post natal depression is not the same condition as the “baby blues” which last only for a day or two.


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