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Typical After-Effects of Childbirth Vaginal Discharge
(lochia) What is it Bleeding after childbirth is normal as the uterus sheds its lining and the site where the placenta was implanted heals. The amount
of odorless, bloody discharge gradually lessens and progressively lightens in color and consistency, from bright red and mucusy (for the first 3 or 4 days) to pink or brownish and watery, finally becoming yellow-to-clear within 2 to 8 weeks (about 30 days is average). Doctors aren't concerned about how long the discharge lasts, but whether or not it diminishes. What to do Use heavy-absorbency sanitary pads, not tampons, to absorb the flow Change the pad every time you use the bathroom, or more often as needed. You should also avoid douching until the healing is complete. Afterpains
(uterine involution) What is it Beginning immediately after delivery, your uterus shrinks from the size of a watermelon to that of a small cantaloupe, a process called involution. The contractions that restore the uterus to its pre-pregnancy size help reduce postpartum bleeding as they clamp off blood vessels. The contractions can feel mild or sharp, similar to menstrual cramps, and are most noticeable during the first postpartum week. Breastfeeding in the first weeks also stimulates uterine contractions, because the hormone oxytocin is released when the newborn suckles. That's why you may notice more intense contractions when you nurse. Breastfeeding speeds involution, causing nursing mothers to bleed less. In the hospital, medical staffers will press on your abdomen to be sure the uterus feels firm, rather than mushy, a sign that it's contracting properly You can also massage the area to speed healing. A second-time mother, or one who had twins or more, tends to have severe afterpains because her uterus is more stretched, requiring more contracting. What to do You may be given pain relievers immediately after delivery (most are safe for nursing). Acetaminophen or ibuprofen are safe, common choices. Other ways to ease cramps are to empty your bladder frequently to give the uterus room or to lie on your stomach on a pillow or apply warm compresses. Also try whatever nonmedical tactics you've used successfully to relieve menstrual cramps, or use the relaxation and breathing exercises that helped you through labor contractions. Perineal
Pain What is it Recovery from an episiotomy or tear may be the most excruciating
aspect of your physical recovery. Many mothers are surprised to discover
that walking, and even sitting, is painful, especially if the stitches are extensive. That's because the skin in the perineum (the area between the vagina and rectum) tends to swell after trauma, tightening the stitches. Compounding the misery are common (albeit unwarranted) fears about straining the stitches during ordinary movement or elimination. Plus, it's hard to see the site and get a good mental picture of why you hurt so much. (The stitches dissolve on their own and do not have to be removed.) What to do To ease pain, keep the area clean. You'll probably be given a plastic squirt bottle (sometimes called a peri bottle) to fill with a special antiseptic or warm water for cleansing after you use the bathroom. Gently pat the area dry from front to back. You may also be given a topical analgesic spray or cold witch
hazel compresses (such as Tucks pads). Acetaminophen or ibuprofen pills help too, and won't interfere with nursing.
Two other standard comfort measures for perineal pain are ice packs and sitz baths. To make a perineal ice pack, soak several large sanitary napkins in water and squeeze out the excess, then freeze. A sitz bath is a hot-water soak. In the hospital, you may be given a special shallow, plastic pan; it fits over the toilet and can be hooked up to a water dispenser to provide a constant flow of water. (Sitz baths are also available in pharmacies.) The pan and dispenser are filled with water as warm as you can tolerate, and you sit in the flow for up to 20 minutes. Some doctors recommend ice-cold sitz baths to numb pain. Repeated several times a day during the first week, a sitz bath soothes traumatized tissues. If toweling the area afterward (or after showering) hurts, try using a blow-dryer on a cool setting instead. Hemorrhoids
Constipation What is it The same veins in the anal area that may have enlarged during pregnancy can worsen after the added strain of labor and delivery. While painful, they tend to disappear within a few weeks. What to do Relief measures include over-the-counter topical ointments (such as Preparation H), witch hazel compresses, ice packs, and sitz baths. Although sluggish bowels are common for the first couple of days postpartum, constipation can result if pain causes you to hold in your bowel movements. You may be given a stool softener in the hospital to help minimize stress during a BM. Also, drink lots of fluids and eat foods that contain fiber (fresh or dried fruits, vegetables, bran cereal, 100 percent whole wheat bread) to keep your digestive system working smoothly Drinking water, juice, and milk is especially important because your body is directing its fluid stores toward milk production. Urinary Problems What is it A need to urinate frequently is normal. Fluids accumulated
in your tissues during pregnancy must be shed. (Some women perspire profusely or have night sweats as well.) Don't assume that an increased need to use the bathroom is a sign to cut back on the amount of liquids you're drinking. To the contrary, continuing to drink eight or more glasses of water a day helps circulation, promotes milk production, and combats constipation and dehydration.
Some women also develop stress incontinence, a reduced ability to control urine flow, or a leakage of urine when they cough or sneeze. (If you had this problem during pregnancy, it may worsen postpartum.) What to do To help regain control, empty your bladder frequently and practice Kegel exercises. Most postbirth incontinence clears up within a month; if not, be sure to inform your doctor at your postpartum checkup because it's easily remedied with Kegels, pelvic inserts to strengthen muscles, or medication. Surgery may be advised as a last resort. Engorgement What is it Expect your milk to come in about 2 to 4 days after you give
birth. Before that, your breasts produce colostrum, a thin but rich liquid that is sufficient to nourish your baby even in small amounts. How will you know when the real thing kicks in? Your breasts will grow bigger, more tender, and hotter to the touch. Sometimes they overfill at first, a painful condition known as engorgement. When this happens, the breasts feel hard and tight. The best way to ease discomfort is to feed your baby on demand, at least ten to twelve times per 24 hours for the first few weeks. At first, it may be hard for the baby to latch on if the breasts are too full; if this is the case, try expressing a little milk manually or with a pump. What to do Ease the discomfort of engorgement with warm towel compresses or a warm shower. The problem clears up in a day or two as your baby begins regular feedings and the milk supply starts to regulate. The breasts then soften and feel more normal, although they will remain one or two cup sizes larger than they were during pregnancy.
You can prevent engorgement by not going longer than 3 hours between feedings, even at night, during the first week postpartum. Engorgement can recur anytime you go too long between feedings (or pumpings), but it's most common when milk first comes in and in the early weeks until a feeding pattern is established. If you don't plan to nurse, your milk glands will cease production naturally When no milk is used by an infant, the supply dries up. In the lag before this happens (usually several days), you'll experience some engorgement. The best way to avoid pain-which is also best for your baby-is to breastfeed at least for the first 2 weeks. Then taper off slowly, replacing breastfeedings with formula feedings (replace one feeding every 2 days or so). This not only prevents engorgement but also enables your baby to benefit from colostrum, the pre-milk substance that protects against disease. (The medication, bromocryptine, trade name Parlodel, was once routinely given to nonnursing mothers to dry up the breasts and to treat engorgement. The U.S. Food and Drug Administration withdrew approval for this drug for these uses on the grounds that its risks, including stroke and death, outweighed its benefits.) Sleep Deprivation What is it Not getting enough sleep because of 'round-the-clock feedings just as your recovering body needs it most can actually slow recuperation and cloud your emotions. Things that intensify fatigue include producing breast milk, postpartum anemia, poor nutrition (including a lack of potassium), and postpartum depression. What to do You can minimize the ill feeling of sleep deprivation with catnaps, healthful eating, and fresh air. This is another reason postpartum helpers are so important.