No matter what kind of a pregnancy, labour or delivery journey you might have or have had, they are all unique and physically and emotionally daunting. Your body and mind undergo a lot of changes when you grow a human inside of you and naturally there are bound to be some effects of it in the recovery period as well. This after-birth period or postpartum can last for about 6-8 weeks, according to Hyderabad-based obstetrician and gynaecologist Dr. Anuradha Panda of Apollo Hospitals.
Postpartum symptoms may include bleeding, cramps, sore breasts, hot flashes and, in some cases, postpartum depression (PPD), which is why pediatrician and author of The Happiest Baby On The Block, Dr. Harvey Karp coined the 12 weeks after giving birth as the fourth trimester. However, Dr. Panda reassures that most of these symptoms resolve on their own. Your body is extremely powerful and can repair itself fairly quickly after birth with a little bit of TLC. But it does help to take extra care of yourself while you nurture your baby. Remember to eat well, rest when you can and go to all your postpartum check ups.
Although it is hard to stay active when you have a small baby, getting some form of gentle exercise can make you feel more energetic and will improve your mood. However, do ignore all nudges to “bounce back” to your pre-pregnancy self. We all heal at our own pace. Dr. Panda suggests, "wait for at least 6 weeks to 2 months after delivery to exercise. In case of a C-section, wait 2 to 2.5 months". If any symptom becomes extreme or lasts too long, do not hesitate to contact your doctor.
1. Abdominal cramps
Your uterus grows and stretches a lot to accommodate the baby throughout the nine months. After delivery, it slowly contracts to its usual size (about 7.6 centimetres in length) and can cause contraction-like pains in the abdomen. “These pains can also occur while you’re breastfeeding or pumping milk,” Dr. Panda notes. Anita Holdcroft et al, in their paper for the journal Pain, conclude that “pain, referred pain, and uterine contractions during breastfeeding in the immediate postpartum period increase with parity (multiple births), suggesting that childbirth can induce central neural changes that increase predisposition for pain during the postpartum period”. These cramps will go away in a few weeks, but in the meantime, prescribed pain-relief medications (if any), heat pads, keeping your bladder empty, warm baths, and walking around are some of the ways to ease postpartum pain.
2. Sore breasts
From the beginning of your pregnancy to after delivery, you will notice a lot of changes in your breasts. These include swelling (due to lactation), soreness and sensitivity, nipular and areolar enlargement, stretch marks, itchiness etc. Breastfeeding or pumping regularly and learning the proper nursing technique is crucial to mitigate these issues. “If the baby latches well and sucks on the entire areola, you have lesser chances of having sore nipples,” says Dr. Panda. If you have trouble nursing or pumping, you can contact a lactation consultant for advice. Ask your doctor for nipple creams to help with the soreness and discomfort. Massages, warm baths, warm compress and switching between breasts while nursing/pumping can also help.
3. Heavy bleeding
You should stock up on sanitary pads and avoid tampons or menstrual cups in postpartum. Your uterus will expel all the residual blood and tissue from your pregnancy. This heavy discharge, which can often include clots, is known as lochia. A study of 477 postpartum women in the Philippines, as published in Obstetrics and Gynecology, revealed that “lochia lasted substantially longer than the conventional assumption of 2 weeks. It was common for postpartum bleeding to stop and start again or to be characterised by intermittent spotting or bleeding. Return of menses (periods) is rare among fully breast-feeding women in the first 8 weeks postpartum”.
Your hair thinning and falling out in clumps months after your pregnancy is normal and expected. Though alarming, It is completely natural, temporary and more apparent because high levels of estrogen had given you thicker hair during the gestation period. In a 2018 paper, published in ResearchGate, titled “Postpartum Hair Loss Causes And Prevention Of Postpartum Hair Loss”, author Divraj Bajwa explains that “A hair development cycle involves two stages, in particular, the anagen (development stage) and telogen (resting stage). Around 90% of hair develops at some random time while about 10% stays in the resting stage and in the long run falls. After delivery, the estrogen level returns to ordinary, making more hair follicles enter the telogen/resting stage. This prompts unnecessary hair fall after delivery”. A nutritious diet, natural hair masks made of eggs and/or curd, oiling your hair and avoiding harsh styling can all help.
5. Night sweats
According to a 2014 study published in the journal Fertility and Sterility, hot flashes or night sweats is usually considered a menopause symptom but was also reported in over a third of their participants both during pregnancy and/or postpartum. Since your estrogen levels fall after pregnancy and while breastfeeding, it can mimic the effects of menopause and cause this symptom. Though the duration of postpartum night sweats varies from person to person, it is temporary and there are ways to cope. Dress in light clothing, drink lots of fluids to stay hydrated and keep absorbent materials at hand while sleeping. You can also lay towels on your bed to absorb some of the moisture.
The first stool after giving birth can be difficult as the pressure of the uterus, labour and delivery can cause constipation and haemorrhoids (swollen veins near the anus). A 2015 paper in the Cochrane Database of Systematic Reviews says that tough or incomplete bowel movement can be painful and uncomfortable, especially if you have perineal (the area between your genitalia and anus) tears after a vaginal delivery. You should not strain bowel movements and let it happen naturally. To ease constipation, you should eat lots of fibre, drink water, buy haemorrhoid creams if needed and consult your doctor if you should take any laxatives.
7. Urinary incontinence
No matter what kind of delivery you may have, you will probably have trouble urinating the first few days after birth. These issues may include a burning sensation while peeing, not being able to pee or not being able to stop peeing (urinary incontinence). The last issue occurs due to the pressure of the baby on your pelvic muscles. In their article for The British Medical Journal, Pauline Chiarelli and Jill Cockburn have lamented that postpartum urinary incontinence is an often overlooked morbidity. Though there is no single cause or preventive measure, they suggest that “new mothers are likely to benefit from routine symptom screening and early discussion of healthy bladder habits and proper muscle techniques as part of their postpartum care”. A good way of promoting your pelvic muscle strength is doing Kegel exercises (contraction and relaxation of pelvic floor muscles) both during pregnancy and in postpartum.
8. Postpartum depression
Feelings of stress, exhaustion and anxiety are natural after birth, especially if it’s your first time. Taking care of a baby while recovering yourself and adjusting to all the major changes is not the easiest and can take a toll on your mental health. Postpartum depression (PPD) can debilitate your day-to-day life. It can hamper your performance and may necessitate medical intervention. According to a 2019 study by the journal BMC Pregnancy and Childbirth, almost a quarter of the participant mothers suffered from PPD. Remember to reach out for help from your partner, family, friends, support groups of new parents etc. Try to sleep and eat well as much as you can. If you feel overwhelmed, Dr. Panda recommends counselling as a completely viable option.