Mayo Clinic Guide to a Healthy Pregnancy: From Doctors Who Are Parents, Too!

CHAPTER 18. Issues for mom

After having your baby, you may wonder if your body will ever return to normal. Take heart; it will! But it does take time to recover from the changes that occurred over the previous 10 months. It’s not realistic to expect to bounce back quickly after giving birth, but over time you will start to feel better physically and get back in shape. This chapter discusses some of the issues you may deal with in the coming weeks as your body goes through a variety of changes.

If you had a cesarean birth, you can expect a few additional discomforts and precautions during the postpartum period. See Chapter 15, “Cesarean birth,” for information about recovering from a cesarean delivery.

BREAST CARE

With breast-feeding, your breasts will remain enlarged for most of the time you are nursing. To keep them comfortable, wear a good-quality, well-fitting bra. Gently clean your breasts and nipples daily with water or baby lotion, but avoid using soap. Soap can aggravate sore or cracked nipples.

If you don’t breast-feed, the enlargement you notice during pregnancy will gradually disappear during your baby’s first month of life.

Engorgement For the first few days after you have given birth, your breasts contain colostrum. Within a few days, they’ll fill with milk. Your breasts may become larger and heavier, flushed, swollen and tender, whether or not you breast-feed. If you decide not to nurse your baby, your breasts may be engorged and hard until you’re no longer producing milk. Engorgement usually lasts less than three days, but it can be uncomfortable. Even if you’re breast-feeding, your breasts may at times overfill and become engorged. To ease engorgement:

 Express a little milk, either manually or by feeding your baby.

 Apply warm or cold washcloths or ice packs, or try a warm bath or shower.

 Wear a tight-fitting bra.

Leaking milk If you’re breast-feeding, don’t be surprised if you leak milk during and between feedings. Milk may drip from your breasts anytime, anywhere and without warning. As many new mothers can attest, you might find yourself leaking when you think or talk about your baby, hear a baby cry or go for a long stretch between feedings. Milk may leak from one breast while you nurse from the other. This is common, particularly in the early weeks. To deal with leaky breasts:

 Stock up on nursing pads, but avoid those that are lined or backed with plastic because they can irritate your nipples. Change pads after each feeding and whenever they become wet.

 Place a large towel under yourself at night when you sleep.

Sore or cracked nipples When you begin breast-feeding, your nipples may feel sore or tender. This is a common problem in the early weeks and can happen even if your baby is positioned perfectly and you’re doing everything right.

Some women are surprised at how vigorously their babies suck — and how uncomfortable it can be. It takes some time to get used to the sensation of baby feeding. However, the tenderness usually disappears after a few days. If you develop a sore nipple that becomes cracked, this can be very painful and can lead to breast infection (mastitis).

Follow these suggestions to prevent and treat sore or cracked nipples:

 Make sure your baby is latched on to your breast correctly, and take care when removing the baby from your breast. To help your baby get the nipple fully into his or her mouth, compress the areola by lifting the breast with your fingers and compressing the areola with your thumb, to help baby get the right grasp on the nipple.

 Expose your nipples to air and let them air-dry between feedings. You might occasionally go topless.

 Avoid nursing pads with plastic linings and clothes made of synthetic fabrics. They can irritate your nipples. You might want to apply a drop of baby lotion to each breast pad.

 Try using a breast shield. The shield fits over the nipple, and the baby sucks through it.

 If a nipple becomes cracked, you may need to keep your baby off that breast for a few days and express milk with a pump to avoid engorgement.

Blocked ducts In the early weeks of breast-feeding, a milk duct may become blocked as a result of engorgement, a too-tight bra or a blocked nipple opening. If you experience a blockage, you will feel a soft to somewhat dense lump that is quite tender to the touch. To clear a blocked duct, start feedings with the affected breast and gently massage it while feeding. You may also try massaging the breast toward the nipple while you take a shower.

Call your care provider if you have constant pain, feel sick or have a fever. This may signal a breast infection (see mastitis in Chapter 29).

BOWEL AND URINATION PROBLEMS

For the first few days to weeks after birth, going to the bathroom can be an un-comfortable experience. It takes a while for damaged tissues to heal and urination and bowel movements to return to how they were before you gave birth.

Bowel movements You may not have a bowel movement for a few days after delivery. That’s because of a lack of food during labor and how empty your bowels may have become during labor, and because the muscle tone in your intestines may be temporarily decreased. A delayed bowel movement is not unusual, but it increases your risk of constipation.

In addition, you may find yourself holding back from passing stools out of fear of hurting your perineum or aggravating the pain of hemorrhoids or an episiotomy wound, or from fear of incisional pain following a C-section. Straining will not disrupt the incision.

If you still haven’t had a bowel movement four days after your child was born, contact your care provider.

Another potential problem for new moms is fecal incontinence — the inability to control bowel movements. This may be caused by the stretching and weakening of pelvic floor muscles, tearing of the perineum or nerve injury to the muscles around the anus. You’re more likely to experience fecal incontinence if you had an unusually long labor or a difficult vaginal delivery.

Kegel exercises, which are discussed in Chapter 12, can help return tone to your anal muscles, but ask your care provider when to begin Kegels, especially if you had surgical repair after delivery.

To prevent constipation and help promote regular bowel movements:

 Drink plenty of fluids.

 Eat more fiber-rich foods, including fresh fruits and vegetables and whole grains.

 Keep as physically active as possible.

 Try using stool softeners (Colace, Surfak, others) or fiber laxatives (Citrucel, FiberCon, others).

Hemorrhoids During your pregnancy you may have developed hemorrhoids. Some women may not notice hemorrhoids until after delivery. If you experience pain during a bowel movement and feel a swollen mass near your anus, you may have a hemorrhoid. Hemorrhoids are worsened by constipation and the need to strain. To help avoid these problems:

 Eat a fiber-rich diet, including fresh fruits and vegetables and whole grains.

 Drink plenty of liquids; water is best.

If your stools are still too firm, try using stool softeners or fiber laxatives.

For additional information on how to relieve hemorrhoidal discomfort, see hemorrhoids in the Symptoms Guide. If you continue to have problems, talk to your care provider, who might suggest a prescription medicine.

Urine leakage If you had a vaginal delivery, it is not uncommon to experience a brief period of time when you leak a small amount of urine each time you laugh, cough or strain. This results from the stretching of the muscles and connective tissues of the vagina that support the base of the bladder.

For most women, this is a temporary problem that improves within a few months after baby is born. In the meantime, you may need to wear sanitary pads, especially if you’re physically active. Doing Kegel exercises (see Chapter 12) can also lead to quicker recovery of your bladder control.

Difficulty urinating After giving birth, you may sometimes experience a hesitancy or a decreased urge to urinate. This may be the result of swelling or bruising of the muscles and nerves of the perineum and the tissues surrounding the bladder and urethra, perineal pain, or the fear of the sting that occurs when urine touches your tender perineal area.

To encourage urine flow:

 Contract and release your pelvic muscles.

 Drink more fluids.

 Place hot or cold packs on your perineum.

 Try straddling the toilet saddle style when you urinate.

 Try urinating while in the shower.

 Pour water across your perineum while you urinate.

The problem usually develops immediately after delivery. If it develops once you are home, let your care provider know. If you experience burning during urination or an intense, painful and unusually frequent urge to urinate, you may have a urinary tract infection. Contact your care provider if you have these signs and symptoms, or you suspect you aren’t completely emptying your bladder.

HEALING

You may experience some aches and pains after delivery, but generally they’re mild and go away within a few days to weeks.

Afterpains After your baby’s birth, your uterus begins shrinking immediately, decreasing to its normal size over about six weeks. Contractions of your uterine muscles cause this shrinking. The contractions, which may feel somewhat similar to labor pains, are also important to prevent bleeding at the site where the placenta was attached. These afterpains are often mild after the birth of your first baby. They’re usually more noticeable and painful if you’ve had a previous child.

Afterpains tend to be more intense when you’re breast-feeding, because the baby’s sucking triggers the release of the hormone oxytocin, which also causes your uterus to contract.

You may find some relief from afterpains by breathing slowly and relaxing. If your cramps are causing a lot of discomfort, your care provider may prescribe a pain medication. Many medicines are safe even if you’re breast-feeding. See your care provider if you have a fever or the pain persists for more than a week, as these signs and symptoms could indicate a uterine infection.

Episiotomies and tears If you received stitches after delivery due to an incision to widen the vaginal canal (episiotomy) or due to a tear, the stitches will gradually dissolve. You may feel discomfort for up to two weeks, but it should gradually improve during this time. As with any surgical wound, the tissue around an episiotomy or a tear takes about six weeks to regain its natural strength. Very rarely with an extensive tear, the tenderness may continue for a month or more. Those weeks can be a bit tough because it can be painful to sit while the episiotomy or tear heals, but you should experience steady improvement.

To ease your discomfort:

 You may want to squat rather than sit when you use the toilet. A squirt bottle of water is helpful for rinsing afterward.

 Gently cooling the wound with ice can decrease swelling. You could try placing ice in a washcloth or rubber glove or using an ice pack.

 Special perineal pads that fit between a sanitary napkin and the wound are soothing. Chilled witch hazel pads also may help.

 Keep the wound clean. Warm baths and showers may be soothing.

 You may find it more comfortable to sit on hard surfaces because soft surfaces allow your bottom to stretch and pull on the stitches. Squeeze your buttocks together when you lower yourself to sit on a soft surface.

 Do Kegel exercises frequently, unless special circumstances cause your doctor to tell you not to. You can start a day or two after birth.

 When you move your bowels, you may fear the pressure will stretch your tissues and cause more pain around the wound. To prevent stretching, hold a clean pad firmly against the stitches and press upward while you bear down.

 If your wound becomes hot, swollen and painful or produces a pus-like discharge, you may have an infection. Call your care provider.

Vaginal discharge As your uterus sheds its lining and returns to its normal size after birth, you’ll have a vaginal discharge known as lochia. It varies widely in amount, appearance and duration, but it typically starts off as a bright red, heavy flow of blood. After about four days, it gradually diminishes and becomes paler, changing to pink or brown, and then to yellow or white after about 10 days. The vaginal discharge can last from two to eight weeks.

To reduce the risk of infection, use sanitary napkins rather than tampons. Don’t be alarmed if you occasionally pass blood clots — even if they’re as large as a golf ball.

Call your care provider if:

 You’re soaking a sanitary pad every hour for more than a few hours or you feel dizzy.

 The discharge has a foul odor.

 Your bleeding increases and you’re passing numerous clots.

 You pass clots larger than a golf ball.

 You have a temperature of 100.3 F or higher.

 You have new abdominal pain.

GETTING BACK INTO SHAPE

It’s one thing to look five months pregnant when you are five months pregnant, but it’s no fun to look that way after you’ve given birth. However, that’s the way it is for most women. Don’t be surprised if you need to wear some of your maternity clothes the first few weeks after delivery. That’s because it takes a while for your body to lose fat and regain muscle tone. It also takes time for other parts of your body, such as your skin and hair, to return to their pre-pregnancy appearance. Give yourself at least a month or more to shed that exhausted look!

Fatigue During the first weeks of caring for a newborn baby, many mothers feel a fatigue that never seems to let up and a definite lack of energy. After the tiring work of labor, you’re hit with the round-the-clock rigors of taking care of the baby. Night after night of interrupted sleep and the energy required for breast-feeding and carrying around a baby can add to your exhaustion. Fatigue may be even more pronounced if you have other children, if your baby was premature or has health problems, if you had multiple babies or if you’re a single parent.

Over time, your fatigue will likely lessen as your body adjusts to the demands of motherhood, you gain experience in dealing with your baby, and the baby sleeps through the night.

You most likely won’t be able to completely avoid being tired, but these tips may keep fatigue from depleting you:

 Try to rest whenever you can. Take advantage of your baby’s daytime naps to get some sleep yourself.

 Enlist your partner to share the work of baby care and household chores. Accept offers of help from other people, too.

 Try not to do too much. Cut back on less important tasks, such as housework.

 Limit the number of guests you have and, at first, don’t allow guests who want to be entertained.

 Exercise regularly to increase your energy level and help you fight fatigue. Eating well also is important, but don’t eat too much late at night because digestion can interfere with your sleep.

 Go to bed early and unwind by listening to music or reading.

 If your fatigue doesn’t improve over time, check with your care provider.

Hair and skin You’ll likely notice some changes in your hair and skin after the birth of your baby.

Hair loss For some women, one of the most noticeable changes after delivery is hair loss. During pregnancy, elevated hormone levels keep you from losing hair at the usual rate — which probably gave you an extra-lush head of hair. After the birth, your body sheds all that excess hair. Don’t worry — the loss is temporary, and by the time your baby is 6 months old, your hair will probably be back to normal.

To keep your hair healthy, eat well and continue taking a vitamin supplement. Ask your hairdresser for a cut that’s easy to maintain. You may want to put off coloring your hair or having a perm until your hair seems back to normal.

Red spots Small red spots on your face after the birth are caused by small blood vessels breaking during the pushing stage of labor. The spots usually disappear in about a week.

Stretch marks Stretch marks won’t disappear after delivery, but over time they fade from reddish purple to silver or white (see stretch marks in the Symptoms Guide).

Skin darkening Skin that darkened during pregnancy, such as the line down your abdomen (linea nigra) and the mask of pregnancy (skin darkening on the face), fade slowly over several months. They rarely go away completely.

Weight loss After you give birth, you may feel very flabby and out of shape. In fact, you may look in the mirror and feel like you’re still pregnant! This is perfectly normal. Very few women can slip back into a tight pair of jeans a week after having a baby. Realistically, it will probably take three to six months or longer to get back to the shape you want to be at.

You’ll probably lose more than 10 pounds during birth, including the weight of the baby, the placenta and amniotic fluid. During the first week after delivery, you’ll lose additional fluid weight. After that, the amount of weight you lose will depend on your diet and how much exercise you get. Look for a gradual reduction in your weight — about a pound a week — if you follow a healthy eating plan and you exercise on a regular basis.

To lose your pregnancy weight, it’s important to eat well and exercise. Instead of cutting back significantly on how much you eat, skipping meals or going on a fad diet, focus on eating healthy foods, including vegetables, fruits, whole grains and low-fat sources of protein. You basically want to follow the same healthy-eating plan you did while you were pregnant, with perhaps a reduction in calories.

Exercise Regular daily exercise is very good for you. It can help you recover from labor and delivery, restore your strength and get your body back to its pre-pregnancy shape. In addition, exercise can increase your energy level and help you fight fatigue, and it can improve your circulation and help prevent backaches. Physical activity also brings important psychological benefits. It can boost your sense of well-being and improve your ability to cope with the stresses of being a new parent.

If you exercised before and during pregnancy and had an uncomplicated vaginal delivery, it’s generally safe to resume exercising as early as 24 hours after delivery or as soon as you feel ready. About a day after you give birth, you can start doing Kegel exercises and gradually work up to 25 or more repetitions several times a day. If you had a cesarean or complicated birth, talk to your care provider about when and how to start an exercise program.

Even if you had an easy delivery, you’ll need to start off slowly and carefully when you begin exercising. Don’t try to do too much too soon or expect to return immediately to your pre-pregnancy level of exercise. Walking and swimming are excellent activities to help you get back in shape. The key is to begin slowly and pick up the pace and distance as you feel up to it. Some new moms take part in and enjoy exercise classes designed especially for women who have just had a baby.

Here are some tips for exercising after giving birth:

 Exercises to tone and strengthen your abdominal and pelvic floor muscles are especially important after giving birth. The exercises help restore abdominal strength, tone and flatten the abdomen, and help you maintain good posture. Exercise also can help heal an episiotomy, prevent incontinence and re-establish control of the anal muscles.

 Start with a series of small, achievable fitness goals — aim for moderate rather than high-intensity workouts. Exercise a few times a day in brief sessions rather than for one long period.

 Choose activities you can do with your baby, such as walking with a stroller or baby carrier, dancing with the baby and jogging with a jogging stroller.

 Wear a supportive bra and comfortable clothing.

 If you’re breast-feeding, you’ll probably feel more comfortable if you feed your baby shortly before you exercise.

 Avoid jumping and jerky, bouncy or jarring motions during the first six weeks after childbirth. It’s also a good idea to avoid certain floor exercises: deep flexion or extension of joints, knee-to-chest exercises, full sit-ups and double leg lifts.

 Don’t overdo it. Stop before you feel tired, and skip your workout if you’re feeling particularly exhausted. Stop exercising immediately if you experience pain, faintness, dizziness, blurred vision, shortness of breath, heart palpitations, back pain, pubic pain, nausea, difficulty walking or a sudden increase in vaginal bleeding.

 Drink plenty of liquids before, during and after exercising.

 Stick with it. Even after you lose your pregnancy weight, physical activity brings many physical and mental health benefits.

THE BABY BLUES

Most new mothers may feel depressed to some degree after giving birth. The abrupt drop in levels of the hormones estrogen and progesterone after childbirth, compounded by a loss of sleep, likely causes the baby blues and contributes to postpartum depression.

Causes Hormonal changes, however, aren’t the only factor. If you’re feeling overwhelmed, it’s natural to feel depressed. Other possible contributing factors include the many physical changes your body goes through after delivery, difficulties during your pregnancy or labor, the letdown after an exciting event, changes in your family’s finances, unrealistic expectations of childbirth and parenting, inadequate emotional support, and relationship and identity adjustments.

Some men also experience symptoms of depression after their babies are born. Men whose partners have postpartum depression are at particular risk of experiencing depression themselves.

Signs and symptoms The baby blues, a mild form of depression, is common among new mothers. Signs and symptoms include episodes of anxiety, sadness, crying, headaches and exhaustion. You may feel unworthy, irritable and indecisive. After the initial excitement of having the baby wears off, you may find that the reality of motherhood seems difficult to cope with. The baby blues usually occur about three to five days after the birth and last about a week to 10 days.

You can help recover more quickly if you get extra rest, eat a healthy diet and get regular exercise. In addition, try to express your feelings by talking about them, particularly with your partner.

Is it more than the blues? If these measures don’t help, you may have a more severe form of depression (see postpartum depression in Chapter 29). Talk with your care provider if your symptoms are severe or last longer than a few weeks.

DEALING WITH THE BLUES

If you find yourself struggling with the baby blues, try these tips:

 Shower every morning and get dressed. Looking good will help you feel good.

 Don’t lie around. Physical activity helps boost levels of endorphins, body chemicals that give you a natural high.

 Eat well. You’ll feel better if you munch on healthy snacks than if you load yourself down with carbs and sugar.

 Get out of the house. Some fresh air, a change of scenery and casual conversation can help stave off feelings of gloom and doom.

BABY BONDING

As soon as babies are born, they need and want you to hold, cuddle, touch, kiss, talk and sing to them. These everyday expressions of love and affection promote bonding. They also help your baby’s brain develop. Just as an infant’s body needs food to grow, his or her brain benefits from positive emotional, physical and intellectual experiences. Relationships with other people early in life have a vital influence on a child’s development.

Some parents feel an immediate connection with their newborn, while for others the bond takes longer to develop. Don’t worry or feel guilty if you aren’t overcome with a rush of love at the very beginning. Not every parent bonds instantly with a new baby. Your feelings will become stronger with time.

Give it time At first, most of your time with your new son or daughter is likely to be spent feeding him or her, changing diapers, and helping little one sleep. These routine tasks present an opportunity to bond. When babies receive warm, responsive care, they’re more likely to feel safe and secure. For example, as you feed your baby and change diapers, gaze lovingly into his or her eyes and talk gently to him or her.

Babies also have times when they’re quietly alert and ready to learn and play. These times may last only a few moments, but you’ll learn to recognize them. Take advantage of your baby’s alert times to get acquainted and play.

To bond with and nurture your baby:

 Don’t worry about spoiling your newborn. Respond to your child’s cues and clues. Among the signals babies send are the sounds they make — which will be mostly crying during the first week or two — the way they move, their facial expressions and the way they make or avoid eye contact. Pay close attention to your baby’s need for stimulation as well as quiet times.

 Talk, read and sing to your baby. Even infants enjoy music and being read to. These early “conversations” encourage your baby’s language capacity and provide an opportunity for closeness. Babies generally prefer soft, rhythmic sounds.

 Cuddle and touch your baby. Newborns are very sensitive to changes in pressure and temperature. They love to be held, rocked, caressed, cradled, snuggled, kissed, patted, stroked, massaged and carried.

 Let your baby watch your face. Soon after birth, your newborn will become accustomed to seeing you and will begin to focus on your face. Allow your baby to study your features, and provide plenty of smiles.

 Play music and dance. Put on some soft music with a beat, hold your baby’s face close to yours and gently sway and move to the tune.

 Establish routines and rituals. Repeated positive experiences provide children with a sense of security.

Be patient with yourself in these first weeks. Caring for a new child can be daunting, discouraging, thrilling and perplexing — all in the same hour! In time, your skills as a parent will grow, and you will come to love this little one far more than you could have imagined.