Pregnancy, Childbirth, and the Newborn: The Complete Guide, 4th Ed.

CHAPTER 15 What Life Is Like for a New Mother

The days, weeks, and months that follow your baby’s birth are a time of major physical, emotional, and social readjustment and recovery.

After the birth, your reproductive organs return to their prepregnant state (usually within six weeks). You begin to lose the extra weight you gained during pregnancy. Your breasts begin to produce milk. These physical changes are normal, but they can seem more difficult than you expected.

During the first weeks, most new parents experience sudden mood changes. You may feel joyous and energetic one moment, then exhausted, let down, or even disappointed the next. Caring for your baby may also upset the equilibrium within your family until you can adjust your roles and schedules.

This chapter describes the typical changes that can affect the lives of a new mother and her family, and offers ways to help smooth your adjustment to parenthood.

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In this chapter, you’ll learn about:

• Factors that affect your recovery after birth and adjustment to life as a new parent

• What you can expect during your physical and emotional recovery and how you can help speed healing

• Warning signs that can indicate a problem with your recovery

• Adapting to parenthood and how it changes your life

Factors That Influence Your Adjustment to Postpartum Life

Every woman adjusts to life with a new baby differently. Some women seem to find a comfortable balance in their lives within weeks. Others take months to adjust, and some never do.

Why do some women adjust to postpartum life more easily than others do? Numerous factors can influence the adjustment process. Some factors are internal, such as the health of the pregnancy. Others are external, such as the strength of a new mother’s support network.

The following are favorable or positive factors that can help ease your adjustment to parenthood. The more of these factors you have, the more likely your adjustment to postpartum life will be smooth. The fewer of these factors you have, the more likely your adjustment will take longer than the typical eight to twelve weeks. You might not be able to control some of these factors, but developing a postpartum plan can help improve others. (See Chapter 8.)

Before pregnancy

• Positive experience with how you were raised

• Good mental and physical health (you and your family)

• Minimal exposure to trauma

• Positive experience with previous pregnancies, births, and baby care

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During pregnancy

• Planned pregnancy

• No pregnancy complications

• Pregnant with only one baby

• No need for prolonged bed rest or treatment for a high-risk pregnancy

• Minimal financial worries

• Physically undemanding job

• Adequate sleep

• Good relationship with the baby’s father or your partner

• Presence of other supportive people

During labor and birth

• Normal, uncomplicated birth

• Presence of continuous, competent care and support from staff, your partner, and other support people

Early postpartum period

• Immediate contact with your baby (including breastfeeding)

• Minimal postpartum pain

• Good health (you and your baby)

Later postpartum period

• Delaying the return to employment until you feel ready

• Your baby’s easy temperament and continuing health

• No feeding problems

• Adequate sleep for the whole family

• Positive emotional state

• Continuing supportive relationships with your partner, family, and friends

Your Care in the Days Following the Birth

If you have a vaginal birth in a hospital, your postpartum stay is typically one to two days (unless a medical reason necessitates a longer stay). If you have a cesarean birth, your stay is usually two to four days. At a freestanding (unaffiliated with a hospital) birth center, your stay is typically three to six hours. At a home birth, your midwife leaves about three to four hours after the birth.

Before leaving the hospital or birth center (or your midwife leaves your home), ask your caregiver for information on newborn care and postpartum recovery. If you’re birthing at a hospital, attend classes offered on these topics during your stay.

Ideally, your caregiver and your baby’s caregiver (or a mother/infant nurse) should examine you and your baby on the third or fourth day after the birth, to detect jaundice, dehydration, or excessive weight loss in your baby and to check your physical recovery, help you with any feeding challenges, assess and treat pain, and answer your questions about baby care. If you develop pain or a fever before this scheduled visit—or if your baby looks yellow (see page 389), has trouble feeding, or seems sleepy or listless—request an appointment for as soon as possible.

Learn about possible warning signs that indicate problems with your health or your baby’s health (see pages 337 and 393). Contact your caregiver and your baby’s caregiver with any health concerns. For non-medical concerns, your childbirth educator, a breastfeeding counselor, doula, or experienced parents may provide helpful advice and information.

Your Physical Recovery: Early Postpartum Period

Immediately after the birth, your caregivers will closely observe your physical condition. They’ll frequently check your temperature, pulse, respiratory rate, and blood pressure. They’ll monitor vaginal bleeding; your uterus’s size, firmness, and position; and the functioning of your bladder and bowels. If you had anesthesia, they’ll monitor the return of feeling and movement in your legs.

UTERUS

Your uterus returns to its prepregnant size—a process called involution—about six weeks after the birth. Immediately after the birth of your placenta, you can feel the top of your uterus (fundus) at your navel. Your uterus involutes (drops) the width of one finger each day and is firm and tight to prevent heavy blood loss from the site where the placenta attached to your uterus. Soon after the birth, you or your nurse massages your uterus, stimulating it to contract. (See page 270 for instructions.) Nursing your baby also helps stimulate the uterus to contract.

As your uterus contracts, you may experience discomfort or pain. These afterpains often occur during breastfeeding and are more common if you’ve given birth before. To ease the pain, relax and use slow breathing patterns (see page 224). Ibuprofen or prescribed medications may also help. Afterpains typically disappear after the first week.

Lochia is the bloody, fleshy-smelling discharge that flows from your uterus and out your vagina for up to six to eight weeks after the birth. For the first few days, the flow looks like heavy menstrual flow. Passing jellylike clots is normal, especially in the first days. The flow amount may change with your activity or body position. Lochia is heavier when you change positions, are overactive, breastfeed, or have a bowel movement. If flow increases, remind yourself to slow down and rest. Within ten days, lochia diminishes and becomes pale pink or rust in color. Over the next several weeks, it becomes white, yellowish white, or tan. (See page 337 for warning signs.)

If you’re not breastfeeding, you’ll probably resume menstruation four to eight weeks after the birth. If you’re breastfeeding, you might not menstruate for several months or until you wean; however, you can become pregnant, because you may ovulate before your period returns. Your first few periods may be heavier and longer than usual or they may be lighter than usual, but they’ll eventually return to normal.

CERVIX AND VAGINA

As your uterus approaches its prepregnant size, so does your cervix. After the birth, your vagina gradually regains its tone, and your labia remain somewhat looser, larger, and darker than before pregnancy.

BREASTS

For the first twenty-four to seventy-two hours after the birth, your breasts secrete colostrum (highly nutritious fluid that’s your baby’s first milk). Mature breast milk appears between the second and fifth day. At that time, your breasts may become engorged, which may present feeding challenges. (See page 419.)

If You’re Not Breastfeeding

If you decide not to breastfeed (or can’t), your breasts typically undergo the same initial changes as breastfeeding mothers. To reduce milk production and increase comfort, apply ice packs and avoid breast stimulation. On the second or third day after the birth, wear a snugly fitting sports bra or wrap an extra wide elastic bandage across your breasts and around your chest to compress your breasts and decrease the swelling that occurs as your milk comes in. Rewrap the elastic bandage every few hours. Keep your breasts bound for twenty-four to forty-eight hours.

Once your milk comes in, apply ice to your breasts for twenty minutes every four hours or so to decrease the pain from inflammation and swelling. Use ice packs or an elastic bandage to hold several bags of frozen peas or corn in place over your bra or shirt. Consider taking ibuprofen or acetaminophen (Tylenol) for pain relief.

If you’re not breastfeeding because your baby has died, suppressing your milk may cause you to experience a “second grieving” for your baby who can’t have the milk. Know that you don’t have to immediately suppress lactation if you don’t want to. Some mothers express and donate their milk in honor of their babies. (See page 303 for more information on newborn death.)

HORMONAL CHANGES

When you deliver the placenta, your estrogen and progesterone levels drop rapidly and remain low until your ovaries begin producing these hormones again. If you breastfeed, your production of prolactin and oxytocin increases, while estrogen and progesterone levels remain low until you wean your baby.

CIRCULATORY CHANGES

During pregnancy, you accumulate extra blood and fluid. When giving birth, bleeding naturally occurs as the uterus contracts to compress the blood vessels that flowed to the placenta. During an uncomplicated vaginal birth, the average blood loss is about 1 cup. If you had an episiotomy or a sizable perineal tear, you may lose more blood. You continue to lose blood in your lochia for a few weeks. See page 299 for signs of excessive blood loss.

In the early postpartum period, you urinate often and sweat heavily (especially at night) to lose the extra fluid accumulated during pregnancy. You may lose as much as 5 pounds of fluid during the first week after the birth.

ABDOMINAL AND SKIN CHANGES

After giving birth, your abdominal muscles are loose, and take several months to regain firmness. Exercise speeds up the process. Your stretch marks fade from red to silver but don’t completely disappear. If your skin darkened during pregnancy, the pigmentation will fade. Any increased hair growth also disappears gradually.

If you pushed hard for a long time during the birth, the rapid changes in blood pressure during and between pushes may have caused broken blood vessels in your eyes and on your face and neck. They typically disappear within a week or two of the birth.

HEMORRHOIDS

Hemorrhoids are swollen varicose veins in the rectal area that may be as small as a pea or as large as a grape. They may itch, bleed, sting, or ache, especially during a bowel movement. Many women develop hemorrhoids during pregnancy; some develop them after a vaginal birth. Most hemorrhoids disappear in the first postpartum month. To prevent hemorrhoids or to reduce discomfort and promote healing, follow these suggestions:

• Take steps to prevent constipation. (See page 120.)

• Do your Kegel exercises (see page 95), with emphasis on the anal muscles.

• Use witch hazel on the area.

• Take sitz baths. (See page 336.)

• Avoid heavy lifting. If you must pick up a heavy object (such as an older child), do a Super Kegel (see page 96) and hold it as you lift.

If these measures don’t help prevent hemorrhoids or reduce their discomfort, see page 353.

BOWEL AND BLADDER FUNCTION

After the birth, you may have trouble urinating because of a tear near your urethra or swelling around it (from the birth or a bladder catheter). To help start the flow, try to relax your perineum, drink lots of liquids, or pour warm water over your perineum (or try urinating in the shower or bathtub). If you still can’t urinate, call your caregiver.

The birth may cause you to become constipated because of loose abdominal muscles, episiotomy, hemorrhoids, or a sore perineum. Iron supplements and narcotic pain medications may also cause constipation. Prevent constipation by eating lots of fresh and dried fruits, vegetables, and whole-grain cereals (to increase your fiber intake) and by drinking plenty of water. Adding a tablespoon of flax meal to your food also may help. When you’re able, walking and exercising your abdominal muscles help restore normal bowel function, as does moving your bowels when you have the urge (instead of waiting until later). If your caregiver prescribes a stool softener, follow the instructions for use.

When moving your bowels, support your perineum by gently pressing toilet paper against your stitches to prevent the tissue from bulging and stretching.

If these suggestions don’t help and you remain uncomfortable, your caregiver may prescribe a laxative, suppositories, or an enema.

PERINEAL CARE

Your perineum needs special care after the birth, especially if you’re bruised or swollen, or had stitches for an episiotomy or a tear. (See below to learn how to care for your perineum.) Stitches dissolve in two to four weeks, and the tissue usually heals within four to six weeks, although you may feel discomfort for some time. Discomfort during intercourse may persist for months. See your caregiver if the discomfort worsens or continues beyond several months.

Steps for Perineal Care

Follow these steps to relieve perineal pain, promote healing, and prevent infection.

• Apply ice to your perineum to reduce swelling. Soon after the birth, your nurse or midwife will apply an ice pack to your perineum. For the next several days, continue to use ice intermittently to soothe pain from a tear, episiotomy, or hemorrhoids. To make an ice pack, put crushed ice or a frozen wet washcloth in a zip-close plastic bag and wrap it in several layers of paper towel. Hold it in place with your perineal pad. Or dampen a maxi pad with witch hazel and freeze it before use.

• Begin doing Kegel exercises immediately after the birth (see page 95). Frequent pelvic floor exercises increase circulation, promote healing, and reduce swelling. They also help restore strength and muscle tone. Don’t be discouraged if you can’t do Kegels as well as you could before the birth. Your strength should improve quickly.

• After urinating, clean yourself by pouring warm water over your perineum from front to back (to prevent infection from organisms in the rectal area). If you birth in a hospital, you may be given a “peri bottle” (squirt bottle filled with warm water) to wash yourself. Use toilet paper to gently pat yourself dry from front to back.

• Don’t use tampons before your postpartum checkup.

• Don’t douche.

• Take a sitz bath to help relieve perineal soreness: Sit in a clean tub of warm water for ten to twenty minutes. After the bath, lie down for fifteen minutes to decrease swelling caused by the warm water. If you like, use cold water. It can be as soothing as a warm bath and doesn’t increase swelling.

• Sit on a plastic donut pillow to lift your perineum off the surface you’re sitting on. If you don’t have a donut pillow, make your own by rolling a bath towel lengthwise and shaping it into a horseshoe shape. Sit on the pillow with both buttocks supported.

• Sit on a firm surface if your stitches are causing pain. You may find sitting on a firm surface more comfortable than sitting on a soft one or on a donut, either of which can separate the edges of your incision. To help keep your incision pressed together and avoid pain, sit down on one buttock first, then ease onto the other buttock.

• Lie down and rest as often as you can in the first weeks after the birth. When sitting or standing, gravity can increase swelling and cause the pelvic floor to ache.

Warning Signs after the Birth That Require Medical Attention

Report any of the following warning signs to your caregiver.

Warning Signs & Possible Problems

Fever (oral or temporal artery temperature of 100.4°F/38°C or higher)

• Uterine infection

• Bladder or kidney infection

• Breast infection (mastitis)

• Infection of episiotomy or tear

• Infection of cesarean incision

• Other illness

Burning with urination; blood in urine

• Bladder or kidney infection

Inability to urinate

• Swelling or trauma of the urethral sphincter

Swollen, red, painful area on the leg (especially the calf) that’s hot and tender to the touch

• Thrombophlebitis or deep vein thrombosis (blood clot in the blood vessel); do not rub or massage the area.

Sore, reddened, hot, painful area on breast(s), along with fever and flu-like symptoms

• Breast infection (mastitis)

Passage of blood clot larger than a lemon followed by heavy bleeding, or any bleeding heavy enough to soak a maxi pad in an hour or less

• Passage of some (but not all) of a retained placenta

• Uterine infection

Vaginal discharge that has an extremely foul odor (like spoiled fish); vaginal soreness or itching

• Uterine infection

• Vaginal infection

Increased pain at site of episiotomy or tear; may be accompanied by foul-smelling or pus-like discharge

• Infection of episiotomy or tear

• Reopening of incision or tear

Opening of cesarean incision; may be accompanied by pus-like discharge or blood

• Infection of cesarean incision

Appearance of rash or hives; may be accompanied by itching

• Allergic reaction to medication

Severe headache that begins after the birth and is worse when upright and less painful when lying down

• Spinal headache following regional anesthesia

Any sudden onset of pain that’s new, such as abdominal tenderness or burning near perineal stitches when urinating

• Uterine infection

• Reopening of perineal tear or incision

Pain and tenderness in front or back of pelvis, accompanied by difficulty walking and a “grating” sensation in pubic joint

• Separation of pubic symphysis (cartilage between the pubic bones in the front of your pelvis)

Feeling extremely anxious, panicky, or depressed; accompanied by rapid heart rate, difficulty breathing, uncontrollable crying, feelings of anger, or inability to sleep or eat

• Postpartum mood disorders, including anxiety and panic attacks, obsessive thinking or worrying, or depression

Frightening relationship with your partner; being verbally or physically abused

• Domestic violence increases during pregnancy and after the birth. If you need to talk or get help, call the National Domestic Violence Hotline, 800-799-SAFE (7233) or 800-787-3224 (TTY).

Your Physical Recovery: Later Postpartum Period

Within three to eight weeks after the birth, your caregiver will give you a general physical examination (including a pelvic exam) to assess your recovery and to discuss any physical or emotional problems you may have. You also may discuss your family-planning preferences. After the checkup, your caregiver will recommend that you have regular Pap smears.

If you notice any of the warning signs listed on page 337 before your checkup, call your caregiver immediately for an appointment.

BREAST SELF-EXAMINATION

Your caregiver may recommend that you examine your breasts every month. To learn how to examine your breasts, visit the Susan G. Komen for the Cure web site at http://www.komen.org/bse. It’s best to check your breasts right after your menstrual period, when they’re softest. If you’re breastfeeding, check your breasts on the first day of each month, after a feeding.

Although only a small percentage of breast changes indicate cancer, tell your caregiver about any thickening breast tissue, lumps that don’t disappear within a day or two, or nonmilk discharge. A medical examination can determine whether the changes are benign (harmless) or suggest a problem. Early detection and treatment of cancerous tissue can help prevent the growth and spread of the disease.

Caring for Yourself after the Birth

After giving birth, you can help your recovery by eating well, getting adequate rest, and asking others for help with household chores, meal preparation, and other tasks that you may find difficult to accomplish while caring for your baby.

NUTRITION

In the postpartum period, continue eating healthful foods, as you did during pregnancy. (See Chapter 6.) If you’re breastfeeding, see page 417 for nutrition suggestions.

Don’t drastically change or restrict your diet to lose weight. The maximum amount of weight you should lose per week is 1 to 2 pounds. Most new mothers lose pregnancy weight gradually over several months without special effort.

If you’re anemic, your caregiver may recommend that you continue taking prenatal vitamins and iron supplements. To prevent constipation, ensure your diet contains plenty of fiber.

REST AND SLEEP

When you first begin caring for your baby, finding time to sleep may seem impossible. If you’re not tending to your baby’s needs, you’re trying to finish household chores or attempting to take a shower.

However, fatigue and sleep deprivation can greatly challenge your physical and emotional recovery, so make sleep a top priority and take every opportunity to nap. Even if you can’t sleep, simply resting gives you the energy to meet your baby’s often unpredictable needs.

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You may notice that your baby sleeps as much during the day as she does at night. This sleep pattern is common and temporary for newborns. As you baby grows, she’ll begin to sleep longer at night when you and your family do. (See page 380.) If you’re used to sleeping only at night, or if your baby naps for short periods and wakes up frequently, the advice to “sleep when your baby sleeps” may frustrate you. In addition, constantly listening for your baby’s cries may make you feel wired and unable to sleep.

You’ll eventually adjust to being awake at night and learn how to rest and sleep when you can. But what can you do in the meantime? Try the following suggestions to help you relax and fall asleep:

• First, commit to making sleep a priority, right after meeting your baby’s needs. Someone else can do household tasks, or they can wait until you’re rested.

• Give yourself permission to do whatever it takes to be able to rest, such as turning off the phone, sitting outside, taking short walks, having a bath, eating and drinking particular food and beverages, having a massage, or taking pain medication.

• Limit visitors; don’t worry about being a gracious host. If a visit lasts too long, ask the guests to leave, or excuse yourself with your baby and retire to your bedroom.

• Try relaxation techniques such as the relaxation countdown (see page 218).

• Keep your baby close to you so you don’t strain to listen for her (which can interfere with your ability to rest).

• Conversely, you may find that your baby’s sounds increase your anxiety and restlessness, especially if you’re extremely tired. In that case, let someone else tend to your baby in another room while you rest. Once you’re rested, anxiety usually decreases.

• If your partner is available, take turns caring for your baby throughout the night. Or try scheduling parenting shifts: One parent goes to bed early, while the other is responsible for caring for your baby during the night. The parent who went to bed first takes over care early the next morning, allowing the other parent to sleep in. If you’re breastfeeding, you may need to adapt this schedule to accommodate feeding patterns.

Recipe for Sleep in the First Weeks after the Birth

Many first-time parents use the following approach to get an adequate amount of sleep until their babies begin to sleep for longer stretches.

1. Ask yourself how much sleep you needed before pregnancy to function well. Six hours? Eight hours? That’s the amount of sleep you now require every day.

2. Because feedings and baby care prevent you from getting this amount of sleep in one stretch, you’ll need more time in bed to meet your sleep requirement. Stay in bed until you’ve slept enough (meals and trips to the bathroom are obvious exceptions). Each time you wake up, keep a mental note of how long you slept.

3. Don’t brush your teeth, shower, or dress until you’ve met your sleep requirement. If you require eight hours of sleep, it may take from 10 pm until noon (or later) the next day to get out of your pajamas!

Notes: You may find that having your baby sleep with you (or in the same room) makes it easier to get enough sleep, because you can care for your baby quickly. Also, if you have other children, this approach may require the help of another adult who can care for them while you sleep.

ASKING FOR HELP

After the birth, you may be upset to realize that you can’t do things (such as manage your household) as well as you could before the birth. You may find it difficult to ask for help, but having support will speed your postpartum recovery.

Accept any offer that will make it easier for you to rest, shower, or otherwise care for yourself. Someone may offer to do the dishes and laundry, shop for groceries, vacuum and dust, or simply watch your baby. If you’re concerned about meals, someone can cook and freeze meals in advance, or bring a meal every day for the first few weeks.

If you’re unable or unwilling to ask friends and family for help, consider hiring part-time household help or a postpartum doula (see page 27) for a few weeks after the birth. Many communities have agencies that specialize in postpartum home care.

In Their Own Words

After my baby’s birth, I struggled to get the time to feed myself and use the bathroom—and I had a lot of helpers! I found it helped to order groceries online and have them delivered. Small decisions like that kept me from feeling too overwhelmed.

—Paige

Postpartum Fitness

Immediately after giving birth, your body begins recovering from the event as your mind begins reordering your priorities to emphasize rest, healing, and caring for your baby. In the early postpartum period, there’s little time or need to resume or begin a vigorous exercise regimen. However, moderate activity (such as walking) and gentle conditioning exercises (see below) can help speed your recovery. If your labor and birth were normal, you can begin doing these exercises when you feel ready, whether that’s a few days or a few weeks after the birth. Follow your caregiver’s guidelines about exercise and other activities such as driving, stair climbing, and lifting.

After several weeks to months, you may want to resume more vigorous exercise. Listen to your body and increase your intensity gradually. You’re over-exercising if you become exhausted, experience any pain, or have increased vaginal bleeding. (See page 337 for postpartum warning signs.) In that case, consult with your caregiver before resuming the exercise.

As you increase your fitness level, your energy, motivation, and endurance will improve.

EXERCISES TO CONDITION YOUR MUSCLES AND RELIEVE TENSION

In the postpartum period, your abdominal muscles require exercise to recover their former shape and strength while avoiding further separation or diastasis (see page 341). Your pelvic floor muscles need exercise to increase circulation, reduce swelling and promote healing in the perineum, and restore vaginal and rectal muscle tone. When these muscle groups are in good condition, they provide core muscle support for your entire body.

You can do conditioning exercises, as well as exercises that relieve tension, with your baby near you. For example, each time you change a diaper, contract your pelvic floor muscles or do pelvic tilts. Before or after feeding your baby, do head tilts and shoulder circles. During a feeding, try doing transverse abdominal contractions.

The following sections describe these and other exercises.

Core and Postural Exercises

Every day or so, try doing the following conditioning exercises, especially the pelvic floor contraction. Whenever exercising your abdominal muscles, first contract the pelvic floor muscles to support them.

Reducing the Separation of Your Rectus Abdominis Muscles

Before you begin doing any abdominal muscle exercise other than transverse abdominal contractions and pelvic tilts (see pages 96-97), check your rectus abdominis muscles for separation. These are the muscles from your chest to your pubic bone. As your abdomen grew and stretched during pregnancy, the connective tissue between these muscles may have begun separating painlessly and without bleeding to prevent the muscles from overstretching. Separation is normal, but your help is required to close the gap.

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To check for separation, lie on your back with your knees bent. Press the fingers of one hand into your abdomen just above your navel. Slowly raise your head and shoulders. The rectus muscles will tense, letting you detect any gap. A slight gap (1 inch or less) indicates normal muscle separation after pregnancy; it doesn’t need to be closed. A larger gap between the muscles (2 to 3 inches) indicates that you need to close the gap before doing crunches and other conventional abdominal exercises. If you don’t close a wide separation, strenuous exercise that requires abdominal stabilization will only increase the separation and defeat the purpose of the exercise.

To help narrow a large gap, do transverse abdominal contractions and head lifts (see below). Progress to more advanced abdominal exercises after the gap has narrowed to the width of one or two fingers and when your abdominals can keep your rectus muscles closely aligned without your support.1

Pelvic Floor Contraction (Kegel or Super Kegel Exercise)

See page 95 for instructions. Immediately after the birth (vaginal or cesarean), do two to three short Kegels whenever you can, then progress to five full Kegels each hour. Gradually work toward holding the contraction for up to twenty seconds (the Super Kegel).

Pelvic Tilts I, II, and III

See page 97 for instructions. Remember to contract the pelvic floor when performing these exercises.

Transverse Abdominal Contractions

See page 96 for instructions. This exercise helps close a separation of the rectus muscles while toning your abdominals and flattening your stomach. It becomes progressively easier to do over time. Begin with three sets of contractions per day and increase the number of sets as you like.2

Head Lifts

Aim: To help close a separation of your rectus muscles while toning your abdominals and flattening your stomach.

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Common Q & A

Q: I know I should exercise to help my recovery, but I just can’t find the time. What can I do?

A: As your baby grows and begins to need your care and attention less frequently, you’ll have more time for exercise. In the beginning, exercising outside the home might not appeal to you. If you’d rather avoid the hassle of having to look presentable and getting to class on time, exercise at home with your baby by dancing with him or doing postpartum exercises with him next to you. No matter how long it’s been between showers, you’re the best thing your baby has seen!

When you feel ready, schedule walks with other new mothers or take a postpartum exercise class to motivate you to get moving and reconnect with the outside world.

Exercise: Lie on your back with your knees bent. Cross your hands over your abdomen, placing them on either side of your waist. Inhale; as you exhale, raise your head. At the same time, pull your bellybutton toward your spine and use your hands to pull the side abdominal muscles toward each other (see photo on page 341). Hold for a slow count of five. Slowly lower your head and rest.

Repetition: To close any separation, repeat twenty times each day and increase repetitions as you’re able. The separation should regain its normal ½-inch (or smaller) width within several weeks. Progress to more advanced abdominal work only after the separation is within this normal range.3

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Bridge Pose

Aim: To tone your hamstrings and buttocks.

Exercise: Lie on your back with your knees bent and your arms resting on the floor along your sides. Inhale; as you exhale, lift your tailbone off the floor, then each vertebra, until your weight is resting on your shoulders. Push your feet into the floor and keep your thighs parallel to each other (not rolled outward). To protect your neck, avoid turning your head. If you like, clasp your hands together under your back and press your arms into the floor to lift your chest. Repetition: Hold the position for several breaths, then roll back into the starting position. Repeat the exercise five to ten times each day.

Pectoral Stretch, Hip Flexor Stretch, and Posture Check

See pages 99–100 for instructions.

Tension Relievers

The following exercises relieve muscle tension and promote overall relaxation.

Head Tilts

Aim: To relieve muscle tension in your neck caused by holding your baby.

Exercise: Look straight ahead and tilt your right ear toward your right shoulder and hold for ten seconds. Don’t let your left shoulder rise. Repeat on your left side.

Repetition: Do this exercise once a day or as often as feels good.

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Peek-a-boo Yoga

Here’s a fun way to stretch your body and bond with your baby. Start on your hands and knees. Place your baby on his back underneath you so your eyes are level with his. Then follow this sequence of poses, which are described on pages 100–103):

• Cat pose

• Child’s pose (Stretch your arms above your head with your forearms cradling your baby.)

• Opposite-limb extensions

• Child’s pose

• Downward-facing dog

• Child’s pose

• Downward-facing dog

• Child’s pose

• Half-dog pose

• Bridge pose (While you do this exercise, move your baby to the side, perhaps on his tummy. Or hold him on your abdomen)

• Corpse pose with five-minute meditation (Your baby can be either on your abdomen or next to you.)

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Shoulder Circles

See the instructions on page 99. This exercise relieves tension in your shoulders and upper back caused by holding your baby.

Relaxation and Slow Breathing

Aim: To relax and rejuvenate your body and to release mental stress that accompanies baby care.

Exercise: Use the same relaxation techniques you found helpful during pregnancy and birth. For example, try five minutes of slow breathing (see page 224), passive relaxation (see page 216), relaxation countdown (see page 218), or the five-minute meditation (see page 102).

Repetition: Do this exercise whenever you have a moment to recognize what a phenomenal job you’re doing as a new parent!

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POSTPARTUM FITNESS AFTER A CESAREAN BIRTH

If you’ve had a cesarean birth, see Chapter 14 for activities that are appropriate for the first few days after surgery, such as deep breathing, knee bends, and abdominal pull-ins, and rolling from back to side while bridging. Pelvic floor exercises are also fine to do.

Your caregiver will probably recommend that you wait six weeks before doing any strenuous activities, including the postpartum exercises described on pages 340–343. Consult with your caregiver before starting an exercise regimen.

POSTPARTUM FITNESS AFTER A CHALLENGING PREGNANCY OR BIRTH

If you were pregnant with multiples, were on bed rest, or had a difficult pregnancy or birth, your recovery may be more challenging than other women’s. Conserve your energy initially, until you can do things more normally. As you resume your daily activities, your strength will return. When you’re able to exercise, expect to tire quickly. Set reasonable expectations and try not to compare your progress with other women’s. Be patient with yourself and celebrate every accomplishment.

A NOTE TO FATHERS AND PARTNERS

When your partner is ready, gently encourage her to exercise, but don’t pressure her. Help her make time for exercise, and consider exercising with her so you can spend some time together while improving your health.

Adapting to Postpartum Life

As a new parent, you may sometimes yearn for the simpler, more predictable life you had before you began tending to your baby’s seemingly never-ending needs. You may wonder how long it’ll take you to physically recover from the birth and to balance the interests and demands of your former life with the joys and needs of your new life with your baby.

At some point after your baby’s birth, you’ll experience postpartum adaptation (also called “postpartum recovery”), the process by which your life generally returns to more predictable patterns. You can take care of daily demands, feel rested most of the time, and begin to enjoy previous interests again. Your body is healing, and you can meet your baby’s needs with growing confidence. (See page 332 for factors that influence your adjustment to postpartum life.)

The following sections describe areas of your life that will be affected by your baby’s arrival and may require special attention as you adapt to your new role. Visit our web site, http://www.PCNGuide.com, to download a work sheet to help you prepare.

Parenting Groups and New-parent Classes

Connecting with other new parents is one of the most helpful ways to ease the transition to parenthood. (See Appendix C for information on specialized support groups for complicated circumstances.) By attending a parenting group or new-parent class, you can learn about other parenting styles, hear new solutions to common parenting problems, see other babies’ development, and discover that you’re not the only one overwhelmed by postpartum life.

Hospitals, churches, community colleges, and community organizations may offer parenting groups and classes. Many of these target mothers, but most welcome fathers and partners. Plan ahead by learning about local groups and classes before your baby’s birth.

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YOUR SEX LIFE AFTER THE BIRTH

Many caregivers recommend that new mothers don’t have intercourse for the first six weeks, but this time frame is arbitrary. If you and your partner want to resume intercourse as soon as possible after the birth, it’s probably safe to do so after any stitches have healed and the amount of lochia has decreased. But be gentle; you may be sore at first. In addition, after giving birth (and for as long as you breastfeed), hormonal changes reduce vaginal lubrication. A water-soluble lubricant can help.

If you’d rather wait until well after the birth to resume your sex life, that’s perfectly normal. Having a sore perineum, a demanding baby, little help, and extreme fatigue can affect your ability to enjoy sex. You may even fear it. Cuddling with your partner and gently enjoying each other’s bodies (with or without orgasm) can help you both relax and show your love.

If you find even touching undesirable, express those feelings honestly but respectfully, especially if your partner has an interest in sex. Discuss other ways you can show your love for each other until you’re ready to resume a physical relationship.

Whenever you choose to have intercourse, remember that you can become pregnant whether or not you’ve begun to menstruate. Your caregiver can help you choose a family-planning method. For example, using a condom in combination with spermicidal foam, cream, or jelly is safe and effective contraception soon after the birth. To learn more options, visit http://www.4woman.gov/faq/birth-control-methods.pdf and http://www.plannedparenthood.org/health-topics/birth-control-4211.htm.

If you’re breastfeeding, you may leak breast milk during intercourse, especially when you have an orgasm. The hormone oxytocin plays a strong role in both orgasm and milk ejection (let-down). Some women wear a bra and nursing pads when having sex. Others choose to ignore the leaking or find humor in the situation. As one woman said, “When the milk starts flowing, my partner and I know I’m having a good time!”

ADJUSTING TO PARENTHOOD

Parenting is learned skill; it’s not instinctive. Your ability to parent depends on several factors, including how your parents raised you, parenting styles you’ve seen, experiences you’ve had with young children; knowledge of the physical, emotional, and intellectual abilities and needs of children; and the temperament and needs of your baby.

Even if you haven’t had much experience with babies, your baby is your best teacher. You can learn about her abilities, needs, and development by observing her behavior and responses to your care, reading baby-care books, or attending parenting classes.

The early weeks of parenting aren’t always easy, but if you (and your partner) are nurtured and receive help, you’ll have the time and energy to care for your baby and build strong family bonds.

PARENTING WITH A PARTNER

If you’re parenting with a partner, you both don’t need to do things the same way to appreciate each other as parents. If you have different approaches, discuss your views and arrive at a comfortable solution together so you both feel respected, supported, and involved. Consult with your baby’s caregiver, a parent educator, a postpartum doula, or a baby-care book for ideas. Let the small problems go (such as a diaper put on backward) so you can work out the large issues together (such as how to respond to crying). Try not to interfere with each other’s parenting or protect each other from the realities of baby care.

A NOTE TO FATHERS AND PARTNERS

Once the excitement of having a new baby has faded, your baby’s constant demands and frequent crying may begin to tax everyone’s endurance. You may feel frustrated that your partner can soothe your baby and meet his needs better than you, especially if she’s breastfeeding.

Despite your feelings, your baby and his mother need your continued support and care. By acknowledging that both parents are under a lot of stress and by sharing the parenting duties, you’ll strengthen your relationship with your partner and your family.

To learn more about baby care and soothing skills, read Chapters 17 and 18.

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CHANGES IN FAMILY RELATIONSHIPS

The birth of a baby can bring many emotional and social changes to immediate and extended family. Relatives, especially grandparents, are usually eager to be a part of your baby’s life. Think about what role they want to play—and the role you want them to play. Then try to discuss ideas and expectations with them before the birth. The sample letter on page 347 may help you express your thoughts.

If you have other children, a new sibling might or might not be a welcome addition. See Chapter 19 for information on preparing an older child for a new baby.

Some new parents find that the demands of baby care challenge their relationship, especially if it was strained before the birth. If your relationship with your partner is troubled after the birth, see page 361 for help.

If you’re a single parent, you may want (or need) the help of your family. See page 362 for a discussion on single parenthood.

RETURNING TO WORK

For some new mothers, returning to work after the birth is necessary because they’re the only ones in their families able or available to work. Many other new mothers return to work to contribute to their families’ financial well-being or to advance their careers, or because they simply love their jobs. Whatever the reason, if you decide to return to work after the birth, see pages 28 and 362 to learn more information about your options.

Postpartum Emotional Challenges

After giving birth, your emotions will fluctuate, partly from extreme changes in your hormone levels and partly from fatigue, inexperience or uncertainty with baby care, loneliness or isolation, changes to your normal routine, and your baby’s around-the-clock demands. Mood swings may also be caused by a disappointing or difficult birth, an unexpected illness or condition in your baby, a personally stressful situation (social, financial, or physical), or a personal or family history of mood disorders.

For most women, these emotional fluctuations are mild and decrease within a few weeks (see page 348). For others, the mood swings are overwhelming, long-lasting, and may require treatment.

A Letter to Grandparents

Although grandparents are the focus of this letter, you can adapt it to suit another family member or friend and to reflect your circumstances.

Dear Grandparents,

Congratulations on the birth of your new grandchild! This arrival continues your family for another generation. If you’re wondering how you can best help the new parents’ transition to parenthood, we have some suggestions.

The new parents need to know that you think they’re the best parents your grandchild can have. They need to hear that parenthood is challenging, tiring, and one of the most important and rewarding experiences they’ll ever have.

You’ll find that some things have changed since you raised children, and some have remained the same. You need to honor the new parents’ decisions and parenting style, even if their ways differ from your own. Please offer advice only when asked and help the new parents find up-to-date answers to their questions. Reading the same books they’re reading about newborn care and feeding may help.

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The new parents need to have hands-on experience to learn the skills that all parents need to develop. While it may be tempting to tell them how to do things, or to do things for them, don’t interfere. If you’re invited to help, recognize the request as an honor. Ask how you can help, and be willing to cook meals, do laundry, shop, and clean the house so the new parents can master caring for their baby. You’ll work hard, sleep little, and leave tired—but you’ll be appreciated.

If you can’t be with the new family or if your relationship with them is strained, think of another way to support them. For example, you can help pay for a postpartum doula, diaper service, meals, or travel expenses for another family member to help them. The new parents will appreciate your gesture, and it can help reconcile a troubled relationship.

Remember your first weeks as new parents and try to have realistic expectations. For example, forgive the new parents if they forget to thank you for your help and gifts. Your care and concern will enhance not only your relationship with your grandchild, but also your relationship with her parents.

With best wishes for joyful grandparenting,

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Grandmothers and coauthors of Pregnancy, Childbirth, and the Newborn

BABY BLUES

About 80 percent of new mothers experience baby blues (or the “blues”), usually within the first week after the birth. Symptoms of baby blues include the following:

• Crying easily

• Feeling overwhelmed or out of control

• Feeling exhausted, anxious, or sad

• Lacking confidence as a parent

Baby blues are normal and rarely last longer than two weeks. You can diminish the condition by getting more rest, reducing any pain you’re experiencing, and surrounding yourself with supportive family and friends. If you’re feeling sad or upset, get support immediately. A few encouraging words may be all you need to feel better. Without support, you may have a tougher time shaking baby blues.

POSTPARTUM MOOD DISORDERS

About 20 percent of new mothers develop postpartum mood disorders (PPMD), which are more serious than baby blues. See Chapter 16 for a complete discussion of PPMD.

Putting Parenthood into Perspective

Parenting a baby upsets the equilibrium in one’s life, and you may wonder how much time you’ll spend caring for your child. The following chart illustrates predictable life phases.

You live roughly the first third of your life before becoming a parent. During this time, you develop as an individual and may begin a relationship with someone and consider starting a family with him or her.

You spend the next third of your life having and caring for your children. During this time, many couples are caught up with child care and careers, and they neglect to nurture their relationship. Make time with your partner for conversation and shared activities. Also make time for your own interests so you keep growing as an individual, as well as a parent and partner.

You spend the last third of your life with an “empty nest.” Your children are grown and living elsewhere, and you and your partner are once again just a couple. This phase may come with reduced responsibilities or different duties such as caring for your aging parents. You may have time to pursue interests—perhaps grandparenting! One of you will outlive the other at some point, and that person must draw on the support of family and friends, as well as on interests and passions, to find a new way in life.

From the moment your child is born, you’ll be a parent for the rest of your life. However, your time spent as a parent of a baby is brief. Enjoy it!

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Key Points to Remember

• The postpartum period is a time of physical and emotional readjustment and recovery. Everyone’s adjustment is unique. Factors that arise before, during, and after pregnancy and birth all affect your recovery.

• Your body undergoes many normal changes in the postpartum period. You can help your recovery by eating well, exercising when ready, asking for help when needed, and getting adequate sleep. Be aware of any warning signs that may indicate a problem with your physical or emotional recovery. (See page 337.)

• Transitioning to parenthood can be frustrating and overwhelming at times, but most parents adjust well with help and support.

• Although you’ll be a parent for a lifetime, the time you’ll spend on baby care is brief.

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