The Physical Changes In The Postpartum Period

During your first 6 weeks postpartum, your body will return to its prepregnant state. You will eliminate the extra fluid that you retained during pregnancy by frequent urination and perspiration.

Your uterus will gradually return to its prepregnant size and position in a process called involution. You may notice periodic contractions as it becomes smaller. If you nurse your baby, you will feel the uterus contract each time you put your baby to your breast for the first few days. Because of this, involution of the uterus occurs faster in breastfeeding mothers. If this is your second or subsequent child, you may find these “after pains” to be painful. A mild pain reliever such as ibuprofen or acetaminophen may provide some relief.

You will have a vaginal discharge for 3 to 4 weeks as the lining of your uterus returns to normal. The discharge will begin as bright red, will then become light pink, will gradually turn brownish, and will finally be clear. If it becomes bright red again after it has become clear, you have overexerted yourself. Slow down, go to bed for a couple of days, and get plenty of rest. If the bleeding is excessive, call your caregiver. You may have a postpartum hemorrhage. Do not use tampons during the postpartum period.

Continue the comfort measures that you used in the hospital for your stitches or hemorrhoids. For pain relief, place cool witch hazel compresses (refrigerate homemade ones or use commercial brands) directly onto your pad before applying it to the perineum. If you did not receive a portable sitz bath in the hospital, you can sit in a clean tub of warm water or use a portable showerhead to run water over the perineal area. You will find that squeezing your buttocks together before you sit down or stand up helps to reduce the strain on the episiotomy stitches. Some women prefer sitting slightly to the side of their buttock.

Many women are concerned about having their first bowel movement after the delivery, especially if they have stitches or hemorrhoids. Your bowel movements should resume within 4 to 5 days. Eat a diet with sufficient green leafy vegetables and whole grain products, and drink plenty of fluids. Prune juice or prunes may also help. Your caregiver may recommend a stool softener, if necessary. Hemorrhoids will gradually shrink over time.

During the next few days, your breasts will change from their size at the end of pregnancy to possibly several sizes larger. Your body sends additional blood and fluids to aid in the production of milk. If you do not breastfeed, your breasts will still undergo these changes. Medication is no longer given to suppress the production of milk. Non-nursing mothers may want to wear a tight sports bra and apply ice to reduce the swelling. Cabbage leaves may also provide relief. (For instructions, see “Normal Breast Fullness Versus Engorgement”.)

Weight loss will be gradual, sometimes taking months. Remember that it took you 9 months to put the weight on, so you cannot expect to lose all the pounds overnight. Nursing will help, since your body will use 500 to 800 calories each day in the production of milk. Continue to eat well and take your prenatal vitamins. Do not go on a strict reducing diet if you are breastfeeding. When you first come home, your abdomen will be flabby and you may still look 4 or 5 months pregnant. If you begin the exercise program described on this article while you are still in the hospital, you will have a head start on reconditioning the muscles that were stretched during pregnancy.

You may experience both emotional highs and lows during the first weeks after birth. It is not surprising that many women have the “baby blues,” since many sudden changes occur. While most women expect to be consistently happy and loving toward their new babies, they may be surprised to also experience the “blues,” characterized by episodes of crying, moodiness, sleeping difficulty, irritability, anxiety, lack of sexual desire, and ambivalence about the decision to have a baby and the change in their lifestyle. And when they do have these negative thoughts and feelings, they feel guilty about it.

When to Call Your Caregiver The following symptoms are warning signs and may indicate a serious problem in the postpartum period. Do not hesitate to call and report any of these signs. Minor breast-related problems can be handled by a certified lactation consultant.
  • Temperature over 100°F and chills.
  • Heavy bleeding. Bleeding should gradually decrease, not increase.
  • Passing a large clot or many clots.
  • Unpleasant odor from the vaginal discharge.
  • Increased pain or swelling in the vaginal and perineal area.
  • Abdominal pain or tenderness (other than the normal uterine cramping).
  • Hot, sore breasts with a lump or area of redness.
  • Cracked and bleeding nipples.
  • A lump or pain in the calves or severe swelling in the legs.
  • Pain in the mid to lower back.
  • Burning, frequency, difficulty, or urgency with urinating.
  • *Severe depression, sadness or withdrawal.
Immediate treatment may prevent these conditions from becoming serious.

Physically, your body will undergo abrupt shifts in hormonal levels, a 30- percent decrease in blood volume, possibly painful uterine contractions, and/or a sore bottom. Pregnancy grows on you month by month, but motherhood is thrust on you very suddenly. One moment your baby is still a part of you, and the next he is a separate, unique human being. To further compound the shock, the spotlight shifts from you to the baby. You are no longer the center of attention, pampered and coddled by family, friends, and even strangers. In the early days, this loss of the spotlight may make you feel isolated and unimportant.
Your husband may also be affected by these changes. No longer will he be the primary focus of your attention. He may feel resentment and jealousy toward the baby if he is not allowed to be an active partner in the newcomer’s care and nurturing. In addition, the sudden awareness of the enormous responsibility that he has just assumed may overwhelm him and even frighten him for a time.

More than any other factor, exhaustion is the primary reason women experience the blues. Therefore, you should consider it a priority to get as much rest as possible during your first 2 weeks at home. Since it will be several weeks before you can fit into your prepregnant clothes again, stay in your nightgown and be comfortable. You will also appear to be recovering and will be treated as such. If you get dressed as soon as you arrive home, you will appear fully recovered and will find yourself pushed into hostess and housekeeper roles before you are ready. This will result in fatigue and irritability, and your recovery will be slower. If possible, nap whenever your baby does. In fact, the two of you should spend the first days at home in bed together. Do not feel guilty about this. Your body needs the extra rest at this time.
If you take care of yourself and follow the suggestions in this chapter, you can minimize and possibly avoid the down feelings that women have come to expect following childbirth. If, however, you become severely depressed and lose interest in taking care of yourself and the baby, you need to seek professional help. (For a discussion of severe depression following childbirth, see “Postpartum Depression.”)

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