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Postpartum changes - For You

Your baby is here, he is happy and gurgling, sleeps when you put him down on any flat surface. You are positively glowing, well-rested and ecstatically happy. Your home is perfectly put together and you eat balanced meals three times a day. That is part of the myth we are sold on what happens after you have a baby.

The reality is not a horror story, but it’s not a story of perfection either.
Having a new baby, especially if it’s your first, is like being alone in an unknown city where everyone speaks another language, trying to get to your hotel without a map.
Add to this the fact that you’re exhausted and leaky, your hormones are all over the place and you feel very vulnerable.

Taking care of yourself postpartum
This topic is coming first for one simple reason - you are important, and your wellbeing is the most important factor in making your postpartum experience a positive one. If you have not been in the
habit of putting yourself first, this is the time to learn how. It’s not easy being vulnerable and needing others and you will learn and grow a lot.

Placenta and membranes
Once your baby is born, the process of your placenta detaching from your uterine wall begins and some time later it is born through your vagina (in the case of a caesarean, your placenta and membranes are removed from your uterus after your baby is born). The placenta looks like a piece of flesh with veins running through it that look like a tree. If you birth in hospital these are disposed of, but you can ask to take them home and bury them in your garden.

Your uterus is doing amazing things
Not only has your body just finished growing and birthing a new human being, it is now quickly doing its best to return to its normal state. Your watermelon-sized uterus will become pear-sized in a few
weeks. Your uterus is emptying everything left over after pregnancy and birth and healing the dessert plate-sized wound left by your placenta.

Bleeding after birth
Your lochia, or bleeding after birth, beings immediately after birth (if you have a caesarean section, the bleeding may be lighter on the first day). It can seem worrisome in the first few days postpartum because you might pass blood clots the size of small lemons. There are some things that you need to be aware of, as described in the illustration. Lochia are heavier when you change positions, breastfeed, have a bowel movement and are too active (in fact, increased lochia or bright red blood after the blood has turned brown are a sign that you need to slow down). Your bladder might be less sensitive than usual so you might have to remind yourself to pee regularly. A full bladder can put pressure on your uterus and cause blood and clots to gush out when you do go to the toilet.
Keep an eye on your bleeding. If you find that your bleeding is becoming heavier instead of lighter, that your lochia smells bad, if you have pain in your lower abdomen not related to afterpains, contact your midwife or doctor.
It’s important to keep your risk of infection down during postpartum, so do a good job washing your hands after you use the toilet and change your maternity pads regularly. Keep your nails short to avoid scratching yourself when wiping. Disposable cotton pads are best to use during this period because they won’t attach to your stitches or irritate your vulva.

Bleeding after birth

Go to hospital or health centre immediately, day or night (or call an ambulance), if you have any of these symptoms:
• Your vaginal bleeding suddenly increases to heavy flow after initially slowing down
• Seizures (shaking fits)
• Fast or difficult breathing
• Fever and too weak to get out of bed
• Severe headaches with blurred vision
• Calf pain, redness or swelling; shortness of breath or chest pain
Taken from: Pregnancy, Childbirth, Postpartum and Newborn Care, a guide for essential practice (WHO, 2013)

Your first menstrual period after birth
If you are breastfeeding you will probably not have your first period for a few weeks or months; if you are not breastfeeding it will probably return within a few weeks. Your first few periods might be different than they are normally (lighter or heavier).

Your breasts are nourishing your baby
No matter how you plan on feeding your baby long-term, your body is making milk at the end of your pregnancy and after birth. The first milk, colostrum, comes out in drops and you usually don’t feel any breast changes until day two or three. At this point you may find that your milk “comes in” fully and your breast tissue is warm, hard and full. This milk must come out and it’s best if baby can drink it. Over the next few weeks your breasts will be adapting their production of milk to your baby’s suckling - the more baby suckles, the more milk you will have.

What to watch out for if you gave birth by caesarean
Postpartum after caesarean is basically the same as it is after vaginal birth, except there are some other things you need to keep an eye on. You can shower with help once your midwife or nurse gives you the ok, but make sure that you change your dressing afterwards (or ask your midwife or nurse to change it) - the dressing should always be dry. Avoid putting too much pressure on your abdomen and your incision for a few weeks, have a look at the incision or ask a loved one to look at it at least once a day to make sure that it is healing nicely – it should not be opening, discharging blood or puss. If it is, contact your doctor. A high fever (over 38C) should also be reported to your doctor immediately.

Other changes
Broken blood vessels in your eyes, face and neck
If you pushed hard or for a long time during your labour and birth, this may have caused broken blood vessels in your eyes, face and neck. These will disappear within a week or two after birth, as the vessels heal.

Dizziness and shivering
Your body is getting rid of a large amount of excess fluid accumulated during pregnancy in the first few days and weeks postpartum which can cause you to feel lightheaded or dizzy, especially when you are sitting and stand up or make a sudden movement. Go slowly and make sure someone is nearby for the first few days postpartum. If you need it, ask them to help you stand up and stay with you for a few seconds as you steady yourself. Shivering is normal after birth for the same reason, covering yourself with a blanket should help. If the shivers become severe, call your midwife or doctor.

Nutrition and digestion
Your body is recovering after pregnancy and birth and is using much of your energy and nutrition for breastfeeding. In fact, your body needs more calories during breastfeeding than during pregnancy.
Your digestive system will take some time to adapt to life after pregnancy. Urinating can sting as urine passes over your perineum (especially if you have stitches). You can ease this by running warm water over your perineum as you pee, either through a bottle with a sports cap or in the shower. Hormonal changes after birth also mean that your first poo might be challenging to pass. Eating foods full of fibre will make your poo as soft as possible will make this easier. Some women take chlorophyll supplements a few times a day postpartum, which help soften poo and also provide iron. Be aware of your iron intake over the first few weeks postpartum, as you are losing iron through your lochia and breastmilk and need to make sure you are getting enough. Foods that are rich in iron include red meat and dark green leafy vegetables (smoothies are an easy option). Some signs of low iron are tiredness and lack of energy, shortness of breath, pale skin, feeling your heart beat (palpitations).

Caring for your perineum
It could be that your perineum is just sore after birth, that you have a perineal injury (with or without stitches) or that you had an episiotomy. Although initial healing may happen in a few weeks, the discomfort can last longer, and sex can be painful for a few months.
Some things you can do to help alleviate discomfort include
• Applying cold packs to your perineum (put a cloth over the area and over the cloth put a waterproof bag with ice; hold in place for as long as is comfortable)
• Dampening a maternity pad with witch hazel extract and water, freeze and apply to your perineum
• Rinsing after urinating and only patting dry (don’t rub)
•Sitting in a tub of warm water for a few minutes, you can include herbs or epsom salts if that feels comfortable
• Air-drying your perineum after bathing, soaking or peeing before putting on a pad or clothes
• Using a donut pillow or swimming ring (halfway inflated) or roll up a towel in a donut shape so you don’t put direct pressure on your perineum when sitting
• Valuing rest and lying down – these are important and help you heal

Sleeping eight hours or more in one shot is a thing of the past. Newborn infants do not sleep on a schedule, over the first three weeks they have periods when they are awake that a last an hour or two, and then they sleep for two or three hours, day and night. You will be up with them and you should also sleep when they are sleeping (or at least rest) whenever you can. You can still get eight hours of sleep, just broken up over the day - it might take you twelve hours to get a total of eight hours of sleep. Give yourself permission to go to sleep at all times of day - being as rested as possible will make your physical and mental adaptation to life after pregnancy much easier.
After meeting your baby’s needs, your sleep and wellbeing should be your next priority - everything else can wait. You’d be surprised how your perspective, mood and anxiety change immensely depending on whether you’ve had at least some sleep. If it makes things easier, ask your partner or another family member to watch your baby while you take a longer nap.

In the first few weeks after baby’s arrival you don’t have the time or energy to think about exercise, and you shouldn’t be lifting anything heavier than your baby. However, getting outside for a walk with your baby and some sunlight is a good idea. Be gentle with yourself, your body has spent ten months adapting to pregnancy and needs some time to return to normal. Over time you might want to seek out postnatal fitness (or mommy and me) classes in your area, like yoga or babywearing fitness.

Friends are eager to come and meet your baby in the weeks and months after birth, and you are probably quite happy to have some adults to talk to. It’s important to take care to be deliberate and careful about when, how and who you accept as visitors. It’s perfectly ok to tell people that you need some time alone and would be happy to see them when baby is a month old, for example. You might want to delay some of your more challenging visitors and plan their visits for when you are feeling good, at least after 6-8 weeks postpartum. Make plans in advance and let visitors know what you’d like them to bring over, keeping in mind that this is not the time to play perfect hostess.
When visitors come, you can ask them to wash their hands before holding or touching baby. Leave the room to breastfeed if that makes you more comfortable. You can also ask visitors to restrict photographs and posting of images of you (and your baby) on social media. Make a list of things visitors can do and put it on the fridge. You can also write different chores or helpful work on cards and ask them to take one from the pile when they visit.

Ask for help
Don’t wait until you reach a breaking point, seek out help from your partner, family, neighbours and friends as soon as you think you need it. Running some loads of laundry, mopping the floor, cleaning the bathrooms, everything is helpful. Just make sure that this help comes without emotional baggage or judgment - if it does, rather pay someone to do it or reach out to a volunteer service. If someone wants to get baby a gift, instead of getting an adorable romper baby will wear once ask them to pay for a week of a cleaning service. If someone wants to visit, ask them to bring you some groceries or a frozen meal or two.