An overwhelming period awaits over the next few days. You and your body need to land after the pregnancy and childbirth. See this as a time to reset, recover, heal and bond.
Once the placenta has detached, your body transitions from a state of being pregnant. This means both physiological and mental transitions, all of which are controlled by hormones. The hormones that dominated during pregnancy now drop to low levels while other hormones skyrocket. It’s safe to say that you’re riding a hormonal rollercoaster right now, so it makes perfect sense if you feel tired or in need of peace and quiet.
Oxytocin and prolactin
Oxytocin and prolactin are the two hormones that have the greatest effect. Oxytocin triggers the let-down reflex and prolactin makes sure that milk is produced. Even if you do not breastfeed, these hormonal changes will affect you.
Oxytocin and prolactin also make you more emotionally vulnerable in general. The why has not been determined, but there are theories that suggest that the condition is to help promote bonding and sensitivity to your baby.
Baby blues
Many women feel low and close to tears without really understanding why on day three. You may have heard about this. It’s called the baby blues. As many as 80% of all women who have given birth experience this so it’s perfectly normal to feel this way.
Over the course of this first week, emotions will gradually become milder. However, we know that lack of sleep can worsen the symptoms so sleep when you can during the day, particularly if the night has been challenging. Speak with those close to you, both about how you are doing and how you feel, but also about whether there is something that can be done so that you get the sleep and support you need.
Recovery
Recovery after childbirth goes smoother if you eat, drink and rest—for both physical and mental recovery. Be close to your baby, take care of yourself and put the rest of the world on hold for a while. Many feel pressured into receiving visitors and taking on the world soon after childbirth, even if that may not be right for them. These days are particularly important for you having just given birth but also for your family as a whole. Bonding, nursing and feeding as well as recovery takes time; your focus needs to be on your emotions right now. Trust your emotions and your instincts about what feels right or wrong for you.
The uterus is a muscle that is the size of a fist before pregnancy, and that then grows to accommodate the entire pregnancy and your baby. This muscle now has to shrink back to its original size. As it shrinks, so does the location of the wound where the placenta was attached to the uterine wall in order to lessen the bleeding and to allow the area to heal.
Lochia
The first few days, you will bleed a bright red blood from the area where the placenta was attached, and the volume may be slightly more than during your period. This is the first stage of what is called lochia. This changes over time in terms of both volume and appearance, from a fresh bright red bleeding to a darker red and then to brownish, coagulated blood. After a few weeks, the lochia will be a white-yellowish color. This is drainage from the wound and a sign that the wound is healing. Lochia can have a special odor, but watch for signs of infection if the odor becomes strong and pungent.
Postpartum contractions
You may experience something called postpartum contractions when the uterus shrinks. This is pain that occurs when the muscles of the uterus contract, just like in labor, but now in order to assume its normal size. This usually happens when breastfeeding since breastfeeding helps the uterus to contract. Try using a heating pad and take pain relief medication as needed. These postpartum contractions can be considerably more painful after the second child, which is perfectly normal.
Swelling and tenderness
You’re usually tender and swollen the first days after giving birth so it is a good idea to take it easy when you go to the toilet. A cool sanitary pad can help alleviate swelling and, by changing it often in the beginning, you will reduce the risk of infection. Take pain relief medication when needed so you can get up and move around. Some movement aids the healing process.
The rule of thumb is that you should feel better and better for each passing day. Swelling may come and go, but you should feel that it’s going in the right direction. Bleeding and pain should gradually lessen, not increase. If you notice an increase in bleeding the first week, contact the birth center. There may be bits of the placenta or embryonic membranes that prevent the uterus from shrinking and the bleeding from stopping.
Try to drink plenty of fluids and avoid sitting still. It’s important to get your digestive system working after childbirth and many women struggle with this. Eat fruits or drink juice made of ingredients that will help your digestion, such as prunes, pears or kiwis. If going to the toilet is uncomfortable, try pressing a sanitary pad against your perineum for support. This will enable you to feel where the pressure is and will usually make visits to the toilet less uncomfortable.
For breastfeeding mothers
Your body will produce mature breast milk between day 3 and 4, and your breasts will feel swollen. Breastfeed on your baby’s signals and, if something does not feel right, don’t wait to ask for help.
Showering your breasts with warm water can help with milk ejection and relieve the most severe swelling. You can also take ibuprofen to reduce inflammation and swelling. Breastfeeding comes naturally for some women, but many need support and help to get things running smoothly. For some women, breastfeeding will not be the best alternative. If you want advice and support, we have compiled a breastfeeding guide that covers everything from breastfeeding hormones to breastfeeding after a Cesarean delivery. There are video clips that explain hand expression and advice for when your baby refuses the breast. You can find the articles about breastfeeding under Articles & Tools.
For women who had a Cesarean delivery
A Cesarean delivery is a major abdominal operation. Several different layers need to heal after a Cesarean delivery, which requires a period of recovery. You will need to limit your range of motion and will often need support in moving. You will need pain relief medication in the beginning, and combining paracetamol and ibuprofen usually gives good results. In some instances, morphine is necessary, but there’s a fine balance here.
On the one hand, it is important that you are not in so much pain so that you can get up and move around as much as possible. On the other hand, morphine has an effect on your digestive system and makes it sluggish. Your bowel movements are already affected by an operation, and it is important that your system gets moving. If it doesn’t, you could experience more pain and discomfort. If you are experiencing pain up around your shoulders, it generally has to do with your stomach. This phenomenon is called referred pain and is typical after a Cesarean delivery when gas and air stays in the abdomen post-surgery. If this is the case, it may help to place a heating pad over the area that is painful.
Mobilization, as in moving around, is what helps the most with digestive issues. This is probably not easy to do since you are most likely in pain and moving is unpleasant. The healthcare staff can give you some good tips on how to get in and out of bed, and what you can and cannot do the first days.
To get out of bed, start by lying on one side. Use your arms instead of your core muscles to push yourself into a sitting position. Make sure someone is with you when you stand up for the first time. If, for any reason, you are unable to get up and stand or walk the first few days, it is good if you can sit on the edge of the bed and bicycle your legs to get the circulation moving and thereby reduce the risk of blood clots. If it hurts, for example, when you cough or exert yourself, holding a cushion against the scar for support can help.
The first bandages should stay in place for two to five days depending on the type of bandage used. This is also something that the healthcare personnel can help you to change. You can shower as usual, even with the bandage in place. Keep an eye out for signs of infection such as drainage, redness, swelling or pain. Nor should you develop a fever after a Cesarean delivery. Should you experience any of these symptoms, it may be a sign of infection and you should contact the clinic where you gave birth.
Source:
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- Kaplan, A. (red.) (2009). Lärobok för barnmorskor. (3., omarb. uppl.) Lund: Studentlitteratur.
- Myles, M.F., Marshall, J.E. & Raynor, M.D. (red.) (2014). Myles textbook for midwives. (16th edition). Edinburgh: Elsevier.
- Savage S. J. (2020). A Fourth Trimetser Action Plan for Wellness. The Journal of Perinatal Education. Apr 1;29(2):103-112. DOI: 10.1891/J-PE-D-18-00034
- Stewart E. D. & Vigod N. S. (2019). Postpartum Depression: Pathophysiology, Treatment, and Emerging Therapeutics. Annu Rev Med. Jan 27;70:183-196. DOI: 10.1146/annurev-med-041217-011106
- Sutton D. C. & Carvalho B. (2017). Optimal Pain Management After Cesarean Delivery. Anesthesiol Clin. Mar;35(1):107-124. DOI: 10.1016/j.anclin.2016.09.010