The Essentials on Postpartum Care:
It is very common for women to self-neglect once their baby arrives. It is certainly not intentional but it just seems to happen with most new mothers. The general rule is to remind yourself to prepare for the period post birth as you prepared for the birth itself. You need this reminder because it is very easy to forget yourself with all the excitement around you.

After delivery you will be taken to your room to rest. You will feel very tired, more so if your labor was long and you did a lot of pushing and slept very little the night before. You will be encouraged to urinate in the case of a normal delivery; catherization, a procedure whereby a tube is passed into the bladder to help you void is required, especially for C-section cases. You will be given pain relievers to help you deal with the pain from the stitches and sitz baths and cold ice packs for the episiotomy (a cut in the perineum to aid delivery) and hemorrhoids if any. A cream will be applied on the stitches to prevent them from drying out. You will be taught how to change your sanitary pads and how to clean up after your visit to the washroom, to prevent infection. It is normal to feel dizzy and light-headed when you get off the bed; this is more likely due to the after effects of the epidural you were given. With ample rest, you should be fine before being discharged from the hospital. Address any issues if in doubt with your doctor before leaving for home.

Home sweet home..

After being discharged and taken home, the intense fatigue felt following the birth has more or less subsided. However you have a new source of headache and concern to deal with: your baby's unpredictable schedule. You may be getting very little sleep at night and insufficient rest periods in the day, which may very well overwhelm you in the start. Gradually you will adjust to this unpredictable schedule as well; it is just a matter of time. If you face problems adjusting and find yourself tired even after a month, be sure to mention this to your doctor during your first postpartum visit. If you had lost lots of blood during delivery, it may take you weeks instead of days to regain your lost strength. Muscle tone in the abdomen returns very slowly for most. This again differs from one woman to another and is dependant on the amount of stretching the abdomen underwent and the mother's muscle constitution. The postpartum period is one where your body undergoes major changes: a change in hormones, body shape and body size. Some of these changes are unpleasant; some you will gladly welcome. It is important to know that these changes are necessary before you return to normalcy and that you have nothing to fear. The other key factor is to listen to your body - no two pregnancies are alike and the same applies to the recovery period. While for some of you the postpartum timetable may fit perfectly, for others it may not go according to plan. There are several discomforts (the unpleasant changes) you will have to undergo after welcoming your bundle of joy into this world!

• Within the first 72 hours your breasts will produce milk in abundance; simultaneously blood vessels fill up causing breast tissues to swell. This is termed as breast engorgement and can be quite painful with the pain spreading into the armpit area. Your breasts may feel tender and lumpy when touched; fortunately this problem subsides when your milk is expressed on a daily basis. For mothers who are not feeding, don't bother expressing or pumping and let the milk dry up on its own. Avoid nipple stimulation and applying warm towels as this work on producing more milk. Instead use ice packs on your breasts and a good support bra to ease the pain and speed up the drying process. The discomfort should disappear in about 3 days and can be relieved by pain medications.



• Painful episiotomy can take a while, upto 6 weeks or more to heal. The V zone having been stretched or torn during delivery may cause your perineum area to feel sore. Continue with the ice packs or sitz baths (sitting in warm water for a while) after going home. Be particular in how you clean yourself to avoid infection; a spray bottle will come handy while toilet paper should be avoided for the time being.



• Lochia, a bloody vaginal discharge is another 'discomfort' to deal with; it is actually the uterus shedding the lining that was formed during pregnancy. After the initial heavy bleeding which lasts for about a week, light bleeding resembling menses, follows. Menses like flow continues for a few weeks to be replaced by white, creamy discharge with an unpleasant odor at the tail end. Lochia usually stops 3-6 weeks after delivery. Your next menstruation will depend on whether you are nursing, although most nursing mothers will have their periods long before they cease breastfeeding.



• Afterbirth pain or uterine contraction is another common discomfort you will just have to go through; like the other discomforts, this one too won't last and can be relieved. It is caused by your oversized uterus shrinking back to its pre-pregnancy size. With first babies the pain is usually mild. The contractions get stronger with subsequent babies but in both scenarios they only last for a couple of weeks. You will continue to feel some bloating and discomfort with your stomach still looking large. Try sleeping or lying on your stomach with your pillow tucked under your abdomen. Make sure your bladder is kept empty. If pain is unbearable, check with your doctor on medications you can take.


• Constipation after delivery is caused by lax abdominal muscles and reduced movement through the intestines. Pain from the incision or hemorrhoids creates a mental block, aggravating the problem further. Avoid straining; instead consume plenty of fluids and juices, dried fruit or and a high fiber diet usually does the trick. Resort to a mild laxative if nothing else works.



• Hemorrhoids can become swollen and even protrude during pregnancy, labor and delivery. The pain can be discomforting. There are special sprays, ointments or dry or moist heat that can be applied to the affected area. Cold compresses are also very soothing. Hemorrhoids will shrink in size and sometimes even disappear altogether.



• Frequent urination is caused by the pressure on your bladder which in turn creates the urge to pee. You will also find it increasingly difficult to hold your urine. This problem can be corrected with time and you can speed up the process if you start practicing kegel exercises, once your V zone area is healed and not causing you any more pain.




Most of the aches and pains should disappear after a few days post delivery except for the caesarean and episiotomy pains which will take some more time to heal. If these pains are intense and unbearable, consult your doctor.

When postpartum symptoms become your doctor's concern..

Call your doctor if you notice any of the following:
• Fever over 38 degrees Celsius (after the first 24 hours)
• Nausea and vomiting
• Chills
• Loss of appetite
• Painful urination, burning and urgency
• Pain, swelling and tenderness in the legs
• Pain in the lower back or abdomen
• Severe constipation
• Chest pain and cough
• Hot, painful, swollen, tender breasts
• Persistent pain in the V zone with increasing tenderness
• Bleeding heavier than your normal period
• Overwhelming fatigue
• Vaginal discharge with foul smell

It pays to note

It is important to begin exercising your pelvic floor muscles to restore its tone soon after your delivery. Despite your busy schedule set time aside for this after checking with your doctor. Failing to do so has heavy repercussions in the form of inability to retain water and prolapsed womb in later life. It can be done several times anytime of the day while you are sitting, standing or lying down. Stitches are no issue here; instead this exercise will promote healing by increasing blood flow to the affected area. Just squeeze and lift the muscles around the front passage as if you are trying to interrupt the urine flow. Hold to the count of three and then relax. Repeat a number of times.

Postnatal posture is just as important now as your posture was during pregnancy. In pregnancy, hormones have softened and stretched the spinal and pelvic ligaments in preparation for childbirth. Your back muscles which are weaker now have to bear the additional strain when you breastfeed your baby or carry him around. Any activity done wrongly can add to the backache. It may take upto several weeks before your back heals. In the meantime these tips will help you deal with your back:

1. find a comfortable position when breastfeeding; a pillow (nursing pillow if you have one) positioned right is very helpful
2. avoid stooping or lifting heavy objects for the first 6 weeks after birth; bend your knees when lifting objects off the ground
3. use prams with handles at waist levels so you don't have to lean forward when pushing it
4. sit with a supporting cushion in the small of your back and avoid slouching
5. try to bathe your baby at waist level to avoid bending
6. walk tall with your stomach tucked in
7. use a baby sling that carries your baby centrally