Physical changes after birth
After delivery your body will begin to return to the non-pregnant state, but it takes about 6-9 weeks for this process to be complete. It is important that you give yourself time for your body to recover, and adjust to being a parent. There are some things you need to remember to watch for in the first few weeks to be sure all is going well.
Bleeding
First 24 hours: Bleeding will be heavier than a heavy period and bright red in colour. It is normal to pass small blood clots (plum sized) and even 1 large clot (orange sized). It is normal to experience a “gush” of blood from the vagina when getting up or changing positions, due to blood pooling in the vagina. Emptying your bladder frequently is very important as it can assist in allowing the uterus to contract and slow your bleeding. Someone should always be present to help you get up in the first day and you should not be holding the baby, as it is easy to becomes dizzy or faint suddenly.
Day 3 to 5: bleeding will thin out and become lighter in colour (pinkish)
Day 5 to 10: bleeding will continue to lighten in color (yellow/white/brown)
Ten days to 6 weeks: Some clients may hardly bleed at all, while others may bleed on and off up to 6 weeks postpartum. This is normal.
*Activity and stress may increase blood flow; this is a sign that you should rest more.
Always call your midwife if…
- You are completely soaking through a maternity pad in 30 mins or less
- Your discharge smells foul (like rotting meat, or pus) It should smell like a normal period but a bit stronger
- You pass more than one large blood clot
- The flow becomes significantly heavier than it has been, unrelated to activity
- You have persistent uterine tenderness
- Fever greater than 38C
Always page your midwife day or night if you have an urgent concern.
Your uterus
First day: your uterus should feel like a firm mass about the size of a grapefruit in the middle of your abdomen. Putting the baby to the breast to feed, and emptying your bladder can encourage this. If your bleeding is heavy and your uterus will not remain firm call your midwife.
Involution: Your uterus will gradually return to its pre-pregnancy state over the next 2 weeks, until you can no longer feel it in your abdomen.
After-pains: It is normal to experience cramping when you are breastfeeding. After-pains are more noticeable as you have more babies. Both Acetaminophen (Tylenol) and Ibuprofen (Advil) are safe and recommended for pain management in the postpartum period.
Your perineum
- Soaking your perineum in a warm bath (or sitz bath) several times a day with epsom salts will reduce swelling, discourage infection and encourage healing. This is also helpful for hemorrhoids.
- Witch Hazel compresses can also help with hemorrhoids and perineal healing. Soak maternity pads with witch hazel and put them in the freezer.
- Herbal baths and compresses with ingredients such as comfrey are soothing and healing, however if you have stitches these products should not be used for the first 3-5 days, as they can cause stitches to dissolve too quickly.
Urination and bowel movements
- You should urinate within 4 to 6 hours after the birth, and continue to empty your bladder frequently in the early postpartum period. Some clients temporarily lose the sensation to urinate, so it is very important to try to go to the bathroom about every 2 to 3 hours when awake. Emptying your bladder frequently is very important, as it helps keep your uterus contracted and therefore keeps bleeding to a normal level.
- To reduce burning/stinging use a squirt bottle to dilute urine by pouring water down your vulva while urinating
- Most clients will have a bowel movement within 2 to 3 days postpartum. To keep stool soft be sure to get lots of liquids and increase the fibre in your diet (e.g. bran, fruit, veggies).
Nutrition
- Be sure to get plenty of fluid. This will encourage proper function of the bladder and bowel and help to build a good milk supply. One way to ensure you are getting enough fluid is to have a big glass of liquid (not coffee or caffeinated tea) each time you nurse.
- While breastfeeding you need a nutritional diet with adequate calories including an adequate supply of proteins, fresh fruits and vegetables and whole grains. (See Canada Food Guide pg. 31)
Rest and support
- The early postpartum period is a sensitive time for new parents, especially day 3-4 when hormonal changes are at their peak and milk is coming in. Both the physical and emotional adjustments to parenthood are stressful – expect to need lots of rest, reassurance and support.
- Regulate the number of visitors, as it is easy for parents to get overtired and baby to get over stimulated. Parents need lots of rest and time alone with their new baby. Try to sleep when the baby sleeps and don’t hesitate to delegate jobs to family or friends when possible.
Postpartum exercises
Strenuous exercise should not be resumed until bleeding has subsided.
Here are some exercises which can be done in bed and can be started shortly after giving birth.
Kegels: (pelvic floor exercises) These help to improve the muscle tone and accelerate healing by increasing circulation and blood flow to the vaginal area. Kegels also help with urinary incontinence, which is common after pregnancy and childbirth.
Pelvic rocks: May help with back discomfort and cramping as well as help firm abdominal muscles. Lie on your back (on bed or floor) with knees bent and feet flat on the bed/floor. Tighten your lower abdominal muscles and buttocks to press the small of your back into the mattress. Relax and then repeat several times.
Hip rolls: These strengthen abdominal muscles and alleviate back pain. Lie on your back, pull knees up to chest, and then roll to either side.
This is borrowed from the Midwives Collective in Toronto. They did such a great job, we didn’t need to change anything!