Last updated on August 26, 2021.
If you just had a baby, let us congratulate yourself on growing a human being inside your body for forty weeks! It’s an incredible feat, and absolutely normal to see changes from head to toe.
In the short term (6 weeks post-partum), there are many temporary aches and pains to deal with as your body begins to settle back into its pre-pregnancy state.
Postpartum health often goes like this: “it takes nine months to make changes and nine months to reverse them.” We’ve all heard it before. After the initial six weeks’ postpartum healing period, you’re left with a body that is familiar but not quite the way it was before. We’re here to tell you that some of these changes may be around to stay.
In collaboration with obstetrician and gynecologist Dr. Edmund Hon 韓慶璋醫生, Healthy Matters brings you Hong Kong’s authoritative guide to Post-Partum Changes.
General postpartum symptoms
- Many women experience post-birth chills and shaking in the hours after giving birth. This should subside within a few minutes or hours. A warm blanket will make you more comfortable.
- You will have a post-birth bump for six to eight weeks as the uterus shrinks back to its pre-pregnancy size. Some new mothers in Hong Kong opt for specialized treatments after birth to increase circulation and perhaps reduce their post-birth bumps and lose water weight more quickly. With the nod from your OBGYN these can be done soon after birth. Treatments such as abdominal binding, Jamu massage and manual lymph draining are a good way to take some time out for yourself and improve circulation.
- Lochia is the vaginal discharge, made up of blood, mucus and tissue you can expect after a vaginal or C-section birth. It will be dark red for the first three days post-delivery and you may pass small blood clots. From the fourth to tenth day post-delivery, it will be more watery and pinkish or brownish in color. After about two weeks, lochia will be creamy or yellowish and can last for up to two months. Ensure you have a stash of maternity pads(available at many grocery stores and pharmacies) for your first few weeks.
- Many new mothers experience an increase in perspiration, especially at night as their hormones settle after giving birth. A lot of this perspiration is the water weight you lose within a few weeks of giving birth and is a good reason to keep your fluid intake up. Sleeping on top of a towel can make you a bit more comfortable.
Perineal and elimination postpartum issues
- If you had a natural birth, you will have perineal soreness as your perineum stretches and may tear during birth. With a tear or episiotomy, you may be sore for up to two weeks. Bring an ice pack wrapped in a towel and a spray bottle with cold distilled water to the hospital in order to soothe the area after urination to help ease the pain. When you return home, if you are still sore, take a sitz bath with Epsom salts to soothe and keep the area clean.
- As a result of a natural birth tear or episiotomy, or a catheter during an assisted natural birth or C-section, you may have trouble urinating in the first few days. Some of this may be a very normal psychological aversion after the trauma of birth. In the delicate first few days after birth, it’s important to keep your fluids up as you will be losing a lot of water.
- Contrary to our last point, you can also experience urinary incontinence which may be worse when you cough, laugh or sneeze. It’s important to begin strengthening the pelvic floor with Kegel exercises as soon as you feel comfortable doing so.
- Constipation is also a common post-birth side effect. Like urination, many women are nervous about their first bowel movement. Drinking fluids and plenty of fibrous foods (fruits and vegetables, dried fruits, a fibre supplement) will make the process run much more smoothly.
Other postpartum pain
- In order to return to its original size, you will have uterine contractions for up to six weeks post-partum. They may be more noticeable during breastfeeding.
- If you had a C-section, you will experience soreness around the incision and may need medication for one to two weeks. With your medical team’s approval, you will likely be moving within 24 hours of your surgery – the longer you wait, the more challenging it will be. C-section abdominal binders and belts are available at many hospitals and pharmacies and can be very helpful to protect the incision area as well as support your back as you move around.
- The change in your posture during pregnancy, the effects of childbirth and the day-to-day caring for your baby can all lead to back pain. To ease back pain, make sure you protect your back while bending to pick up your baby and consider a breastfeeding pillow to avoid being hunched over during the many, many hours you will spend feeding. Binders and belts can help support the back but won’t make your tummy disappear!
- Breast engorgement is a swelling of the breasts and is another reason to bring an ice pack (or 2) to the hospital! While feeding or pumping is the only way to ‘cure’ engorgement, there are many things you can do to ease the discomfort: applying cold, warmth, gentle massage, and cold cabbage leaves. You can expect to experience breast engorgement for a few days after birth, regardless of whether you are breastfeeding. Breasts will be warm, hard and heavy. It occurs as a result of several factors:
- in the first two to five days after birth as your milk comes in;
- if you miss a feed or two; or
- if you suddenly stop breastfeeding.
- If you are breastfeeding, you can expect some breast discharge. Disposable or washable bra inserts can be found at many mom and baby stores and will help you avoid any embarrassing shirt stains.
Breastfeeding is a real challenge for many new mothers. Luckily in Hong Kong, there are many private midwives and lactation consultants available to help. Most private hospitals will have a midwife trained in lactation on-staff and private lactation consultants are available for in-house visits. In the public system, Queen Elizabeth Hospital is the first hospital in the city to have a lactation specialist on-staff. If you aim to breastfeed, make sure to enquire about lactation resources at one of your prenatal visits.
Postpartum depression and mental health
Bringing a new baby home is a monumental life event. Many new mothers expect to feel complete bliss, punctuated by the occasional dirty diaper, but instead feel moody, overwhelmed and exhausted. Babies are a full time (as in 24 hours, not 8 hours!) job with no “off” switch. Babies don’t come with a manual and mothers often feel isolated and alone. The tasks required to take care of a baby are simple but relentless and can leave a completely exhausted new mother doubting their abilities.
It is important for all new mothers to prioritize their mental health. For most women, that means finding support, either by themselves or with their baby:
- Have a family member/partner/helper/someone you trust watch the baby while you catch up on sleep. Ideally this should be out of earshot so you can sleep undisturbed – even half an hour helps.
- Leave your baby with someone while you do something that connects you to your pre-baby self – pampering yourself, exercising, or visiting friends are some suggestions.
- In moments of desperation, place the baby somewhere safe (cot, fastened in the pram etc.) and go to the other room or in the shower to take some deep breaths. Just a few minutes’ break will make a difference.
- Making connections with women who have given birth at a similar time as you can go a very long way toward maintaining sanity. The WhatsApp messages you will exchange when you’re awake at 3 am will make you feel less alone. Now that you’re working on a 24-hour, 7-days a week clock, having friends available who you can talk to about dirty diapers at 10am on a Tuesday will make you feel like you have a social life.
Between days 3 to 5 post-partum, it is normal for new mothers to feel anxious, tearful and upset as post-pregnancy hormones start to settle.
We will discuss postnatal mental health at length in a future article, but in the meantime, please consult your OBGYN, GP, the Hong Kong Family Health Service or NHS Choices if you have questions or concerns about postnatal mental health.
Managing your postpartum health – Preparation is key
It’s important to remember that your body has carried a baby for nine months and there are a lot of changes that happen in the first six weeks after giving birth. Understanding and being prepared for the changes will help relieve a lot of the symptoms. In a period in life where so many things are upended, it goes a long way to take control of symptoms where you can.
Appearance – Postpartum long term changes after pregnancy
- The extra weight gained during pregnancy can take a long time to lose. After the initial loss of the baby’s weight, amniotic fluid, increased plasma volume and water weight, many women will hold on to some of the weight they’ve gained during pregnancy. How much weight you retain in the long term is associated with how much weight you gained during pregnancy. Aiming to lose 0.5 – 1 kilogram per week over a longer period of time by incorporating movement is more realistic and sustainable than losing weight quickly. Try to make sure you practice healthy habits such as eating a balanced diet full of fruits and vegetables and exercising – even walking with your baby in the stroller will help. Think of these as lifelong habits to model for your little one.
- Speaking of weight gain, those extra 10-15 kilograms gained during pregnancy often flatten the arches in your feet and cause an increase foot size. The solution? New shoes!
- As a result of post-partum hormones settling back to normal, the full and shiny hair you had during pregnancy starts to fall out, peaking at around the 3-4-month post-partum mark. It can be alarming at first but it should even out within a year.
- After plumping up during pregnancy and breastfeeding (whether you actually breastfed or not), your breasts may change shape when you stop. Producing milk causes breast tissue to become more dense. When you finish breastfeeding, that fatty and connective tissue may shift. Some women may end up with breasts that are larger than pre-pregnancy, while others may have breasts that feel ‘empty’.
- Approximately 80-90% of women will get stretch marks at some point in their pregnancy. Some stretch marks may fade to a light, silvery colour, while others may remain dark and more red. Unfortunately, they are difficult to remove altogether without laser therapy or cosmetic surgery, however some women have found that applying a cream containing hyaluronic acid when stretch marks are red can help them fade.
- During pregnancy, some women develop a dark line, known as the linea nigra, going vertically down their bellies. The linea nigra takes up to several months to fade.
Sexual health – Postpartum long term changes after pregnancy
- Tiredness, a changing family life, increased life and work stress, and low estrogen levels can lead to a decreased sex drive in post-partum women. It may seem impossible now but most women are back to their normal levels within a year.
- Your fertility may decrease in the months post-partum as your hormones balance and you begin to ovulate again, but it is still possible to get pregnant in that time. Don’t forget that ovulation occurs before your period arrives so you may be fertile before your first period arrives. Birth control is still advised in the post-pregnancy period!
Physical health – Postpartum long term changes after pregnancy
- A weak pelvic floor can lead to longer term issues. During pregnancy and delivery, your pelvic floor muscles can become stretched, potentially causing long term incontinence, bowel control, uterine prolapse, and reduced sensation during sex. Strengthening your pelvic floor anytime in the pregnancy/post-partum period can help prevent and address these issues. If you are having trouble doing Kegel exercises or have a feeling of heaviness or pulling in your pelvis, experience pain during sex, or have a sense of rubbing against your underwear, please contact your physician.
- Key to getting back into or starting to exercise after a baby is ensuring your core muscles are strong enough to support your body. Women with uncomplicated vaginal births can begin gentle postnatal exercise a few days after giving birth; women who had a c-section birth should wait until they have their six-week check-up. The Hong Kong Family Health Services has a helpful guide to early postnatal exercise plan. Once the core is stable and you have no further concerns, you can ease into the exercise plan of your choice. Make sure you keep an eye on what feels comfortable and if vaginal bleeding increases, slow down and give your body more time to heal. Keep in mind that your body has worked hard over the last nine months and it make take some time to get back to the fitness levels you had pre-pregnancy.
- Finding time to fit exercise in is another big challenge for new (actually, all) parents. If you cannot leave your baby with someone during hours you actually want to be awake, there are lots of ways to fit in a bit of exercise here and there. Your baby will be captivated watching you do lunges, push-ups and star jumps all over the room! Or try taking your baby outside for a walk. Pushing them in a stroller or carrying them in a carrier will add a bit of resistance and expose them to the fascinating outside world.
Mental health – Postpartum long term changes after pregnancy
By now, you will have experienced the highs and lows of parenthood. Some days feel like you’re completely on top of this motherhood gig and other days, teething/sickness/a sleepless night hits and all of a sudden, everything you knew about this little bundle of joy goes out the window and you feel like you’ll never get a hang of being a parent.
Everyone needs support of one kind or another. Your support system can be made up of other parents with a baby of a similar age, someone who can watch your baby, and/or a partner who shares the load.
Knowing when you need a bit of extra support is key to taking charge of your mental health. In our book, The Hong Kong Maternity and Baby Book, psychologist Dr. Quratulain Zaidi describes the difference between baby blues and postpartum depression. With the baby blues you may feel emotionally fragile, anxious and overwhelmed but it only lasts for a few days and should be gone by two weeks postpartum. Postpartum depression is longer term and onset is anytime in the first year. Symptoms may include unexplained sadness, insomnia, feelings of worthlessness, disinterest in your baby, anxiousness, and a feeling of a loss of control. If you begin to feel like this, it’s important to contact your obstetrician, GP, or a psychologist as soon as possible. Early intervention is key to both you and your family’s well-being.
Take home message about postnatal health
After all new parents go through in the first year, it’s a hard pill to swallow that having a baby will affect your appearance as well as physical, mental, and sexual health. It’s important to give yourself time to heal, discover what being a parent means to you and get to know your baby. Keep an eye on yourself and arm yourself with the resources you need.