Before we begin, please take a moment to congratulate yourself on growing a human being inside your body for forty weeks! It’s an incredible feat so it’s no surprise that you’ll 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.
In collaboration with obstetrician and gynecologist (OBGYN) Dr. Edmund Hon 韓慶璋醫生, Healthy Matters brings you a guide to Post-Partum Changes, Part One: Short Term Changes.
General post-partum 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 post-partum 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 post-partum 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!
If you’re experiencing pain and are breastfeeding, please be cautious as to the type of pain relief you take as it may cross the blood-breastmilk barrier and be passed on to your baby. Ibuprofen and paracetamol/acetaminophen are both safe to take while breastfeeding.
- 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.
Post-partum 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.
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.