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 The First Few Weeks Following Birth

The first few weeks after having a baby are a time of great change. You may look at your baby with wonder and amazement, but at the same time you may feel exhausted from  lack of sleep and overwhelmed by your new responsibilities.  Regardless of the type of birth you have had, your body will go  through many changes as it adjusts to not being pregnant and  recovers. You may feel the physical and emotional effects of childbirth all at once or over a period of time. These changes are different for every woman.


Emotional wellbeing
Giving birth is an emotional and tiring experience and your hormones change dramatically in the first few days following birth.  Many women get the ‘baby blues’ during the first few days or weeks after birth. The baby blues usually peak around the fourth day and then ease up in under two weeks. If you have the blues for more than a few days, or if you have thoughts of hurting yourself or your baby, call your doctor right away. You may have postnatal depression, which needs to be treated. Further information about depression following the birth of your baby can be found on the RANZCOG website under patient information.  Not all birth experiences go according to plan or as imagined.  This may lead to a sense of disappointment or feelings of failure.

A birth that meets your expectations is ideal, but a healthy baby is more important. Any birth experience that has produced this cannot be considered a failure. If you have any questions or concerns, it is important to talk to your doctor or midwife.  During your baby’s first few weeks, you will spend most of your time feeding, cleaning, dressing and comforting your baby. You may feel overwhelmed at times. It’s normal to feel like you don’t know what you are doing, especially if this is your first child. It can be difficult to admit to yourself that you are struggling and even harder to tell somebody else (your partner, family, child healthcare nurse, midwife or doctor). However, there is often an enormous sense of relief when you share these feelings and any problems are addressed.

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Physical changes
Bleeding after the birth
Over the first few days and weeks after giving birth, you will have some period-like bleeding as your uterus returns to its pre-pregnancy size. This will be quite heavy at first, which is why you will need super-absorbent sanitary pads. Gradually, the bleeding will become a brownish colour and may continue for about two months. If you find you are losing blood in large clots, you should save your sanitary pad to show your midwife, as you may need some treatment.  While breastfeeding, you may notice that the bleeding is redder and heavier. You may also feel  cramps, like period pains, known as ‘afterbirth pains’. These are often felt while breastfeeding due to the uterus contracting and tightening. These pains are more likely to be felt following a  second or subsequent birth and can be relieved by applying hot packs or taking simple pain relief, such as paracetamol, 30 minutes before breastfeeding.

Stitches
If you’ve had stitches after a caesarean section, tearing or an episiotomy, it is safe to bathe the area often in clean warm water. Have a bath or shower with plain warm water. After bathing, dry yourself carefully. In the first few days, remember to sit down gently and lie on your side to keep pressure off the area.  Pain, discomfort and numbness are common after having stitches. If the stitches are sore and uncomfortable, tell your midwife, as they may be able to recommend measures to relieve pain. Regular pain relief, such as paracetamol, will also help.  Usually stitches are reabsorbable, meaning they are absorbed by the body and do not need to be removed.  If you have swelling or pain around the opening of your vagina, you can put ice or a cold witch hazel compress on the area for 10 to 20 minutes at a time. Put a thin cloth between the ice and your skin, or place the ice compress inside your pad.

Going to the toilet
If you have had a vaginal birth, you may have some grazes or tears to the skin around the vaginal opening. The thought of passing urine can be a bit frightening at first because of the soreness and numbness. These grazes can cause a stinging sensation when you pass urine during the first few days following childbirth. Increasing the amount of water you drink will dilute your urine and reduce the stinging sensation. You can also try sitting in a few inches of warm water or pouring lukewarm water between your legs while you are sitting on the toilet. If you find it really difficult to pass urine, tell your doctor or midwife.  You probably will not need to open your bowels for a few days after the birth, but it’s important not to let yourself become constipated. Haemorrhoids are very common during pregnancy and after birth and usually disappear within a few days. To minimise constipation and haemorrhoids, increase your intake of foods high in fibre, such as fresh fruit, vegetables, bran and wholemeal bread, and drink plenty of water. This should make bowel movements easier and less painful. Whatever it may feel like, it is very unlikely that you will break the stitches or open up the cut or tear again. It might feel better if you hold a clean pad or toilet paper over the stitches for support during a bowel movement.

Breastfeeding
The hormone changes that occur during pregnancy change your breast tissue, whether you breastfeed or not. An increase in breast size is common during pregnancy and you may have noticed your nipples getting darker and becoming more tender.  Many women find their breasts change dramatically during the first few days after birth as they begin to produce milk. When your milk comes in on day three or four after birth, your breasts may become enlarged, firm and uncomfortable. To manage any discomfort, wear a well-fitted maternity bra for support. If your milk is flowing, take warm showers. Gently massage your breasts while in the shower to increase circulation, reduce any lumps and open the milk ducts. Use warm or cold compresses – whichever provides relief.  If you are breastfeeding your baby, practice makes perfect. Your baby has great instincts for breastfeeding, but still needs to master the skill of attaching, suckling and emptying the breast. As your baby masters this skill, so will you. Breastfeeding can be a challenge. Don’t misinterpret this as signs that your ‘baby doesn’t want it’ or you ’aren’t making enough milk’. Have patience and confidence in yourself and do not hesitate to ask advice from your midwife, lactation consultant or child health nurse.

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Rest
It is very easy to become too tired or overwhelmed during the first few weeks after childbirth. You need to focus your energy on yourself and getting to know your new baby. Even though you may be very excited and have requests for visits from family and friends, try to limit visitors and get as much rest as possible. Try to maximise the opportunity for rest by:
  • Trying to sleep when your baby does
  • Letting family and friends bring you meals and do chores
  • If you have other children, planning for childcare
  • Not expecting to keep the house perfect
  • Not being afraid to ask for help

Diet and nutrition
Eating a variety of healthy food is important to help you keep your energy up and can help you to lose any extra weight you gained during your pregnancy. Try to consider the following points when choosing what to eat:
  • Calcium – increase the number of serves of dairy and green leafy vegetables, particularly if you are breastfeeding.
  • Fibre – eat plenty of fibre in the form of fresh fruit (particularly pears) and wholegrain cereals. This will help to activate your bowels.
  • Protein – eat meat, fish, poultry, eggs or legumes to help regain and maintain your strength.
  • Vitamins and minerals (particularly vitamin C) – increase the number of serves of fruit and vegetables to promote healing. Limit your intake of fruit juices and canned fruit though as they are  high in sugar with limited nutritional value.
  • Iron – eat iron-rich foods to replace what was lost by bleeding during and following the birth. Iron-rich foods include red meat, seafood, green leafy vegetables, legumes and tofu.  If your doctor or midwife has told you that you lost a large amount of blood or had a postpartum haemorrhage, it may take longer for you to feel back to normal and an iron supplement may be advised. Combining iron-rich foods with vitamin C will increase the absorption of iron.
  • Fluids – increase your fluids to help your bladder and bowels work sooner and more easily. Having a glass of water within reach while you are breastfeeding is also recommended, as most women feel quite thirsty when feeding their baby.  Make sure that you don’t skip meals or go for long periods without eating. Try to eat small, nutritious snacks throughout the day to keep up your energy.

Exercise
Exercise helps you feel good and helps your body get back to its pre-pregnancy shape. Although your body needs time to recover, some exercises can start the next day. Even if you are resting in bed, it is important to do deep breathing and leg exercises regularly. Postnatal exercises are important to get all your muscles working again, but take things at a gentle pace.

Pelvic floor exercises
It is quite common after having a baby to leak urine accidentally if you laugh, cough or move suddenly. Pelvic floor exercises can help prevent this. It is normal for your pelvic floor to feel weak
and you may not feel these muscles working. Firmly tense the muscles around your vagina and bottom as if you are trying to stop passing wind. Hold for as long as you can, then slowly release and relax. Squeeze and let go a couple of times until you are sure you have found the right muscles. Try not to squeeze your buttocks. Do at least 25 repetitions at various times of the day. You can do these exercises while you stand or sit. You can practise while urinating, contract to stop, then relax to release the flow of urine. Do this to learn which muscles are the right ones to use – but only once a week. Your bladder may not empty the way it should if you stop and start your stream more often than that. These pelvic floor exercises should continue beyond the postpartum period. If you find that there is no improvement after more than three months, see your doctor or midwife, who may refer you to a physiotherapist.

Stomach muscles
Your stomach will probably be quite baggy after the birth.  Despite having your baby, you will still be a lot bigger than you were before pregnancy. This is partly because your muscles have stretched. A balanced diet and gentle exercise will help improve the strength and tone of your stomach muscles. It is not uncommon for the pair of vertical muscles that run down the centre of your stomach to separate during pregnancy. If this has occurred, you may be referred to a physiotherapist who will advise you of some postnatal exercises and support garments that will help bring these muscles back together.

Be active
In general, you can start exercising four to six weeks after the birth. However, check with your doctor before you start exercising, especially if you had a caesarean section. Before this time though, try to get outside, take walks, or keep your blood moving with a gentle workout. Remember to give yourself a break if you are overtired, feeling unwell or experiencing pain.

 
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Sex
For a while after childbirth, don’t be surprised if you have little interest in sex. Physical recovery, exhaustion and hormonal changes often affect sexual desire after childbirth. It is important to avoid sexual intercourse until you feel comfortable. Your body needs time to heal after childbirth. After birth of any kind it is normal to take weeks, even months, before you are ready to have sex. This is due to a number of reasons:
  • Lack of energy – exhaustion, your baby’s demands and recovery from childbirth may make sex less important to you. You will have more energy when you adjust to caring for your baby and are healed, more rested and settled into a routine.
  • Hormonal changes – until your menstrual cycle starts up again, your oestrogen is low and vaginal dryness may be a problem. High prolactin levels while breastfeeding also play a part in vaginal dryness. If you have this problem, use a vaginal lubricant to provide moisture.
  • Breastfeeding – newborns need to breastfeed often. This not only takes up your time and energy, but it can lead to sore breasts. Generally this does not last long and, as your baby settles into a feeding routine, your breasts will adjust. As the healing and feeding demands on your body decrease, you may feel more interested in sex again.
  • Body consciousness – your body has undergone enormous changes and you may feel embarrassed by them. Talk with your partner about your feelings, concerns and expectations.

Contraception
Your periods, and your ability to become pregnant again, will return at your body’s own pace. Remember it is possible to get pregnant during the month before your first period, as early as three weeks after childbirth. If you don’t want to become pregnant, use contraception. Most methods of contraception are safe and effective after childbirth. Talk to your doctor or midwife about which type is best for you.

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When to contact your doctor or midwife
Your doctor or midwife will want to see you for a postnatal checkup two to six weeks after the birth of your baby. Contact your doctor or midwife earlier, if you notice any of the following:
  • Heavy clotting or bleeding
  • Offensive smell
  • High temperature or fever
  • Pain, tenderness or warmth in your calf or thigh, particularly when you flex your foot
  • A lump or hardened area in your breast
  • Redness, heat or oozing from your stitches
  • Depression that affects your ability to cope and does not subside after a few days

It is commonly expected that this should be the happiest time in your life. However, it is also a time of great challenges and learning experiences. Many women fear that they will be judged for not coping. Remember that it is far better for you and your baby to put up your hand and ask for help. This will enable you to be confident physically and emotionally to embrace the journey into motherhood.

DISCLAIMER: This document is intended to be used as a guide of general nature, having regard to general circumstances. The information presented should not be relied on as a substitute for
medical advice, independent judgement or proper assessment by a doctor, with consideration of the particular circumstances of each case and individual needs. This document reflects information available at the time of its preparation, but its currency should be determined having regard to other available information. RANZCOG disclaims all liability to users of the information provided.

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