One thing to keep in mind is you just went through one of the toughest and most emotional workouts on the planet! This new postpartum phase is a physical adjustment, no matter which method you delivered by. Your uterus fit a whole baby, it’s not going to snap back to pre-pregnant size or shape overnight. All your organs had to accommodate the growing uterus so they’ll be readjusting too. And sometimes, this can feel like a baby in there kicking! You’re not imagining the sensation, but you’re not going crazy either, and it will stop.
There’s lots of extra fluid onboard after delivery. You needed it to help maintain your blood pressure and circulation to your baby. Now that baby has been born, the fluid shifts to your tissues. IV’s during labor contribute to the volume. You may have swelling of your hands, face, or feet when you didn’t before. Hopefully it won’t contribute to high blood pressure, but be aware the risk of pre-eclampsia can happen up to 6 weeks postpartum. You will naturally get rid of this fluid through sweating and lots of pee over the next 1-2 weeks.
Speaking of pee, try to keep your bladder emptied frequently. If you read the part about labor, a full bladder interferes with uterine function, in this case making it where it can’t contract. A uterus that can’t contract, bleeds. Other measures to reduce bleeding are fundal massage and breastfeeding. With the topic of bladders…you might also notice some leaking. This is usually temporary from the pelvic floor weakening with pushing and delivery, plus hormonal changes. It can also occur if you were catharized for epidural or c/s. Keep drinking water, as you don’t need a UTI on top of it. Kegels might help too but current recommendations are to do them when your bladder is empty instead of full. If there is no improvement of leaking in a few weeks, there are pelvic physiotherapists or you can talk to your doctor.
Pooping is a topic of interest to many, especially if you have hemorrhoids or any repair of your perineum. If you didn’t eat during labor or because of surgery, it can take 2-3 days to start going again. You’ll want fluid and fiber onboard to help your stools remain soft so you don’t have to strain to go. Increasing your intake of fresh produce such as lettuce, cabbage, broccoli, cauliflower, spinach, cucumber, and celery can be an easy way. Also melons, blueberries, and oranges have higher water contents.
While we’re talking about “down there” let me mention peri-care. In all situations you should be wiping front to back in order to reduce contaminating your urethra with bacteria and causing a urinary tract infection. No sexual intercourse for 6 weeks because you just pushed out 5, 6, 7, or more pounds of infant. (It could take even longer for you to want to! Which is perfectly normal and ok. You are healing and spending a lot of energy taking care of a tiny human). If your perineum is intact – yay! - no other special care needed. If you have any laceration or stitches, using a peri squeeze bottle filled with warm water during urination can reduce any stinging, but definitely use it to rinse after you’re finished. Pat dry instead of wiping. Any stitches will dissolve on their own in about 7 days, so try not to be alarmed if you see that on the toilet paper. If the labia or perineum are swollen, ice packs for 20 minutes at a time will help you feel better. Here’s a hack: wet a pad with water and freeze it; when it’s ready, insert into those fabulous knit panties they issue on top of your regular pad. The top pad helps catch the flow, the bottom pad helps catch the melting of the top pad.
Bleeding, aka lochia, is going to continue for a while. The color changes follow a period: red, to darker red, to pink, brown, and then white. It can last 2 weeks or more. It is heaviest the first 24 hours, then should taper off. At no time should you be soaking pads, having to change more than once every 2 hours, or passing large or multiple clots. Menstrual cycle returns in about 6 weeks, often longer for breastfeeding moms due to hormonal suppression. However, fertility is a tricky beast! No method other than abstinence is 100% fool proof! When you decide to resume sexual relations, please 1. Take precautions and use birth control. 2.Don’t feel pressured to perform. 3. Be open and communicate with your partner. Things have changed emotionally and physically and you need time, patience, even self-compassion to discover what is pleasurable now. 4. Use water or silicone based lubrication. This should not be perceived as a failure on either partner but as protection for your vagina against the microtears that cause problems down the road.
Which birth control? All barrier methods are safe with breastfeeding but their reliability is less. If you choose oral hormones, stick with progestin only. Exposure to any estrogen will quickly diminish your milk supply. Non-hormonal IUDs are ok too. Stay away from early use of “the shot.” There is not enough scientific evidence to show depo-provera harms milk supply, but observationally over the years, I have seen it dry up more than one woman. Wait at least 6 weeks so your production is well-established first if you choose that route.
Rest is super important to your overall mental and physical wellbeing. Resting means rest. Your baby sleeps in short sessions which means your sleep is now disrupted too and many parents underestimate the effect this is going to have. Taking advantage of when baby sleeps does not mean it’s time for scrolling, catching up on emails, watching TV, trying to do birth announcements, or any chores. In the first few weeks it means naps are in order!
It also means limiting visitors – to the hospital and at home. It may be unpopular, but I know what it’s like to be excited, tell everyone, and then regret the constant stream of people, which happened with my first child. I also know the experience of a more peaceful transition as a result of waiting to tell everyone until we were home with my second. No one acted offended. Limit who gets access to you and when! If you feel you must have visitors in the hospital, make sure they have a specific time period of arrival and how long they can stay. A sign up sheet with groups of no more than 5 at a time, making sure there are breaks of 2-3 hours in between can be helpful. At home, have visitors bring nutritious dinners and snacks for you and your partner. Trade small household tasks like starting or folding a load of laundry, taking out the trash, loading the dishwasher, etc. for interacting/holding your baby. I promise, people want to help, they just need to be told how.
So far, this has all addressed the physical and you are more than a baby maker or baby feeder. You are more than any roles, more than labels. You are whole, you are enough.
Those dang hormones though!
Having a baby brings an upheaval to everything in your life. The physical changes. The emotions surrounding parenthood. The responsibility. When you get to eat or shower. The quiet time. To top it off, your hormones are in major state of flux. And sleep deprivation makes everything worse!
Mental Health
Dads/partners aren’t immune to mood swings, either, and for some of the same reasons (although astonishingly, I’ve seen men sleep through a crying baby). In fact, there is such a thing as Paternal Perinatal Depression too (PPND). Dad or any partner may feel less important now, since your focus is the baby. The symptoms differ from women; where moms are typically sadder, fathers or significant others are often more aggressive with lack of impulse control and more alcohol abuse and food disorders. Counseling, therapy, and online support groups are available. Other ways to help is having them spending time with baby. It will be a separate and different relationship. Partners don’t need to do things exactly as mom does; it may be different but avoid making them wrong. Bonding with baby through cuddling, skin to skin holding, and eye contact with baby, as well as bathing and diaper changes are ways for your partner to feel included. They can also help with feed after 4 weeks. Both parties need to be patient.
- Baby blues – a result of hormonal changes, healing, and exhaustion, it’s common, normal, and not your fault. Hitting 2-3 days after delivery, it can last up to 2 weeks. You may have times you’re tearful about things you normally wouldn’t be or feeling less able to cope. You may even catch yourself asking if you should’ve even had a baby! It will pass.
- Postpartum Depression – this is either lasting longer than 2 weeks, or feels more severe and it intense than baby blues; it occurs all day, making it hard to even function, you can’t think rationally, or you have thoughts about wanting to hurt yourself or your baby. Call your doctor! It is not something to be ashamed of. You can and should continue to breastfeed if able. Many antidepressants are safe and temporary.
- Postpartum OCD (problematic repetitive actions or thoughts) or psychosis- if you start hearing or seeing hallucinations, attempting self-harm, show agitation, confusion, aggression/violence, feeling afraid or paranoid, or start speaking nonsense, it is time for 911. In this state, you may not be aware of the gravity, so partners and support people need to be aware.
Ways to help your mood
- Mindfulness/meditation – there are many forms of active medication that don’t require a monk’s level of time, silence, stillness, or lack of thoughts
- Breathing exercises
- Music and Dancing
- Movement like yoga or walking
- Sunshine
- Making sure your microbiome is regulated
- Journaling – and acceptance of negative feelings such as regret/remorse/guilt