The first week
You’ve done it! You’ve given birth to your baby!
After many, many months waiting and preparing, your baby has finally arrived safely into your arms and is now being cuddled on the outside. You must have so many thoughts, feelings and emotions rushing around your body, but because you have been so focussed on the birth, you probably haven’t stopped to think about what changes and sensations your body will go through now in this first week.
Women will sometimes comment when I visit them at home during this time “Oh! Nobody told me about this!” or “Nobody told me I would feel like this!” It’s tricky, because most people want you to try and enjoy meeting your baby and getting to know your baby, they don’t want you to focus on what is happening to your body – but often you just can’t.
Here’s a little bit of general information about some things you might experience…
Your head (or brain)
You may feel overwhelmed with all sorts of thoughts and emotions. You may go from the highs of happiness to the depths of despair and anywhere in between – all in about 5 minutes! The sudden changes in hormones is a huge shift for the whole body, but your brain will probably feel it the most. Exhaustion and tiredness will make it difficult to concentrate, stay focussed and awkward to make rational decisions. Sometimes in our world of midwifery we will say “baby/placenta out also means brain out” – giving reference to the “fog” women are in during the first 6 weeks after the birth of the baby. My advice to help you during this time would be to make your world as less complicated as possible. Your sole purpose during these early weeks is to nurture your baby (and in doing so, nurture yourself). Rest as much as you can, eat nutritious food, stay well hydrated, call in the helpers to do things for you so you can focus on the baby e.g. prepare and cook meals, clean and tidy, and don’t attempt to make big decisions e.g. purchase big items or renovate or move!
For the purpose of this blog, I am going to assume you are breastfeeding, but even if you choose not to breastfeed, you may still have some of these sensations and feelings (if not, please read on).
You will have experienced some breast growth and development during the pregnancy, but it will be nothing compared to what will occur in the first week after the birth of the baby. Your breasts will go from soft and pliable in the first couple of days, to large, firm/hard, lumpy, tender rocks in 3-4 days. The feeding bra you may have purchased a few weeks ago will no longer be the right size and even though your partner may be very impressed, you will not! You may find it difficult to latch the baby and get the baby to take all that milk your breasts are producing. All mothers will produce too much milk for their baby initially and it will take your body a few days (sometimes even a couple of weeks) to settle down and produce just the right amount for what your baby needs. Some women will also have what is called engorgement – where the breast tissue is actually full of fluid (oedema). This fluid build-up within the breast tissue makes the breast feel very tight and very tender and actually prevents the initial production of milk as there is no space for the ducts to store the milk. Be patient! It just takes time for your body to work it all out, drain the fluid out of the tissues and allow milk production to kick in. Things to help include wearing the right-sized bra (no tight seems digging in, the edge of the cup pressing into the breast preventing drainage of fluid); take some anti-inflammatory medication and simple pain relief like you were given in hospital; feed the baby frequently; light and gentle reverse massage (stroking from the nipple upwards toward the collar bone); warm compresses before a feed; cold/frozen compresses after a feed (not cabbage leaves as these may reduce your milk production too much); using a Haakaa or breastmilk saver bottle for a few minutes to save some of the milk that leaks out while the baby is suckling on the other side (only save about 30-40ml of milk, try not to leave it on for the whole feed as this will tell your body to keep making all this milk). Sometimes, it may be necessary to seek some professional advice from a Midwife, Lactation Consultant or a Physiotherapist for some ultrasound therapy to relieve the oedema.
If breastfeeding, you may have developed some degree of nipple damage along the way. Usually this will occur in the first couple of days in hospital as a result of incorrect or poor positioning and attachment of the baby. It is fixable, but it does make the introduction of breastfeeding challenging for many mothers and babies. My advice would be to learn as much as you can in the last couple of weeks of your pregnancy, before the baby is born. Ask your midwife or care provider to show you how to hand express and spend some time practicing! This will not only help you become more familiar with your breasts, how they feel, where to press to express the colostrum/milk, but also to feel more comfortable and confident when handling your breasts. I worked with an amazing Lactation Consultant some years ago, who would often say to women “hold your breasts like you love them!” meaning hold them with confidence and with your whole hand. I love this and will often use this when I teach women how to breastfeed. If the damage and soreness has been unavoidable, there are a couple of things you can try to help them heal: Lansinoh nipple cream; multi mam compresses; resting them and perhaps expressing with a pump; get some professional advice and help with positioning and attachment.
Once the baby is born, unfortunately, your belly does not instantly go back to pre-pregnancy size (sorry!). You may feel like you can’t breathe properly; you may feel like your lungs aren’t expanding properly; you may be short of breath; and your abdominal muscles may feel sore and unable to work properly. Your diaphragm needs to learn how to work properly again (after being restricted by a baby in your abdomen), so once you are up and about, try to make sure you breathe deeply and fill your lungs right up with air – especially if you have had a caesarean section, this is very important. Your abdominal muscles have also been stretched as your baby has grown bigger so they will be weak. It will take time to retrain them again and make them strong again – don’t rush into doing this too early, it has taken 9 months to grow your baby, it will take time to make your body fit again. Wearing a binder or a good pair of high waisted leggings will help support your belly as things get back to normal, but also remind you to be careful. No heavy lifting; being careful when getting in and out of bed; being careful when getting in and out of the car; being careful when lifting the baby in and out of bed or the car; if you have a toddler to care for, being careful lifting the toddler as well. You may need some professional advice from a women’s health physio when you feel ready to return to some sort of physical activity, especially if you have been told you have a significant abdominal muscle separation.
Your uterus, by the time the baby is fully grown, is the largest muscle in your body. It has grown and stretched to capacity housing your baby, the placenta and membranes and all the fluid over a period of just over 9 months. It has worked extremely hard throughout your labour, pulling open your cervix to then help you give birth to your baby and expel all the membrane and placenta. It will now take time to recover, reduce in size (involution) and reduce the blood loss – about 5 to 6 weeks. You may notice every time you breastfeed, your uterus will contract and you will experience what we call “after-pains” (contractions) which can be quite uncomfortable for the first few days but they will reduce in intensity as the uterus becomes smaller and the blood loss reduces. To help you cope with this, you may be offered simple pain relief, anti-inflammatory medication and heat packs. Other tips which may help include going to the toilet to empty your bladder and changing your pads before sitting down to feed – as when the baby suckles, it stimulates the hormone oxytocin which also makes the uterus contract therefore causing an increase in blood flow.
Your vagina has worked hard during the birthing process as well. It has been pulled and stretched as the baby has travelled down the birth canal, there may be some grazing or even some small tears to the walls of the vagina because of this. If you have needed the assistance of forceps or the vacuum cap there may also have been some trauma to the walls of the vagina. You may have needed some stitches to these areas on the inside which will be sore and painful. Simple pain relief and anti-inflammatory medication will also help this, resting on the bed and not sitting or standing for long periods of time. You may need some professional advice from a women’s health physio to guide you during your recovery time and show you to perform pelvic floor exercises properly so you can tighten these muscles, making them strong again.
This is the area of skin and muscles between the vaginal opening and your anus. Before the birth of the baby, this area is not very long at all, however, as the baby’s head advances toward the vaginal opening and is crowning it will measure anywhere between 5-10 cm in length. This area will sometimes sustain a tear or an episiotomy (a surgical cut to widen the opening or prevent a tear going toward the anus). It will be sore and may make it uncomfortable to sit properly, therefore interfering with breastfeeding. Ice packs will be your friend! We will sometimes use the baby’s nappies to make ice-packs in the hospital – wet the nappies with a small amount of water and put them in the freezer. You can make up a few of these at home to prepare – if you don’t need them for your perineum, you can use them for your sore breasts! Resting on your side on the bed, if you don’t need to be sitting; breastfeeding lying down if you feel comfortable doing so; simple pain relief and also anti-inflammatory medication; firm, comfortable high waisted undies or even bike shorts – as these will give you support in all the right areas.
As your anus is very close to all the other areas I have already discussed; it too will get very stretched during the birthing process. You may even develop what are called haemorrhoids (varicose veins in your bottom). These will resolve over time, but it can be quite a shock and many women describe their bottom as being “broken”. It isn’t broken, but it will take a bit of time to start to feel a bit more normal. It may be uncomfortable sitting and many women also worry a lot about going to the toilet to do a poo for the first time – but will always say “oh, that wasn’t as bad as I thought it was going to be!” However, to help, I would suggest drinking plenty of water, eat some fruit each day (even the prunes), increase your healthy fibre intake, gentle exercise (walking), not straining when you go to the toilet, as well as all the other measures you are already using for the other sore areas (ice packs, pain relief and firm undies/bike shorts).
It is fairly common for many women to suddenly develop leg, ankle and foot swelling (oedema) in the first few days after the birth of the baby. Even if you were lucky enough to not have swelling at the end of the pregnancy, this is sure to happen after. It will decrease and eventually go away but may take up to 3 weeks. Resting on the bed with feet elevated, gentle walking and wearing compression tights/socks. If you develop any red, hot, tender areas in your lower legs or calf muscles speak to your doctor – this could be a blood clot that needs attention.
Your beautiful pregnant body has been replaced by something very different and foreign to you, but with time, care and a bit of extra work, you will get your healthy and fit body back again. Just as your body has created, grown and given birth to a baby, you have created a new body and have become a mother – how incredibly amazing is that!
‘Til next time,