Following the birth, you may have a range of concerns about you and your baby .
However, few of these are serious and are usually easily remedied or
are part of the normal development of your baby or your recovery
process. The concerns in this section may require more attention from
yourself or a health professional.
Maternal problems
Mastitis
This painful
inflammation of breast tissue most commonly affects breast-feeding
women. There may be localized redness, hardness, and soreness in the
breast; the breast may feel swollen and hot; and there may be flulike
symptoms. Research shows that 10 percent of women experience mastitis
within the first three months of giving birth, although it can occur up
to two years after the birth.
Causes
Mastitis is either
noninfectious or due to a bacterial infection. Noninfectious mastitis is
caused by a blocked milk duct that allows milk to stagnate in the
breast tissue. If bacteria get into the blocked duct, infectious
mastitis can occur. If not treated, an infection can develop into a
painful abscess.
What to do
It’s important to
continue breast-feeding to help remove the blocked milk. Massaging the
breast from under the arm (axilla) toward the nipple while feeding can
also help, as can expressing milk after a feeding. Rest is advised and
it’s important to drink lots of fluids. A warm compress on the breast
and mild analgesia such as acetaminophen can relieve pain. If an
infection is present, treatment with antibiotics is required. An abscess
will need to be surgically drained.
Bladder problems
After a vaginal
birth, you may have problems controlling your bladder. You may leak
urine when you cough, sneeze, laugh, or move around, known as stress
incontinence, or you may have a sudden, intense need to urinate referred
to as urge incontinence or overactive bladder.
Causes
Both conditions
are caused by the stretching and weakening of pelvic floor muscles and
are exacerbated by excess fluid from pregnancy. Bladder problems should
improve in the days and weeks after the birth as your pelvic muscles
start to tone up.
What to do
Kegel exercises
to strengthen and tone muscles are recommended. If problems persist,
your doctor may check that you’re doing the exercises properly and that
there are no other symptoms, such as cloudy urine, pain on passing
urine, or an odor, that could indicate an infection and require
treatment with antibiotics. You may be referred to a urologist.
Postpartum depression
This affects about 1
in 10 new mothers. It usually develops 4–6 weeks after the birth, but
can come on any time in the first year after the birth. If left
untreated, it can persist and have a serious effect on a woman’s life.
Emotional symptoms
include anxiety; irritability; tearfulness; panic; a prolonged low mood;
an inability to cope; a lack of interest in appearance; difficulty in
concentrating or getting motivated; and not bonding with the baby. There
may also be feelings of inadequacy, guilt, rejection, and isolation.
Physical symptoms include not sleeping; fatigue; headaches; lack of
appetite; loss of libido; stomach pains; and feeling unwell.
Causes
The causes are
unclear, but there are several factors than may increase the risk of
postpartum depression. These are having a previous history of depression
or mental health problems, experiencing a traumatic birth; or having
relationship problems.
What to do
In mild cases,
emotional and practical support may be sufficient. More serious cases
are often treated with antidepressants and counseling or psychotherapy
may be recommended.
Postpartum psychosis
This is a severe
psychotic illness that affects 1 in 500 women and occurs in the first
two weeks after the birth. The mother may be confused, unable to cope,
may neglect her appearance, and forget to take care of her baby. In
severe cases, she may have suicidal thoughts and could possibly harm her
baby.
What to do
This needs treatment from a psychiatrist. The mother may be admitted to a hospital and will need follow-up care.
Perineal problems
In a vaginal delivery,
the perineum, the area between the vagina and anus, may stretch and
subsequently feel sore. If you had a tear that needed stitches or an episiotomy,
this can be especially painful. If, after stitches, the area becomes
red and swollen or you have throbbing pain, you may have an infection.
What to do
Warm baths are
soothing, as are chilled witch hazel pads. Pouring warm water over
stitches when urinating eases stinging, and Kegel exercises can help
with healing. Your doctor may prescribe prescription medications or
suggest a stool softener or over-the-counter painkillers for mild to
moderate pain. Cooling gel pads can reduce swelling and bruising, and a
pillow or inflatable swimming tube can make sitting easier. If your pain
won’t go away or you have signs of infection (the wound becomes hot,
painful, and swollen or you notice pus) contact your doctor.
Secondary postpartum hemorrhage
Excessive bleeding more than
24 hours and up to six weeks after the delivery occurs in around one
percent of women with postpartum hemorrhage. The most common cause is
retained tissues or bits of placenta, which may in turn become infected.
The bleeding may be accompanied by symptoms such as fever, abdominal
pain, and feeling generally unwell. Infection is treated with
antibiotics and retained tissues are removed under anesthesia.
Congenital problems in babies
Down syndrome
This is the
most common chromosomal abnormality, affecting 1 in 700 newborn babies.
Babies with Down have some developmental delay and learning difficulties
and an increased risk of other congenital abnormalities such as heart
problems. Down causes a number of typical features, such as floppy
muscle tone at birth; distinctive facial features such as upward
slanting eyes; a single skin crease running across the palms; and a
somewhat flat back of the head.
Causes
Down is due
to an extra chromosome 21. Increasing maternal age makes Down more
likely, although most are born to younger mothers, because overall more
babies are born to younger women.
What might be done
Some parents who are
told they are expecting a baby with Down syndrome choose to have a
termination. Parents who continue with pregnancy usually find that their
child has a good quality of life with advances in education meaning
that many enjoy a degree of independence when older; life expectancy
with Down is around 55 years.
Clubfoot
Clubfoot describes the condition when a baby is born with one or both feet turning down and inward.
Causes
doctors don’t know the exact cause of clubfoot.
What might be done
Treatment generally
begins soon after birth. You may be referred to a pediatric orthopedist.
The most common treatment is the Ponseti method, in which the baby’s
foot is manipulated into the right position and a cast put on. The foot
is repositioned and a new cast placed every week for several weeks. More
severe cases may require surgery to lengthen the tendons. The baby will
wear casts and/or a brace for some time after surgery to prevent
deformities from returning. The results are usually excellent, with a
normally functioning foot and ankle.
Hip dysplasia
About 1 in 1000 babies
is born with a hip socket that is too shallow, meaning that the hip is
easily dislocatable. It’s more common in girls than boys. After birth,
the pediatrician will check the hips by moving them around and making
sure they’re well situated within the sockets. If the condition is
suspected or there is an increased risk of the condition, an ultrasound
may be done.
Causes
The risk is increased if there is a family history of congenital dislocation of the hip, if a baby is breech, or if a baby has clubfoot.
What might be done
Treatment involves
placing baby in a Pavlik harness for a month or two to keep the hip in
place and allow the sockets to develop properly. If the problem goes
undetected until the baby is walking, she will walk with a limp and will
probably require surgery.
Cleft lip and palate
In this condition, which
occurs in 1 in 700 babies, the two halves of the face don’t join
properly, causing a gap in the upper lip and/or palate. A cleft lip can
be symmetrical or, more commonly, asymmetrical, with the cleft on one
side of the lip distorting a nostril. This may be detected prenatally,
but isn’t always so it can be a shock initially. There’s evidence that
extra folic acid in pregnancy can reduce the risk of having a baby with
cleft lip and palate.
What might be done
Treatment may begin
soon after the birth. Special bottle nipples and appliances may be used
to aid feeding. Usually, at around three months, surgery is done to
close the gap in the lips, and surgery to close the gap in the palate at
about 6 to 18 months.
Congenital heart disease
Any abnormality
involving the structure of the heart chambers or connections between the
chambers can affect the function of the heart. Some heart problems are
detected prenatally and you will be given advice about where your baby
should be delivered and what will happen after the birth.
Septal defects
These holes in the
heart consist of a small hole between two heart chambers; some types may
cause a murmur that is picked up at birth. In many babies, a hole
closes on its own.
Blue baby
Some babies are blue at
birth because they have a major problem involving abnormal heart
connections. This is an emergency. The doctor will do a series of tests
and your baby may need surgery to repair the problem.
Patent ductus arteriosus
If the duct between
the lungs and the heart fails to close after birth, oxygenated and
deoxygenated blood mix. Treatment may be needed in the form of
medication and sometimes surgery.
Undescended testicles
This occurs in around
3–4 percent of full-term boys. In most cases, just one testicle is
undescended. Testicles often descend naturally within a year. Otherwise,
surgery is advised since undescended testicles can affect sperm
production and fertility and increase the risk of testicular cancer
later in life.
Syndactyly
Sometimes babies are born
with two digits, either the toes or fingers, joined together. This
condition, called syndactyly, is usually caused by the soft tissues
fusing together and is often linked to other congenital abnormalities,
such as Down syndrome. Treatment is surgical and skin grafts are used.
Birthmarks
Marks present at birth may be long lasting, although they often fade over time.
Stork bites
These pink skin patches on Caucasian babies often fade by 2–5 years.
Mongolian blue spots
Some babies,
particularly of Asian or American Indian origin, have extensive gray
markings on the lower back, buttocks, and other areas that resemble
bruises. Known as Mongolian blue spots, they fade over a few years. They
do get mistaken for bruises, so it’s worth asking your pediatrician to
make note of them.
Port wine stains
These permanent marks
are caused by abnormal blood vessels in the skin and may occur anywhere
on the baby. If one occurs on the face, your baby may be referred to a
specialist for laser treatment.
Strawberry nevus
This is an overgrowth of
blood vessels, but is not permanent and usually needs no treatment. The
nevus, or hemangioma, looks like a strawberry, and although it can be
upsetting, it vanishes in a few years. It appears days after the birth
and grows over a few months. If it’s in a critical area, such as
obstructing an eye or nose, your baby may be referred to a specialist.
