Q: I've heard about “afterpains,” but what exactly are they?
A: The term “afterpains” refers to the discomfort felt after the birth as the uterus starts to contract back down to its normal, pre-pregnancy size. These pains are often described as feeling similar to menstrual cramps. Sometimes, women having their first baby may not notice any afterpains, or they are fairly mild; they are more commonly felt by women having their second or subsequent baby, due to the fact that the uterus has to work harder to regain its usual size after being stretched on more than one occasion.

Afterpains also tend to be felt more in women who are breast-feeding their babies, since breast-feeding stimulates the release of the hormone oxytocin, which in turn triggers the uterine contractions that are felt as afterpains.

If you experience particularly uncomfortable afterpains, it is perfectly safe to take a mild analgesic such as acetaminophen. You should find that the discomfort disappears after a few days. Taking warm baths can also be soothing.

Q: I'm still bleeding heavily. How long will this last?
A: The bleeding you experience after birth is known as lochia, which is a heavy, bloody vaginal discharge made up of blood and tissues from the uterus and from the site where the placenta was attached to the wall of the uterus. This is how your body gets rid of the lining of the uterus that supported your baby. Most women find that the bleeding looks initially like a “period” type of blood loss, and then gradually turns to a brownish or pinkish, watery discharge. The final color may be yellowish and the discharge quite light. This bleeding can last for anything from two to six weeks after giving birth. After returning home, if you are saturating a pad an hour, contact your doctor right away.
Q: Is it safe to use tampons while I'm bleeding?
A: It is not advised to use tampons for the first month after giving birth. This is because you are more vulnerable to contracting an infection during this period, so it is important to pay close attention to personal hygiene during this time to keep your vaginal area free from any bacteria, which can be introduced through the use of a tampon. So you should avoid using tampons until the bleeding turns from red to pink.

You can start to use tampons again for your first period after the birth. If in doubt, check with your doctor since your particular circumstance might require a different plan of care.

Q: Ouch! My stitches are really uncomfortable. What's the best way to ease the pain?
A: Stitches do cause discomfort for a few days after giving birth, so keep the area as clean as possible since this will help prevent infection and minimize your discomfort. You should wash the area with warm water several times a day and make sure you change your pad frequently. Many women find the following techniques for reducing discomfort helpful:
  • Using a cold pack. You can use a cooling gel pad that has been specially designed for the purpose of soothing the discomfort caused by stitches in the perineal area. These have been demonstrated to effectively reduce swelling, bruising, and pain. Or make your own cool pad by placing crushed ice in a plastic bag and wrapping this in a dry flannel.

  • Taking the homeopathic remedy arnica, which is thought to help reduce bruising.

  • Taking a warm bath with a few drops of lavender or camomile essential oil.

  • Taking pain medication such as acetaminophen. Ask your doctor or midwife for advice.

Q: How quickly will I lose the weight I put on during pregnancy?
A: How quickly a woman loses weight after the birth of her baby varies widely. Some women seem to get back into shape within a few weeks of the birth, while for others, losing their pregnancy “flab” can take a few months or more. Whichever category you fall into, it is important not to adopt a strict diet during the early weeks and months of parenthood, especially if you are breast-feeding. However, it is sensible to eat a healthy, balanced diet and get some exercise. You should try to lose your “baby weight” gradually since this will ensure that you are receiving enough nutrition in the postpartum period, and will give your belly more time to adjust its shape. Some women do attend professional meetings such as Weight Watchers, but it is important that you inform the trainer or person in charge that you have recently had a baby.
Q: How can I get rid of my stretchmarks?
A: Unfortunately, there is no magic way to get rid of stretchmarks, which affect a large number of pregnant women and seem to be influenced by genes since they often run in families. You will find that the marks fade over time from bright red to a paler pink, and then to a silvery color that blends in with your skin tone. Massaging a natural oil into your skin may help them fade.

If, after time, your stretchmarks are still troubling you, you could discuss treatment options with your doctor, which include laser treatments to reduce the redness of stretchmarks. However, you should be warned that treatments for getting rid of stretchmarks are often not completely effective and simply speed up the natural fading process rather than eradicate the stretchmarks entirely. Cosmetic procedures are not usually covered by insurance.

Q: I'm losing weight fast, but my belly is really flabby—how can I tighten it up?
A: This is a common problem after giving birth. The flabbiness you are experiencing is caused by the muscles and skin having stretched to accommodate your pregnancy and baby. After the birth, these muscles relax and have lost their tone. However, you should find that the muscle tone gradually returns, although it may never be quite the same as it was before your pregnancy.

You can try some gentle toning exercises (see Postpartum exercise) as soon as you feel able to, although you should wait for at least six weeks if you have had a cesarean. Your doctor will be able to give you more information about what is safe to do and what is not. If you do go to an exercise class or gym, make sure you inform the trainer that you have recently given birth and what type of birth you had so he or she can give you appropriate advice.

Q: I've still got a huge appetite—is this because I'm breast-feeding? How much should I be eating now?
A: This could be because you are breast-feeding, which requires an extra 500 calories each day. However, this may not equate to as much food as you think—it works out to be about a bagel and an egg! Your big appetite therefore isn't a problem in itself, but how you satisfy it can be! As long as you are eating a healthy, balanced diet, you shouldn't find that you gain weight (and you definitely shouldn't be trying to diet while you are breast-feeding). Ensure that your diet is providing sufficient quantities of protein and carbohydrates and plenty of fresh fruit and vegetables. Also avoid filling up on “empty calories” such as candy, cookies, and chips, and instead try to snack on foods such as fruit, nuts, and seeds. This will ensure that you receive the best nutrition during such an important time, which will benefit you and your baby, and will also help you lose any extra weight you have gained during the course of your pregnancy.
Q: I've heard that breast-feeding helps you lose the weight quicker. Is this true?
A: Breast-feeding can help you lose weight more quickly after the birth because your body is using up energy to provide an adequate milk supply for your baby. Some of the 500 extra calories a day you need may be taken from fat supplies deposited in pregnancy. Often, extra fat laid down on the hips and thighs in pregnancy is lost first, providing the “fuel” required to make milk and breast-feed your baby. Gentle exercise such as walking and swimming will also help to shift the pregnancy pounds.
Q: I'm not breast-feeding my baby at all—when will my periods start again?
A: If you are not breast-feeding, you can expect your first period to arrive any time from four weeks after the birth. Most women find that the first period is a little different from normal. It may be heavier or lighter and it may last for longer or shorter than usual. A more regular pattern should establish itself over the next few months.
Q: What will happen at my postpartum checkup?
A: Around four to six weeks after the birth of your baby, you will need to see your midwife or doctor for your postpartum checkup. During this appointment, your caregiver will ensure that your body is returning to normal after the pregnancy and birth. Your blood pressure will be checked, and you will have an internal examination to make sure that any stitches you had have healed and that the uterus has returned to its pre-pregnancy size. Your care provider will also ask you about your contraception plans and discuss the available options, and you may be asked about your emotional health—how you are adjusting to parenthood and whether you have any particular issues or concerns.
Q: I had an emergency cesarean—when is it OK for me to go for a walk with the baby?
A: Nowadays, women who have had a cesarean section are encouraged to get up and move around as soon as possible after the surgery, even if this is just to get out of bed and walk a short distance. This is to reduce the risk of problems developing, such as blood clots in your legs (known as deep vein thrombosis) or lung infections. However, it is still important that you take things slowly and don't try to do too much too soon. You should find that you are able to walk short distances within 12 to 24 hours after the surgery, but you probably won't feel like going for a longer walk outside for another few days, or perhaps even more.
Q: How long do I have to wait after my cesarean before I can drive again?
A: It is generally thought best to wait for around three to four weeks before driving again following a cesarean section, although there are no specific guidelines based on research on the subject. We would suggest that you wait until you feel that you have totally recovered from the operation and that you would be able to perform driving maneuvers such as reversing and parking, as well as an emergency stop, without experiencing pain or discomfort. You would also need to feel comfortable with the car seat belt around you, since this will be directly over the area of your incision.

You should contact your insurance company as well to check their criteria, since some do not insure people to drive within a certain period following major surgery such as a cesarean.

Q: I developed hemorrhoids at the end of my pregnancy—will they go now the baby has been born?
A: Hemorrhoids are swollen veins in or around the anus. They are fairly common in pregnancy and after childbirth due to the weight and pressure of the baby's head pressing down. Most women find that hemorrhoids disappear within a month of giving birth, although a very small minority of women are not so fortunate and will need to discuss treatment options with their caregiver. In the meantime, if you are finding the hemorrhoids uncomfortable or itchy, there are a few things you can try. Applying a cool maternity pad to the area can be soothing (you can make your own by freezing a folded wet washcloth) or your caregiver or pharmacist may be able to recommend a cream that can ease the discomfort. You should also try to avoid becoming constipated since straining on the toilet will make the hemorrhoids worse, so drink plenty of water and eat lots of fresh fruit and vegetables as well as whole grains.
Q: I had an episiotomy and am terrified of going to the bathroom. Do you have any advice?
A: Many women who have had a cut or tear to the perineal area experience discomfort for a while after the birth. There may also be some pain or “stinging” when urinating or moving the bowels, but this should last only for a few days. You may find it helpful to pour warm water over the area when you urinate. If your toilet is near the shower, you may be able to use the shower head over the toilet. A bidet, of course, is ideal, though not many people have these. Drinking plenty of fluids will also help to dilute your urine.

It is normal not to move your bowels for a day or two after the birth. Many women feel anxious the first time, but it is very unlikely that this will damage your stitches. However, if you become constipated, this could cause discomfort. Make sure you drink plenty of water, and eat fresh fruit and vegetables to help prevent this. If you find that you are still feeling constipated, your doctor or midwife can give you a mild stool softener if necessary. You may also want to provide counter pressure to your stitches with a cloth while you bear down.

Q: I had a long delivery and I'm worried that my vagina has stretched. Will it go back to normal?
A: Try not to worry. Although at first you may notice changes to your body as a result of the pregnancy and birth, a woman's body is designed to give birth and return to normal afterward. To help the muscles around your vagina to tighten after the birth, do some Kegel exercises as you did in pregnancy . These involve identifying which muscles you need to exercise by tightening the muscles around your vagina and back passage and lifting up just as if you were trying to stop yourself from urinating and passing gas at the same time. You should practice 5–6 at a time, ideally several times a day. If at first you are not able to hold the muscles tight for 5 seconds, just do what you can and keep practicing. You can also try faster contractions where you tighten and lift the pelvic floor muscles quickly and hold for one second, then relax for one second, and repeat.
Q: It's four weeks since the birth and I feel such a mess still—how can I get my self-esteem back?
A: When you have had a baby, your body will (at least at first) look and feel different than usual; you may feel sore from stitches, have hard leaky breasts, and will be extremely tired! In addition, you are learning how to care for, and bond with, your new baby and still keep your other relationships intact—that's quite a lot to deal with. It can take anywhere from a few weeks to a few months for your body to return to normal. How you feel will also depend on the type of birth you had, whether you are breast-feeding, and how healthy your lifestyle is in terms of diet and exercise. In the meantime, there are a few things you can do to improve the way you feel about yourself:
  • Take time out for yourself. Whether you take a bath, wash your hair, or do your nails, regularly taking even just half an hour to yourself each day can really help you relax and feel better.

  • Go to the hairdresser. Even if you're not happy with the way your body looks, having a haircut can be a real boost.

  • Invest in a few new items of clothing if you can afford to. During the early period of parenthood, maternity clothes are too big, but your usual clothes may be a little tight. Having clothes that fit you properly will not only feel more comfortable but will look good too!

  • Begin an exercise regimen. Go for a daily brisk walk pushing the carriage. Your baby will benefit from the fresh air and the exercise will give you an energy lift and a boost to any weight loss plan.

  • Keep reminding yourself that you have done an amazing job bringing your baby into the world, and are now doing another amazing job nurturing and caring for him each day. There's no job quite as exhausting as caring for a newborn baby, but equally nothing that is quite as rewarding!

Q: My feet are still swollen after the birth—is this normal?
A: Swelling in your feet and legs is an unpleasant side effect of pregnancy. After the birth, the pressure on your veins decreases and your blood flow returns to normal, so excess fluid is no longer pushed into the tissues. You will excrete the extra fluid that your body collected and so may urinate a lot at first. This can take a while and the swelling can linger for at least a week, which is normal. You can relieve swelling by resting on your left side; sitting with your legs raised; drinking lots of water; urinating often; stretching your legs and feet; not standing for long periods; getting gentle exercise, such as walking; and eating healthily.
Q: I've had a headache since the birth. Is this due to the epidural?
A: Headaches after childbirth are common and causes include fatigue, dehydration, stress, and lack of fresh air and exercise, as well as the upheaval in your hormones after delivery. After an epidural, you have a 1:100 to 1:500 chance of developing a “post-dural puncture” headache. This occurs between one day and one week after the epidural, is worse when sitting or standing, and is relieved by lying down and taking pain-relieving drugs, such as acetaminophen. Drinking fluids and avoiding lifting can also help. If this is thought to be the cause, the midwife or doctor may refer you back to the anesthesia team for treatment. However, it's most likely that your headache is not related to the epidural.
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