Just One Thing - The Postnatal Check
After the strangeness and excitement of the first days and weeks of parenthood, we often find that our focus has become entirely on our baby and our own physical and psychological needs can drift off into the background. But looking after our own health - both mental and physical - is so important at this stage to prevent difficulties later on.
With this in mind, I asked Dr Claire Ashley what she would say to new mums about their postnatal health. Claire is a GP interested in lifestyle medicine, combining traditional medical approaches with a holistic view of health and wellbeing.
So what's just one thing Claire would tell you? "Make the Most of your 6 week check!
Congratulations on the safe arrival of your precious baby. After 9 months of pregnancy it is the most wonderful feeling to finally be able to hold your baby in your arms!
Whilst everyone coos over the baby, regardless of how you gave birth, you will be wondering about the changes that have happened to your body after your delivery.
Vaginal delivery recovery
It’s normal to feel pain, discomfort or numbness after a vaginal delivery. This may be worse if you have had a tear or episiotomy. If you have had a 1st or 2nd degree tear then expect some discomfort with having a wee or poo for about a week post delivery. You will find, however, that the nerves and muscles will still be weakened and can take several more weeks to heal completely. If you have experienced a 3rd or 4th degree tear then your pain will probably last for about 2-3 weeks, but again the nerves and muscles will take much longer to fully recover.
Having a wee after a vaginal birth can be a terrifying prospect! You might find it helpful to pour water from a jug, or squirt it from a squeeze bottle, over your perineum whilst having a wee, as this will stop it from stinging so much. If you can’t face using toilet paper then you could try drying yourself with a hair dryer on a cool setting.
Taking a shallow bath filled with warm water may also be helpful for pain and discomfort. You can use paracetamol to make you a bit more comfortable too. You can also buy disposable ice packs to put in your underwear to soothe your perineum- but make sure you wrap the ice in a towel first as you don’t want to risk the ice sticking to your poor bruised skin!
You may have trouble feeling the urge to pass urine because stretching during childbirth can cause mild temporary damage to nerves of the bladder. Try to urinate frequently, even when you don't feel like you have to. You may also leak a little bit of urine when you cough or laugh. This is normal, but you can help speed up your recovery by starting to do your pelvic floor exercises.
Caesarean section recovery
Caesareans are major abdominal surgery, and whilst some women seem to breeze through them, others don't and feel like they have been hit by a truck (at least, that’s how I felt after I had mine!). You will need to take it easy for a few weeks whilst you recover.
Your wound will be covered by a dressing that is normally removed after 24 hours. Depending on the type of stitches that you have they will either dissolve away, or if they are not dissolvable stitches then you will need to arrange to have them removed at 5 days post delivery. Once the dressing is removed, make sure that you wash the wound daily and keep it clean.
I would recommend that you buy some high waisted pants that come up over the incision as otherwise you will be really uncomfortable.
It’s normal to have some bruising and pain around the incision for a few weeks after delivery. It’s also normal to have some altered sensation around the scar.
Even if you have had a Caesarean then you must still do your pelvic floor exercises.
You must avoid heavy lifting for 6 weeks after your surgery. It’s fine to hold the baby or carry them in the sling if you feel comfortable, but nothing heavier than that. You won’t normally be able to drive for the first 6 weeks after delivery, and you won’t be covered by your insurance if you do drive unless you have been to your GP and demonstrated that you are capable of doing an emergency stop.
Drink lots of water and eat foods high in fibre to avoid constipation- straining to have a poo after a Caesarean is awful!
Contact your midwife or GP straight away if you have any of the following symptoms after a caesarean:
- severe pain
- leaking urine
- pain when peeing
- heavy vaginal bleeding
- your wound becomes more red, painful and swollen
- a discharge of pus or foul-smelling fluid from your wound
- swelling or pain in your lower leg
- a cough or shortness of breath
These symptoms may be the sign of an infection or blood clot, which should be treated as soon as possible.
Regardless of how you have delivered your baby, there are some other common changes which you might experience:
The afterpains are lower tummy pains that are the result of your uterus (womb) contracting down back to its normal rebirth size. Generally speaking, afterpains are not normally felt after your first baby, and may be stronger with any subsequent babies. I certainly remember feeling them more strongly with my second baby; they were a bit uncomfortable but not too bad (frankly, the pain is nothing compared to having a newborn ravage your nipples whilst feeding, or the horror of labour!).
Breastfeeding releases the hormone oxytocin which causes the uterus to contract. So, if you are breastfeeding you might notice the afterpains during feeds.
It normally takes 6 weeks for your uterus to return to its pre-pregnant size. Your midwife or doctor will check after delivery that the uterus is starting to contract.
Lochia is the medical term for normal post natal bleeding that occurs after delivery. This bleeding will initially be bright red and brisk. It should turn pink within a few days before gradually slowing, turning brown, and then stopping. It is normal to pass small clots in the first few days after delivery. If your lochia starts to slow but then becomes red and brisk again then that might be an indicator that you are being too active- take some rest and the lochia should settle again.
If your lochia is very heavy, if it smells a bit offensive, or if it carries on beyond 6 weeks then that might mean that you have a small bit of placenta left inside the uterus. If you think you might have this then please contact your midwife or GP immediately.
It is important that you only use pads for post natal bleeding, and you should avoid using tampons until the bleeding has settled completely. This is due to the risk of infection.
My advice is however many pads you buy before the baby arrives- buy at least double the amount that you think you will need. Make sure you put them in your hospital bag as, certainly at the hospital that I had my babies at, you might be rationed to just one pair of netty knickers and pad! I also recommend buying some big black Bridget Jones-style pants for the immediate aftermath of the birth- you will want to feel as comfortable as possible. I believe that one well-known brand of incontinence pads do big disposable pants which can be used for post-natal bleeding.
3. Increased urination
Some women find that they wee more frequently after giving birth. This occurs as the body gets rid of all the excess fluid that it was carrying during pregnancy.
4. Night sweats
I had the most horrific night sweats after having my first baby. No-one had warned me about them, but a quick internet search during a sweaty night feed showed me that they are more common than I had thought. It is thought they occur as your hormones fluctuate. Mine settled within a couple of weeks, but they truly were horrendous whilst they lasted. My only advice is to go to bed wrapped in a towel, with a spare next to the bed that you can swap into during night feeds.
5. Breast changes
If you are breast feeding, you will notice that, once your milk comes in (normally around day 3), your breasts become engorged, swollen and veiny. If they are very uncomfortable you might find massaging them in a hot bath or using cabbage leaves in your bra helps to soothe them. Your breasts will soften as the weeks progress if you continue to breast feed. If you choose to bottle feed then your breast engorgement should settle within a few days of delivery. You can take paracetamol or ibuprofen if they are really uncomfortable.
How to make the most of your 6 week check:
The 6 week postnatal check isn’t just for the doctor to check your baby’s development, it’s also to check on you and to address any concerns or issues that you have been experiencing.
Having a newborn baby is completely overwhelming so it’s important to make the most of your 6 week check.
This guide allows you to think about what you might want to discuss with your doctor. The issues might not all be relevant to you but in the fog of the newborn days it might help you to think about what you might want to share with your GP at your 6 week check!
- Physical symptoms
The 6 week check is the perfect opportunity to discuss how your baby was delivered and to talk through any questions you have about the birth. If you are struggling to come to terms with a difficult birth, your GP can help you to access counselling or an opportunity for you to discuss the delivery with the hospital itself. You can also talk about any concerns you have about your perineum or caesarean scar at the 6 week check. Your lochia (post natal bleeding) should have settled by 6 weeks, so if it hasn’t your doctor might want to organise an ultrasound scan to check to see if there is a reason for this. This is also a good opportunity to discuss any post-birth problems with the bladder or bowels. If you are breastfeeding then the doctor will also ask you how you are getting on with that.
- Sex and contraception
Sex might be the furthest thing from your mind right now! However, even if you are exclusively breastfeeding, the 6 week check is a great time to discuss contraception. Your doctor might ask if you have had sex yet, and if so how it went.
- Mood and wellbeing
It is normal to feel low and emotional in the early days, but for some women this can then go on to develop into depression. Your doctor will ask how your mood is, and may then go on to ask more detailed questions if they think it's necessary. Please don't be afraid to share how you are really feeling with your doctor. No-one will judge you, and if you are really struggling then your GP can help you access support and/or medication, if that's the right thing for you.
- Support and home life
Your doctor will ask how you are being supported at home with the new baby and explore any issues surrounding this. These issues might include domestic violence or relationship difficulties. Again, your GP is here to help so please tell them if you are struggling.
Your doctor might want to feel your tummy, check your blood pressure if it had been high in pregnancy, or check your perineum or caesarean scar.
You need to wait until 3 months after delivery to have a smear test.
- Pelvic floor exercises
I always discuss pelvic floor exercises with mums at the 6 week check. Even if you have had a caesarean delivery, pelvic floor exercises after birth are crucial for restoring strength to your pelvic floor, and will help prevent problems with incontinence and prolapse in the future. "