Caring for yourself and feeling well after you have had your baby
Women vary a lot in how they recover physically and psychologically from their pregnancy and the experience of giving birth to their baby. You may feel that your body has got back to ‘normal’ within a few weeks of having your baby, but it can take much longer to adjust to the emotional changes of being a mother, especially where this is for the first time.
Some women find that the physical symptoms they experience after childbirth carry on for longer than they expected and they may feel unsure or embarrassed about telling someone. Regardless of the time frame of these problems, it is important that you seek advice from your midwife and/or doctor (GP) if you feel that you have not fully recovered from the effects of being pregnant and giving birth.
As well as your partner, family and friends, there are many people in the health service available to help and support you through the early days, weeks and months of parenthood. You will continue to have visits from your midwife for at least ten days following the birth, although visits can continue for as long as you and your midwife consider necessary. You can also make an appointment to see your GP at any time and will also have contact with a health visitor.
This article tells you what research has shown about where support for new mothers is most effective. However, care after childbirth has not been researched to the same extent as other areas of maternity care and there is still a need for more studies about women’s physical and psychological health and wellbeing following childbirth.
Who should help?
The time after you have had your baby is a period of adjustment for you, your partner and family, and every woman’s experience is individual to them. The health service tries to meet these needs and you will have support from a team of health professionals, which includes your midwife, your health visitor and your GP.
Many women experience a range of problems either immediately or in the first few days after they have had their baby or, sometimes, this can be several days or even weeks after the event. The most common physical health problems that women report experiencing are: backache, stress incontinence (leaking urine), exhaustion, breast problems, perineal pain, haemorrhoids (piles) and constipation. While less common, some women report experiencing headaches, difficulties controlling their bowels, and pain or discomfort during sexual intercourse.
Research has shown an association between women’s experience of various physical and sexual health problems and the presence of depression at six months postnatal. If you are left with a problem you did not have before becoming pregnant, it is always a good idea to tell your midwife or GP and seek their advice as the majority of these symptoms can be resolved.
In the first few hours or days after the birth
Some women may bleed heavily immediately after they have given birth and this may lead to ‘anaemia’. Where this is severe, you may be offered a blood transfusion; otherwise taking iron tablets and eating iron-rich foods such as dark green vegetables, red meat, fortified breakfast cereals, dried fruits, wholemeal bread, plain chocolate and eggs can help to restore your haemoglobin levels back to normal within a few weeks. If you have anaemia this may lead to feelings of dizziness, tiredness or if the anaemia is more severe, extreme exhaustion. If this is the case, you need to let your midwife or GP know.
If your blood pressure has been raised in pregnancy it may take several weeks to return to its normal levels. Some women’s blood pressure rises after the birth where it had been normal before. Headaches, swollen hands and feet and generally feeling unwell can all be associated with a raised blood pressure, so if you are not feeling yourself it is a good idea to tell the midwife and have your blood pressure checked.
Sore stitches around the birth passage
You can help reduce the soreness by taking painkillers and by using ‘comfort measures’ such as applying cool gel pads to the area. The available research studies may not be able to provide the evidence to support a range of measures that women have reported finding helpful, but there is evidence that painkilling suppositories (called ‘Diclofenac’) are the most effective medication, especially in the first few days after birth. Alongside this, applying a cool gel pad or cold compress may make you feel more comfortable and reduce any swelling in that area. Ultrasound or pulse electromagnetic therapy may be offered by the physiotherapy services, although studies about the effectiveness of these are inconclusive.
Difficulties passing urine
Once your baby is born your body naturally tries to get rid of the extra fluid that you have been carrying around for the past few months. Therefore in the first 24 hours or so after the birth you may find that you pass large quantities of urine frequently. Sometimes, temporary injury (bruising and/or swelling) to the soft tissues around the bladder may mean that some women are unable to pass urine; however this can be relieved by passing a small tube, called a ‘catheter’ into the bladder to drain the urine out. The catheter may be left in place for 24-48 hours after the birth to allow the tissues to recover and you should not have any further problems. Doing pelvic floor exercises has been shown to help reduce urinary incontinence.
Assisted births (ventouse, forceps and caesarean section)
You are likely to have more sore patches in more places than women for whom the birth was unassisted, which means that you will need time to recover and, probably, help with your own and your baby’s needs. Don’t be afraid to ask for this help, no matter how busy the midwives and doctors may appear to be. Getting rest and taking time to adjust to your new circumstances will have benefits in the long term.
The effects of an epidural or combined spinal-epidural (CSE) anaesthetic
The numbness and heaviness of the epidural should wear off in four to six hours following the birth. You may be left feeling a bit stiff and you may have problems knowing when you want to pass urine or being able to pass urine, but these almost always resolve within the first 24 hours. Some women develop a headache especially when they get up or sit up and this lessens when they lie down. This type of headache is directly associated with the epidural or combined spinal-epidural anaesthesia and can be treated very effectively, so it is important to tell your midwife or your GP if you develop a headache when you are at home.
Some women will develop problems associated with breastfeeding or where they choose to bottle feed, suppressing their lactation. Women who experience breastfeeding problems such as sore nipples, engorgement, blocked ducts and mastitis require referral and specialist support.
Your mind in the first few hours or days after birth
For most women the achievement and fulfilment of giving birth leaves them feeling exhilarated even though they are also exhausted. Where the birth takes place within a hospital, and especially if this is during the evening or night, all this excitement may need to be contained until the following day. It is not unusual to feel wide awake and to be anxious about the baby and your new responsibility for the baby, particularly in these first few hours or days. The midwives in the hospital environment are there to help you, but it is well known that the postnatal wards can be very busy and the staff may not appear to have time to ask you about your needs. If you are feeling worried or unsure, please go to the midwives or other staff in the ward and ask for any help or advice that you need. As you gain knowledge and understanding of your baby and their care needs, so you will gain your confidence as a mother.
Adjustment to motherhood
You might have had a clear idea of what life would be like with your new baby and then you may find that the reality is very different. This mismatch between your expectations and the reality, including your choices for the birth, has been found to affect how well you adjust to motherhood. In addition, the tiredness that is associated with childbirth and afterwards can make coping more difficult and you may not be able to be the mother you think you should be. This is well recognised and however ‘busy’ you might think your midwife, GP or health visitor is they will always make time to listen if you start to talk.