Chapter 2: Your Body After the Birth

From the Diary

Week 1 at home. Nobody told me how much a caesarean wound would be part of every single movement. Getting out of bed takes a plan: roll onto my side, push up with my arms, breathe, stand. When I laugh or cough, I hold a small pillow against my stomach, as the midwife showed me, and it really does help. My husband lifts everything. He carries our daughter to me for feeds and carries her back to the cot, and he brings me water before I even know I am thirsty. The bleeding is still heavy, and I keep checking it, half worried and half amazed. My body feels like a house after a storm. Everything is still standing, but nothing is quite where it used to be.

Day 6 at home. My milk came in a few days ago, and this morning my breasts were still so full and heavy that I could hardly lift my arms. The midwife helped me find a better position for feeding and told me the fullness usually settles as feeding finds its rhythm. After my shower I looked in the mirror for a long time. My stomach is still round and soft, there is a line of dressing low across it, and my face looks like someone who has not slept properly for days. I had imagined, without really thinking about it, that my body would go back to normal after the birth. It has not. For a moment I felt ashamed, and then I felt silly for feeling ashamed. This body carried our daughter and brought her out into the world.

Week 2. Today I walked to the end of our street and back, pushing the pram very slowly, with my husband beside me. It was the first time I had been outside since we came home, and the air felt wonderful. I was more tired afterwards than after a long day at the office. My mother came on the weekend with soup and cooked enough food for several days. I sat at the table and ate a real meal while she held the baby, and I nearly cried with gratitude. One small embarrassment: when I sneezed, I leaked a little. I told the midwife, very quietly, and she said this is common after pregnancy and showed me some gentle exercises for the muscles underneath. I am doing them while I feed.

Week 2, the last evening of my husband's leave. He goes back to work tomorrow, and I am nervous about being alone with our daughter all day. The midwife looked at my wound again and said it is healing slowly but well. "Slowly but well" is the nicest thing anyone has said to me all week. My husband has put the things I need on the low shelf, so I do not have to reach or lift: nappies, water, snacks, the phone charger. I wrote down the date of my check-up after the birth and started a list of questions for the doctor. The last question on the list is: "When will I feel like myself again?" I am not sure anyone can answer that one.

Healing in the First Weeks

After the birth, the body begins a long, quiet process of recovery. The womb slowly shrinks back towards its earlier size, the body adjusts after the changes of pregnancy, and any wound or stitches begin to heal. In the first days, many parents feel cramping pains low in the tummy as the womb shrinks. These are sometimes called afterpains; they are often stronger during breastfeeding and usually ease over the first days. This happens whether the birth was vaginal or by caesarean, quick or long, planned or unplanned. Recovery usually takes weeks, and for many parents it takes months before the body feels truly strong again. Like the mother in the diary, many people are surprised by how much the body needs after the birth. Knowing what is common can make the first weeks less worrying, and knowing the warning signs, explained later in this chapter, helps you act quickly if something is not right.

Bleeding from the vagina is normal after every kind of birth, including a caesarean. This bleeding is sometimes called lochia. At first it is usually bright red and may be quite heavy, with some small clots. Over the following weeks it slowly becomes lighter in amount and in colour, turning pink or brown and later pale yellow or white, before it stops. The bleeding may become a little heavier for a while after you have been more active, or during breastfeeding, and this can be a sign that your body needs more rest. Many midwives suggest using pads rather than tampons in the first weeks; ask yours what they advise. Very heavy bleeding is a warning sign, as described later in this chapter.

After a vaginal birth, the area between the vagina and the anus, called the perineum, may be swollen and sore, and some people have a tear or a small cut that was stitched. Stitches usually dissolve on their own as the skin heals. Keeping the area clean, changing pads often, rinsing with warm water after using the toilet and sitting down carefully can all make the first days more comfortable. The midwife can show you other simple ways to ease the soreness. If the pain grows instead of slowly easing, if the stitches seem to open, or if there is a bad-smelling discharge, tell the midwife or doctor soon.

After a caesarean birth, there is a wound low on the tummy, and the muscles and tissues underneath are healing too. It is common for the skin around the scar to feel numb or strange for a while. Supporting the wound with your hand or a small pillow when you cough, laugh or get up, as the mother in the diary does, can make movement easier. Many people are asked to avoid heavy lifting and some activities, such as driving, for a time after a caesarean; ask your doctor or midwife what applies to you and for how long. Watch the wound for redness that spreads, heat, swelling, discharge or pain that gets worse, and tell the midwife or doctor if you notice any of these.

Pain and discomfort are part of healing, but you do not have to simply put up with them. If you need something to ease the pain, ask your doctor, midwife or pharmacist what is suitable for you, especially if you are breastfeeding. Many parents are also anxious about the first bowel movement after the birth, particularly after stitches or a caesarean. This worry is very common. Drinking enough water, eating foods with plenty of fibre, such as fruit, vegetables and whole grains, and taking your time on the toilet can help. If you have not had a bowel movement for several days, or if it is very painful, mention it to the midwife or doctor.

Breasts, Bladder and the Pelvic Floor

The breasts change a great deal in the first days. At first they make a small amount of thick, yellowish milk called colostrum, which is rich and exactly suited to a newborn. A few days after the birth, the milk "comes in", and the breasts may feel full, heavy, warm and tender, as the mother in the diary describes. This fullness usually settles as feeding finds its rhythm. Sore nipples are common in the early days of breastfeeding, and a midwife or feeding helper can often find a position that makes feeding more comfortable. If you are not breastfeeding, the breasts still make milk at first, and they may feel full and uncomfortable for a few days before the milk slowly stops; the midwife can tell you what helps.

One breast problem needs quicker attention. A hard, red, painful area on the breast, especially with a fever or a feeling like flu, is a reason to contact your doctor or midwife soon. Do not wait for it to pass on its own. Chapter 4 explains feeding in more detail, including the feelings that often come with it, and both breast milk and infant formula are good ways to feed a baby. Whatever you choose, your breasts are part of your recovery, and it is fine to ask questions about them as often as you need. The midwife may also show you how to notice when the breasts feel softer after a feed, which can be a comforting sign that feeding is going well.

Pregnancy and birth also affect the bladder and the muscles around it. The pelvic floor is a group of muscles that lies like a hammock at the base of the body and supports the bladder, the womb and the bowel. During pregnancy these muscles carry extra weight, and during a vaginal birth they stretch. Even after a caesarean, the months of pregnancy have put them under strain. In the first weeks, many parents find that they leak a little urine when they cough, sneeze or laugh, like the mother in the diary, or that they need to hurry to the toilet. It can feel embarrassing, but it is common, and it often improves as the body heals.

Gentle pelvic floor exercises can help these muscles recover. A midwife, a nurse or a physiotherapist, who is a health worker trained in movement and recovery of the body, can show you how to do them correctly and when to start. Many parents do them during feeds, as the mother in the diary does, because they need no equipment and nobody can see them. If leaking continues after the first weeks, if it gets worse, or if you have pain or a feeling of heaviness low in the body, tell your doctor or midwife. Help exists for these problems, and it is never too late to ask about them.

Rest, Food, Movement and Your Check-up

Tiredness after a birth is not only the result of broken nights. The body is healing, and if you are breastfeeding, it is also making milk. Many parents hear the advice to sleep when the baby sleeps. That is not always possible, but resting is still worth protecting. Lying down for a while, even without sleep, gives the body a chance to recover. Let the housework wait, keep visits short, and say yes when someone offers to hold the baby so that you can sleep. If you have a partner, or someone close to you is helping, share the night so that each of you has at least one longer stretch of rest.

Eating and drinking well helps the body heal and gives you energy for the long days. You do not need a special diet. Regular, simple meals with vegetables, fruit, grains and some protein, and snacks within reach for the moments when you cannot leave the sofa, are enough. Many breastfeeding parents feel very thirsty during feeds, so keeping a glass of water nearby helps. Cooking can feel impossible in the first weeks. Accepting meals from family and friends, as the mother in the diary does when her mother brings soup, is not a weakness. It is a practical way to let people who care about you help.

Gentle movement, when your body is ready, can lift both the body and the mood. For many people this starts with short, slow walks, like the walk to the end of the street in the diary, and grows little by little. Your body will tell you when you have done too much: more pain, more bleeding or great tiredness are signs to slow down. Harder exercise, such as running or lifting weights, is usually better left until your doctor or midwife says your body is ready, often after the check-up after the birth. Every recovery has its own pace, and there is no prize for being fast.

Many parents have a check-up after the birth, with a doctor, a midwife or a nurse, some weeks after the baby arrives. The timing and the form of this check-up differ from place to place, so ask your midwife or doctor when yours will be. At this visit the health worker may ask about bleeding, healing, the bladder and bowel, feeding, sleep and your mood. Bring a list of questions, as the mother in the diary does, because it is easy to forget them in the moment. No question is too small or too personal. Health workers hear the same questions from many parents, and they would much rather you ask than worry alone.

The body and the mood are closely connected. Pain, poor sleep, hunger and the effort of healing can all make the mood lower and the days feel heavier. In the other direction, worry and sadness can make the body feel even more tired and sore. This is one reason why health workers ask about feelings as well as stitches at the check-up. If you tell them only about your body, they see only half the picture. Saying "I am healing, but I feel very low" or "I feel fine, but I cannot sleep even when the baby sleeps" helps them understand how you really are.

Warning Signs and a Kind View of Your Body

Most recovery after a birth goes well, but some signs mean that you should get help at once and not wait. Call the emergency number straight away for very heavy bleeding, such as bleeding that soaks through a pad very quickly or large clots, especially if you also feel faint or dizzy. Call the emergency number for chest pain or trouble breathing, and for a severe headache, especially one that comes suddenly or with problems seeing. These are rare, but it is important to know them, so that you do not hesitate. If you are unsure whether a sign is serious, call your doctor, your midwife or the after-hours line and describe what is happening; they will tell you what to do next. It helps to keep the number where everyone in the home can find it.

Other signs are reasons to contact a doctor straight away: a fever or shivering, a painful, swollen, red or hot leg, bleeding that has a bad smell or that becomes heavier again instead of lighter, a wound that becomes red, hot, swollen or starts to leak, or pain in the tummy that gets worse. If you have a painful swollen leg together with chest pain or trouble breathing, call the emergency number. Put these signs on a piece of paper near the phone, or share them with a partner or someone close to you, so that another person knows them too. You will not be making a fuss by calling. Health workers would always rather check and find that all is well.

Many parents look at their body after the birth with surprise, and sometimes with disappointment, as the mother in the diary does in front of the mirror. The tummy often stays round and soft for weeks or months. There may be stretch marks, a scar, loose skin, changes in the hair and skin, and breasts that look different. Pictures online and in magazines often show bodies that seem to recover in days, but these pictures do not show ordinary recovery. Your body has done something remarkable. It grew a baby, gave birth and is now healing while caring for that baby day and night.

A kind way of looking at your body can make recovery gentler. Try to speak to yourself the way you would speak to a friend who had just given birth. You would not tell her she should look different; you would tell her to rest and to eat well. Feelings about the body can affect closeness between partners too, and both partners may need time and patience. If you find that thoughts about your body are making you very unhappy, or that you feel ashamed most of the time, mention it to your doctor or midwife. These feelings are common, and talking about them helps.

The other parent or partner has a part in recovery too, even though their body did not give birth. A partner can carry, lift, cook, take night feeds where possible, notice warning signs and give quiet encouragement. A parent raising a child alone can ask family, friends or neighbours for the same kinds of help, perhaps one task each. If you are the partner reading this, your care for the parent who gave birth is also care for your baby. And if the parent who gave birth is you, letting others help is part of healing well.

A Checklist of Things to Prepare

A recovery corner by the bed or the sofa: water, snacks, pads, a small pillow to support the tummy, and your phone, so that you can rest without getting up again and again.

The list of warning signs for the mother near the phone: share it with a partner or someone close to you, so that two people know when to call the doctor or the emergency number.

The date of the check-up after the birth, written down with a list of questions about healing, bleeding, the bladder, feeding, sleep and mood.

Help with lifting and housework for the coming weeks, especially after a caesarean: ask who can carry the shopping, do the washing and clean the floors.

A supply of simple meals and snacks: food in the freezer, easy breakfasts and fruit, so that eating well does not depend on having energy to cook.

A plan for the first day you are alone with your baby: who you can phone, what you will eat, and one small thing that will make the day feel easier.

A short, gentle walk to look forward to when your body is ready, and a kind sentence for yourself on hard days, such as "I am healing slowly but well."