What to Expect in the 4th Trimester
Initial Recovery From Childbirth – What to Expect
Post birth recovery differs for many women and for many reasons. For the most part, physical recovery from a vaginal birth (including forceps births) is quicker than for a Caesarean section, although not always. Its why My Expert Midwife developed their range of unique, award winning pregnancy and postnatal products.
If we focus for the moment on the physical aspects of a vaginal birth recovery, that too differs depending on the type of birth you have, the amount of blood you lose and the length of your labour. What appears to be universal is the pain and swelling of the perineum and labia and this appears to come as a shock for most women. For those women who lose a larger than average amount of blood their physical recovery takes longer due to the tiredness they experience as a result of low iron levels. For those women who have a longer than average labour, and remember that a first labour takes on average 24 hours, they too will feel extremely tired following the birth.
Following a Caesarean section that was done electively and therefore without any labour, the recovery is usually quicker and more straightforward than one done following a labour, especially if that labour was also longer than average. A greater than average blood loss will also lead to similar symptoms of low iron levels.
So what can you expect following a vaginal birth...
You will initially feel full of energy due to the adrenalin coursing through your body. This helps with the initial breastfeed, enabling you both to manage this as you're both alert. Once an hour or two has passed you'll feel extremely hungry and tired, please eat and rest at this point (although this may be easier said than done in hospital).
Most women don't feel an overwhelming rush of love for their baby initially. Most women describe feeling immensely protective, but not love, not immediately anyway, especially if your labour has been difficult. That comes later as bonding between mother and baby and partner develops.
To help with bonding, skin to skin contact and talking/singing to your baby all help, no matter the time delay. Having something with your smell close to baby will also help. Another fantastic tool to learn, for both mother and partner is baby massage and there are many practitioners teaching this with some areas offering free classes through sure start centres. Your midwife and health visitor will have information on your local classes and there will also be other private classes local to you.
Your First Trip to the Loo
The first time you open your bladder it may sting, especially if you have grazes or cuts to the labia. Having a jug of luke warm water to pour over the area whilst passing urine will help with the stinging. You can also use My Expert Midwife's award winning 'Spritz for Bits' to help ease the stinging. The midwives will probably want to measure the amount of urine you've passed so just let them know the amount of water that you used.
You probably won't feel like opening your bowels for a few days. Drink plenty of water before then, along with fibre rich foods to make sure it's as soft as possible. When you do eventually go place a clean sanitary pad against your perineum. This will help to support your pelvic floor whilst opening your bowels.
'Piles' (or Haemorrhoids)
Piles are most often caused by straining to open your bowels when you're constipated, however when you're pregnant the added pressure of your baby can also cause them so you may have already developed them. Piles are basically a weakness in a vein around your anus that causes blood within that vein to 'bulge' causing pain, swelling, itching and (in some cases) bleeding. Witch hazel and tea tree oil are excellent for helping to reduce the swelling and size of the bulges. They also help with itching and hygiene. Lavender oil is also fantastic for soothing any painful area. Those ingredients are all found in Spritz for Bits and it can safely be used during pregnancy and afterwards for the treatment and management of piles. You can either spray the Spritz for Bits directly onto your piles or soak a cotton pad in some Spritz for Bits and apply to your anus.
I'm going to be honest here...it will hurt quite a bit; especially if you've had a forceps birth and or an episiotomy. You can take paracetamol and ibuprofen, even if you're breastfeeding and this will help to make you more comfortable. My Expert Midwife’s ‘Spritz for Bits’ will also work wonders for that immediate, soothing relief. The first week is the most intense, however by week two you should feel that it's getting back to normal.
If you find that the pain is getting worse, especially after day 5 or 6 post birth then call your midwife to ask her or him to check that you've not developed an infection. This is rarely the case, but it's best to have them check you over.
Hygiene of Your Bits
Infection in any wound means that it will take longer to heal and be painful for longer. To minimise the risk of infection change your sanitary pads regularly (at least every fours hours) and make sure that you wipe your bottom from the front towards your anus. This will prevent any anal bacteria from tracking towards any cuts or tears. Bathe the area regularly and you may want to add a tablespoon or two of 'Spritz for Bits' to your bath, as this will help to soothe the area. Once you've finished your bath make sure that your bottom is dried thoroughly (most women find sitting on a clean hand towel achieves this).
Pelvic Floor Exercises
Once your placenta has been delivered, and providing you don't have a catheter in, you can start pelvic floor exercises straightaway. These exercises can be the difference between peeing yourself whilst running for a bus, or not...they're dead easy and the NHS has a great app called 'squeezy' which is excellent.
Eating, Drinking & Feeding
If you decide to breastfeed you need to remind yourself to eat, and frequently. You also need to drink frequently too as you'll become dehydrated very quickly and this will affect your milk supply. It's a good idea to get into the habit of having a drink of something whenever you're feeding. If you do find that breastfeeding becomes painful or your nipples are cracked in the first instance speak to a breastfeeding specialist for advice on positioning and attachment of baby at the breast and to help you solve any other problems. My Expert Midwife's No Harm Nipple Balm will also help to soothe and protect cracked, sore and bruised nipples (as well as moisturising baby's face!). No Harm Nipple Balm is tasteless, odourless and doesn't need to be removed prior to feeding, so use before and after a feed.
Sleeping and Resting
Ha..ha..ha.. I hear you say. Seriously though, you do need to try and sleep. A fabulous doula I work with (another Lesley) always says 'when you get home go straight to bed (or if you're at home, get into bed) and stay there for the entire week'. Plan for no visiting, apart from close family and friends who understand that you'll be having this babymoon and who will do laundry, cook meals and clean for you. Resurface to wash and wee, but otherwise, stay in bed.
Your partner will also be exhausted from the birth and he or she also needs time to bond without a constant supply of visitors interrupting this. You may also find that having your partner sleep in a separate room for the first week enables them to care for you both throughout the day more easily (although that's not to everyone's taste).
And, a Caesarean section...
Apart from the 'hygiene of your bits' part, everything else is transferable.
- Rest when you can, eat and drink well. Take regular pain relief, such as paracetamol and ibuprofen.
- Once you do remove the dressing keep the wound clean and dry (your midwife will tell you when it needs to be removed). Spritz for Bits is excellent for this.
- You still need to do pelvic floor exercises as your pelvic floor has still had 40 ish weeks of weight and stretching to contend with.
- Scarring, like stretch marks, can take a while to fade. My Expert Midwife's 'Fantastic Skin Elastic was developed to help soothe tight, itchy skin, bruising and to fade scarring.
Strangely, the quicker you can start walking (around 6-8 hours after birth) the less chance you have of wind pain. The more often you move the less chance you have of becoming stiff, sluggish and just generally sore. Wind pain is pretty unpleasant and usually consists of very sharp abdominal pain and (strangely) referred shoulder tip pain. Peppermint oil diluted in warm water and sipped over a few minutes is excellent at reducing this, however peppermint oil can interfere with and reduce milk production so it’s best to avoid if you’re breastfeeding. Spritz for Bits can also be used on the wound once your dressing has been removed to ease any itching as it heals.
These usually occur a few days following the birth where you feel down and prone to crying. This usually lifts in a few days and support, help and encouragement are usually all that are needed. If the blues persist beyond a few weeks then this needs to be investigated further as it may be postnatal depression
There is no 'type' of birth that is easier psychologically. It is your birth and your experience. If you feel that your psychological recovery is long then it may be that you've suffered some level of psychological birth trauma and this needs to be recognised as just as significant as physical trauma. There are excellent services that can help you work through your birth experience and your midwife, GP or health visitor can help put you in touch. There are also numerous support groups such as the birth trauma association (website and facebook page).
Postnatal depression is a different thing entirely from the baby blues and usually begins from around 3 weeks, but can take months to appear. The symptoms are feeling down depressed and hopeless and it's usually family members who detect this. They can, on your behalf contact your GP or health visitor and it doesn't always mean medication, there are many other things that help
Birth affects everyone differently, and it's not just about having a healthy baby. Healthy babies need healthy mums. Be kind to yourself, talk about how you feel, and recover.