The postnatal period begins immediately after giving birth to when the community midwife discharges you from her care.
The early hours
During the first few hours after giving birth the midwife will continue to monitor you as there are still many risks to you and the baby.
You can expect to be checked for the following;
- That the uterus is contracting properly and that the placenta has delivered itself intact.
- Your blood loss with be monitored.
- Your blood-pressure is checked
- You will feed your baby for the first time.
Later postnatal period
- Vaginal bleeding is called lochia and will occur after delivery.
- The colour, amount and smell are checked so any infection can be quickly detected.
- Bleeding can be heavy during the first few days.
- Bleeding can last approximately 7 to 10 days and then gradually disappear after 2 or 3 weeks.
- The colour is bright red during the first few days then turns pinkish and light brown and then lighter still.
Bleeding, especially heavy bleeding which lasts for a long time (more than 15 days) or an offensive smell can be a sign of infection. You MUST seek medical help.
Look for signs of feeling unwell or a fever as this also can be a sign of infection.
- They persist for ten to fifteen days.
- They become less severe after about one week.
- They are less significant after one week.
It is essential to consult a doctor if these pains persist beyond approximately 10 days.
Breastfeeding causes the uterus to contract, so you may experience twinges during the first few days.
Urinary incontinence can be a problem after giving birth.
The perineum, and a set of muscles which support the pelvis and the bladder, were distended and "damaged" by your efforts during labour, the strong pushing, the passage of the baby, the episiotomy or tear can cause weakening of the pelvic floor and as a result affect the bladder.
It is important to carry out your pelvic floor exercises and if your problems are particlalry troublesome see your GP as you may benefit from a course of physiotherapy
Exhaustion after childbirth is normal for most women and is an accumulation of giving birth, meeting your newborn baby, lack of sleep, learning how to feed your baby and a complete change in lifestyle..
It is necessary to rest as much as possible after giving birth, sleep when your baby sleeps, and limit the amount of family and friends that come to visit.
- It is common to be constipated for a few days after delivery.
- Ask for treatment if the constipation persists for several days.
Your stitches will not tear and should not prevent you from going to the toilet.
Haemorrhoids are quite common during pregnancy and following delivery. They occur as a result of the baby laying above the rectum, hormones that circulate during pregnancy and the pressure from pushing during child birth.
Do not put up with any discomfort - your GP can prescribe simple soothing ointments if necessary.
Menstruation after giving birth
If you are bottle feeding or combining bottle and breast feeding then you periods could return a quickly as 4 to 5 weeks after giving birth. If exclusively breastfeeding your periods may not return until after you have stopped breastfeeding.
Sexual intercourse might not be high on your agenda to begin with, but there are no rules about how long you must wait. Take your time, and you might want to try using lubricating gels, as you can be drier to begin with.
You should think about contraception, as there is no way of calculating when your periods will return. This should be done before leaving hospital and by your GP at your 6-week check.
Becoming pregnant again can happen quickly after giving birth and you may want to avoid this.
- Most women are likely to ovulate 4 to 6 weeks after giving birth if bottle-feeding. It is difficult to calculate when a breast feeding mother first ovulates so precautions are advised for both feeding methods if wanting to prevent an immediate pregnancy.
- In approximately 10% of women ovulation can occur within the first few weeks after giving birth.
- Choices of contraception for women who do not breastfeed :
- The contraceptive pill can be taken 21 days after giving birth. This includes the combined pill and progesterone only pill.
- The coil: can be fitted from approximately 6 weeks after delivery. If planning to have more children then a coil may not be the most appropriate method of contraception - speak with your GP for further advice.
- Condoms, diaphragm or cap or natural family planning can be used but do not offer a reliable contraceptive rate.
For women who breastfeed :
- The combined pill pill is contraindicated whilst breastfeeding.
- The Mini pill (Progesterone only pill) is safe to take whilst breastfeeding. It can be started 21 days post delivery. Compliance is essential, as some progesterone tablets have to be taken at the same time every day.
- Coils, condoms, caps or contraceptive injection (Depo) are all safe to use whilst breastfeeding.
It is essential to seek advice from your doctor or family planning nurse before taking contraception again.
Personal and genital hygiene
- Having a daily shower is recommended to keep the perineum area clean.
- Avoid using any creams, lotions or soaps.
- Do not use tampons or try to 'douche' the vagina - wait until your post op check before inserting anything into your vagina.
- In the immediate post natal period, if you feel bruised and are tender in the perineal area then ice packs maybe of some comfort.
- Keep the perineam clean and dry and always wipe from to back to prevent germs from your bottom infecting any wounds or causing a urine tract infection.
Document produced in collaboration with Claire Gabillat