New mums have enough on their plate looking after their new little one. Worrying about the changes in their body can sometimes become a real focus and cause for concern. Changes in the body are very normal and usually temporary. Give your body time to start to feel and look a little more like your old body. Read on to discover that what you feel and experience is the same for most new mums. It is true that giving your body up to a year is what you really need.
In Part 1 of this series, Heba will cover what are some of the normal changes that occur in a woman's body after birth, whether vaginal or caesarean birth. She will cover topics such as post-partum bleeding and vaginal discharge, abdominal muscle separation, lactation and the baby blues. She will also cover what is common after birth but not necessarily normal.
Take this as a guide of what is 'usual' to expect, and if at all concerned, visit your GP, OB or women's health physiotherapist for assessment, advice and treatment.
During pregnancy, the volume of blood in a woman's body rises by 50%. This is to prepare the body for blood loss. When the placenta detaches from the uterus, it leaves open blood vessels, which bleed into the uterus. The uterus contracts to allow for childbirth and delivery of the placenta. The uterus continues to contract, to close these blood vessels, to reduce the bleeding. Breastfeeding allows the body to produce oxytocin, which also helps the uterus contract. This is why many people feel cramps when breastfeeding. If a woman has a c-section, she may experience more bleeding. If a woman has an episiotomy or tear, she may also bleed from these areas.
Post-partum haemorrhage, which is excessive blood loss due to the uterus not contracting well after delivery. It is common in 1 out of 20 women, and can happen within 24 hours of birth, and even days or weeks later.
Post-partum vaginal discharge (lochia)
Lochia is the excess vaginal discharge women experience after birth. It is made up of blood, bacteria, and tissue from the lining of the uterus. In the first few days after birth, lochia is made up of mostly blood so it should look bright red, like a heavy period. It can come out continuously or it can come out in small gushes. Each day, the lochia should reduce and become lighter in colour. It should be pinkish and watery by day 4 and should have reduced to a small amount of yellow or white discharge by day 10. It should stop by day 40 but can stop earlier. Some women experience intermittent spotting for a few more weeks.
Abdominal Separation (Rectus Diastasis)
During pregnancy or labour, the abdomen can stretch to a point where a membrane between the abdominal muscles can split. This allows for your growing baby inside your uterus. This degree of separation can vary from woman to woman, based on hormone changes, age, body type and size, size of baby, multiple babies, repeat pregnancies, etc. It is very common in pregnant women, with 2 out of 3 women having some degree of tummy separation. It is acceptable to have a separation of less than 2cm, which isn't too deep. However if the separation is more than 2.5cm and deep, this will need support and strengthening. The gap should shrink after birth with strengthening of the transversus abdominis muscle and an abdominal binder.
Support garments such as basic elasticised stocking (Tubigrip) or SRC Recovery shorts can be prescribed to allow for a gentle compression to bring together the belly muscles and allow for their strength to return and separation to decrease. Making sure you see your pregnancy physio at The Fix Program for correct fitting and to teach you appropriate deep abdominal exercises is suggested.
During pregnancy, oestrogen and progesterone levels rise, which cause a rise in prolactin – the hormone responsible for breastfeeding. After birth, oestrogen and progesterone drop significantly, but prolactin continues to be elevated, especially if breastfeeding. If a woman chooses to bottle-feed, prolactin drops to normal levels by day 7. The high prolactin levels and low oestrogen levels are why women experience low sex drive whilst breastfeeding – physiologically this is to prevent another pregnancy. This is also why some women do not have periods whilst breastfeeding, as prolactin suppresses ovulation. The low eostrogen can also make the vagina dry and lower your cervical mucous.In some women, the oestrogen levels remain high compared to prolactin, which makes it difficult for her to produce milk and breastfeed. Some women develop mastitis, which is an inflammation of the breast due to a build-up of milk. It is common in 1 out of 10 breastfeeding mothers and even in some bottle-feeding mothers too.
After giving birth, 50-80% of women experience weepiness and irritability, also known as the 'baby blues'. After birth, women have significant changes in their hormones, which lead to these baby blues, primarily the large drop in oestrogen and progesterone. These feelings often last for a few days, with the worst being the day 4 or 5 after birth. A new mother may feel moody, weepy, tired or anxious.
Some women experience low moods for a month or more after birth. This is a symptom of post-natal depression. Women with PND may also experience poor sleep, low energy, decreased pleasure, hopelessness, constant negative feelings and thoughts, and inability to cope. If these symptoms persist, she should seek help from her GP, as she may require counselling sessions or temporary anti-depressant medication.
In Part 2 of this series, I will cover some of the more common symptoms post-birth, which are not necessarily normal. I will discuss topics such as incontinence, pain and prolapse.