What is normal after having a baby? Part 2

Heba talks about the stuff they don't tell you about being a new mum

Last month, we talked about what is normal and common after having a baby. We discussed post-partum vaginal bleeding and discharge, abdominal separation, lactation and the baby blues. This month we're going to have a look at what is common after birth, but not normal.

Prolapse

Prolapse is surprisingly common post-birth affecting about 50% of women. During pregnancy, the extra hormones make the connective tissue in women's bodies more lax to allow for childbirth. In some women during birth, this connective tissue overstretches and doesn't really tighten back up after birth. This means that the pelvic organs being held up by this connective tissue are sitting lower than they should be. If they have a forceps or vacuum delivery, their risk of prolapse goes up even more.

Women will experience symptoms like:

• Lower back pain. This is because the uterus attaches to the lower back via ligaments and if the uterus is sitting lower there is more pull up onto the lower back from within.
• Pelvic pressure or feelings of heaviness or dragging sensations
• Sensation of a bulge vaginally
• Leaking from the bladder. This is because the bladder and urethra are sitting lower than they should be.
• Incomplete emptying of the bladder. This is because the bladder sits lower than it should, a little pocket of the bladder can form and store urine

The best way to manage and sometimes even cure prolapse is to see a women's health physiotherapist 4-6 weeks after birth. She will fit you with a device to lift the prolapse called a pessary. The pessary will prevent any sensation of prolapse and sometimes even allow the connective tissue to tighten up completely within a year post-birth.

Incontinence

Incontinence is really common post-birth affecting at least 30% of women. Usually the incontinence is a direct result of a prolapse. Sometimes it is because of a weakness of the pelvic floor muscles. 1 in 3 women will have bladder control issues post-birth and 1 in 8 women will have bowel control issues post-birth, especially if she has had an anal sphincter injury or 3^rd/4^th degree perineal tearing during her labour.

Women may leak with a cough, sneeze, laugh, jump or run and this is known as stress incontinence. Or they may leak due to urgency, which is known as urge incontinence; sometimes they can have both. The great thing is physiotherapy can cure 80% of cases, and it can be as simple as doing your pelvic floor strengthening exercises.

A great set of exercises to get started with are doing 10 second holds, followed by 10 quick lifts, followed by 3 elevator exercises. The elevator exercise is visualising the pelvic floor as an elevator in a 3-storey building, and taking the pelvic floor to level 1, then level 2 then level 3, and then letting it drop back down to ground. If a woman does this every time she feeds her baby, she can keep her pelvic floor muscles strong.

It is a good idea to stop to ask yourself at your bub's 3 month 'birthday' the following question. "Have I felt that my bladder control has improved and is returning to normal since the birth?" If you have any concerns answering this favourably, seek assessment and advice from your women's health physiotherapist. She may wish to assess your strength, coordination and any presence of prolapse with an internal vaginal examination. You may need extra training and help to regain your strength or the pelvic floor region and to regain good bladder and bowel function and control. Perhaps you may need a pessary fitted and prescribed to help you along? This examination is the only way to truly see how well you are going with your pelvic floor muscle function after having your baby. We do hope that after the birth, our internal exams wouldn't worry you at all!

Pain

Having a baby is often compared to major surgery. And if you have a caesarean section, then it definitely is! Most women will have some amount of scar tissue after birth, whether it is vaginal scar tissue from an episiotomy or perineal tearing, or scar tissue from a c-section. And scar tissue, when it's not numb, can be quite sore.

This is why women can sometimes experience pain when sitting or when getting out of bed, while emptying their bladder and bowel, or even during sex. It's as common as 1 in 5 women. On top of that, the drop in oestrogen makes the vaginal area dry and more likely to be painful especially during sex. If you do have scar tissue, it's very important to do scar tissue massage along the entire length of the scar. Rub your finger perpendicular to the scar and spend 5 minutes every day rubbing into it to smooth out the tissue.

In some women the pelvic floor muscles go into spasm from the tearing, scar tissue and pain down there. These women may need to see a women's health physiotherapist for pelvic floor release work. These women often won't tolerate doing pelvic floor lifts, and can sometimes experience more pain from these types of exercises.

Be kind to yourself   

So remember, prolapse, incontinence and pain are common post-birth, but they are not normal. And you can certainly do something about them and sometimes cure them altogether with early visit to your women's health physiotherapist.

Do you feel like your legs are as thick as tree trunks?

By Nicky Davies, Massage therapist form TREWellness Centre, Cremorne

You may be pregnant, trying to get pregnant or had your baby. It doesn't matter which boat you're in, no doubt you've heard lots of stories about "what to expect when you're pregnant". Every pregnancy differs from person to person and baby to baby, however some symptoms are quiet common.

One of these is puffy legs, ankles and hands (which can lead to carpel tunnel syndrome.) This is one of the conditions that we aim to relive or elevate with pregnancy massage.

Hormones, namely progesterone and oestrogen, have a huge role to play during pregnancy which is to primarily prepare your body for the main event. Unfortunately these hormones also cause some unwanted effects, such as pregnancy related swelling. Swelling (or oedema) is an increase of fluid in the body. This can often be up to 40% in the third trimester of your body's usual fluid levels. No wonder it gets stores in the legs and we are left feeling puffy and without shapely wrists or ankles! Progesterone causes the smooth muscle to relax which impacts on the body's ability move or pump the oedema away. This oedema often pools in the ankles, calves hands and wrists.

Even Kim Kardashian can't escape pregnancy related ankle swelling!

Pregnancy massage to these areas consists of long gentle pumping strokes to help flush out the congested areas, a bit like a lymphatic massage. This helps to reduce the discomfort on the surrounding soft tissues and improve mobility of the ankle joint. This has, with some clients, provided relief with restless leg type complaints due to the improved circulation.

For more information of the benefits of pregnancy massage take a look at TRE Wellness Centres website: www.trewellness.com

TRE Wellness Centre was evolved with a very clear goal in mind, which we believe makes us that little bit different.

Nicky Davies

Nicky has been in the allied health industry for over 12 years, with a passion for helping people of all ages and backgrounds to achieve their health goals. Nicky has a BSc in Sports Therapy from the UK, Pregnancy massage Certificate, Post Graduate certificate in Vocational Education as well as qualifications in Personal Training and Nutrition. As well as practicing, Nicky is also an educator of health and remedial therapies.

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 and 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.

Post-partum bleeding

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.

Lactation

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.

Baby blues

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.