You saw your body go through nine months of changes, but it's not over yet.
Giving birth doesn't give you back your former body -- you're still in for some big changes as it recovers and adjusts to its new demands. But "you don't have to have a tough '10th month,'" says Sylvia Brown, coauthor of The Post-Pregnancy Handbook (St. Martin's Press). "A well-informed woman can use this time to heal her body properly and give it the rest and care that it needs." Here's a guide to what's coming.
When: Right after delivery
Why: The pushing you do during labor also pushes to your face and extremities any extra fluids that you've been carrying, says Kristina Sole, MD, an associate ob-gyn at the Cleveland Clinic. Indeed, shortly after I delivered my son, Campbell, I inflated like a float at the Macy's Thanksgiving Day parade, as much of the extra fluid that had been coursing through my body for the past nine months spread to my legs. Women who have c-sections are also likely to find themselves swollen, thanks to the IV fluids they received. Fortunately, within days of your baby's birth, your kidneys will kick into overdrive, and you'll start peeing and sweating out this water. If your legs, ankles, or feet resemble those of the Pillsbury Doughboy, use a pillow to elevate them above your heart while lying down. However, "if the swelling is worse on one side or if pain is involved, you may have a significant problem like deep vein thrombosis, a condition where there is a blood clot that usually occurs in the leg," says Nicole Karjane, MD, assistant professor of obstetrics and gynecology at Virginia Commonwealth University, in Richmond. Contact your doctor immediately if you suspect you may suffer from this rare but serious condition.
When: From delivery to six weeks
Why: Really, wouldn't it be more surprising if you weren't sore? When you give birth vaginally, your perineum (the area between your vagina and anus) will swell and may even tear; you might also have an episiotomy. "Honestly, I wondered when I would ever be able to sit down again!" says Liz Delizia, of New York City, mother of Morgan, now 2. "You have to look at birth as a trauma to the body," says Joel Evans, MD, coauthor of The Whole Pregnancy Handbook (Gotham). "But the good news is that the body has the ability to repair itself." Recovery time varies, but nearly all new moms see the soreness dissipate within six weeks. Until then, try sitting on doughnut pillows, which provide cushioning while preventing direct contact to the vaginal region; sink into a sitz bath, a shallow basin that allows you to soak only your bottom; or relax for a spell in a regular bath. And use the ice packs and witch hazel pads offered in the hospital. They'll help ease the swelling and relieve pain temporarily.
Vaginal Bleeding (Lochia)
When: From delivery to six weeks
Why: After labor, whether you've delivered vaginally or by c-section, your uterus will slough off tissue from its lining, resulting in what might seem like a monthlong period. "In most women, it changes from bright or dark red blood to a pink blood, then to a clear or yellowish discharge over the first few weeks," Dr. Karjane says. "Some women will stop bleeding for a day or so, but the bleeding can start up again as you engage in more activity. As long as there is no fever or abdominal or uterine pain, discharge and mild bleeding in the first six weeks is normal."
Bladder Dysfunction and Incontinence
When: From delivery to eight weeks
Why: A few days after delivery, you may let out a sneeze or a cough...and, yep, a trickle of pee. Slight incontinence is a very common side effect of giving birth, says Roger W. Harms, MD, editor-in-chief of the Mayo Clinic Guide to a Healthy Pregnancy (Collins). Before you got pregnant, your pelvic muscles and ligaments worked together to prevent urinary leakage; now they've softened and stretched, so they lack their previous strength. Additionally, your bladder has shifted position, sinking close to the space where the baby came out. All of which means that with each "achoo," you're involuntarily peeing. "Kegel exercises, in which you tense and release your vaginal muscles, can strengthen those internal muscles and push the bladder back up," Dr. Harms says. "In nearly all cases, this resolves itself within six to eight weeks."
When: The first few days after delivery
Why: In the days that follow giving birth, while your uterus shrinks back to prepregnancy size (a process that can take up to six months), you'll experience cramps that can range from mild to contraction-like. These cramps can be exacerbated by breastfeeding, which stimulates the release of oxytocin, the hormone that causes contractions. Ibuprofen, massage, or a heating pad can help ease the pain, Dr. Sole says.
When: The first few days after delivery
Why: The narcotics used in some epidurals and those that are given during a c-section slow digestion, Dr. Sole says. And don't forget that your rectum is swollen from the pressure exerted on it during delivery; this swelling needs to subside before you can have a bowel movement. To help get things moving, stay hydrated, eat high-fiber foods such as fruits and vegetables, and take the stool softener they give you in the hospital. And even though you fear it may hurt, try to go to the bathroom or you'll get further backed up, Dr. Karjane says.
When: Two to five days after delivery
Why: Until your system determines how much milk you need to produce and when, your breasts might swell and feel rock hard. "Most women can tell when their milk comes in," Dr. Sole says. "Your breasts might feel like foreign objects attached to your body." To prevent pain, wear a supportive bra, both during the day and at night, Dr. Sole recommends. Also, nurse your child on demand, applying cold cabbage leaves (their shape can conform to your breasts); when necessary, pump out excess milk. For moms who opt not to breastfeed, avoid any nipple or breast stimulation, she suggests. And to help compress your breasts, apply cold compresses, which help stunt milk production, and wear a sports bra.
When: One to five months after delivery
Why: "Around the fourth month after Lily was born, I had an incredible amount of hair falling out," says Missy Jacobs, of New York City. Don't worry -- there's no need to invest in Rogaine. "Due to hormonal changes in pregnancy, hair becomes thicker and fewer hairs fall out," Dr. Karjane says. "After delivery, these effects go away. Although the amount of hair loss can be shocking, rarely do women experience extensive hair thinning." Within several months to a year, you should be back to normal.
When: Up to or longer than a year after delivery
Why: During pregnancy, most women will experience hyper-pigmentation, such as a linea nigra (the line that runs down your belly) or melasma (darker pigmentation on your face) in some form, both of which are caused by an increase in estrogen, experts believe. After delivery, these lines will fade, Dr. Harms says, but they do so slowly and may never disappear entirely. Your best bet: prevention. "These lines can be reawakened with sun exposure, so I recommend an SPF of 30 or higher," Dr. Harms says.
Copyright © 2008. Used with permission from the March 2008 issue of American Baby magazine.
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