Post-Pregnancy Problems

Post-pregnancy Problems

Conquer Them
with Common Sense

It's over. The doctor's gone, the nurses are gone, your husband's gone, the baby's asleep in a bassinet by your side, and your body's your own once again.

In fact, exhausted, bruised, stretched and stitched together though it may be, your body already has a lighter-than-air feel. But before you move even an inch, reality--a cramp--intervenes.

Arrrrgggh. Isn't this kind of stuff supposed to be over? Well, yes and no.

Aches and pains are a fact of life after delivery. But most women between the ages of 30 and 45 who are pregnant for the first time have fewer serious health problems than women under 20, says Stephen Fortunato, M.D., director of maternal and fetal medicine at Tulane University in New Orleans. That's because, he says, most of these women go into pregnancy in a bit better health and are more likely to have supportive husbands.

The Aftershocks of Delivery

Although each woman's experience is different, the most frequent postpartum problems are things like cramps, vaginal bleeding, vaginal dryness and pain from the incision (called an episiotomy) that your doctor may have made between the anus and vagina to prevent you from tearing during delivery, says Dr. Fortunato.

"The crampiness is just the uterus coming down to its normal size and stopping itself from bleeding," he says. "In most parts of your body, a clot stops the bleeding. But the way the uterus does it is to squeeze the blood vessels shut."

Every woman has uterine contractions to some extent, says Dr. Fortunato. They're usually more intense for women who are breastfeeding, because every time the baby suckles, their bodies release a burst of pitocin, the hormone that stimulates milk release and contractions in the uterus. That's why the uterus of a woman who is breastfeeding will shrink back into shape more quickly than that of a woman who isn't, says Dr. Fortunato.

Bleeding is also a sign that the body is healing itself, says Dr. Fortunato. "You'll have a discharge that is red, moving toward a paler color, for about three weeks after birth. The bleeding will stop, then somewhere around the fourth or fifth week after pregnancy, most women will shed the scar from the placenta, which is basically like a scab coming off. This resembles a menstrual period."

Women should wear regular menstrual pads to catch the drips--tampons are not a good idea because they can increase the likelihood of infection.

You Can Get Pregnant

This bleeding is not a menstrual period. When will your periods begin again? It can take six months, but since every woman is different, it's tough to say exactly, says Yvonne Thornton, M.D., professor of clinical obstetrics and gynecology at Columbia University College of Physicians and Surgeons in New York City and director of perinatal diagnostic testing at Morristown Memorial Hospital in New Jersey.

But don't think that you can't get pregnant if your periods haven't started up, cautions Dr. Thornton. You can--even if you're breastfeeding.

Most of us have heard that breastfeeding women don't ovulate, but that's not always true. That's why breastfeeding is not a reliable form of birth control, says Dr. Thornton.

Until a woman's menstrual cycle gets back on track again, she may also have vaginal dryness, adds Helen Kay, M.D., a specialist in maternal/fetal medicine and associate professor of obstetrics and gynecology at Duke University in Durham, North Carolina. Low estrogen levels after delivery, particularly if a woman is breastfeeding, can make the vagina so dry that intercourse is painful. Dr. Kay recommends taking time to heal or using lubricating jelly, like K-Y, until vaginal moisture returns.

Low estrogen levels can also make women feel like they're going through menopause, adds Dr. Fortunato. They can actually have hot flashes. The only cure for that is time.

To Cut or Not to Cut?

Probably the most common postpartum complication is pain from an episiotomy. It makes walking, sitting and going to the bathroom uncomfortable. In addition to helping to avoid tearing, an episiotomy is done to help prevent loss of muscle tone in the pelvic area that can lead to bulging of the rectum or bladder, says Dr. Fortunato.

But you may not need an episiotomy, so discuss it with your doctor. If you tell your doctor you don't want an episiotomy to begin with, many doctors will go along with this, says Dr. Fortunato.

If you do have one, however, here's how to avoid episiotomy pain.

Get a midline incision. There are two types of incision, Dr. Fortunato says. One goes through the vaginal lips; the other cuts down from the vagina to the rectum. With the second type, the big muscle tissue is not cut. Healing is more rapid and the likelihood of prolonged pain is reduced, he says.

Take a sitz bath. If you have an incision, sitting in a warm, shallow bath three or four times a day for the first week after delivery should reduce the pain of both the episiotomy and any hemorrhoids left over from pregnancy, Dr. Kay says. Soap is optional. Taking the bath after a bowel movement--or using a turkey baster to spray your bottom with warm water at that time--will also prevent infection of the incision.

Use anesthetic sprays. If the area is still painful between baths, pick up an over-the-counter anesthetic spray that contains benzocaine from your drugstore and use it to numb the area, says Dr. Fortunato.

The Problem with Infections

Although most postpartum difficulties are more aggravating than serious, there are two that can put you in danger: Infections of the uterus or breast.

"A uterine infection is much more common in cesarean deliveries than in uncomplicated vaginal deliveries, but before antibiotics were used regularly after all cesarean births, about 80 percent of women got infected," says Dr. Fortunato. Today, with antibiotics being given, the infection rate is down to somewhere around 10 to 30 percent after cesarean section.

Here's how women are infected, says Dr. Fortunato. "Membranes tend to protect the uterus and the fluid inside during pregnancy. But if they've ruptured during labor, you've been in labor for a while and you've had multiple pelvic examinations during labor, all of those things can introduce bacteria from the vaginal tract up into the uterus."

Breast infection, called mastitis, is another common problem, particularly for women who breastfeed, says Dr. Fortunato. It's caused by staphylococcus or streptococcus bacteria.

"A lot of times it comes from the baby's mouth through a cracked nipple," says Dr. Fortunato. "The first sign is a little red streak from the nipple out to the periphery. Other signs are redness, heat, tenderness, swelling, pain and fever, which may also indicate clogged milk ducts."

Frequently emptying the breasts can help head off an infection, and "if an infection is caught early, it can be treated with antibiotics and does not need to interrupt breastfeeding," says Dr. Fortunato. If you let the infection go, however, it will form an abscess that will have to be lanced and drained.

Here's how you can avoid both uterine and breast infections.

Avoid sex until you stop bleeding. "I usually tell people to wait a month or until bleeding has completely stopped, whichever occurs last," says Dr. Fortunato. "The reason for that is that the mucus plug in the cervix doesn't form for as long as you're bleeding. And the mucus plug is what protects you from getting an infection."

Keep your nipples clean and supple. For women who breastfeed, "good nipple care will prevent them from cracking," says Dr. Fortunato. Wash the nipples with warm water after you feed--never use soap. If you think a breast cream would maintain the suppleness of your skin, ask a nurse or breastfeeding instructor which one to use, or try a lanolin ointment. Vitamin E oil is also popular.

Feed your baby on a regular schedule. "Emptying the breast helps prevent mastitis," says Dr. Fortunato, "since one of the things that promotes the infection is when the breast is engorged with milk." Bacteria thrives in stagnant milk no matter where it is, he adds. So if you're back at work or not able to breastfeed your baby frequently, express some milk. You can refrigerate or freeze it for later.