Information available to women once they have a baby is sadly lacking. All the focus of information is mainly on the pregnancy and birth. The postnatal period begins from birth and ends when the baby is six weeks of age. The postnatal period is a very special time where women undergo the transition into motherhood. For during pregnancy it can be very difficult to comprehend just what being mother will be like. However once the baby is born women have no option but to face major changes in their lives. The changes women undergo do not just include the physical changes that occur from the birth, but social and psychological changes as well. Each woman’s experience is different. However it is not unusual for a woman to take time emotionally and personally feel to like they have ‘become a mother’. A woman’s experience as new mother is shaped by her past experiences. These experiences include the nature of her baby, prior experience with babies and the amount of support available to her.
Commonly women feel that the experience of mothering a new baby is very challenging. Women often feel drained as their role is all consuming. Tiredness is a common problem. Some women find that they feel alone or isolated - this is particularly evident in women who have worked full time and have not built a support network. Women also report a sense of loss. Be that a loss of time, freedom or loss of control. However once women grow in their confidence of parenting their new baby - the challenges begin to ease. By acquiring knowledge and skills about caring for a newborn baby - women are able to work it out and enjoy this wonderful part of life (Barclay, Everitt, Rogan, Schmied and Wyllie, 1997).
The physical changes a woman experiences after birth are dramatic and amazing. Once the baby and the placenta have been born, the uterus begins to shrink. After birth the uterus weighs nearly one kilogram, by six weeks it weights approximately 100 grams. The process by which the uterus shrinks is not very well understood, but it appears that the muscle fibres of the uterus are gradually broken down. The uterus continues to contract after birth to control any bleeding. These contractions can cause lower abdominal pain (or afterbirth pains) in some women. These afterbirth pains tend to be worse in women who have had a baby before.
Women experience a vaginal blood loss known as lochia. Lochia is like a heavy period loss for the first twelve hours after birth and then begins to slow down. The lochia is usually bright red in colour for the first couple of days, then changes to a pinky, brown colour which can continue for up to four weeks after the birth. Then there is a cream or white discharge that can continue for up to eight weeks after the birth. This is a general guide as every woman’s experience is different.
The pelvic floor gradually regains its strength after birth. This process is greatly aided by practicing pelvic floor exercises during pregnancy and making sure that they are done soon after the birth. Passing urine after birth can sting - particularly if stitches were required or there was some grazing. Pouring warm water over the vulval area when passing urine can help reduce any discomfort. Women often find that they pass urine a lot, particularly in the first day or two. This is because the body is getting rid of fluid that has built up in the body during pregnancy.
The breasts under go changes soon after the birth. Breastfeeding hormone levels rise, this causes an increase in blood supply to the breasts which is necessary for milk production. The breastmilk production starts in a big way by about day three or four. Breasts enlarge and can feel quite uncomfortable initially. The breasts gradually adjust to milk production as breastfeeding establishes and any discomfort soon disappears (Silverton, 1993).
Problems women can experience during the postnatal period include: tiredness, perineal pain, breast problems, backache, haemorrhoids, constipation, depression, anaemia, headache and urinary symptoms. It is wise to seek the advise of a midwife or doctor if any of these problems are experienced in the postnatal period.
The return of periods following the birth of a baby varies greatly. For women who breastfeed their babies, the return of their periods is very difficult to predict. The hormones of breastfeeding usually suppress the hormones responsible for fertility and menstruation, so generally the return of periods is delayed. For some women periods may not return until they have stopped breastfeeding completely, for other women it occurs once they start to introduce solids into their baby’s diet. However it is possible for periods to return even when the baby is fully breastfeed. For women who choose to bottle feed their baby, they can expect their periods to return four to six weeks after the birth.
The care women experience in the postnatal period varies greatly. Women can choose hospital or home care during this period, depending on what is available in their area. Generally care lasts for 3 to 4 days for a normal birth and up to 6 days for a caesarean birth. Midwives usually provide the majority of this initial care to women. Each day a postnatal check is carried out - in general women are checked for the following: Temperature, pulse, blood pressure, the height of the uterus, breast and nipple check, the type and amount of bleeding, any problems with elimination (urine or bowels), the perineum (stitches, bruising, swelling) and emotional adjustment. Babies are also checked every day. Evaluation usually includes: Temperature, cord, skin (colour, rashes etc.), how feeding is going, sleeping patterns, weight loss/gain and elimination (urine and stools). Education is a big part of postnatal care. Education may be offered on a one to one basis or in group classes.
At six weeks after the birth a final postnatal check is carried out. This check can be provided by a local doctor, private obstetrician or family planning centre. Some midwifery practices provide this service as well. The main aim of the six week postnatal visit is to ensure that the woman and her baby are physically well. Contraception is usually discussed, as well as adjustment to family life. If a PAP smear is due, this can be done at this visit. It is an ideal opportunity to be referred to community resources, if a need exists.
Women can experience stitches after birth as being uncomfortable to very painful. Pain can interfere with caring for a new baby. There are some simple steps that help reduce any pain or discomfort and promote healing. The first important thing is good hygiene practices. Having a shower or washing the perineal area every 6 to 8 hours is a good idea. Salt is not necessary to add to water, research has found that salt has no benefit for stitches or the healing process. Perineal pads should be changed frequently. To help reduce pain and swelling - applying ice to the effected area for 15 to 20 minutes every two to four hours. Stop applying ice around 24 to 36 hours after the birth, as it has no benefit after this time. Some women can experience significant pain and may find that taking some pain medication helpful - suggest discussing this with your midwife or doctor. It is important to have short periods of walking, as well as frequent rest periods. Starting pelvic floor exercises 24 hours after birth as this has been found to help reduce discomfort.
(25th July 2000)