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How To Deal With The Havoc Pregnancy Has Wreaked On Your Body


You've just been wheeled out of the maternity ward. Thanks to the high of cradling your newborn baby, your 12-hour labor is fast becoming a fuzzy memory. You marvel at the perfection of this little person who has been growing inside you for the last nine months, you thank your lucky stars he didn't inherit his father's ears and you look down expecting to finally be able to see your toes again.

That's when you realise you got two out of three right. First-time mums may be surprised at how pregnant they look after having their baby. It's important to understand and accept that chances are, for now, your postnatal body is going to be flabbier, bigger and possibly more matronly than your own mother's figure. It will take time for your body to recover from the dramatic changes that have taken place over the last nine months. Here's what to expect in the first few days and weeks after the birth:

Jelly Belly

In general, your tummy, now devoid of baby contents, will still look at least as large as it was when you were about six months pregnant as your stretched-out uterus and slack stomach muscles need time to go back in shape. The uterus will take about six weeks to shrink from the size of a basketball back to normal, about the size of a pear. Says Dr Lai, an obstetrician and gynaecologist in private practice:

"This pregnant-looking state is due mainly to lax abdominal muscles that have been stretched during pregnancy and the additional fat deposit that the mother put on during her pregnancy. Regaining the abdominal muscle tone may take time and is helped by exercises which firm these muscles, while breast-feeding is one good way of losing the extra stores."

Tip: There are no short cuts in shedding those pregnant pounds. Says Dr Lai: "Some of the extra weight may be due to the increase in breast size due to the pregnancy and breast-feeding! In mothers who are keen on losing weight, breastfeeding has been shown to help. However, the laws of thermodynamics cannot be changed and weight loss can only occur if more calories are expanded than consumed.

A sensible diet and a gradual return to physical activity helps. While extreme dietary measures, demanding physical activity and weight-loss pills may be effective in the short-term, weight management should involve long-term lifestyle changes by way of healthy eating and an adopting an active lifestyle."

Vaginal Bleeding

After giving birth, you will experience vaginal bleeding, called lochia (pronounced LOCK-ke-ah), even if you delivered via Caesarean. This bleeding occurs as the uterus sheds its lining after birth. It starts out bright red and heavy before tapering to an almost colorless or yellow-tinged discharge over four to six weeks. Says Dr Lai: "The flow is not as heavy as a menstrual period and you should inform your obstetrician early should the lochia be heavy (like tap water flowing), develops a foul odor or if you're passing large clots." These could be signs of a postpartum haemorrhage or uterine infection.

Tip: Since you may rest in bed most of the time at the hospital, use ultra thin night sanitary napkins which are long in the back to minimise staining the sheets (especially if you have visitors!). For extra convenience, use disposable undies.

Perineal Pain

After passing a 3kg baby the hard way, it's no surprise that your perineum (the area between your vagina and anus) is sore and tender, all the more if you've had an episiotomy. Says Dr Lai: "An episiotomy is a surgical enlargement of the vaginal orifice by an incision of the perineum during the delivery.

If there is perineal pain after delivery as a result of trauma sustained during the delivery process, the discomfort would normally disappear by the time the wound heals, which normally takes around a week." An infection of the episiotomy wound is not common, and if it does happen, is usually the result of wound breakdown, says Dr Lai. "This may be related to the woman's poor healing ability, suture material or sub-optimal repair."

Tip: Keep the perineal area clean to prevent infection. Change your pads often and wash the area regularly and gently. Research suggests that even using tap water to clean the wound reduces infection rate. You may also be given a cleansing solution like salinem procaine spirit or an antiseptic like chlorhexidine.

After Pains

The work of your uterus is not done yet. Now it has to shrink from over 1kg to about 50g, which takes a lot of contracting. Most women will experience after-pains ranging from barely noticeable to ouch-painful! These cramps are due to your uterus spasmodically contracting as it returns to its pre-pregnancy size. The intensity will subside over a few days. The pain is also more noticeable during breastfeeding when the nursing baby triggers the release of oxytocin, a hormone that causes the uterus to contract. If the pain is causing you serious discomfort, your doctor may prescribe suitable oral painkillers

Tip: If you're breastfeeding, and would rather not take any oral painkillers, Dr Lai suggest gently pressing a warm water bottle over the lower abdomen. "It's just as effective," she says.

Difficulty Having Bowel Movements

One mother recalled how she had guests in her hospital room admiring her new baby when a nurse popped her head in and chirpily asked in a penetratingly loud voice: "Have you moved your bowels yet?" The question may be embarrassing but it's an important one that can point to complications in the area. Dr Lai says: "Asking for bowel movements is important if there has been a third-degree tear or extension of an episiotomy into the rectum. 

The repair would involve repair of the disrupted anal sphincter." Ideally, your first bowel movement should be soft to prevent any tears to the tender anal tissues. On the other hand, if you experience faecal incontinence, that could indicate that the surgical repair in the anus was not complete. But don't be too worried if you don't feel the urge. The abdominal muscles that assist in pooping would have been stretched during childbirth too, rendering them flaccid and temporarily ineffective.

Plus, the lack of solid food during labour, the extended time lying in bed and a psychological fear of injuring your sore perineal area (or bursting your stitches - a very unlikely scenario) means you may not have any bowel movements for a few days. Explains Dr Lai: "The simplest advice is to reassure the mother that she does not need to worry about the psychological fear and a glass of prune juice usually works!"

Tip: Soft stools will be easier to pass, given all the tenderness in the area, so drink plenty of fluids and eat sufficient fibre. Also, get moving and staying as active as you can to help your sluggish digestive system get on track.

Difficulty Urinating

Some women may experience difficulty urinating in the first 24 hours after giving birth. There are many reasons for this: Low fluid intake during labor and the loss of fluids during the delivery (sweating, throwing up, bleeding), trauma or bruising to the bladder; the effects of the anaesthesia or even a fear of urinating because your perineal area feels so sore.

Says Dr Lai: "Sometimes after a delivery (more often in an assisted vaginal delivery or with an epidural), the mother is unable to pass urine properly either due to the pain, spasm or tissue swelling. When this occurs, the bladder may get over-distended and if unrecognised, may result in permanent loss of control of urination. Hence, it is important to note that the mother has passed urine after delivery and is able to control it."

Rest assured, this is a common condition but like the passing of your first stool, a crucial step to overcome in your postpartum healing. It is important to empty the bladder within six to eight hours of giving birth to prevent a urinary tract infection and an over- full bladder can interfere with the proper descent of the uterus.

Drinking lots of fluids will not only help trigger your first pee, it will dilute the acidity of your urine to minimise stinging the perineal wound. You can also try squirting or pouring water over the perineal area when you pee to decrease discomfort.

Tip: If you're really desperate, and can't seem to get over the psychological barrier of peeing, try doing it while you shower!

Urinary Incontinence

If its not one, it's the other. Some women find that they have trouble holding in their urine after giving birth. This is also normal and is due to the physical stress on the organs during childbirth. The muscle tone in your bladder may be temporarily weakened, leading to leakage.

Tip: Ideally, start doing Kegel exercise (where you tense and hold the muscle around your anus and vagina - as if you're stopping yourself mid-pee) immediately after giving birth.

Hair Loss

It's time to bid farewell to your shiny, lush head of hair which you flaunted when pregnancy hormones kept your hair from shedding. Now that oestrogen levels are falling to pre-pregnancy levels, you'll find a drain-clogging fall out every time you wash your hair. Alarming as these clumps may seem, rest assured they are merely all the hairs that should have fallen during the months of pregnancy. Since your natural re-growth will not be able to match the rate at which you're shedding, chances are you'll have to decline that shampoo ad endorsement till about half-a-year's time.

Tip: There's nothing you can do to stop the hair loss at this point so we suggest heading to your hairstylist to get a fuss-free, flattering 'do for now!

Stretch Marks

Those of us who are familiar with those crayon-red, wavy streaks across the navel will now enjoy an even more wrinkly view of our slack skin. Don't be alarmed if they look an angry, they will eventually fade to silvery lines over time.

Tip: Applying a rich moisturiser will keep the skin supple and help reduce the appearance of the stretch marks. It contains plant extracts which help stimulate cell renewal and reactivate the synthesis of collagen and elastin fibres.

Breast Changes

Ironically, while you may feel at your most physically unattractive - with limp hair, big tummy and stretch marks - your boobs are probably looking obscenely full. Whether you're planning to nurse or not, your breasts, already swollen with colostrum, will fill out even more once your milk comes in. This usually happens two to five days after birth. The increase in size comes at a price: Your breasts may become too uncomfortably full or engorged.

Tip: Wear a nursing bra that is not too tight - chafing against engorged breasts will only add to your discomfort and possibly lead to more serious problems like blocked ducts and mastitis.

Sore Nipples

You would think that nipples should handle a baby suckling at them effortlessly, after all, that is their function. But as you would painfully discover, nipples - especially for first-time mums - have to be "broken in" first. The first few days of nursing a hungry newborn may leave your nipples sore, or in some cases, cracked or bleeding from broken skin. While some tenderness is expected initially, always check that your baby is latched on correctly during feeds.

Tip: After washing your nipples with clean, warm water after a feed, apply a thin layer of lanolin nipple cream to soothe and protect the tender skin. Never wash with soap as it will strip your body of its natural protective oils. There is no need to wipe off the cream before the next feed.

What Is Not Normal

The physical (and emotional changes) to your body after giving birth may be dramatic but there are certain red-flag symptoms that could point to a postpartum complication, and warrants a visit to your doctor. These include:

Fever

Says Dr Lai: "Fever during the post-partum period is abnormal and the commonest cause is engorgement of the breasts."

A Burning Sensation During Urination

This is also not usual and may be due to catheterisation during the delivery or a urinary-tract infection.

Severe Or Constant Abdominal Pain

This may or may not be accompanied by swelling, especially in the lower abdomen.

Severe Or Constant Vulvar Pain

Especially if the pain lasts beyond the first few days.

Heavy Vaginal Bleeding

See a doctor if your flow is so heavy, it saturates more than one pad every hour or if you experience bright red bleeding after the first week.

Localised Pain In The Calf Or Thigh

Look out for symptoms of thromophlebitis, or a blood clot in the leg vein, which may be caused by thickening of the blood during childbirth. (This is nature's way of preventing a mother from excessive bleeding). There could also be tenderness with or without swelling, and pain when you flex your foot. Call your doctor immediately and keep your leg elevated.

Depression

Seek professional help if your depression starts to interfere with your daily activities or particularly if you have strong feelings of anger or resentment towards your baby or urges of committing violent acts against yourself or your baby.

 

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