Recovery after birth

The after-effects of labour, including pain and swelling, can vary.
The after-effects of labour, including pain and swelling, can vary. 

Regardless of whether you deliver vaginally or by Caesarean section, all mothers will experience certain symptoms as they recover from giving birth. After months of being elevated, hormones such as oestrogen, progesterone, prolactin (the milk hormone that is stimulated through breastfeeding), thyroid hormones and cortisol, will fluctuate as the body tries to rebalance itself, and greatly influence the amount of time it takes to recover from giving birth, both physically and emotionally.

Fatigue is inevitable so mothers should take the chance to rest in the hospital, before returning home. But once you are at home, further care should be taken to ensure the body recuperates completely, and so that none of the wounds acquired during childbirth can be exacerbated.

General recovery after birth
- It is common to have bloodshot eyes, facial bruising and muscle/joint pain related to the strain of pushing during labour and this won’t last long.

- The uterus will take approximately six to eight weeks to shrink to its pre-pregnancy size and the contractions may be felt as “after pains” for the first few days after giving birth, especially when breastfeeding and in later pregnancies.

- Stretch marks that develop during pregnancy (mainly on the stomach and breasts but often on the thighs and buttocks as well) may turn from red and purple streaks to a silver or pearly colour and may itch after pregnancy is over. Treating stretch marks with Vitamin E creams as soon as they appear, in addition to trying not to gain too much weight during pregnancy, will help to reduce the extent to which stretch marks evolve, but for the most part, they will never fade completely.

- Breast pain caused by engorgement (as the breasts begin milk production), mastitis (if milk ducts become blocked) or cracked nipples affect lots of new mothers and can usually be treated with creams or antibiotics. 

- Other symptoms such as fever and/or chills, inflammation, having difficulty passing urine that resembles a urinary tract infection, a very strong vaginal odour, a lack of appetite, hot flashes, night sweats or dry skin could be an indication of infection or circulation problems so it’s best to advise your GP as soon as they occur.

- Even several months after giving birth, some women may feel a lack of libido due to dips and spikes in hormonal activity, while others may have a lack of vaginal lubrication even if libido levels seem fine. Both should pass with time.

- Most women are aware of what post-partum depression is but may be unsure how to differentiate between it and the less severe baby blues. Post-partum hormonal instability causes a rush of emotions and mood swings that range widely between elation, sadness, anxiety and agitation, but this is very normal. More extreme emotions such as persistent despair, anguish and rage may be felt by some women, and are suggestive of post-partum depression. It can manifest as panic attacks, suicidal thoughts and insomnia, and can surface anywhere between the early days following birth and up to twelve months later. Counselling, antidepressants and oestrogen replacement therapy are several different alternatives that are available to mothers who are suffering from depression, and often doctors will recommend all three things be used in conjunction with one another.

Recovering after vaginal birth
- The swelling and pain that women will experience after giving birth vaginally varies, depending on if there was any tearing or if forceps or vacuum ventouse was used to assist with delivery and this can be further aggravated by stitches or constipation. Painkillers and ice packs can alleviate this.

- Urinating or defaecating will probably be very uncomfortable at first but this should feel less sore with each day, and laxatives may help with avoiding constipation and to make passing bowel motions easier, given that the vaginal area will be tender and sore for some time, especially if haemorrhoids develop, which are caused when tissue and veins protrude through the skin around the anus. Sitz baths will ease both haemorrhoids and episiotomy-related pain, and can be taken in warm or cold water, but their main function is to alter the blood flow to the vaginal area so that there is less pressure.

- Bleeding with small clots and then later bloody discharge called lochia, continue for the first week or two after birth, shifting from dark to pink to a yellowy-white colour, but there is nothing to be concerned about unless the bleeding doesn’t ease over time or blood clots are frequently being passed and are very large. These things should be reported almost immediately, rather than waiting for a scheduled post-pregnancy check up.

- Urinary (and sometimes anal) incontinence is a physical effect of vaginal birth that can last for years for some women, but not all women are affected. Again the degree to which the vagina is distended and how much this impacts on the pelvic floor will determine the degree of incontinence, and doing Kegels exercises pre- and post-pregnancy are the best way to sidestep and improve incontinence.

- Most doctors recommend waiting until six weeks after giving birth vaginally to start having sex again as well as engaging in anything more strenuous than light exercise (such as walking). This is because the six week mark is usually the point at which the body has healed well enough that the body is functioning normally again. To have sexual intercourse any sooner increases susceptibility to infection, bleeding and tissue damage. Tampons should also be avoided throughout this entire period of recovery – use pads for the bleeding instead.

- Pelvic bone injuries that occur during a vaginal birth such as separated pubic bones or a fractured tailbone because of the movement of bones and ligaments during pregnancy and labour (of which the pain can go undetected until after delivery if an epidural or anaesthesia has been given), could take a few months to get better. Drugs could be prescribed for this and sometimes physical therapy may be needed too.

Recovering after Caesarean birth
- Women who have a Caesarean birth will find that the focus of their recovery is on how their incision heals, and monitoring the aching, itchiness, numbness and sensitivity of the incision as they recover. It is important to keep the incision clean and dry to avoid infection and note how fluid retention, bruises, skin irritation and the stitches in and around the wound look, so women can advise their doctor if an incision is or is not improving. 

- Recuperating after a Caesarean birth will unsurprisingly take longer because of the care that needs to be taken not to re-open the incision when compared to vaginal birth so commencing an exercise program, lifting anything heavy, driving (because of the rapid muscle movements needed to apply pressure on the brakes), sexual intercourse and walking up stairs are advised to be avoided for up to six to ten weeks after a Caesarean birth. Even small movements such as rolling over in bed, coughing or getting up out of a chair can be challenging.

- Gentle walking after a Caesarean birth as well as wearing compression stockings can both be effective in preventing blood clots and deep vein thrombosis, which women who have given birth by Caesarean have more of a propensity to develop.

- The lower segment incision that is used most during a c-section doesn't normally cut through the muscles, only the sheath covering the muscles (the aponeurosis) but a classic incision will be deeper (although it is rarely done these days). In order to strengthen the muscles so that actions such as sitting up from a horizontal position are made easier, simple abdominal exercises should be done regularly to tighten them, once the incision has healed properly.

- If there are any signs of pain escalating, excessive blood loss, coughing or shortness of breath, swelling or pain in the lower legs or the incision is becoming red and oozing pus, there may be complications and you should seek the advice of a medical professional straight away.

Discuss birth and your body after baby with other mums on the EB  forums.

Most doctors recommend waiting until six weeks after giving birth vaginally to start having sex again.