by Rosemary Romberg
Post Partum Bleeding
Lochia refers to the normal vaginal bleeding that occurs during the first few weeks after the birth of a baby. As a rule most women bleed fresh red blood for about 1-2 weeks following delivery. This gradually tapers off and becomes whitish or brownish for about 1-2 more weeks. The type and amount of bleeding varies considerably from woman to woman, and some women bleed very little following birth. The amount and length of lochia can depend on many things. Generally women tend to have less postpartum bleeding if they are breastfeeding. This is because the suckling of the infant stimulates the uterus to contract. The opportunity to nurse the baby shortly after birth and often during the first couple of days also contributes to less postpartum bleeding. Sometimes women who have been heavily medicated during labor and birth tend to bleed more. Also, problems with third stage (expulsion of the placenta), for example, if the placenta did not come out in one piece, often results in heavier bleeding. Finally, if the mother does a lot of running around and doing too much physical exertion within the first few weeks after birth, this can cause an increase in bleeding. This is one of the reasons that it is very important to relax and not do too much during the postpartum period.
Normal lochia should not be any heavier than a heavy period. If you give birth in a hospital and your bleeding is excessive, you may have to stay longer than you had planned. If you give birth at home or in a birth center and you have excessive bleeding you will probably have to be transported to a hospital for treatment and observation. It is of utmost importance that all birth attendants know the difference between normal and excessive postpartum bleeding. By the time the baby is 3-4 hours old, you will probably be changing your pad every 1 and 1/2 to 2 hours, or possibly even less often. If you are soaking your pad every half hour or oftener, you are bleeding too much! If you are still in the hospital bring this to the nurse’s attention. If you are at home, call your doctor or birth attendant immediately!
Excessive bleeding can result in anemia (insufficient red blood cells). If excessive bleeding is not treated promptly and properly the condition can be extremely dangerous. Treatments for hemorrhage may include chemicals to make the uterus contract, massaging the uterus, removal of pieces of the placenta, or (in extreme cases) blood transfusion.
If your lochia develops a bad odor, or especially if you develop a fever, this could indicate an infection of the uterus. Consult your doctor or midwife if this happens.
GET YOUR REST!!
During the first few weeks after giving birth it is a good idea to try not to do any more than take care of yourself and your baby. Your husband or other helpful people should do the housework, laundry, fix meals, take care of older children, etc. What other people should not do is take over with the care of the baby. This is the time when you and he/she need to establish a mother/infant bond and if you are breastfeeding, a nursing relationship.
Postpartum blues are fairly common. As a rule, women tend to have less post- partum depression if they breastfeed, if they give birth with little or no medication, and if they have a positive birth experience. Several factors can contribute to postpartum depression. If the mother tries to do too much, entertain too many visitors, etc., this can cause physical exhaustion and result in depression. If you are around people who are critical of you, or rub you the wrong way your reaction can be exaggerated. Eating poorly, especially eating too much sugary food, can result in low blood sugar which causes depression. Finally, sometimes if the actual birth experience or baby conflicts with a preconceived fantasy ideal birth or baby that you had dreamed of during pregnancy, this can cause disappointment. For example, perhaps a natural birth was planned but a Caesarian delivery was necessary, perhaps home birth was planned but you had to go to a hospital, perhaps birth was more painful than you had imagined or perhaps you had your heart set on a baby of one sex and got the other. While it is important for all expectant parents to make choices and plans about birth, it is also important to be open to a variety of possibilities and not be overly rigid in one’s expectations.
Today all forms of depression are becoming recognized as a more serious and treatable problem than was previously believed. Depression is a common form of illness related to inadequate levels of Seratonin in ones system. This can be diagnosed and successfully treated with prescription anti-depressant drugs. There are also various herbal remedies such as St. John’s wort, which are believed to work as anti-depressants. These can be purchased over the counter. Consult with a physician, psychiatrist, or herbal specialist if you wish to consider either prescription or herbal anti-depressants. If you are breastfeeding, make sure the remedy is safe for the baby. (Just because something is an herb does not necessarily mean it is harmless.)
Body Size and Weight:
Women very rarely have their normal figure back immediately after giving birth. A normal, healthy weight gain during pregnancy is around 20-35 lbs. (more if twins!) Immediately after giving birth you lose around 10-15 pounds from the baby, placenta, water, etc. This means that you are usually left with another 10-20 pounds above your pre-pregnancy weight. Usually women have a certain amount of extra “flab” around the middle right after giving birth and tend to look about 5 or 6 months pregnant. DON’T PANIC!! You won’t stay this way!!
In the past many people believed that women should gain only a small amount of weight during pregnancy so that she wouldn’t lose her figure. It has now been learned that restriction of weight gain during pregnancy deprives the mother and baby of important nutrients and is dangerous to the baby’s health. You should gain between 20-35 pounds during pregnancy (and more than this is NOT dangerous) even if you are overweight to begin with. Preferably, your weight gain should come from wholesome, nutritious foods such as whole grains, fruits, vegetables, protein foods and/or dairy products. Most of us succumb to junk foods occasionally, but remember that things like candy, cookies, chips and the like only add calories and create fat without adding important nutrients to you or the baby.
It has been learned that the extra weight gain during pregnancy provides an important cushion of nutrients and calories that will help insure an adequate milk supply for breastfeeding. If the baby gets all of its nutrition from your milk this requires approximately 1,000 calories per day (in addition to your normal caloric intake for maintaining body weight.). Therefore, most women can follow a normal diet and lose the additional weight during the first 4-5 months after giving birth, if the baby is totally breastfed.
If you are overweight you can follow a reducing diet while nursing your baby. The diet should be a moderate one which will result in a gradual weight loss over a long period of time. Following an extremely restricted reducing diet can diminish your milk supply and can be dangerous to your health in any event.
If you bottle feed your baby, you may have more difficulty losing your extra weight gain from pregnancy than if you had breastfed.
Exercises can help restore your body shape and muscle tone which tends to be lost during pregnancy. You should wait at least two weeks following an unmedicated vaginal birth, and wait until you are no longer bleeding heavy or red blood, before beginning an exercise program. If you have a Caesarian birth you must wait even longer before you begin exercising. Any body toning exercises that are taught in prenatal classes are also good as postpartum exercises. Yoga is excellent for the postpartum period. Any sport in which you were formerly active in can be resumed, but you should go back into it gradually.
Shopping List for the Postpartum Period:
Somehow magazines and baby books offer plenty of advice about what to have ready for the baby. Less often are women advised as to what they should have on hand for themselves:
1. Two boxes of 40 each, super-size sanitary napkins. You may not need this many, but this is a good amount to have on hand. (Save your husband or partner an embarrassing trip to the store!) Some stores sell obstetrical pads which are larger and thicker than ordinary pads and are regularly used in hospital maternity departments. You may wish to purchase this kind also, especially if you will be giving birth at home, in a birth center, or leaving the hospital shortly after birth. If you will be staying in the hospital for a few days following birth, they will provide them while you are there and you will probably not need that kind once you get home.
(Historical tidbit: Dealing with menstrual and postpartum flow has gotten easier with the generations. When I first had the need for these items, back in the 1960’s, sanitary pads were thick and bulky and required a cumbersome elastic belt to hold them in place. When my mother was young, women usually made their own out of rags which they washed out and re-used. At some time in the 1970’s some genius came up with the idea of attaching an adhesive strip to the underside of the pad, hence making our lives infinitely easier! Today they make them much thinner as well. Now I’ve gone through menopause!)
I used to instruct moms to “get the special kind of pads with the adhesive that attaches to your underpants.” Today, they are all made that way, except for the O.B. pads that hospitals use. You may not have a pair of underpants ready right after giving birth, so they hold these pads in place with the old-fashioned belt. These still can be purchased. You may wish to have one or two extra sanitary belts on hand for the first few days following birth.
2. One or two boxes of mini-pads or panty-shields. Usually the lochia diminishes to a very small amount after about one or two weeks and then continues that way for several more days or longer.
3. What about tampons or menstrual sponges? If you have an episiotomy or internal tearing, tampons or any type of internal menstrual product will not be comfortable during the postpartum period. Even after the episiotomy or tear is no longer sore on the outside it may be uncomfortable to put something like that inside. If you do not have an episiotomy or tearing following a vaginal birth, or if you delivered by Caesarian birth, and if you normally prefer tampons, most sources have indicated that it is okay to use them after the first 3-4 days. (Ask your doctor or birth attendant about this matter, to be sure.) Menstrual sponges are not as sanitary as tampons and would be more likely to introduce infection, therefore should not be used during the postpartum period.
4. If you are planning to breastfeed you need at least two nursing bras. These are sold in some specialty shops and in lingerie departments of most major department stores. Nursing bras have a snap or clasp that opens the cup so that the baby can nurse while the bra stays on. If you are planning to bottle feed, your milk may come in anyway and you may be uncomfortable for a few days, so you should have a couple of good regular bras on hand. During breastfeeding you will probably need a nursing bra that is somewhat larger than your pre-pregnancy bra size. Since the breasts tend to enlarge during pregnancy, many women buy nursing bras during this time and wear them during pregnancy. Even if you don’t normally wear a bra, it is advisable to wear one during the first few weeks after giving birth, as this will help prevent leaking and engorgement.
5. Ointments for nipple preparation before birth and nipple soreness during breastfeeding: Plain lanolin, either anhydrous (without water) or hydrous (with water) is most commonly advised, as it can be left on while the baby nurses, and is inexpensive. This can be purchased in most drug stores. (Lanolin should not be used if you are allergic to wool.)
Stores often sell, and some hospitals give out more expensive types of breast creams These are less advised as they contain perfumes and must be wiped off before the baby nurses. Some mothers have found vitamin E oil, A & D ointment, olive oil, coconut oil or similar preparations helpful.
6. If you are planning to breastfeed you may also wish to buy a box or two of nursing pads. Many new mothers experience leaking of milk during the first few weeks or longer, especially if this is the first baby. Nursing pads are specially designed pads made of cotton and paper which fit inside the bra and soak up excessive milk. (Stay away from the type with a plastic liner as they do not allow air circulation and can lead to nipple soreness.) Some women have also used cut up pieces of fresh sanitary pads, cut up pieces of disposable diapers, small washcloths, or folded up handkerchiefs for this purpose. (Washcloths or handkerchiefs can be washed and re-used, while commercial nursing pads are disposable and therefore more expensive.)
The following things are usually not helpful for breastfeeding and are not advised:
1. Manual breast pump: This looks like a tricycle horn. It has a small bulb on one end and a plastic horn-shaped opening on the other. It supposedly works by depressing the bulb, putting the opening over one’s nipple, letting go of the bulb and creating a vacuum which will draw out the milk. In practice many women find that it simply does not work even though they have plenty of milk. Also its application can cause soreness. If you wish to hand express your milk to save it or get out excess milk, most women have more success with simply “hand-expressing” which consists of gently squeezing the breast so that one or more streams of milk comes out. If it is necessary to express milk over a long period of time (for example if the baby must be hospitalized and you wish to resume nursing) many hospitals and La Leche League groups provide electric breast pumps, sometimes for a deposit or small rental fee, for this purpose. There are also effective electric breast pumps which can be purchased for personal use.
2. Nipple shields: There is one type of plastic nipple shield that is designed to correct flat or inverted nipples which can be greatly helpful if worn during pregnancy. There is another type of nipple shield that is not often used any more that is a plastic shield with a conventional bottle nipple attached to it. The purpose of this type of shield is supposedly to alleviate nipple soreness by placing it over the breast and nursing the baby through the artificial nipple. However, it has been found that this device does not truly eliminate nipple soreness, as once you quit using the shield the nipple sorceress still remains and must be dealt with. There are many, much more helpful methods of treating nipple soreness. In addition, some women have had the unfortunate experience of nursing the baby with this device and then finding that the baby would only take that type of nipple and would not take the breast for subsequent feedings. Some women who have desired to breastfeed have ended up bottle feeding instead because of this device.
c. 1981 (Revised – 2012)