Your Postpartum BodyLeigh Balber
Blame it on hormones. Blame it on wishful thinking. But many pregnant women suffer major delusions of grandeur when they imagine what they’ll look and feel like walking out of the hospital, toting their newborns. Time for a reality check: You won’t be wearing your pre-pregnancy jeans and strappy stilettos. A woman who has just delivered a baby may still look about five months pregnant despite the fact that she’s carrying her newborn in her arms, instead of in her womb.
While you may be elated that you’ve got this adorable, 7-pound little bundle to take home and that your pregnancy is finally over, the temporary aches and pains of new motherhood are just beginning. You’re sore from the delivery, your breasts are starting to swell, your uterus is cramping, and you may be experiencing some of the other “joys” of new motherhood—mainly constipation, incontinence, hemorrhoids, and hair loss.
Here’s a little more detail for the uninitiated. And just remember: it doesn’t last forever!
So just how much lighter will you be leaving the hospital? “It varies from patient to patient,” says Dr. Bruce Shephard, a clinical associate professor of Obstetrics and Gynecology at the University of South Florida, College of Medicine and an OB-GYN in private practice in Tampa. He continues, “But as a general rule, less than you expect, less than you would like.” You shed about 10 to 15 pounds while giving birth. Whatever came out of your uterus during delivery—the baby, the placenta, and the amniotic fluid—is what constitutes your initial weight loss. However, the fluids put into your body during labor (like IV fluids) may damper that effect at first. Don’t be discouraged.
Dr. Shephard says that by six weeks postpartum, about two-thirds of your total pregnancy weight gain will probably be gone. “More than 90 percent [of patients] are not back to their pre-pregnancy weight by six weeks,” observes Dr. Shephard. Many women seem to follow the “nine months up, nine months down” weight mantra that so many OB-GYNs are fond of reciting.
Your uterus has just endured a strenuous workout and it bulked up quite a bit so that it could handle the job of carrying and delivering a baby. Immediately following delivery, the uterus is about the size of a football, and patients can feel it just below the bellybutton. But then it starts to shrink. By six weeks postpartum, it’s back to normal, about the size of a pear. “Normally it sits behind the pubic hairline and you can’t feel it,” explains Dr. Iffath Hoskins, executive director of the Women’s Health Institute at Memorial Health University Medical Center in Savannah, Georgia.
You may experience “afterpains,” sharp abdominal pains or cramps, as the uterus contracts back into the pelvis, especially while breastfeeding. That’s because the hormone oxytocin is released during breastfeeding and triggers contractions. Hoskins says these cramps generally last three to five days, with residual effects continuing for a week or more. Many women claim afterpains are a lot stronger after the second baby. Hoskins jokes, “I guess the uterus is ticked off. It remembers from the last time.”
Your uterus also does its version of a little spring cleaning after the pregnancy. You’ll get a discharge of “lochia” consisting of blood, mucus, and tissue. Arm yourself with plenty of maxi pads because things can get quite messy. The discharge starts immediately after the birth and lasts two to six weeks. For some women, it continues for a few months. The color will change from bright red, to a dark reddish brown and then taper off to a yellowish white.
During the last part of pregnancy, and for a day or two after the baby is born, the breasts produce colostrum, a pre-milk substance loaded with protein and nutrients that give the baby’s immune system a boost. It takes two to three days for the actual milk to come in. As that happens, the breasts will become engorged, meaning they’ll be swollen, hard, and potentially painful. If you’re breastfeeding, you’ll carry as many as three to 5 pounds of extra weight in your breasts.
You can’t sit down. You can’t stand up. You’re so sore you can’t find any position that’s comfortable. Welcome to motherhood!
The perineum, the area between the vagina and the rectum, takes quite a battering during vaginal delivery. If you’ve had an episiotomy or perineal tear, you’ll probably be sore for three to seven days, although some women experience discomfort for weeks. The incision itself can take up to 10 days to heal.
So how can you make yourself more comfortable after delivery? Ice packs are typically used in the first 24 hours postpartum. Not only does ice provide pain relief but it also helps constrict blood vessels and minimize bleeding. Some doctors even suggest women stick with the ice a little longer. Patients eventually switch to heat, in the form of hot compresses or a sitz bath—a special bucket-like contraption producing a continuous flow of running water that you place over the toilet. “That is usually advantageous because that dilates blood vessels and helps to increase blood flow and healing in the perineal area,” explains Dr. James Martin, director of Maternal-Fetal Medicine and Obstetric Services at Winfred L. Wiser Hospital for Women and Infants in Jackson, Mississippi.
A Cesarean section is major abdominal surgery, so the recovery period is often longer than for someone who delivered vaginally. After the anesthesia wears off, the area around the incision site may feel quite sore. Pain relief medications in the first few days can help alleviate the discomfort. Some women may find they need to take over-the-counter pain relievers for a few weeks afterwards; it all depends on your individual pain threshold.
Dr. Gila Leiter, an OB-GYN in New York City, says it takes about two weeks for the incision to close and heal on a superficial level, and six to eight weeks for the area to heal on a cellular level. While she gives her C-section patients the green light to exercise at six weeks postpartum, “I always ask [them] to wait an extra few weeks to do sit-ups because the muscles have to heal as well,” says Leiter.
Cesarean patients are often plagued by intense gas pains for the first few days, as the digestive system starts to get back on track.
You can blame your mother for these! Doctors say there’s a hereditary component, meaning if your mother has stretch marks, you’re likely to get them. At least half of all women get stretch marks on their abdomen, breasts and/or hips. As the name suggests, they’re caused by a stretching of the connective tissue. “All of the fancy creams are not going to penetrate deep enough. Nothing’s really been shown to be effective in preventing them,” says Dr. Carolyn Cline, who works with Brigham and Women’s/Faulkner Hospitals OB/GYN Associates, PC. She adds, “If you’re going to get them, you’re going to get them.” They gradually fade to a silvery color after appearing red or purple during pregnancy.
During pregnancy, and especially through the homestretch, you store up quite a bit of fluid. Are your feet so swollen that your shoes don’t fit anymore? And what about your wedding rings? Postpartum perspiration is one way to get rid of this excess fluid. In addition, you can blame hormones for the reason you’re waking up drenched in sweat. “There’s also some hormonal changes,” notes Dr. Cline. She explains, “Your estrogen levels are lower, particularly immediately postpartum, which can cause you to sweat and have hot flashes.” What a great warm-up for menopause!
Immediately following delivery, many women find they have trouble controlling the flow of their urine. Dr. Hoskins explains that the muscles and nerves surrounding the bladder and urethra take a beating during delivery. “So in the recovery period, they’re not quite as adept,” she says. Hoskins suggests doing Kegels to restore tone to the muscles.
These are likely to emerge during the last few months of pregnancy, and pushing during delivery can exacerbate the situation. Those suffering from hemorrhoids can find relief in the form of sitz baths, topical medications, and pads. Unfortunately, hemorrhoids can be pretty difficult to get rid of. “I usually tease my patients and say, ‘First to come, last to go,'” says Dr. Hoskins. “The hemorrhoids come during the third trimester of pregnancy and then they’re still sort of hanging around by the fourth or fifth week [postpartum].”
Passing the first bowel movement after giving birth is sometimes more painful than the birth itself! Fear of popping a stitch from the episiotomy (or a C-section) and further aggravating matters “downtown” can be quite a deterrent from taking care of your bathroom business. Prenatal vitamins, narcotics for pain, and a recent lack of food can all contribute to constipation. A word to the wise: Take the stool softeners they offer you in the hospital.
While pregnant, you may think your hair looks so healthy and shiny you can’t believe executives from Pantene haven’t asked you to star in their next commercial. That’s because the hormones of pregnancy change the cycle of your hair. Instead of each hair being on its own individual cycle and falling out at different times, all of the hairs’ cycles come into sync. As the pregnancy hormones leave your body postpartum, your hair can start falling out in clumps and may do so for three to six months. But don’t despair. It’ll grow back!