The Fourth Trimester: What You Should Know about Life PostpartumDeborah Bohn
Know What to Expect
I was fully prepared to take care of an infant. I had faithfully read all the latest books, attended newborn care classes, and stocked the nursery with clippers, soaps, cotton balls, and ointments. When my baby came home, I knew how to give baths, trim tiny nails, and burp like a pro. But when I endured a six-week-long period, peed when I laughed, and found my hair falling out in clumps, I gazed in the mirror at the zit-covered, flabby ghost of my former self and wondered, “What on earth happened to me and when will the old me come back?”
Although the discharge notes from the hospital briefly outline postpartum care for mothers, and a few baby books toss in a quick chapter for new moms, most of the available literature focuses exclusively on the baby and assumes that once you’re not pregnant anymore, you’re back to your old self. Wrong! Wrong! Wrong! The first three months postpartum are a time of tremendous physical upheaval in a woman’s body, and every woman should know what to expect.
Lochia: When Will I Stop Bleeding?
The area in your womb where the placenta was attached to the wall of your uterus is chock full of blood vessels. Immediately following the birth of a baby, the uterus begins a process called involution where it shrinks to its normal size. This shrinking of the uterus and uterine blood vessels causes bloody discharge known as lochia. While lochia tends to be bright red for the first few days, it generally tapers off to a paler color over the course of two to six weeks. As with a normal menstrual period, the uterus also sloughs off its lining as part of the lochia, so seeing bits of tissue or small blood clots isn’t uncommon or cause for alarm. You should call your doctor if your bleeding is bright red for more than a few days or doesn’t seem to decrease over time, if you pass a clot bigger than a large grape, if your lochia has a foul smell (the odor should resemble menstrual blood), or if you feel dizzy or faint. These symptoms could indicate excessive bleeding or an infection. As always, when in doubt, check it out!
The Linea Nigra: When Will That Line On My Belly Disappear?
Ancient wisdom goes that fair-skinned women get stretch marks and darker-skinned women get the line. As a woman of Italian ancestry, my olive skin handled all that stretching with nary a mark, but five months after the birth of my last child, I still looked like someone drew a stripe down my abdomen with a brown magic marker. The dark line—linea nigra—is caused by the same pregnancy hormones that cause your nipples and labia to darken during gestation. It usually fades over time, but unfortunately doesn’t always disappear entirely. Consider it a badge of motherhood!
Stretch Marks: When Will They Go Away?
The good news is that unlike the linea nigra, it is possible to get rid of stretch marks. The bad news is that it takes a doctor, a surgical procedure, and a bit of money to do it. On the positive side, marks that initially appear red or purplish often fade to light silver of flesh tone and are barely noticeable. Don’t fall for creams or other products that claim they can erase stretch marks; only weight loss and time will help them fade.
And on the topic of stretching and bellies, don’t freak out when you first check on your tummy after delivery and find a wiggly, jiggly midsection. Your belly expanded quite a bit to accommodate your growing baby, but things will get better (and firmer) with time. Doing sit-ups and crunches in your recovery room is not necessary!
Postpartum Alopecia: Why Is My Hair Falling Out?
The answer to almost any pregnancy question is usually the same … hormones. Those pesky chemicals are responsible for your hair falling out too. Normally about three-fourths of your hair is in the growth phase and one quarter is in resting or shedding phase. When you become pregnant, a larger percentage of hair enters the growth phase—so many women enjoy nine months of thick, lustrous hair. Once the baby’s born, your hormones shift into reverse and send higher than normal numbers of hair into the shedding phase, leaving some people with sparse, stringy hair and bald spots. Not all women suffer from this new-mom malady, and some only lose a few extra strands while others clog the shower drain. Postpartum hair loss generally occurs around three months after delivery and can last until six months. By the time your baby celebrates his first birthday your hair should be back to its former glory.
Sleep Deprivation: Why Can’t I Think Straight?
Sleep deprivation is a common form of torture used on prisoners of war. In fact, humans can only survive for about a week without any sleep. While new parents won’t keel over from frequently interrupted slumber, they will certainly suffer from the physical effects of sleep loss which include confusion, irritability, lack of concentration, reduced decision-making skills, and loss of emotional control. Lack of sleep also impairs your immune system, making you more susceptible to illness and often leads to an increased appetite and weight gain. Does any of this sound familiar? The only solution is to get more sleep any way you can: hire sitters, go to bed earlier, sleep when the baby sleeps and let the housework wait another day … or two … or more.
Skin Changes: Why Do I Have Pimples?
If you’ve heard it once, you’ve heard it a thousand times … hormones! Those same hormones that wreaked havoc with your skin in high school are back with a vengeance. Add in lack of sleep (necessary for skin cells to replenish themselves), zero time for facials, moisturizing or showering for that matter, and you’ve got a recipe for zits. The good news is that your hormones will settle down in a few weeks (although breastfeeding moms may experience more break-outs when they wean), and the older your munchkin gets, the more time you’ll have to take care of yourself. For now, take solace in the fact that absolutely nobody is looking at you while you’re holding that adorable baby in your arms!
Engorgement: How Do I Get My Breasts to Calm Down?
Although most breastfeeding moms know that their breasts will swell considerably when their milk comes in, few are prepared for the actual feeling of engorgement or what to do when it really hurts. Your breasts usually feel fine for the first few days when they are only producing colostrum. But around the third day after delivery, they suddenly fill with milk and fluid, often becoming tight, hard, and enormous. The quickest way to get relief is to nurse the baby frequently and for as long as she wants to eat. Since some babies are slow to get the hang of nursing and others are still sleeping off the trauma of delivery, a breast pump can be a lifesaver. Pump just enough milk to feel normal again, because if you pump too much and too frequently, your body will continue to create excess milk to meet the pump’s “demand” and you’ll defeat the purpose.
Soft Breasts: Where Did All My Milk Go?
While most women are forewarned about engorgement, few are tipped off to the fact that their breasts will suddenly deflate at six weeks postpartum. It takes about that long for your body to figure out your infant’s nursing needs and adjust to making milk at the appropriate times. With milk coming in at regular intervals, moms don’t have that bursting-your-buttons feeling anymore, leading some to erroneously believe that they’re not making enough milk. Couple the feeling of soft breasts with the fact that most babies have a big growth spurt at six weeks and seem constantly hungry, and you’ve got legions of nursing mothers running for the formula to take up the imaginary slack. The answer here is to trust your body—your baby is hungrier because he’s growing, so just feed him when he asks and your breasts will make more milk to meet the demand.
Stress Incontinence: Why Am I Dribbling?
It’s pretty simple; your hips, pelvis, and bladder were stretched, shoved, and rearranged to make room for that baby, and it will take some time for them to settle back into their rightful positions. While they slowly migrate back into place you may find yourself tinkling a little bit whenever you cough, sneeze, or laugh. Kegel exercises are your best bet for firming up the muscles that control your bladder, but it can take six to twelve weeks to see results from Kegels. Until then, just wear a panty liner or other absorbent protection and things should dry up somewhere between a few weeks to a couple of months down the line.
Sweating: Why Am I Soaking the Sheets Each Night?
Sweating is one of your body’s methods of getting rid of excess pregnancy fluid. While most moms experience night sweats, it is also common for lactating mothers to sweat between their breasts at any time. This is because breasts are basically modified sweat glands, so when a nursing woman’s breasts are working overtime to create milk, the sweat glands around them work hard too. There’s no way to stop the sweating, so just wear cool, absorbent clothes to bed and stuff a cloth diaper (which happens to make a handy burp cloth!) between your breasts. The dampness should subside by the end of the first month.
Surviving: Hang In There!
The bottom line is that in about three months the quirkiest postpartum effects will have passed, and by six months you should feel like a close representation of your old self. Until then, behave as though you were still pregnant; take care of yourself, eat nutritious foods, dress comfortably, and get as much sleep as you possibly can. Take heart in the fact that you’re in the homestretch and already holding the best prize of all.