Life at home after birth – your first 6 weeks with the baby

Conduct of the puerperium!

The puerperium is basically the name given to 6-week period following childbirth – when all your organs return towards their pre pregnant states – well almost! It is a time of great change – towards motherhood and fatherhood. It is a time filled with surges of emotion, exhaustion, euphoria, as well as OMG – what have we done? The realisation of acquiring such huge responsibility and dependency will undoubtedly be overwhelming … you have done it – you have done an amazing job, you have a beautiful baby but you have to adapt, it is so jolly difficult and really doesn’t seem to stop – these initial weeks become a blur – but are really -relentlessly rewarding. Thinking – we are in love and so lucky but life is not so lovely just now – with feeling TATT (tired all the time), and having  SBN (sore bleeding nipples) – how on earth do normal people manage?

Until fairly recently – just before my time, a puerperal woman was treated as – ‘an ignorant, idle ill woman who required careful discipline, so that she would not damage herself’ and as Derek Llewellyn-Jones, in his 4th edition of the Fundamentals of obs and Gynae, describes, was kept in a maternity ward, expected to obey orders and fit into hospital routine with humility and without question. She was confined to her bed, as to get up would undoubtedly cause a prolapse and in consequence was unable to pass urine and became constipated – which confirmed the nurse’s opinion that she was a sick woman. On the 7th day following birth she would get out of bed for the first time, obviously weak and would be emotional – normal physiological reaction to the process of reproduction but again the emotional instability confirmed to the nurses, then, that she was in fact ill. For the convenience of the hospital her baby would be kept in a nursery and at regular intervals was produced in a production line manner for breast feeding.  Lewellyn states – ‘the patients perineum was painful, her emotions affected, her psyche dominated by an attitude that – nurse knows best’.

Things are hugely different today – a very new approach has been adopted by health professionals and the whole philosophy of the puerperium has changed. In essence this philosophy is that the puerperal woman is a healthy intelligent individual who has just achieved a memorable event; she has given birth to a live healthy individual; she is a person who needs to be treated with understanding, she needs to see and touch her baby and to co-operate in caring for it – with or without a partner.

Midwives and obstetricians encourage early bonding and skin to skin contact with parents as soon as possible following birth – even following a caesarean section – providing a good temperature can be maintained.  The first days of the puerperium need to be a time of rest and of education – for the responsibility of caring for the baby after discharge home and one of emotional enhancement and of a tremendous sense of achievement despite feeling completely engulfed with enveloping anguish.

Immediately following birth parents need to be able to spend time alone with their new baby – bonding together – this time frame is entitled the golden hour. After this sleep is so important…..

Following on within this piece, I aim to cover the main elements generally referred to within the puerperium period so that you can conduct it with a little bit of knowledge and make various adjustments along the way ….

Components of the puerperium  –

Care of the vulva – You will probably have a painful swollen perineum – even if you do not have stitches. Regular bathing/warm showers to keep clean. Do not use soaps/scented bath oils. Take regular analgesia – Panadol/ibuprofen. Sit so that area is protected/lie on side if able to reduce pressure. Stitches will dissolve after around 14 days, longer if you have sustanined a deep tear.  Encourage regular bowel opening – do not get constipated.   

Micturition – if is often to pass urine following birth for first 24 hours. Keep mobile and drink adequate fluids. You may have had a catheter during labour – making micturition uncomfortable. Showers/baths can assist.

Bowels – it is best not to get constipated following birth. Your bowels will have probably be opened during birth. It is important to take a normal diet with fibre. You may need a rectal suppository on the 3rd day following birth if bowels not opened. Do not get dehydrated. The first time you have your bowels open following birth can be painful and you may notice some slight bleeding.  Please note that some drugs used in labour affect your bowels.

After pains and lochia – the muscles of your uterus will continue to contract following birth and tend to be particularly painful in some multigravida women. At the end of the 3rd stage of labour the contracted uterus is around the size of a 20 week pregnancy and weighs about 1 kgm. By the end of the first week it goes down to 500 gms – involutes then slowly over the 6 weeks to its pre pregnant size.   When I had Poppy I had dreadful after pains – she was my 6th baby though and my poor old uterus needed to really contract to get itself back together. You will notice this more during and following feeding your baby. The discomfort should not be ignored and simple analgesia should be taken. Some women do need a stronger form – discuss with hosp/midwife. You will bleed red blood following birth which comes from the placental site. As the thrombosed veins become organised the character of your lochia changes, as it includes decidua from the placental site, it becomes dark brown colour,  then goes yellow, then pink. It usually subsides after 14 days. Lochia may may include clots – which feel weird when passed – these can be normal as produced following a period of inactivity when passing urine, if followed by fresh bleeding however you need to seek medical assistance – ASAP – may be a post-partum haemorrhage and you may need to have emergency treatment.

Breast feeding – this is fill discussed within our breast-feeding download. Your breasts will become very full and uncomfortable around day 3 when your milk supply comes in. Beware! Latching is so important. Years ago, women used to only put the baby to the breast for 3 mins each side for first feed – then they gradually increased this to 5 – we kept charts and often got in a right old pickle. This is not the case now. We feed on demand and watch for feeding cues …

Visitors – providing you feel satisfactory you can have visitors but generally and especially with Covid 19 the less disruption you have over the first few days/weeks the more of a routine you will create and the more settled your baby will become. Most hospital units have now reintroduced limited visiting within post-natal wards. You do not want to refuse visitors, but the puerperium is a good time for you and your partner to bond together with your new baby without too much disruption from others. Good to have them come to deliver food, treats, and offer to cleanse though – covid 19 allowing.

Third day blues – several women do become temporarily depressed between the 3rd and 5th day following birth. The cause of this depression has not fully been established. Most research speculates its aetiology includes hormonal imbalance, reaction to the excitement of childbirth and her uncertainty to be able to cope. Another factor in our culture may be the expectation that the mother immediately loves her baby, when motherlove is a learned behaviour. The condition called third day blues leads to out burst of crying, to irritability and in some cases depression. The management of this is to be aware of it and be able to speak openly to a trusted professional /friend about how you are feeling. Evidence indicates that is could be reduced if infant bonding has occurred but I believe that sleep deprivation makes this a whole lot worse….. things do feel better after a nap. However, in a small proportion of women severe depression may persist for the whole of the puerperium. If this is seeming to be the case, then you will need to seek medical advice from GP in a timely manner.

Adjustment to parenting and puerperal depression – not all gps understand that adjustment to parenthood is difficult for most women. Women have over the years believed that they will be good housekeepers, excellent lovers and good with babies. Most women now are in full time careers and brilliant within the business world as well. We really do know best. Sometimes however problems occur because of this…. We do feel pressured to do everything. It is so difficult becoming an experienced mother – we cannot do it all at the same time. On return home after childbirth – as Llewellyn suggests – the persistent demands of the newborn baby on the energy, the time and the emotions of a woman may cause considerable stress! This stress will be aggravated by the nuclear family and the way we all live miles away from each other – especially with Covid 19 and isolation. Stress levels can become intensified as sleep patterns change. Relationships together require adjusting, simple housecleaning tasks become difficult and women feel guilty that they cannot keep on top of things as they could do. There is help available if you feel that everything is too much – we need to reduce the incidence of puerperal depression.  In about 5 – 10% of women depression becomes severe and they need to seek medical treatment. The presenting symptoms include – tearfulness, psychosomatic anorexia, not being able to sleep, complaints of mood changes, nausea.

Sexuality – problems adjusting to parenthood and tenderness surrounding perinium area may reduce sexual desire and activity of many puerperal women. Other women have increased sexual desire. We used to always suggest waiting until your 6-week post-natal check-up before resuming sexual activities. Although it seems several of these appointments are done virtually now and not always discussed. I think most couples need to do what feels right for them both – although beware of contraception….

Exercise – most women will wait until 6 weeks to resume physical activities such as training or gym work. Personal trainers will want to do a hands-on abdominal test before starting you on a programme. By this time you should have stopped bleeding.

Today Covid 19 has unfortunately had a huge impact on the way heath care is provided – as you will have realised over your pregnancies. Most women following birth will currently only have 2-3 visits. These will generally be on your first day home, following birth then day 5 for the Guthrie and to weigh your baby, then around day 10 when you will be discharged form care of the midwife and handed over to the health visitor. The health visitor will be your point of contact withing the primary health care team.

I hope this has helped you understand a little about the puerperium period. You will all conduct yours differently but try to embrace and enjoy it – remember listening, good latching, interacting and sleeping are so important and that help is around but that you will sadly need to realise yourselves that you actually need it……  You will never be the same again – in a good way though – honestly.

Sally x

Sally Underwood

Founder of UB Academy