June 22, 2020
Physical Care in The Early Postnatal period
Congratulations on your pregnancy and your baby. Here is a guide to what you can expect of your body in the early postnatal period - both in hospital and in the first few weeks at home.
Following the birth, the hormones and the excitement of the new babe means that you are usually wide awake for the next day – and then you crash as the babe is starting to wake.
While in hospital, take every opportunity to learn from the experts around you and to rest or sleep in between. Have the idea that if baby is sleeping, you are too.
Take care of yourself
Lie down as much as possible to take the weight of your pelvic floor. You may feel that your privacy has completely eroded. There will be viewings of the pelvic floor to check that you are on track – i.e. not too much bleeding or bruising around the stitches.
Mamas who had a vaginal birth
If your perineum is feeling swollen and sore, use ice packs regularly. Remove them when they melt and replace them an hour or 2 later – don’t leave a wet (not frozen) icepack against your perineum. Pressure can relieve discomfort – try 2 maternity pads for extra thickness – you may want to wear some underpants with mild compression.
Mamas who had a caesarean
There will be a dressing over your wound, it is intended to stay in place for 2 weeks at least. But it will need to be changed if there is bleeding showing through on the surface of the pad. Pressure is usually more useful for pain relief than ice following a caesarean. Put on some compressive underwear.
Getting in and out of bed
Roll on to your side to get out of bed. Drop your feet over the side of the bed and use your arms to push your body up. You may want to hold your pelvic floor or abdomen for the first few days with one hand as you do this. If your baby is in bed with you, it is always easier to get up by yourself and then pick up baby once you are standing.
Moving up the bed if you had a caesarean
There is an easier way move up the bed. First, you bend your knees and then have your partner anchor your feet to the bed as you push away from them and up the bed.
Hold onto your low tummy or pelvic floor if you are tender when you cough. Huffing is easier than a cough on your tummy. Huffing is when you force a breath out of your open mouth.
You should try to pass urine (wee) within 3-4 hours of having the baby. If you are unable to wee let the staff know. Passing urine may sting after a vaginal birth for a day or so – the skin has been very stretched and can feel like a graze. Let the staff know if this does not settle. You can dilute the urine by pouring water over yourself at the same time as you are voiding (weeing).
Passing urine should be easy. Alert a nurse or your doctor if you are unable to wee at all or if you are having to force out the wee. Usually, you are passing urine quite often in the first few days while the body removes the extra fluid you carried during pregnancy.
It is common (but not normal) to have a complete loss of bladder contents when standing up in the first day or so. This is due to the nerves being stretched during the birth process. Let the nursing staff know that it has happened and if it persists.
Drink plenty of water. Aim to drink 2 - 2.5 litres each day initially. You will quickly be drinking more once your milk comes in – often up to 3 litres a day.
Don’t wipe your perineum after a wee – It hurts. Gently blot once and hold the paper against the perineum.
A catheter is a tube that is passed into the bladder via the urethra (urine tube) to drain urine from the bladder. It is used sometimes following an epidural or if you have had a larger perineal tear or instrumentation (forceps or suction). The nurses will empty the catheter bag before it is full. If you feel full in the bladder, the bag may need more frequent emptying or occasionally, there may be a kink in the tubing. Let the nurses know this. Aim to pass urine within 3 hours of having a catheter removed, and once again – let the staff know if you cannot wee.
The body often “shuts” the bowel down for a few days after the birth. This is a hormonal response. Your first bowel action maybe 3 days after the birth. Aim for a soft motion (poo). Drink plenty and eat lots of soft fibre: fruit, salad, vegetables. Pay extra attention to soft fibre if you developed haemorrhoids during pregnancy or the birth. Haemorrhoids may cause a very small amount of bright blood on the bowel action or the toilet paper. If you have not had a bowel action by the end of day 3, do something to ensure a soft action the next day. Do what works for you – extra prunes, dates, or take simple aperients.
Most hospital toilets have a picture of the “perfect position for a poo”. Sit tall. Lean forward. Place your hands or forearms on your thighs. If the toilet is tall or if you are shorter than 162cm, lift your heels so that your knees are higher than your hips (toilet rolls can be a good heel raiser). Have a big sigh to relax your abdomen and pelvic floor and use only a little effort to have your bowel action. It can be helpful to hold the front half of your pelvic floor when you have a poo – it takes less effort to have a poo then. If your bottom is very sore, it may be easier to wash your bottom rather than to wipe with paper. Let the staff know if the bowel action is very painful.
Abdominal separation, pelvic floor weakness and pelvic floor exercises
It is normal to have an abdominal separation. It often feels very big immediately after having the baby because of the low tone in the surrounding tummy muscles. The separation will reduce over time. Ask someone to show you how to assess this yourself – but check once a month or so – not more frequently or you will worry unnecessarily.
Draw the low belly in – think about your very recently pregnant uterus and lift it up and towards the spine. Do this when you get in and out of bed and when you sit up.
Your pelvic floor is much more your focus if you have had a vaginal birth. Really don’t worry too much about pelvic floor exercises in the first few days. Wait until you have had your first bowel action and then start. If you cannot feel your pelvic floor, ask someone to have a look while you contract your pelvic floor so that they can tell you if the muscles lift. Plan to do around 10 squeezes of low belly and pelvic floor during daytime breastfeeds.
Now after reading all of this, the most important things are:
Get adequate rest
Ask an expert if you are unsure if you have a bothersome issue or pain
Ask your partner and family for help – Please don’t do house work for at least 6 weeks if possible
Get help with older children for the first 6-12 weeks
ENJOY your baby and your move to being a mama.
Anny is a Pelvic and Women's Health Physiotherapist. She works with women during pregnancy and postnatally for any physical concerns: pelvic pain, post-birth recovery, pelvic floor rehabilitation and mastitis treatment.
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