There is so much preparation for the pregnancy and delivery, I found that even I as an ob/gyn was unprepared for the physical, emotional, and social dynamic changes that happens in the postpartum period. It seems to be the big secret that nobody discusses until one is actually going through it. After carrying a fetus for 9 mo, our bodies need to return to its pre-pregnant state. For many of us, this takes much longer than expected.
The most obvious change is the involution of the uterus from holding a full term baby, to getting as small as the size of a fist. There is a lot of cramping that occurs, especially when breast feeding. Many patients report that the severity of the cramping mimics labor contractions. However, the cramping intensity does decrease, especially after the first couple of days. Generally, it can take about 6-8 weeks for the uterus to return to its normal size. If the pain becomes more intense or you have a fever, you should contact your physician.
Vaginal bleeding can last up to 8 weeks. It should decrease with time, but at times can go away for days, and then return, sometimes with clots. It is abnormal if one is having heavy bleeding with or without clots over several hours or if it persists beyond 6-8 weeks, and you should call your physician. After the initial weeks, many women will not get their periods until breastfeeding is discontinued, and some sooner, especially if not breastfeeding.
The most surprising thing for me was the amount of swelling I had of my feet and legs. During the delivery, especially with an epidural or spinal, a lot of fluids are given. In addition, there is the increase in blood volume from the pregnancy itself. It takes the kidneys about two weeks to catch up, and excrete the extra fluid. Swelling is abnormal if it is unilateral, associated with redness and pain. This can be a sign of a serious condition called deep venous thrombosis (DVT), and you should contact your physician immediately.
After a vaginal delivery, there can be swelling not only of the vaginal area, but also worsening or development of hemorrhoids. Ice packs, sitz baths, stool softeners, and time will relieve pain and speed healing. If sutures are needed, these will often dissolve on its own within 4-6 weeks. After a cesarean section, it is important to keep the incision clean and make sure it is dry after taking a bath or shower. Sometimes I will recommend that a patient uses a blow dryer on a cool or warm setting to aid in keeping the incision dry, especially if the skin folds over the incision. If there is redness, oozing of fluid, or increasing pain in the area, your physician should be contacted.
Breast engorgement a few days after delivery is not uncommon as there is a delayed let down of milk. For those who are breastfeeding, mastitis (breast infections) can occur, which is caused when bacteria from the babies mouth infects the breast through an opening in the skin. Signs of infection, include pain, redness, fever, body aches. Antibiotics may be needed, so it is important to contact your doctor. It is important to continue breastfeeding, even on the infected side to not allow for engorgement. The breast milk itself is not infected, and safe for the baby. For those not breastfeeding, the pain of engorgement can be helped by binding the breasts with a sports bra, ice packs, and in some cases antihistamines.
Although your doctor will often clear you for full activity after 6 weeks, it often will take longer to get to your pre-pregnancy state. Losing the weight gained during pregnancy can take up to 6 months to a year. Although breastfeeding can increase weight loss, it often makes us hungrier, so this alone is often not the solution, especially if there has been excessive weight gain. During breastfeeding, it is important to not decrease your calories too low, otherwise you risk a decrease in milk production. Darkening of the skin, such as the linea alba (dark line in the center of the abdomen) or melasma (sometimes called pregnancy mask) can take up to one year to lighten up. Although issues such as varicosities, stretching of the skin, and changes in the shape of your body improve. Pain after a c-section will decrease with time, but it may take 6 months to one year to completely resolve. Once you are cleared from your physician for normal activity, it is important to listen to your body. If you are doing an activity that causes pain such as exercise, back off for a week, and try it again and see how you feel. Everybody recovers at their own pace, and what occurred during your labor and delivery is a big part of that.
Most moms will agree that the physical changes that occur after a delivery are well worth the joys of motherhood, but support and knowledge are key to a smooth transition.