Postpartum

We often forget that there are many areas of our bodies physically that need to heal after birth, not to mention the emotional and physiological changes of giving birth that we need to adjust to. It is really important that you prioritise yourself and your baby in the first few weeks following birth. During birth the perineum stretches to make room for the baby to be born. The perineum is the area of skin between the opening of the vagina and the anus. Leaning forwards while passing urine can also reduce the stinging as the urine is less likely to be in contact with the tender area. 

Perineum/Vulva care 

• you may not experience any tearing or grazing of the skin after birth but will still feel tender, swollen or bruised. Others may experience tears and some episiotomies. For most women, these heal very well after birth thanks to it being very vascular down there! There are lots of ways you can stay as comfortable as possible while helping your body heal 
• change your pads frequently after birth to keep the area as clean as you can (remember to not use tampons in the first 6 weeks after birth to reduce the risk of infection to your uterus) 
• use frozen pads. Soak with some water (you can add witch hazel too) & then freeze. These often make a bruised, swollen or tender perineum much more comfortable in the first few days following birth. Applying an ice pack for no more than 10 minutes at a time (and at least 4 hourly) to the perineum can ease discomfort and help reduce any inflammation. There are some herbal preparations such as hypericum cream may also help healing and provide comfort. Try to do pelvic floor exercises as often as you can, this helps to increase blood flow to the area and encourage healing 
• a witch hazel based perineal spray to aid healing. Try get a bottle than you can spray upside down too! 
• arnica drops can help the body in healing (to reduce bruising, and stimulate tissue repair) 
• warm baths can be relieving (you can also use a sitz bath or bath soak with herbs and essential oils) 
• use a squeezy bottle or peri bottle to pour warm water on your perineum when you pass urine; this most helpful if you have had an episiotomy or tear 
• ural sachets to reduce the acidity in your urine. Drink this straight after birth and continue a few times a day 
• donut cushion to sit on if you’re finding it difficult to be seated 

Caring for your perineal tear 

Tears that require stitches (which will usually dissolve in 1-2 weeks) can be quite sore and good hygiene is important in the days after birth. Showering at least once a day and using only water to carefully clean the perineal area is recommended – pat gently to dry the area with a clean towel. Sanitary pads need to be changed regularly. Drinking lots of water can help with avoiding constipation. A healthy diet with fibre – such as fruit and vegetables – is recommended. Regular pain relief can also help. 

Bowel Motions 

Thinking about passing the first bowel motion after birth can be stressful. It may be a few days after birth before this happens. 

• putting your feet on a footstool, or something similar, that raises your knees to above your hips can help 
• avoid straining and take your time 
• passing a bowel motion will not affect your stitches 
• take regular laxatives in the first few days and for as long as you feel you need them. Discuss this with your LMC 

Haemorrhoids

You may have haemorrhoids, which are swollen and inflamed veins in the rectum and anus that can be painful and cause bleeding. These should shrink over time but there are medications to help you that your LMC can prescribe. During a vaginal birth you put a lot of extra pressure on your rectum so it’s common to develop haemorrhoids postpartum. You also may have developed them during pregnancy.

Here are some tips that may help:

• it’s important to prevent constipation and avoid straining to pass a bowel motion as these can make haemorrhoids worse 
• keep poo soft by drinking plenty of fluids and eating a high-fibre diet. You can also take a laxative which your lmc can prescribe 
• apply a cold compress to the area and sit in a warm salt bath (sitz bath) 
• there are topical cream that your LMC can prescribe or you can buy over-the-counter at your local chemist

Your bladder and pelvic floor

It’s common to wet your pants a bit if you sneeze or cough after you’ve given birth vaginally. The pelvic floor muscles that support your bladder, uterus and bowel stretch 2.5 times their resting length during a vaginal birth, and more stretch is caused by a forceps birth, suction or pushing for a long time.

You can work on strengthening your pelvic floor muscles when you’re sitting on the couch, lying down, or standing at a desk and no one will ever know.

• squeeze and tighten your back passage (imagine you’re stopping a fart) 
• squeeze and tighten your vagina like you’re holding a tampon 
• squeeze and tighten your bladder as if you’re stopping the flow of wee 
• hold the squeeze for a few seconds – you might only be able to do it for a couple of seconds until your muscles get stronger again. Later, try to count to 10 
• relax and then repeat about five times 
• try to do this several times a day 
• keep breathing while you do these exercises. If you pull in your stomach or squeeze your bottom when you squeeze, you’ll be using the wrong muscles! 

Avoid doing pelvic floor exercises when you’re actually having a wee, as it might stop you from properly emptying your bladder. If you keep having problems, talk to your LMC or see a pelvic floor physiotherapist.

Afterpains

Your uterus starts contracting back to its pre-pregnancy size after your baby is born. It’s normal to feel period-type pains, or quite painful twinges or tummy cramps. This is especially common if it’s not your first baby. Breastfeeding also makes the uterus contract, so you may get tummy pain while you’re feeding. This is due to the release of oxytocin when your baby feeds. A full bladder makes the pain worse, so try to wee regularly, and make sure you wee before breastfeeding.