POSTPARTUM CHANGES IV

POSTPARTUM WARNING SIGNS

As time passes, be aware of the changes that are happening in your body. They are a good way to tell how you are healing. You will probably heal with few, if any, problems. But in order to take good care of yourself, you should be able to identify any changes that are not normal. Contact your health care provider if any of the following symptoms appear:

·         fever higher than 100.4°F (38°C)

·         sharp pains in your abdomen, breast, or chest

·         blurred vision or dizziness

·         headache that does not go away

·         severe pain or burning sensation in your legs (this pain could be a sign of phlebitis)

·         foul smell or an unexpected change in your lochia; you should not see bright-red bleeding or clots after the first postpartum week

·          localized swelling or tenderness in your breasts

·         burning or urgency when you urinate; being unable to urinate

·         crying spells or mood swings that feel out of control

·         thoughts of harming yourself or your baby

SLEEP AND REST

In the days and weeks after your delivery, you’ll be constantly reminded to rest. Why? Because resting helps you heal and gives you the energy you need to be a mother. You may have so much to do every day—feeding and caring for your baby, getting used to this new stage in your family life—that you may ignore your own needs. It’s no surprise that the most common complaint heard from new mothers is that they just can’t shake off that tired feeling. How much rest is enough? It depends on how much energy you have day by day. If you need more rest, try making time for sleep and relaxation by:

·         scheduling periods of rest along with your other activities; for example, try to nap  when your baby naps

·          avoiding noise and distractions, including many visitors and phone calls

·          if you are having trouble resting, thinking of ways you used to relax before or during your pregnancy—take a warm bath, ask someone for a back rub, listen to music, go for a walk

·         viewing feeding your baby as a time for you to enjoy each other’s company, and making feeding time a restful and calming time for yourself and the baby

POSTPARTUM CHANGES III: AFTER CAESAREAN BIRTH

If the delivery of your infant required a caesarean incision, or “c-section,” you’ll have some extra concerns to keep in mind while you heal. Remember, you’re healing from major abdominal surgery as well as from childbirth!

·         If you are asked to stay in bed, or if the effects of anaesthesia leave you too weak or nauseated to walk comfortably the first day, you can begin some simple leg exercises. Bend and stretch your knees, or press the back of your knees into the bed and then relax your legs in gentle rhythm. These exercises will help prevent blood clots from forming in your legs.

·          Your staples will probably be removed after four to six days. Your internal stitches will dissolve on their own.

·          Because the caesarean involved surgery to your abdomen, you may not be able to start eating solid foods right away. If you’re unsure, ask your health care provider.

·         Many new mothers have constipation and gas pains at first. Walking, light exercise, drinking plenty of water, and eating high-fibre vegetables, fruits, and grains will help. If constipation becomes a problem, contact your care provider.

·         As you heal, you will need to make sure your incision is healing normally. Contact your care provider if you have a fever or if the incision becomes red or swollen or oozes pus.

·         It will take four to six weeks to feel fully recovered from surgery. Allow yourself enough time to rest and to heal! Don’t expect to recover as quickly as you would if your baby were born vaginally.

·         Remember, if can’t stop feeling emotionally down or you have thoughts that are quite disturbing, do not keep it a secret. Talk to someone about it especially your healthcare provider

POSTPARTUM CHANGES II: MAKING YOURSELF COMFORTABLE AND PREVENTING INFECTION

The perineum is the area between the vagina and rectum. This area may be swollen and painful after stretching to allow your baby to be born. Your doctor or midwife may have made a surgical incision, called an episiotomy, to enlarge the vaginal opening. This area may also be painful. During the time that the lining of the uterus and the episiotomy are healing, you will want to be extra-careful to prevent infection. It is important to keep your perineum very clean. Each time you use the bathroom or change your pad, be sure to remove the pad from front to back and clean the area from front to back (from your vagina to your rectum). After going to the bathroom, you can squirt yourself off with warm water, using a squirt bottle, and then pat yourself dry with clean tissue. You may feel discomfort or pain in this area for two or three weeks. There are several different ways to relieve the soreness and keep down swelling:

·         Place an ice pack on the perineum continually for the first 24 hours to minimize swelling.

·        Have your nurse show you how to use a sitz bath. A sitz bath is a small tub you place on the toilet. It can be filled with warm or cool water, whichever is more comfortable. As you sit on the toilet, the water washes over your perineum, relieving pain and speeding healing. Many women find this bath very relaxing and soothing. Women who are extremely uncomfortable may find it soothing to use cold water and add ice to the tub. When you are at home you can clean your bathtub well and sit in there if your perineum is still uncomfortable. If your doctor or midwife placed stitches, they will dissolve over time. Be sure that the water you sit in is not extremely hot, since this could dissolve the stitches prematurely.

·         If your health care provider suggests a spray or ointment for your perineum to relieve pain, read the instructions on the container. Most can be used three or four times a day. There are also small pads containing witch hazel that can be placed on the sanitary napkin and placed against your perineum to relieve pain. Talk to your health care provider about these options if not suggested.

·          Your doctor or midwife may also prescribe an analgesic for the pain.

Lochia

Your body will begin to expel the blood and mucus built up in your uterus. This flow is called lochia, and it will last about four to six weeks. For the first three days, your lochia is dark-red and made up of blood and some small clots. From the third to the tenth days, the fluid is pink or light-brown. Finally, the discharge will turn to a yellowish-white mucus and lasts for another two to eight weeks. Lochia should have a clean smell, like fresh blood or mucus. The amount of lochia may increase slightly when you first get out of bed in the morning, when you breastfeed, or when you stand up after lying down for a period of time. Contact your health care provider if:

·         your flow suddenly becomes heavier than it has been,

·          if it is bright-red beyond the first three or four days,

·          or if you notice large clots or a foul odor at any time.

 If your lochia suddenly becomes bright-red or contains clots after it has turned paler, this should also be reported to your health care provider.

Uterus

Your uterus will gradually shrink over the next six weeks, though it will probably never be as small as before your pregnancy (Mums, please believe me on this one!!).

For the first week or two, you can make sure your uterus is shrinking normally by gently pressing down and feeling it through your belly. PLEASE DO NOT PRESS HOT WATER AGAINST YOU TUMMY, IT IS AN ARK AGED TECHNIQUE THAT HAS BEEN PROVEN UNSAFE!!Have your nurse or doctor show you how to do this correctly. Your uterus should feel firm and round. The top of your uterus is normally just below your bellybutton on the first day or two after birth. It should descend one or two finger-widths every 24 hours. After the second week, you should no longer be able to feel your uterus, since it has grown much smaller. You can also wear a post pregnancy girdle to help with the uterus shrinking. Its also a great idea to have that girdle on while you excersice!!

POSTPARTUM CHANGES: TAKING CARE OF YOURSELF

The moment you’ve waited and planned for—your child’s birth—has arrived. The first days and weeks with your newborn will be a very busy time. One of your greatest challenges will probably be to find time to take care of yourself. Fortunately, there’s much you can do to help yourself to heal and to adjust more easily to the changes in your life.

During the first few hours or even days after giving birth, you can expect to feel both very excited and very tired. You may feel very happy or you may feel sad immediately after birth; you may want to gather friends and relatives around you to celebrate the birth, or you may want private time to start breastfeeding as soon as your baby is ready. It can be helpful to talk about how the labour and birth went with your nurse or doctor. Just don’t forget that both you and your baby need and deserve a good, long rest after the exercise of childbirth!

The period during which your uterus repairs itself and returns to normal size and during which most of your physical recovery takes place—the first three months or so after childbirth—is called postpartum(don’t be confused-the word postpartum has many definitions; this is just one of the many). Understanding the changes that affect your body during this time will help you know that you are recovering well.

Let’s take a look at a few body changes you may encounter.

	THE FIRST HOURS AFTER BIRTH	THE FIRST WEEK AFTER BIRTH	THE SECOND WEEK AFTER BIRTH	THE THIRD WEEK TO THE THIRD MONTH AFTER BIRTH
Lochia	The placenta separates from the uterus and is pushed out over the first 30 minutes after birth. If you breastfeed immediately after birth, that separation will often happen more quickly.	You will experience a vaginal discharge called lochia over the next few weeks, as your uterus heals. For the first one to three days after giving birth, your lochial flow will look much like your period. It should be dark-red or brownish. It may contain clots that should not be larger than quarters, and it should smell like blood. From days 3 to 10, this flow turns pink.	Lochial flow at this time is made up of a small amount of blood, mucus, and white blood cells. The colour is pink or brown-tinged. It usually continues until about day 10. Call your caregiver if you notice a fishy odour, or if you notice a bright red colour or clots after your lochia has turned pink. After day 10, your flow should become white or pale yellow.	White or pale yellow lochial flow lasts from two to eight weeks. It should not contain any blood or clots and should not have an odour. If you are breastfeeding, your period will usually start again one to three months after weaning. If you are not breastfeeding, your period can return anywhere from one to four months after the birth.
Uterus	Your uterus stretched to hold your infant and now needs to shrink back into a tight ball of muscle. Your nurse or doctor may gently massage the area over your uterus to feel for this tightness. Right after birth, you will be able to feel the top of your uterus just below your bellybutton.	Your uterus shrinks a little every day. By the end of the first week, you should be able to tell that it has grown smaller. Your nurse or doctor may want to teach you how to locate your uterus and feel for firmness to make sure it shrinks about one finger-width a day. Some women will notice “afterbirth pains” that feel like menstrual cramps. These cramps are the result of the muscle of the uterus contracting back to its pre-pregnant size. These pains are usually felt more strongly by women when they start to breastfeed or by those who have given birth to other children.	By the end of the second week, you should no longer be able to feel the top of your uterus through your belly. The “afterbirth pains” you may have felt should be over.	Your uterus should return close to its pre-pregnant size by the sixth week.
Perineum	The area between your vagina and rectum is called the perineum. After giving birth, this area is often swollen and may have torn. Your health care provider may have made a surgical incision here called an episiotomy.	Your perineum will probably still be swollen, and it may be uncomfortable for the first week.	Swelling should be mostly gone by the end of the second week. If you had an episiotomy, the area may still be uncomfortable.	If you have an episiotomy wound, it should heal by the end of the third week.

The Feeble Wall

I witnessed a death earlier today. It was a woman. A mother in her forties or maybe early fifties, she wasn’t sick or in any other state, she had started the day with no inclination that something fatal was coming her way. She was just a victim of an overlooked circumstance.

How did she die? There is no nice way to put it. She was stoned to death. Literarily! A fence which had been weak finally gave way and unfortunately she was the unsuspecting victim behind it.

As I watched people amidst the wailing and chaos try to pull her blood bathed lifeless body out from the heap of concrete over her, I couldn’t help but harbour thoughts of accusation.

Everyone knew the fence was weak. It had been that way for years and the owner never bothered to fix it. Nobody knew when it would fall or in what direction, so everyone was careful (not all the time) around it, but nobody did anything about it! We all knew it would fall one day, but no one suspected the fall would happen this way. No one thought carelessness towards the feeble wall would cost a life.

But it was just a wall! A wall which was already weak by the way. How bad could the impact have been?

The wall was weak but only at the bottom. The blocks at the top were strong enough to knock someone out cold. To support the stronger more visible parts of the wall, the weak bottom needed repairs or at least a support structure.

It’s the same as our bodies. We may look and seem healthy in our top priority parts- brain, kidneys, stomach and all, but what about our emotional health. Most times we overlook the state of our psychological health that holds the rest of the body firmly up.

The mental health of anyone particularly the new mum is important too, you know. But just like the weak base of the wall it can be overlooked and ignored until ‘that someday’ all other vital parts come crashing down.

Postpartum depression is not a situation to be overlooked, it’s a health crisis!
To which category do you belong?

1. “It’s just the baby blues, I’ll get over it. Nobody wants to hear me cry about being unable to sleep. They’ll think I’m crazy to say I don’t feel like touching my baby. I’ll just pretend it’s not happening and maybe it’ll all go away”.

Are you that mother waving off the severity of your emotional health?

2. “Get yourself together woman! You are being silly and that’s the least of my concerns right now.”

Are you that spouse or relative who has no time for mama drama?

3. “She’s like a time bomb right now, just be careful what you say around her and try not to get into her business. We have enough problems of our own”

Or are you that friend tiptoeing around the walls of her emotions, unwilling to lend a shoulder?

Whatever your category, a wall is about to fall and there’s not only an undeserving baby behind it, you are behind it too!

Like the base of that wall, a woman who is suffering psychologically (from a perinatal mood disorder) needs to have a support structure around her and such a support structure is really not that hard to find.

If you are an expecting or new mum (you fall in this class even if your third baby just turned two!!!!), or if you are family or a close friend, you can be instrumental in getting help or becoming the support needed.

How do you know a mum needs help ASAP? Check for symptoms such as:
• Loss of interest or pleasure in life
• Loss of energy and motivation to do things
• Sleeping too much or too little
• Feeling like life isn’t worth living
• Irritability, anxiety, or restlessness
• Feeling worthless and guilty
• Withdrawal from friends and family
• Eating too much or too little
• Having trouble remembering, focusing, or making decisions
• Crying a lot
• Having thoughts of hurting self
• Thinking about hurting the baby

If you've noticed any of these symptoms present it shouldn’t be overlooked, find a health care provider to talk to before it gets out of hand. Like they say- A stitch in time saves nine. You could be that stitch that saves lives!!

Playing God On No Sleep

So a woman walks into a pediatrician’s office. She’s tired, she’s hot and she’s been up all night throwing sheets into the washer because the smaller of her two boys has projectile vomiting so severe it looks like a special effect from “The Exorcist.” Oh, and she’s nauseated, too, because since she already has two kids under the age of 5 it made perfect sense to have another, and she’s four months pregnant. In the doctor’s waiting room, which sounds like a cross between an orchestra tuning loudly and a 747 taking off, there is a cross-stitched sampler on the wall. It says GOD COULD NOT BE EVERYWHERE SO HE MADE MOTHERS.
THIS IS NOT A JOKE, and that is not the punch line. Or maybe it is. The woman was me, the sampler real, and the sentiments it evoked were unforgettable: incredulity, disgust and that out-of-body feeling that is the corollary of sleep deprivation and adrenaline rush, with a soupcon of shoulder barf thrown in. I kept reliving this moment, and others like it, as I read with horrified fascination the story of Andrea Yates, a onetime nurse suffering from postpartum depression who apparently spent a recent morning drowning her five children in the bathtub. There is a part of my mind that imagines the baby, her starfish hands pink beneath the water, or the biggest boy fighting back, all wiry arms and legs, and then veers sharply away, aghast, appalled.

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There are two very different kinds of horror here. There is the unimaginable idea of the killings. And then there is the entirely imaginable idea of going quietly bonkers in the house with five kids under the age of 7.

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But there’s another part of my mind, the part that remembers the end of a day in which the milk spilled phone rang one cried another hit a fever rose the medicine gone the car sputtered another cried the cable out “Sesame Street” gone all cried stomach upset full diaper no more diapers Mommy I want water Mommy my throat hurts Mommy I don’t feel good. Every mother I’ve asked about the Yates case has the same reaction. She’s appalled; she’s aghast. And then she gets this look. And the look says that at some forbidden level she understands. The looks says that there are two very different kinds of horror here. There is the unimaginable idea of the killings. And then there is the entirely imaginable idea of going quietly bonkers in the house with five kids under the age of 7.
The insidious cult of motherhood is summed up by the psychic weight of the sampler on that doctor’s wall. We are meant to be all things to small people, surrounded by bromides and soppy verse and smiling strangers who talk about how lucky we are. And we are lucky. My children have been the making of me as a human being, which does not mean they have not sometimes been an overwhelming and mind-boggling responsibility. That last is the love that dare not speak its name, the love that is fraught with fear and fatigue and inevitable resentment. But between the women who cannot have children and sometimes stare at our double strollers grief-stricken, and the grandmothers who make raising eight or 10 sound like a snap and insist we micromanage and overanalyze, there is no leave to talk about the dark side of being a surrogate deity, omniscient and out of milk all at the same time.
The weight was not always so heavy. Once the responsibility was spread around extended families, even entire towns. The sociologist Jessie Bernard has this to say: “The way we institutionalize motherhood in our society-assigning sole responsibility for child care to the mother, cutting her off from the easy help of others in an isolated household, requiring round-the clock tender, loving care, and making such care her exclusive activity-is not only new and unique, but not even a good way for either women or-if we accept as a criterion the amount of maternal warmth shown-for children. It may, in fact, be the worst.”
It has gotten no better since those words were written 25 years ago. Worse, perhaps, with all the competing messages about what women should do and be and feel at this particular moment in time. Women not working outside their homes feel compelled to make their job inside it seem both weighty and joyful; women who work outside their homes for pay feel no freedom to be ambivalent because of the sub rosa sense that they are cutting parenting corners. All of us are caught up in a conspiracy in which we are both the conspirators and the victims of the plot. In the face of all this “M is for the million things she gave me” mythology it becomes difficult to admit that occasionally you lock yourself in the bathroom just to be alone.
The great motherhood friendships are the ones in which women can admit this quietly to one another, over cups of tea at a table sticky with spilt apple juice and littered with markers without tops. But most of the time we keep quiet and smile. So that when someone is depressed after having a baby, when everyone is telling her that it’s the happiest damn time of her life, there’s no space to admit what she’s really feeling. So that when someone does something as horrifying as what Andrea Yates did, there is no room for even a little bit of understanding. Yap yap yap, the world says. How could anyone do that to her children?
Well, yes. But. I’m imagining myself with five children under the age of 7, all alone after Dad goes off to work. And they’re bouncing off the walls in that way little boys do, except for the baby, who needs to be fed. And fed. And fed again. And changed. The milk gets spilled. The phone rings. Mommy, can I have juice? Mommy, can I have lunch? Mommy, can I go out back? Mommy, can I come in? And I add to all that depression, mental illness, whatever was happening in that house. I’m not making excuses for Andrea Yates. I love my children more than life itself.
But just because you love people doesn’t mean that taking care of them day in and day out isn’t often hard, and sometimes even horrible. If God made mothers because he couldn’t be everywhere, maybe he could have met us halfway and eradicated vomiting, and colic too, and the hideous sugarcoating of what we are and what we do that leads to false cheer, easy lies and maybe sometimes something much, much worse, almost unimaginable. But not quite.

Anna Quindlen
Newsweek
July 2 issue —
© 2001 Newsweek, Inc.

Is Massage Necessary????

Its is important for new mothers to enjoy the birth experience. Why then would antenatal class instructors instruct new mothers to abstain from getting relief from body aches during the crutial periods of pregnancy?

I recently discussed with a customer who told me that the midwife who facilitated her antenatal classes said it was wrong(I'd assume in a sinful way) to get massages for back pain. the nurse went further to say pain is what pregnancy is all about and women should endure it and resist the temptation to ease the pain. WHAT! I beg your pardon but that is just cruel! The period of pregnancy should be filled with memories of bonding and learning. Women should not be made to anticipate suffering and forced to detatch themselves from the experience because it goes a long way to affect the fetus psychologically. By the way how many of us were victims of such cruel beliefs?

Back pain is one of the more common side effects of pregnancy. Back pain can continue throughout pregnancy and even after. If you have to carry around other small children you may find your symptoms exacerbated during pregnancy. Massage specially designed for pregnancy help relieve back pain associated with muscular tension. Here are just a few of the other benefits prenatal massage has to offer:

* Prenatal massage helps relieve edema or swelling by stimulating circulation throughout the body.
* Leg massage can help reduce leg cramps and swelling in the legs.
* Massage is very beneficial for relaxing anxiety during pregnancy.
* Massage can help promote more restful sleep and help prevent pregnancy related insomnia.
* Pregnancy massage may relax your baby, particularly if you have your abdomen gently stroked.

It is vital however that women seek the assistance of a qualified professional who offers massage during pregnancy (Flora initiative for Mothers offer this service at affordable costs by the way). Massaging the wrong areas or focusing on certain acupressure points may actually trigger uterine contractions in some women. Fortunately massage therapists trained in prenatal massage know exactly what areas to avoid and what areas to focus on to provide pregnant women the most benefits during a massage therapy session.

So what on earth is that Midwife talking about? Please share your thoughts