THE first six weeks after giving birth can be a period of significant adjustment for new mums, both mentally and physically.
Between aches and pains, hormonal changes and sleepless nights, it can be an intense time that brings with it a variety of new symptoms and questions.
Midwives often refer to this phase as the ‘postpartum period’, and no matter how easy or complicated your baby’s birth was, your body needs time to recover.
Here are six of the most common postpartum health issues and changes that can occur, and how to manage them...
1. Urinary incontinence
During the first three months after labour, around one in three women will experience postpartum incontinence says Pradnya Pisal, consultant gynaecologist and obstetrician at London Gynaecology (london-gynaecology.com).
Pisal explains: “This usually improves to some extent within the year after delivery, but there are a few things you can do to help the recovery process.
“Remaining active throughout pregnancy and avoiding excess weight gain is a good thing in the antenatal period, as this will put less pressure on the pelvic floor.”
Pisal says practising pelvic floor exercises as soon as you can after giving birth is really important, as these will strengthen the muscles under the uterus and bladder and can often make a huge difference.
“Learning to do the exercises is very easy and you can do them practically anywhere,” adds Pisal, who recommends downloading the Squeezy app (squeezyapp.com), which guides you through the whole process.
Also known as ‘piles’, haemorrhoids can be common during and after pregnancy, and may cause pain and discomfort if left unchecked, possibly accompanied by blood during bowel movements.
Dr Sadia Bhatti, consultant obstetrician at The Harley Street Centre For Women (hscfw.co.uk), explains: “Piles are swollen veins inside your rectum or the skin around your anus. They usually occur due to increased pressure on the lower part of the rectum and they can develop during or after pregnancy.”
Haemorrhoids usually go away on their own eventually, depending on their size, which according to Bhatti may take any time between a few days to several weeks.
“If you suffer from bleeding from haemorrhoids, you should seek treatment and speak to your GP.
"You can start with over-the-counter haemorrhoid cream, which contains a local anaesthetic, to help sooth the swelling and itching that comes with it.
“Try to avoid constipation and straining, as this can make the problem worse, and it’s a good idea to stay hydrated with water and eat a high-fibre diet, as hard stools will cause haemorrhoids to bleed,” Bhatti adds.
Swelling — usually in the legs and feet — occurs mostly during the course of the pregnancy.
“It doesn’t happen immediately after the birth, so the swelling experienced postpartum is more of a continuation of what’s been happening during the pregnancy leading up to the birth,” says Bhatti.
During pregnancy, the body retains water to support the baby. This will usually start to subside about a week after birth — Bhatti says women will notice they are passing urine more frequently in the first few days.
“Often, you don’t need to do anything about the swelling as you should see improvement by a week,” she assures.
“However, if you’re not seeing improvement after a few days, use compression stockings to reduce the swelling (you can pick these up from a local pharmacy).
“It’s also good to elevate the legs during the night-time, so place a couple of pillows under the feet while you’re sleeping.”
Vaginal discharge experienced after birth is called ‘lochia’ and it can linger for up to four to six weeks. “Initially, lochia is like menstrual blood, as it’s made up of the inner lining of the womb and mucous membranes being shed,” notes Bhatti.
“It will be red and heavy for up to a week — a bit like the first day of your cycle — and then it will become more of a brown discharge by week three.
“Passing clots is completely normal, especially when you breastfeed, due to the changing hormones and the contracting of the uterus after a breast-feeding episode,” she assures.
The most comfortable solution is to wear thick sanitary pads in the first few weeks after birth, and then decrease them in size when it feels appropriate. Changing the pads as soon as they get wet is advised, as the perineum area needs to stay dry to avoid a risk of infection.
Finally, foul-smelling discharge is not normal and can be a sign of an infection, so Bhatti suggests contacting your GP or midwife if this occurs.
5. Nipple pain
Nipple pain is common niggle for women who are breastfeeding, but if you feel that the pain is excessive, it might be a sign of a fungal infection.
“If your baby isn’t latching on correctly, this can cause sore nipples and they may crack and bleed, but this should usually settle down once the baby learns to latch on correctly and feeding becomes more efficient,” says Bhatti.
Babies can also pass thrush to their mother whilst breastfeeding, so this can be another cause of discomfort in the area.
If the pain is too much then you might decide to use a breast pump to allow your nipples time to heal. Also, using a nipple shield when feeding can give some relief.
“Putting some freshly expressed breast milk onto cracked nipples may help them heal, as this offers antibacterial protection — plus, applying a lubricant like lanolin will also help,” says Bhatti.
“If the pain is continuous, I’d suggest seeking support from a breastfeeding counsellor or your local midwife or GP.”
6. Diastasis recti
Diastasis recti is the separation of your ‘six-pack’ muscles, which meet at the midline of your abdomen.
“It often happens during the course of your pregnancy, where your bump is being pushed against the abdominal wall,” explains Bhatti.
“Often it’s more likely to occur with bigger babies or multiple births, and it may depend on how athletic and fit you were before the pregnancy.”
New mums with diastasis recti will still notice their stomach protruding some months after giving birth.
So how can you treat it at home?
“Women that have had a vaginal delivery can start gentle exercising relatively soon after birth, but if you’ve had a C-section, it’s advised to wait six weeks (or until individually advised),” says Bhatti.
“Exercises working on your core muscles, such as Pilates, can help.
There are also support belts available that can help with diastasis recti, but it’s best to discuss with your obstetrician or midwife about suitability.”
If you’re concerned about diastasis recti, or any other post-partum symptoms, ask a GP or health visitor for help at any time.
They can advise you, and refer you to a specialist if necessary.