Postnatal care – after delivery

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Mother’s Health

The first few days after birth are consumed with the joy of being a mother. After the ‘blues’, typically around day 3 (feeling weepy because of the big drop in hormones), the job of motherhood gets underway in earnest. While all this is happening the body is rapidly returning to normal. Whether the delivery is by Caesarean or vaginal the vaginal bleeding should start to settle and reduce in the first week. Although it may last for 4 – 6 weeks, it should gradually reduce with time. If it increases in the first weeks you should return to your doctor for assessment. This is called a secondary post (= after) partum (= delivery) haemorrhage (= blood loss) and may indicate that there is some infection in the womb.

The womb itself reduces in size (involutes), returning to normal by about 6 weeks. The breasts will swell and engorge with milk, which starts to flow after about 3 days (Colostrum, the milky fluid in the breast before birth, is released in the first couple of days). There will be considerable weight loss in the first couple of weeks, but then the weight loss slows.

Wound healing and infection

Whether the wound is from a Caesarean or vaginal delivery, it tends to heal rapidly as the mother is young. If infection occurs (about 5%), it is usually the patient’s own bugs taking advantage of the healing skin. The body delays healing, so that it can deal with the infection. It is important therefore to control any infection sooner rather than later. This is often by local means (keeping the area clean, washing), but will sometimes require antibiotics. Bruising can also cause some extra pain. Arnica may help the body to absorb the bruise and quicken healing. Bladder infections are also common; you should contact your doctor if you have symptoms (wanting to go often, pain passing urine). Breast infection (mastitis) occurs when the bugs on mother’s skin get in through the nipple and infects the gland. Antibiotics are usually necessary to help with this problem.

Breast-feeding

There is abundant evidence that breast-feeding is beneficial for both the mother and baby. However in the developed world the differences between bottle-fed and breast fed babies is small, so mums who cannot breast-feed for whatever reason should be reassured that they are not endangering their baby in any way.

For the mother, breast-feeding helps with bonding to the baby, weight loss and in the long term they have a reduced risk of developing breast cancer. There is also the practical advantage of not having to sterilize bottles etc.

For the newborn baby, breast is best, containing the added value of mother’s antibodies, which help protect the baby from infection. Breast fed babies are less likely to be seen in hospital with infection.

In the long term it would appear that there is no difference between breast-fed and bottle-fed babies.

Leg clots – Deep Vein thrombosis

When we cut our skin, the blood clotting products are activated so that a clot forms and we stop bleeding. Sometimes the clotting system malfunctions and produces a blood clot (thrombosis) in the veins in the body, typically in the deep veins in the leg, a deep vein thrombosis or DVT.

If the clot breaks away it will travel to the lung (a pulmonary embolus), where it will block some of the lung’s ability to provide oxygen for the body. This can be a life threatening complication.

Situations that increase the likelihood of a DVT include air travel (economy class syndrome), clotting factor defects, being immobile for whatever reason and pregnancy. In pregnancy a woman is at particular risk after having her baby, particularly if there has been a long labour, a forceps delivery or Caesarean section (see Labour and Delivery).

If you are considered to be at increased risk of having a DVT you will be given heparin or a derivative of heparin (low molecular weight heparin). Heparin is a compound that occurs naturally in the body, which acts as a balance for the clotting system. By giving the patient extra heparin (by injection), we can reduce the risk of you getting a clot.

If you are unfortunate and suffer a DVT you may have to be placed on stronger anti-clotting (or anti-coagulant) drugs such as Warfarin.

Coping with baby

After the excitement of being pregnant, after the ecstasy and anxiety of labour and delivery, after the indescribable joy of seeing your own child alive in your arms, you realize that you have a living human who you are responsible for, an awesome challenge. There are major changes in lifestyle as you learn to adapt to your new situation. Both parents will be shocked by the extent to which their life is altered, an even greater challenge for the single parent. It is important to recognize the strain and keep talking to each other about the change in your life, especially in the first few months of the baby’s life. Within months everyone adapts and life becomes more enjoyable.

Postnatal depression

About three days after birth, when the hormone levels from pregnancy rapidly return to their normal pre-pregnancy values, the new mother may feel weepy for no particular reason. This is called ‘The Blues’ and usually only lasts a day or two.

Many women feel mildly depressed in the first few months after birth, reflecting the great strain brought about by becoming a mother. For some women many repressed issues surrounding their own personality and childhood experiences can no longer be hidden away and must be addressed.

If you feel this way you are not alone. Please talk to someone and get professional help, so that you can enjoy your experience of being a mother (and father, as the case may be). A very small number of women develop severe depression or psychosis after delivery, typically becoming quiet, withdrawn and inappropriate in their behaviour. These women need specialist psychiatric help, often requiring formal admission and drug therapy to restore the mother to her normal self.

Getting help
If you wish to make an appointment to seek further advice and or treatment, please email Dr Harrington's secretary.