Birth is a normal physiologic process, but during the days and weeks that follow the baby's arrival, your body must go through a period of healing. In fact, it may take up to a year before your body completely returns to its pre-pregnancy state. Although there are a couple of differences between healing after a vaginal birth versus a cesarean birth, the general healing process holds true for both types of delivery. Several factors can affect this healing, including your general health, nutritional status, and degree of fatigue or stress.
Uterine Contractions and Involution
Soon after the baby is born, the placenta separates from the wall of theuterus and is expelled. The area where the placenta was attached is very much like an open wound that must be healed. Fortunately, your body gets to work quickly. Within minutes after birth, the uterus contracts tightly to seal off the open blood vessels on the uterine wall at the placental site. These uterine contractions, sometimes called "after pains," may be felt as strong cramping sensations for the first couple of days but will then diminish. You may experience these sensations during breastfeeding, as nipple stimulation promotes uterine contractions. You can take an analgesic (pain relief) medication if these cramps are too uncomfortable.
Immediately after birth you can feel your uterus at the level of the belly
button. Afterbirth contractions will cause the uterus to feel like a hard ball in
the abdomen. Each day it will get smaller and smaller until it can no longer be
felt through the abdominal wall. As it decreases in size, it moves down into the
pelvis behind your pubic bone. This is called the process of involution and shows that healing is progressing. While you're still in the hospital, the nurse will regularly check your uterus to monitor the involution process. If the uterus is not contracting as it should, she or he may massage it to stimulate it to contract. Lochia
It takes up to 10 days for the placental site to be totally healed, and during that time you will notice a bloody vaginal discharge called lochia. The lochia will be bright red for a day or two after birth, very much like a heavy menstrual period. It then decreases in amount and becomes a dark brown color, then a pinkish discharge, and by 10 days a slight white discharge. When that point is reached, you will know that the placental site is completely healed. This process may be accelerated in women who are breastfeeding, because the action of the baby's sucking at the mother's nipple stimulates the uterus to contract, and healing may take less time. Until the lochia has disappeared, you should avoid having sexual intercourse and should use good hygiene in the perineum (the area between the anus and the vulva) throughout the day to prevent the introduction of bacteria into the vaginal tract.
Black Eyes and Bruises
If you experience a long or difficult labor, you may notice other physical signs
after birth that require a period of healing. Some women experience black or bloodshot eyes; bruises, evident as small dots on the cheeks or larger bruises on the face and upper chest area, are also possible. Any of these may occur as a result of the forceful bearing down efforts used with breath-hold pushing during the second stage of labor to help birth the baby. These spots are less likely to occur if a more gentle, controlled exhale pushing is used rather than forceful breath-holding. If any of these bruises do occur, they will disappear within a few days. Incision Site Healing
Whether birth takes place vaginally or by cesarean, there is likely to be an incision involved that requires healing. With a vaginal birth, you will probably have an episiotomy. This small incision, made to enlarge the vaginal opening just before the baby's head emerges, is then repaired with stitches. As with any incision, the healing of the episiotomy takes a couple of weeks. The body will absorb the stitches, but the incision may be tender or sore for the first week or so after birth. Infection is possible if the incision is not kept clean; but if good perineal care is used (see below), it should not occur.
If the birth is a cesarean, the abdominal incision will take longer to heal. If the cesarean was not planned and scheduled, but occurred after you had spent some time laboring as well, the recovery needed will be from childbirth as well as from surgery. In addition to the same recovery components already discussed for a vaginal birth(uterine involution and lochia), recovery from the surgical procedure must take place. This recovery is much longer, taking four to six weeks.
The cesarean incision is likely to be painful after the anesthesia wears off. Pain relief medication can be given as needed; at first this will probably be a stronger narcotic analgesic drug that is likely to make you feel woozy and sleepy. If the stitches are not self-absorbing, they will be removed about five days after birth. Some physicians may use metal staples rather than sutures to close the incision; these also will be removed a few days after birth. The sutures or staples may cause a pulling sensation as the skin is healing. Because a urinary catheter must be inserted into the bladder prior to surgery, once it is removed after surgery it is important to drink plenty of fluids and urinate frequently to prevent a bladder infection.
To promote good circulation after surgery, you will be asked to move your legs, flex your feet, and wiggle your toes as soon as the anesthesia wears off. You will also be asked to sit up on the side of the bed, sit in a chair, and then walk within the first day after birth; you may be asked to wear elastic stockings to promote good circulation and prevent blood clots. Because the healing process is more complex for a cesarean birth, you will stay in the hospital for a longer time, perhaps three to five days. Home Healing Tips
Once you return home after giving birth, the continued healing process will become your responsibility. Here are some tips to help you promote healing and comfort:
- Use slow relaxed breathing and massage if after pains are bothersome. If these measures do not help, take the over-the-counter pain medication recommended by your physician. Keep in mind that these after pains show that involution and healing are progressing, and this is a good sign.
- To prevent infection with an episiotomy incision, use a clean sanitary pad at least every four to six hours. Always remove the pad from front to back to avoid dragging bacteria from the rectum to the vagina. Cleanse the perineum after urinating or a bowel movement by pouring warm water over the area and patting dry with gauze pads. Remember to always wipe from front to back as well. Sit in a warm bath ("sitz bath") or use warm compresses to promote incision healing. Doing pelvic floor contract / release exercises (Kegels) will bring circulation to the area and promote healing.
- Follow the instructions given at the hospital for the care of the cesarean incision. Keep the dressing clean and dry.
- Eat a healthful diet to support the healing process. Be sure you're getting protein, vitamins, and lots of fluids.
- Do not resume sexual intercourse until the lochia has disappeared and the episiotomy site has healed; you may still not feel like having intercourse at that time due to fatigue. But other means of affection can let your partner know that you still love him, despite the fact that much of your emotional energy may be going to the baby at this time.
- Rest! This is a major component to the healing process. Stay in bed or on the sofa for the first week after birth. Don't do too much too quickly, even though you may feel good. The only activities you do should relate to the care of the baby. Let someone else take care of errands, cooking, laundry, and other housework. Plan ahead so help with these activities is available.
- Sleep when the baby sleeps. Since you can expect that you will have many nights of interrupted sleep, you will need to make up for that by taking naps during the day. You should aim to get as many hours of sleep in a 24-hour period of time (although broken into more segments) as you did before the baby was born. Take the phone off the hook and place a "Do not disturb!" sign on the door.
When to Call the Health Care Provider
Contact your provider if you observe any of these signs, as they could indicate that healing is not progressing as it should, or that you're developing an infection:
- A temperature above 100 degrees Fahrenheit that lasts for more than one day.
- Bright red or heavy bleeding (lochia) after the fourth day postpartum, or very large blood clots in the lochia.
- Lochia that has a foul odor. Normal lochia should have a slight musty smell, very much like normal menstrual bleeding.
- Pain in the lower abdominal area after the first few days after birth.
- Signs of infection (redness, heat, swelling, an oozing discharge) at the site of the episiotomy or cesarean incision.
If you follow these recommendations, you'll be amazed at how quickly you feel like you're back to "normal" after birth. Because having a baby is a normal process, not an illness, your body will heal quickly. And the few days of some minor discomforts while you're healing will be overshadowed by the joys of having a new baby in your arms!