Your head
You may feel overwhelmed with all sorts of thoughts and emotions, from the highs of happiness to the depths of despair and everywhere in between — all in about five minutes. The sudden shift in hormones is enormous for the whole body, and your brain will probably feel it most. Exhaustion makes it hard to concentrate or make rational decisions.
In Midwifery we sometimes say “baby and placenta out also means brain out”, which is our shorthand for the fog many women are in for the first six weeks. My advice is to make your world as uncomplicated as possible. Your only job right now is to nurture your baby, and in doing so, yourself. Rest, eat nutritious food, stay hydrated, call in the helpers to cook and tidy, and do not make big decisions — no renovating, no moving, no major purchases.
Your breasts
Whatever growth happened in pregnancy is nothing compared with the first week after birth. Your breasts can go from soft and pliable in the first couple of days to large, firm, lumpy and tender in three or four. The feeding bra you bought a few weeks ago will no longer be the right size, and although your partner may be impressed, you will not be.
Every mother makes far too much milk for her baby at first, and it takes days — sometimes a couple of weeks — for your body to settle to exactly what your baby needs. Some women also have engorgement, where the breast tissue is full of fluid. That tightness actually prevents milk flowing, because there is no room for the ducts to fill. Be patient; it just takes time.
What helps: a properly fitted bra with no seams digging in; simple pain relief and anti-inflammatories; feeding frequently; light reverse massage stroking from the nipple up toward the collarbone; warm compresses before a feed and cold ones after (not cabbage leaves — they can reduce supply too much); and a milk saver for a few minutes on the other side, keeping only 30–40ml rather than leaving it on the whole feed. Sometimes ultrasound therapy from a physiotherapist, or a visit from a Midwife or Lactation Consultant, is what is needed.
Your nipples
Some degree of nipple damage is common, and it usually happens in the first days from positioning and attachment that is not quite right. It is fixable — but it does make the beginning of breastfeeding hard.
Learn what you can in the last weeks of pregnancy. Ask your Midwife to show you how to hand express, and practise, so you know how your breasts feel and where to press. A wonderful Lactation Consultant I once worked with used to tell women to “hold your breasts like you love them” — with confidence, and with your whole hand. I still say it.
If the soreness is already there: Lansinoh cream, multi-mam compresses, resting them and expressing for a feed or two, and proper help with attachment.
Your belly
Your belly does not spring back the moment your baby is born, and I am sorry about that. You may feel short of breath, as though your lungs will not fill, and your abdominal muscles may feel sore and useless. Your diaphragm has to learn to work again after months of being crowded, so breathe deeply and fill your lungs right up — especially after a caesarean.
Your abdominal muscles are stretched and weak, and retraining them takes time. It took nine months to grow your baby; give your body at least that much grace. High-waisted leggings or a binder help support you and remind you to be careful — no heavy lifting, and take care getting in and out of bed or the car, and lifting your baby or a toddler. A women's health physio is worth seeing before you return to exercise, particularly if you have been told you have a significant separation.
Your uterus
By the end of pregnancy your uterus is the largest muscle in your body. It has stretched to hold your baby, the placenta and all that fluid, worked extremely hard through labour, and now it needs about five to six weeks to shrink back and for the bleeding to settle.
Every time you feed, your uterus contracts — the after-pains. They can be quite uncomfortable for the first few days and then ease as things reduce. Simple pain relief, anti-inflammatories and a heat pack all help. So does emptying your bladder and changing your pad before you sit down to feed.
Your vagina, perineum and anus
All of this area has worked hard. There may be grazing, small tears or stitches, and if forceps or the vacuum were needed there may be more soreness again. Simple pain relief, anti-inflammatories, and resting on the bed rather than sitting or standing for long stretches will all help, and a women's health physio can guide your recovery and teach you to do pelvic floor exercises properly.
Ice packs will be your friend. In hospital we sometimes make them from nappies — wet a nappy with a little water and freeze it. Make a few up at home; if you do not need them for your perineum you can use them on sore breasts. Lie on your side, feed lying down if that is comfortable, and wear firm high-waisted undies or bike shorts for support.
Your anus gets very stretched too, and haemorrhoids are common. Many women describe their bottom as “broken”. It is not broken, and it does settle. Drink plenty of water, eat fruit (yes, even the prunes), get some healthy fibre in, walk gently, and do not strain. Almost everyone tells me afterwards that the first poo was not as bad as they feared.
Your legs
Sudden swelling in your legs, ankles and feet is very common in the first days, even if you had none at the end of pregnancy. It settles, but it can take up to three weeks. Rest with your feet up, walk gently, and wear compression socks.
Do speak to your doctor about any red, hot or tender area in your lower leg or calf — that needs checking for a clot.
And one last thing
Your beautiful pregnant body has been replaced by something that feels foreign to you, and with time, care and a little work it will feel like yours again. Just as your body created, grew and birthed a baby, you have created a new body and become a mother.
How incredibly amazing is that.
— Penny