Our Bodies, Ourselves (93 page)

During the initial period of recovery (the first twenty-four hours), most women find it helpful to apply ice, which not only assists with pain relief but can help reduce the swelling in the area. Keep a squirt bottle next to the toilet to spray on your perineum as you urinate. This will dilute the urine and reduce the stinging. After twenty-four hours, you can soak the vulvar/perineal area in tepid water in the bathtub or in a sitz bath, a special insert that can be placed on the toilet. Some women find that adding herbal infusions of comfrey or witch hazel to the sitz bath promotes healing and decreases swelling. You may also use pain medication for perineal pain.

If you have had a cesarean section, you will likely need stronger pain relief medication than women who have had vaginal births. Talk with your health care providers about postsurgical pain relief, both for the first few days and then for the first two to three weeks after going home. During the first day in the hospital, you may require intravenous medication, followed by a gradual change to pain medication you can take by mouth. You may be given a liquid or light diet initially; solid, heavier foods should be added slowly. Eat what you feel you can tolerate. When you go home, usually four to five days after surgery, you likely will need to continue to take prescription medicines for pain relief. It is best to take opioid pain medication only when it is really needed, because such medicines can cause constipation and other side effects. Be sure that you get enough pain relief to be able to comfortably care for yourself and your baby.

You may not move your bowels for a day or two after birth. This is normal. To make the first bowel movement easier and prevent future constipation, drink plenty of water, move around as soon as possible after birth (it will probably take a day to begin walking again after a C-section), and eat plenty of fruits, vegetables, and fiber. Prunes, prune or cherry juice, or a stool softener can also help with constipation.

Bowel movements will likely be uncomfortable if you had an episiotomy or tear, or if you developed hemorrhoids during pregnancy or birth. Holding some folded toilet paper gently against your perineum when you have a bowel movement can help reduce discomfort. Witch hazel pads—especially ones that have been chilled in the refrigerator—and sitz baths can ease the discomfort of hemorrhoids, as can over-the-counter medicines. If your hemorrhoids are very uncomfortable, talk with your provider about prescription creams and suppositories that can help.

After giving birth, your body gets rid of the excess fluid volume you built up during the pregnancy. You will likely need to urinate frequently and in large amounts. A few women have difficulty emptying their bladders after birth because of swelling; this can occasionally require getting a temporary urinary catheter.

You may experience pelvic muscle weakness, which can lead to urinary incontinence (leaking urine). You may also have bowel or gas incontinence due to weakened pelvic floor muscles. Kegel exercises can help you recover pelvic muscle tone. (For more information on Kegels, see page 643.) If incontinence persists, ask your provider about a referral to a pelvic floor physical therapist who can help you restore strength with various exercises.

Fatigue is a major factor in the days and weeks after you give birth. You are recovering from the physical demands of labor and birth and, at the same time, your sleep is being interrupted by your baby. If possible, have your partner or a support person sleep in the room with you—even if you are in a hospital or birthing center—to help support you in your recovery and facilitate your bonding with the baby.

In the first days either at home or in the hospital, be choosy about the visitors you see. Their job is to help you, not the other way around. A visit that interferes with a much-needed chance to rest should be avoided. Ask friends and relatives to stay for a few minutes only or to delay their visits. Many will be happy to share their concern and generosity in other ways, such as volunteering to care for your other children, doing simple errands, or dropping off meals for your family. For some new mothers, however, visits from family and friends are welcome. The important thing is that you be aware of your needs and ask others to be considerate—or ask someone to be a buffer for you.

My midwife told me to stay in pajamas or even in bed when visitors came. This was such great advice. People don't want to stay long when you look and act like you need rest (which you do when you've just had a baby!). Some friends stayed longer but visited with my older daughter or my husband in another part of the house while I slept or nursed. After a week or so, I was ready to put on real clothes and visit with friends and family downstairs. But I was glad I was protective of those early days
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You may have a postpartum visit at your care provider's office one to two weeks after giving
birth, especially if you had a cesarean. Your care provider will check your blood pressure, ask about your bleeding, assess your breastfeeding, and, if necessary, discuss birth control options with you. If you had a laceration, episiotomy, or cesarean section, she or he will also check to see that you are healing properly. If your cesarean incision was closed with skin staples, they will be removed at this visit. This is rarely painful.

A visit to the midwife or doctor is usually scheduled at six to eight weeks. This visit usually includes an internal pelvic exam to make sure that lochia has stopped or nearly stopped and that the cervix is closed and the uterus is back to its nonpregnant size. If you are sexually active with a male partner and don't want to immediately become pregnant again, discuss options for birth control with your care provider, if this was not done immediately after the birth (see
“Birth Control”
).

For many of us, postpartum care on this schedule is adequate, and after six weeks we feel well enough to manage any persistent health concerns ourselves. But for other women, the U.S. model of postpartum care falls short. A survey of women who gave birth in 2005 found that many women had significant health problems related to pregnancy or birth that lasted six months or longer.
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This was especially true of women who had cesarean surgery: Nearly one in five had pain at the incision site for longer than six months. Some women also reported new onset of chronic illnesses, such as high blood pressure, diabetes, or mood disorders during or soon after pregnancy. Just because your postpartum period has ended according to medical milestones, don't hesitate to follow up with your regular health care provider when you are experiencing ongoing discomfort or other health problems. Unfortunately, many women become ineligible for Medicaid after pregnancy and have no insurance to pay for health care for ongoing problems, even if the problems are related to pregnancy.

Attachment is a natural, biological process that occurs between human beings to create an emotional bond. Just like other mammals, human newborns are born with behaviors that help ensure that they are protected and nourished. Parents learn how to respond to cues such as the baby's hunger signs or distress cries. Over days, weeks, and months, the attachment strengthens.

Although attachment occurs as part of the continuum of pregnancy, labor, and birth, we need not have given birth to our children in order to experience attachment. Fathers, partners, and adoptive parents form deep emotional bonds with babies, although these may evolve on a different rhythm from attachments made between a biological mother and her newborn.

Research indicates that there is a sensitive period around the time of birth when it is easier for secure attachments to be made. Procedures in labor and after the birth may disrupt this sensitive period. These include medications given to women in labor,
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cesarean surgery,
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and separating mothers and babies after birth.
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These disruptions can be overcome, especially if the woman has excellent emotional support in labor and after birth.
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But all efforts should be made to keep these disruptions to a minimum so that mothers and babies get off to a good start.

Most babies are quite alert during the first hour or two after birth. This is an ideal time to share skin-to-skin contact with your baby and to begin breastfeeding. After the initial alert period, most babies experience a sleepy period that usually lasts for three to five hours. This is a great time for you to recover—to rest, bathe, and relax.

You may encounter unexpected circumstances that delay contact with your baby. Be patient and creative in your efforts to connect with your baby. If your baby requires special medical care and cannot be held for a while, talk to your baby, sing to your baby, and just be there, to the extent possible given your situation and your baby's health. If you have medical complications that delay the contact, ask another close family member to hold your baby. If you have conflicting emotions that complicate your ability to connect with your baby right away, give yourself permission to connect with your baby at your own pace. You will grow into the relationship with your baby over time.

Increasingly, hospitals have a policy of rooming in, where mothers and babies stay in the same room after birth and both are cared for together. Still, many hospitals take babies to a central nursery right after birth for a short observation period, especially if the mother has had a C-section, and take babies to the nursery for procedures such as weight checks or medications throughout the hospital stay. However, if you and/or your support people are able to take care of the baby, you can request that your baby stay in the room with you.

After the surgery, I know that Andrew and my midwife, Maria, met up and she gave him advice on how to get the baby to me as soon as possible. She gave him the confidence that it was possible despite their usual policies. The hospital staff said, “Well, we don't really allow the baby to go right away.” But Andrew said repeatedly, “I understand, but how about we just take him.” And it worked. Andrew remembers pushing Luke down the hall in the little rolling crib feeling as if he'd just committed a felony—crazed and exhilarated. When he delivered him to my breast, with Maria's encouragement all the way, he felt he was returning a lost jewel to a crown! And that's how it felt, as if a piece of me had returned. He latched on right away, and I felt a new joy on my baby's birthday
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Rooming in will help you and the baby get to know each other. Often, for instance, a mother rooming in with her baby will quickly become familiar with the signs that her baby is hungry, wet, or otherwise in need of attention well before the infant begins to cry. Rooming in can also facilitate more frequent breastfeeding and touch. Whether you are at home or in a hospital or birthing center, you can cuddle with your baby and keep her or him skin to skin after feedings.
You may also wish to bring a sling with you to the hospital so that you can comfort your baby with your warmth, smell, and movement while still having your hands free.

Once you are home, the baby can sleep in a crib, bassinet, or co-sleeper (a three-walled, criblike baby bed that attaches to your bed) or in bed with you (this practice is known as bed sharing). To reduce the risk of sudden infant death syndrome (SIDS), always have the baby sleep on her or his back. Create a safe space where the baby is secure from falling and from things that could accidentally smother the baby, including quilts, comforters, crib bumpers, sheepskin pads, stuffed toys, and pillows.

Some research indicates that bed sharing may increase the incidence of SIDS, particularly if the baby is sleeping on soft bedding or on her or his stomach. This is a controversial issue. One review of the research suggests that the increase in SIDS that has been associated with bed sharing is likely related to other factors, such as an adult in the bed drinking alcohol, smoking, or being extremely tired; overcrowded housing conditions; and/or when sleeping takes place on a water bed or soft sofa or the infant is placed under a heavy comforter.
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Many health care providers and researchers suggest that when bed sharing is practiced safely, it has benefits for infants and parents, including better sleep and easier nighttime feedings.
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Though bed sharing may be controversial, room sharing is not. Having your baby in close proximity to you allows you and your baby to respond to each other more easily than if you are in separate rooms. It also may reduce the risk of SIDS.
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I had read all the books about how good breast milk is for babies, and I wanted to nurse my child, but before he was born I still felt a little strange about it. I never had any experience like that before, so I didn't know what it would be like to have this little person sucking on my breast almost twenty-four hours a day. I was almost wishing deep down that formula was better for babies. Then, after the birth and when we were in the hospital and started trying to breastfeed. I had this total change in attitude. I was like “This isn't as weird as I thought it would be. This is a bonding thing.”