What to expect when you're expecting (171 page)

If all efforts fail and you haven’t peed within eight hours or so after delivery, your practitioner may order a catheter (a tube inserted into your urethra) to empty your bladder—another good incentive to try the methods above.

After 24 hours, the problem of too little generally becomes one of too much. Most new moms usually begin urinating frequently and plentifully as the excess fluids of pregnancy are excreted. If you’re still having trouble peeing, or if output is scant during the next few days, it’s possible you have a urinary tract infection (see
page 498
for signs and symptoms of a UTI).

“I can’t seem to control my urine. It just leaks out.”

The physical stress of childbirth can put a lot of things temporarily out of commission, including the bladder. Either it can’t let go of the urine—or it lets go of it too easily, as in your case. Such leakage (called urinary incontinence) occurs because of loss of muscle tone in the perineal area. Kegel exercises, which are recommended for every postpartum mom anyway, can help restore the tone and help you regain control over the flow of urine. See
page 454
for more tips on dealing with incontinence; if it continues, consult your practitioner.

“I delivered two days ago and I haven’t had a bowel movement yet. I’ve actually felt the urge, but I’ve been too afraid of opening my stitches to try.”

The passage of the first postpartum bowel movement is a milestone every newly delivered woman is anxious to put behind her (so to speak). And the longer it takes you to get past that milestone, the more anxious—and the more uncomfortable—you’re likely to become.

Several physiological factors may interfere with the return of bowel- business-as-usual after delivery. For one thing, the abdominal muscles that assist in elimination have been stretched during childbirth, making them flaccid and sometimes temporarily ineffective. For another, the bowel itself may have taken a beating during delivery, leaving it sluggish. And, of course, it may have been emptied before or during delivery (remember that diarrhea you had prelabor? The poop that you squeezed out during pushing?), and probably stayed pretty empty because you didn’t eat much solid food during labor.

But perhaps the most potent inhibitors of postpartum bowel activity are psychological: worry about pain; the unfounded fear that you’ll split open any stitches; concern that you’ll make your hemorrhoids worse; the natural embarrassment over lack of privacy in the hospital or birthing center; and the pressure to “perform,” which often makes performance all the more elusive.

Just because postpartum constipation is common, though, doesn’t mean you can’t fight it. Here are some steps you can take to get things moving again:

Don’t worry.
Nothing will keep you from moving your bowels more effectively than worrying about moving your bowels. Don’t worry about opening the stitches—you won’t. Finally, don’t worry if it takes a few days to get things moving—that’s okay, too.

Request roughage.
If you’re still in the hospital or birthing center, select as many whole grains (especially bran cereal) and fresh fruits and vegetables from the menu as you can. Since those pickings may be slim, supplement with bowel-stimulating food brought in from outside, such as apples and pears, raisins and other dried fruit, nuts, seeds, and bran muffins. If you’re home, make sure you’re eating regularly and well—and that you’re getting your fill of fiber. As much as you can, stay away from bowel-clogging foods (like those gift boxes of chocolates that are likely piling up on your bedstand or coffee table—tempting but, sadly, constipating).

Keep the liquids coming.
Not only do you need to compensate for fluids you lost during labor and delivery, you need to take in additional liquids to help soften stool if you’re clogged up. Water’s always a winner, but you may also find apple or prune juice especially effective. Hot water with lemon can also do the trick.

Chew, chew, chew.
Chewing gum stimulates digestive reflexes for some people and could get your system back to normal, so grab a stick of gum.

Get off your bottom.
An inactive body encourages inactive bowels. You won’t be running laps the day after delivery, but you will be able to take short strolls up and down the halls. Kegel exercises, which can be practiced in bed almost immediately after delivery, will help tone up not only the perineum but also the rectum. At home, take walks with baby; also, see
page 465
for postpartum exercise ideas.

Don’t strain.
Straining won’t break open any stitches you have, but it can lead to or aggravate hemorrhoids. If you already have hemorrhoids, you may find relief with sitz baths, topical anesthetics, witch hazel pads, suppositories, or hot or cold compresses.

Use stool softeners.
Many hospitals send women home with both a stool softener and a laxative, for good reason. Both can help get you going.

The first few bowel movements may be a pain to pass, literally. But fear not. As stools soften and you become more regular, the discomfort will ease and eventually end—and moving your bowels will become second nature once again.

“I’ve been waking up at night soaked with sweat. Is this normal?”

It’s messy, but it’s normal. New moms are sweaty moms, and for a couple of good reasons. For one thing, your hormone levels are dropping—reflecting the fact that you’re no longer pregnant, as you might have noticed. For another, perspiration (like frequent urination) is your body’s way of ridding itself of pregnancy-accumulated fluids after delivery—something you’re bound to be happy about. Something you might not be happy with is how uncomfortable that perspiration might make you, and how long it might continue. Some women keep sweating up a storm for several weeks or more. If you do most of your perspiring at night, as most new moms do, covering your pillow with an absorbent towel may help you sleep better (it’ll also help protect your pillow).

Don’t sweat the sweat—it’s normal. Do make sure, though, that you’re drinking enough fluids to compensate for the ones you’re losing, especially if you’re breastfeeding but even if you’re not.

“I’ve just come home from the hospital and I’m running a fever of about 101°F. Should I call my doctor?”

It’s always a good idea to keep your practitioner in the loop if you’re not feeling well right after giving birth. A fever on the third or fourth postpartum day could possibly be a sign of postpartum infection, but it could also be caused by a nonpostpartum-related illness. Fever can also occasionally be caused by the combination of excitement and exhaustion that’s common in the early postpartum period. A brief low-grade fever (less than 100°F) occasionally accompanies engorgement when your milk first comes in, and it’s nothing to worry about. But as a precaution, report to your practitioner any fever over 100°F that lasts more than a day during the first three postpartum weeks or that lasts more than a few hours if it’s a higher fever—even if it’s accompanied by obvious cold or flu symptoms or vomiting—so that its cause can be determined and any necessary treatment started.

“My milk finally came in, leaving my breasts three times their normal size—and so hard and painful that I can’t put on a bra. Is this what I have to look forward to until I wean my baby?”

Just when you thought your breasts couldn’t get any bigger, they do. That first milk delivery arrives, leaving your breasts swollen, painfully tender, throbbing, granite hard—and sometimes seriously, frighteningly gigantic. To make matters more uncomfortable and inconvenient, this engorgement (which can extend all the way to the armpits) can make nursing painful for you and, if your nipples are flattened by the swelling, frustrating for your baby. The longer it takes for you and your baby to hook up for your first nursing sessions, the worse the engorgement is likely to be.

Happily, though, it won’t last long. Engorgement, and all its miserable effects, gradually lessens once a well-coordinated milk supply-and-demand system is established, typically within a matter of days. Nipple soreness, too—which usually peaks at about the 20th feeding, if you’re keeping count—generally diminishes rapidly as the nipples toughen up. And with proper care (see
page 444
), so does the nipple cracking and bleeding some women also experience.

Until nursing becomes second nature for your breasts—and completely painless for you—there are some steps you can take to ease the discomfort and speed the establishment of a good milk supply (read all about it starting on
page 435
).

Women who have an easy time getting started with breastfeeding (especially second timers) may not experience very much engorgement at all. As long as baby’s getting those milk deliveries, that’s normal, too.

“I’m not nursing. I’ve heard that drying up the milk can be painful.”

Your breasts are programmed to fill (or make that overfill) with milk around the third or fourth postpartum day, whether you plan to use that milk to feed your baby or not. This engorgement can be uncomfortable, even painful—but it’s only temporary.

Milk is produced by your breasts only as needed. If the milk isn’t used, production stops. Though sporadic leaking may continue for several days, or even weeks, severe engorgement shouldn’t last more than 12 to 24 hours. During this time, ice packs, mild pain relievers, and a supportive bra may help. Avoid nipple stimulation, expressing milk, or hot showers, all of which stimulate milk production and keep that painful cycle going longer.

“It’s been two days since I delivered, and nothing comes out of my breasts when I squeeze them, not even colostrum. Is my baby going to starve?”

Not only is your baby not starving, he isn’t even hungry yet. Babies aren’t born with a big appetite or with immediate nutritional needs. And by the time your baby begins to hunger for a breastful of milk (on the third or fourth day postpartum), you’ll undoubtedly be able to serve it up.

Should I Stay or Should I Go Now?

Wondering when you’ll be able to bring baby home? How long you and your baby stay in the hospital will depend on the kind of delivery you had, your condition, and your baby’s condition. By federal law, you have the right to expect your insurer to pay for a 48-hour stay following a normal vaginal delivery and 96 hours following a cesarean delivery. If both you and your baby are in fine shape and you’re eager to get home, you may be able to arrange with your practitioner for an early discharge. In that case, plan on having a home nurse visit (your insurance plan may pay for it) or taking your newborn for an office visit to the doctor within a few days, just to be sure no problems have cropped up. The baby’s weight and general condition will be assessed (including a check for jaundice). There should also be an evaluation of how feeding is going—keeping and bringing along a feeding diary will help.

If you do stay the full 48 or 96 hours, take advantage of the opportunity to rest as much as possible. You’ll need that energy stash for when you get home.

Which isn’t to say that your breasts are empty now. Colostrum, which provides your baby with enough nourishment (for now) and with important antibodies his or her own body can’t yet produce (and also helps empty baby’s digestive system of excess mucus and his or her bowels of meconium), is definitely present in the tiny amounts necessary. A teaspoon or so per feeding is all your baby needs at this point. But until the third or fourth postpartum day, when your breasts begin to swell and feel full (indicating the milk has come in), it’s not that easy to express by hand. A day-old baby, eager to suckle, is better equipped to extract this premilk than you are.

“I expected to bond with my baby as soon as she was born, but I’m not feeling anything at all. Is something wrong with me?”

Moments after delivery, you’re handed your long-anticipated bundle of joy, and she’s more beautiful and more perfect than you ever dared to imagine. She looks up at you and your eyes lock in a heady gaze, forging an instant maternal-child bond. As you cradle her tiny form, breathe in her sweetness, cover her soft face with kisses, you feel emotions you never knew you had, and they overwhelm you in their intensity. You’re a mom in love.

And most likely, you were dreaming—or, at least, pregnant daydreaming. Birthing-room scenes like this one are the stuff dreams—and sappy commercials—are made of, but they don’t play out for a lot of new moms. A possibly more-realistic scenario: After a long, hard labor that’s left you physically and emotionally drained, a wrinkled, puffy, red-faced stranger is placed in your awkward arms, and the first thing you notice is that she doesn’t quite resemble the chubby-cheeked cherub you’d been expecting. The second thing you notice is that she doesn’t stop squalling. The third, that you have no idea how to make her stop squalling. You struggle to nurse her, but she’s uncooperative; you try to socialize with her, but she’s more interested in squalling than in sleeping—and frankly, at this point, so are you. And you can’t help wondering (after you’ve woken up): “Have I missed my opportunity to bond with her?”

Absolutely, positively not. The process of bonding is different for every parent and every baby, and it doesn’t come with a use-by date. Though some moms bond faster than others with their newborns—maybe because they’ve had experience with infants before, their expectations are more realistic, their labors were easier, or their babies are more responsive—few find that attachment forming with super glue speed. The bonds that last a lifetime don’t form overnight. They form gradually, over time—something you and your baby have lots of ahead of you.