THE POSTPARTUM PERIOD

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Thrilled and excited. This is a big moment in your life, a natural high. You may find it hard to sleep, hard to think of anyone but your baby. You and your partner may feel compelled to tell your birth story to anyone who will listen. If there are things that happened that you are still a little confused about, talk them over with your doctor or midwife.

Overwhelmed. The full-time care of a tiny baby is a critically important 24-hour-a-day job, and it's yours now. The job begins when you're already worn out from labor and birth, and it may be months before you get more than three or four hours sleep at a stretch.

Let down. Lows often follow emotional highs. It's natural to feel a bit of a letdown, especially with the new challenges you're facing. You may also feel a twinge of sadness about no longer being pregnant. And even though you are his primary caregiver, you now have to share the baby with your partner, family, and friends.

Weepy. "Baby blues" are probably the result of sudden changes in your life and in your hormones. They strike a few days after the birth. You may feel anxious and worried about your ability to care for your baby, and you may feel guilty about having all these feelings. You should feel better in a few days, especially if you are being well cared for and have lots of support.

"Feeling beat up." You've just been through the most strenuous work of your life. Nearly every muscle, joint, and organ of your body has worked overtime to push the baby out. It's no wonder you feel the effects from head to toe. Depending on the length and intensity of your labor and whether you had a vaginal or surgical birth, expect your body to feel the effects of delivery for at least a few weeks. Your eyes may be bloodshot due to broken blood vessels from intense pushing. You may also have popped a few blood vessels in your face. Your baby's face may have similar marks, but these "spider marks" on baby's face will clear up within a few days; yours may take a few weeks. In the days after birth, you may look and feel washed out, pale, and exhausted.

Feeling faint. For a day or so after delivery it's usual to feel lightheaded and dizzy, especially when changing position from lying to sitting, or sitting to standing. You may feel woozy and wobbly when you walk. The end of pregnancy brings a sudden shift in blood volume and total body fluid; it takes a while for your cardiovascular system to adapt and compensate for changes in position. Until this lightheaded stage subsides (usually after a day), you may need to seek assistance when getting out of bed or walking.

Shivers and shakes. Immediately after delivery many women experience chills and whole-body shakes, probably due to a resetting of the body's temperature regulating system after a long bout of hard work. Rest and ask for warm blankets to cover yourself. These chills should subside within a few hours after delivery.

Bleeding and vaginal discharge. For days, sometimes weeks, after birth, the uterus continues to discharge leftover blood and tissue, called lochia. In the first few days the lochia is usually red, in an amount comparable to a heavy menstrual period, and it may contain a few clots. Toward the end of the first week the amount of lochia usually decreases and it becomes reddish- brown and thinner. In the next few weeks this discharge changes from pinkish to yellowish-white, and you will find yourself changing fewer pads. Any activity that increases the emptying of the uterus, such as standing, walking, or breastfeeding, will also increase the amount of discharge.

If you experience heavy and worrisome bleeding, lie flat and place an ice pack over your uterus just above the center of your pubic bone while waiting for a return call from your doctor or while en route to the emergency room. Or place the ice pack against the episiotomy site if the pain and bleeding seem to be coming from there. Usual causes of bleeding are failure of the uterus to contract sufficiently, retained fragments of placenta, or infection. Your doctor will examine you to see if any of these problems have occurred or if what you are experiencing is just normal postpartum vaginal discharge.

Even after birth the uterus must continue contracting to get back to its original size. Uterine contractions also help to pinch off the blood vessels in the uterine lining to control postpartum bleeding. For a few hours after delivery, these contractions may be regular and intense. They will decrease in frequency and intensity over the next few weeks. Afterpains may resemble menstrual cramps or the Braxton-Hicks contractions you experienced in the final few months of pregnancy. They intensify during breastfeeding, since sucking stimulates the release of oxytocin. This hormone is nature's way of contracting the uterus and stopping bleeding. Birth attendants often suggest mothers encourage their baby to suck right after delivery to help the uterus contract.

Afterpains are not usually very intense following a first delivery, but they will be quite noticeable after subsequent births. To cope with the discomfort, use whatever relaxation techniques worked for you during labor. This will help make breastfeeding more comfortable.

Leaking urine. It's normal to leak a few drops of urine when you cough, sneeze, or laugh. This "stress incontinence" is a temporary nuisance that occurs while your bladder and pelvic organs are rearranging themselves back to their pre-pregnancy positions. Wear a sanitary pad for a few weeks until this annoyance subsides.

Profuse sweating. Another way your body gets rid of the excess fluids accumulated during your pregnancy is by perspiring more, especially at night. For the first night or two wear cotton clothing to absorb the perspiration and cover your sheet and pillow with a towel to absorb the night sweats. Excessive sweating is most prominent during the first week and gradually subsides by the end of the first month.

Painful perineum. Your sensitive perineum has been stretched to the limit and it may possibly have been bruised or torn. If it has been cut into, it's bound to smart. Ask the nurse to instruct you on "peri-care". Heat increases blood flow and promotes healing; cold numbs pain and decreases swelling. Both measures are necessary to heal a traumatized perineum. The nurse will tuck an ice pack up against your perineum as soon as possible (it will feel so good). She will advise you about soaking in a warm bath and show you how to squirt warm or cool water over your perineum, using a "peri-bottle." Try using cool witch hazel pads between your perineum and the sanitary pad.

Constipation. Your bowels may be as reluctant to work as your bladder is, and for similar reasons. The muscles involved in passing a stool may have been traumatized during passage of the baby. Drugs and anesthetics temporarily cause the intestines to be a bit sluggish; and your bowels were probably emptied naturally by the normal "diarrhea" that normally precedes birth. Besides these physical causes for problems with bowel movements, many mothers have a psychological reluctance to do any pushing with their perineal muscles, either for fear of hurting these tissues or because of a desire to rest them. Yet the sooner you get your intestines moving, the better you will feel. (See )

Gas and bloating. The bowel sluggishness that contributes to constipation also may make you feel gassy, especially if you are recovering from a cesarean section. Drinking and eating frequently, but in smaller amounts, and getting your body moving again, will ease these discomforts.

In the first couple of days postpartum you will notice only slight changes in your breasts. You may even wonder where all the milk is supposed to come from, as you produce only small amounts of the first milk, called colostrum. But then, around the third day, you may suddenly awake with breasts the size of a melon, and nearly as hard. You find that you've grown two-cup sizes overnight. This is breast engorgement. Some mothers find that their breasts become suddenly and painfully engorged, while others, especially those whose babies have been nursing frequently and effectively since birth, experience only a gradual increase in breast fullness. Yes, it's hormones at work again; as estrogen and progesterone levels drop in the days after birth, prolactin -- the milk-making hormone -- takes over. As the breasts begin to do their work, the tissues swell, partly with milk and partly with other fluids. These dramatic breast changes may not have been part of the lovely, peaceful breastfeeding experience you envisioned during pregnancy. After your baby learns to latch on properly and your breasts settle into a comfortable balance of milk production where supply equals demand, you will be well on your way to a gratifying, nurturing experience. If your breasts seem too full for baby to latch-on properly, use a breast pump or hand expression to soften your areola enough that your baby can latch onto more than just your nipple. The best remedy for engorgement is frequent breastfeeding. Nothing relieves breast fullness as quickly as a baby who is nursing well. Frequent feedings will also bring your milk supply in line with your baby's demands

Sore nipples. Most sore nipples are the result of a baby who is not latching-on to the breast correctly. When a baby latches and sucks effectively, your nipple goes to the back of his mouth, away from the tongue and gum action that can irritate skin. Sore nipples are not an inevitable part of breastfeeding. If your nipples are starting to get sore, you need to pay some attention to what's going on during feedings. While you may want to call in some helpers (a knowledgeable nurse, a lactation consultant, an experienced friend, or a La Leche League Leader) for expert advice, you are the expert on your baby.