After you deliver a baby: The often unmentioned symptoms

This blog is dedicated to those “Yikes—what is happening to me?!?” symptoms that often occur after the delivery of a baby.  My patients have been shocked to find themselves battling with bladder and bowel incontinence, cramps and heavy vaginal bleeding, all while having to learn the role of new motherhood.  While many other equally important postpartum issues exist, here I will discuss pelvic dysfunction, issues about sexuality, emotional changes, and some challenges of raising a new human being.

Pelvic Dysfunction

Most women know to expect heavy vaginal bleeding, called lochia, after childbirth.  What can be shocking is the volume of blood and blood clots that can be normal.  I have received phone calls from women who were convinced they just passed part of their liver out of their vagina, when in fact they had passed a large blood clot.  Some general guidelines are that you should call your health care provider if you are soaking through a pad an hour for more than two hours in a row, if you are becoming dizzy or lightheaded, or if you are having pain that does not get better with ibuprofen. 

Pain is very common after delivery, but usually improves quickly. A woman may have vaginal pain, incisional pain, and uterine pain as the uterus clamps back down in size.  These cramps can actually be as intense as labor pains themselves.  Many women agree that cramps can worsen with subsequent pregnancies.  Ibuprofen can help greatly, especially in the first few days after delivery.

While most women expect some level of discomfort or pain after delivery, some are surprised by pelvic organ prolapse as well.  Prolapse, usually of the uterus, occurs when the pelvic ligaments supporting the uterus have become so stretched out that the uterus drops in the vagina.  A patient may feel her cervix coming to the vaginal opening, or even through the vagina itself.  This finding is understandably very upsetting.  Fortunately, a combination of a pessary (a vaginal support device), estrogen cream, and later pelvic floor strengthening or physical therapy, can usually greatly improve the problem.    

A large fraction of women have urine or bowel incontinence, or both. In some women, this is caused by muscle stretching, tears, or pelvic nerve injury.  The good news is that time improves most symptoms.  Coughing, sneezing, or lifting the baby can cause abrupt urine leakage because of increased abdominal pressure, a problem known as “stress incontinence.” Some women with pelvic-nerve stretch injuries also have “urge incontinence.” With urge incontinence, women may have a sudden very strong need to urinate, and then lose control of the bladder.  One survey found that three months after birth, 15% of women still had urinary leakage and 5% had loss of stool.  These problems should definitely be discussed with a health care provider who has experience in treating incontinence.  

Sex is not typically recommended until six weeks after an uncomplicated delivery.  Those initial attempts at sex can often be complicated by low libido, decreased sensation, decreased lubrication, and pain.  Fatigue can also be an overwhelming obstacle to resuming your sex life.  Many new mothers have a low libido – three weeks after delivery, around 40% of women describe having little desire for sex, complete loss of desire, or an aversion to sex.  At six weeks postpartum, about half of women will have some pain with intercourse.

Do not give up hope!  Many of these symptoms are a result of the still-high levels of progesterone in postpartum women, which will continue for six to eight weeks  after delivery, or until a woman stops breastfeeding.  It is helpful for patients and their partners to understand that the woman has undergone a dramatic series of hormonal shifts that can squash sexual function.  To help regain some passion, try to schedule alone-time with your partner, use a liquid based vaginal lubricant, practice Kegel exercises, and choose a contraceptive method that meets your needs.  The last thing new parents need is more stress about becoming pregnant again before they are ready.

Hormone shifts in the first days after delivery frequently cause dramatic mood swings. Some doctors estimate that up to half of women (and the people around them) notice these “baby blues.” Mood swings from these hormone changes should not last more than a week or two at the most.

Postpartum depression is a common problem that begins weeks to months after delivery. About one out of every six or seven women develops this more serious depression. Postpartum depression can make a new mother weepy, easily upset, and unable to sleep. It can cause her to be less attentive to her infant or more worried and preoccupied with her baby’s care. Depression is a problem for the emotional health of both the mother and the baby, and it is important that a depressed mother receive medical attention.

Ten percent of women are found to have at least mild abnormalities in thyroid function in the months after delivery, and thyroid abnormalities can cause symptoms of anxiety or depression. For most new mothers, thyroid abnormalities are temporary, but if they occur after childbirth they may recur later in your life.  Women should alert their health care provider if they feel continuously anxious or irritable, have a racing heartbeat or palpitations, or develop a lump in their neck.

Fatigue is universal to new mothers, and headaches are common. These problems can make you less emotionally resilient.  Remember to stay well hydrated (especially for breastfeeding women), and try to rest when the baby is sleeping.    

Babies are all different, and, unfortunately, none comes with an instruction manual. Despite prenatal classes and infant-care advice guides, mastery of motherhood is born of trial and error.  Motherhood is humbling, and it provokes anxiety. Do not be hard on yourself if it takes you time to feel like an expert.

As you may expect, newborn babies lead a simple life: They coo, cry, eat, sleep, and fill diapers. You may not have anticipated that babies cycle through these functions rapidly, leaving you little break time in between feedings and changes, and they cycle at this speed through both the day and the night. As a new mom you will sleep, but your sleep will always be interrupted. Give in to your fatigue, and take a nap whenever you can claim one in the early days after delivery. Arrange to have a lot of support at home, especially in the first two weeks after you have delivered.

Breast-feeding is not easy for most women.  However, don’t give up!  It is one of the most valuable gifts you can give to your newborn, and to yourself as you continue to bond with your baby. Do not be afraid to call your provider’s office if you need help.  Fortunately, many lactation consultant services now exist; they can do home visits, observe the mother/infant pair, and address breast feeding challenges. If you are given the chance to schedule such a visit at the time of your delivery experience, accept the opportunity without waiting for problems. Even if breast-feeding is going well, you will have collected some questions by the time of the visit.

Parenthood is an incredibly exciting event, but what happens is not always what is expected.  If a mood or physical problem is not improving, contact your health care provider. Just as each of us is different, each of our postpartum and parenting experiences will be different.  

Click here to join the group Harvard Med: Talking About Health on Gather

You can find the following related articles on Gather:

Colic, Postpartum Depression Linked?

Health makeover for mommy

Post-baby: Good nutrition for the long term