There’s a tendency to focus on that one day, investing in antenatal education, researching the best pram or car seat - and little thought about what comes after. Becoming a parent is a mix of instinct, our own experience of childhood (what we do and don’t want to take forward), advice from friends and family and the odd book or podcast. But for certain aspects of your postnatal journey, it would help to be more prepared.
Lochia
This is the bleeding that happens after birth, regardless of the type of birth you have, for around six weeks, maybe up to 12, becoming brown and diminishing over time.
If you’re breastfeeding, you may initially experience sudden pain or gushes of blood when you feed, due to the release of oxytocin, the same hormone that causes the uterus to contract.
If there’s a bad smell, pain in your lower abdomen, a sudden large unexplained bleed or you’re feeling unwell, it may indicate an infection, so contact your GP or midwife (taking pictures may help explain what you’re concerned about).
Finally, to save late-night desperate shopping searches, stock up on large pants and maternity pads or period knickers.
Diastisis recti
This is the vertical split of the abdominal muscles which all pregnant women experience by 35 weeks. One third will have persisting symptoms postnatally and will benefit from formal rehabilitation. Find a good women’s health physiotherapist who can support your recovery. It is completely fixable with the right support and it’s never too late. Other ways to support healing are breath awareness when lifting, avoiding constipation, placing your feet on a step when opening bowels and responding to signs in your own body when exercising, such as pressure sensations or doming of the abdomen.
Pelvic floor health
It’s difficult to measure the prevalence of urinary and faecal incontinence in those who have had a baby, as people are reluctant to report it, but urinary incontinence is experienced by around one in three women. Faecal incontinence is less common.
A vaginal birth increases the chance of these symptoms, but pregnancy itself is a risk factor, so those who birth via caesarean may still suffer incontinence. Low postnatal oestrogen levels (especially if breastfeeding) can contribute to symptoms.
Don’t suffer in silence. A women’s health physiotherapist is your best friend. Most of us know about pelvic floor exercises, but doing them correctly is important, as is relaxing the pelvic floor. In some women, having a hypertonic (overly contracted) pelvic floor can contribute to incontinence.
Returning to sex
With sleep deprivation, changes in your body and focusing on keeping this new human alive, sex may be far from your mind. Birth trauma and the hormonal cocktail you’re experiencing may also have an impact. Consider being open with your partner about this.
If you’re ready, we recommend waiting six weeks after the birth before penetrative sex, largely due to the uterus taking time to shrink and the cervix to close, increasing risk of infection.
The WHO recommends a 24-month interval between pregnancies. Be aware that you can become pregnant even if your period hasn’t come back yet.
If you’re exclusively breastfeeding (every four hours during the day and six hours at night, with no bottles and dummies), you will probably have stopped ovulating. This method of lactational amenorrhoea is 99.5 per cent effective, but other methods of contraception are worth considering as there’s still a risk of pregnancy.
Breastfeeding
Breastfeeding confers significant health benefits to you and your baby and if you’re struggling with this, it can be heartbreaking. Few find breastfeeding instantly easy. You are trying to teach your baby this new skill that you have zero experience of doing yourself.
The support of a lactation consultant who can perform a feeding assessment and identify any functional issues like tongue tie can be the difference between the end of breastfeeding and enjoying it, pain-free (it should not be painful!).
Your health visitor or midwife should be able to direct you to your local infant feeding team, or if you have the resources to see someone privately, identify someone with an IBCLC (International Board of Lactation Consultant Examiners) qualification.
Baby blues
These are common and normally kick in around day three as hormone levels plummet. You might feel tearful, emotional, irritable, anxious or low in mood, often compounded by lack of sleep and simply being overwhelmed by new parenthood. It can be terrifying to feel such a lack of control over your emotions, especially if you’ve experienced the initial oxytocin-fuelled high following birth.
Take care of yourself where you can; eat healthily; stay hydrated (keep water in each room in case you get nap-trapped), resting and napping when you get the opportunity, getting outside for some fresh air, or gentle movement like walking.
If these feelings aren’t going away, or become more extreme, with invasive thoughts of harm to yourself or your baby, difficulty sleeping, anxiety, anger or low mood, you aren’t alone. One in five experience postnatal depression and anxiety.
Birth trauma is also common — in 8 per cent of cases meeting the criteria for PTSD. Symptoms include flashbacks, avoiding or isolating yourself from any reminders, being hypervigilant and jumpy with difficulty sleeping and negative thoughts of blame of yourself or others.
There are effective treatments out there — with different approaches for postnatal depression and PTSD, so the correct diagnosis is important.
These feelings are unlikely to go away on their own, so it’s essential that you get help — pandasfoundation.org.uk and makebirthbetter.org are two great charities where you can find support.
Becoming a parent can be terrifying, incredible, exhausting and hugely rewarding. If those close to you are excited about bringing gifts for your new baby, perhaps instead of a cute little outfit for your newborn they could ‘treat you’ to an appointment with a healthcare professional to give you the support you need.
Dr Leah Deutsch is an experienced NHS obstetrician and gynaecologist and mother. She established The Leto Clinic in response to the need for more comprehensive and trauma-informed postnatal care. She is based at Dr Silberstein’s Clinic in Hampstead Garden Suburb, where she offers 50-minute bespoke appointments, allowing the opportunity to take a holistic and individualised approach to care.
You can book an appointment at theyogadoc.org/postnatal-clinic or find her on instagram @yoga_doc where she shares useful, free information
