The time after childbirth can be a dizzying time for the woman. The body has been through a lot of physical stress and it is completely normal that your mental health can be all over the place during the first few weeks.

In this guide, we will go through common problems that can arise during childbirth. Remember that the journey to recovery is individual and any discomfort will be experienced differently from person to person.

In this guide:

• Vaginal bleeding
• Tears and wounds
• Post-birth aches and pains
• Breastfeeding and producing milk
• Lack of sleep
• Prolapse
• Urinary Tract Infection
• Baby blues and postpartum depression
• Peeing and pooing after giving birth
• Separated abdominal muscles

Vaginal bleeding
Everyone bleeds from their vagina after childbirth. This is called lochia and comes from the wound left behind by the placenta after it detaches from the uterine wall. Lochia begins as a heavy period, then turns more brownish and finally becomes lighter before stopping. During the 6-8 weeks that it is common to bleed, the smell and consistency of the bleeding can also vary.
After childbirth, your uterus is extra sensitive and susceptible to bacteria and there is an increased risk of infection. A uterine infection can be treated with antibiotics, and in some cases the woman may need to be admitted to hospital to receive antibiotics as a drip directly into the blood.
As you are extra susceptible to infection during this time, you should avoid bathing, do not use menstrual protection that you insert into the vagina (tampon or menstrual cup) and remember to use a condom during sex. However, you should avoid intercourse while you have fresh bleeding.

If you are worried, you can seek care at a health centre or a midwifery clinic. However, contact an emergency department or a gynaecological emergency department if one or more of the following match your condition:

• You bleed more than you did the first day after giving birth.
• There are many or large lumps of blood coming from your vagina.
• You have a fever over 38.5 and pain in the lower part of the stomach. It feels tender when you press on the uterus.
• Your lochia smells very bad.
• You are tired and have a headache along with any of the symptoms above.

Sometimes the uterus does not contract properly, or there may be remnants of the placenta inside the uterus. Should this be the case, you will be given medication that causes contractions so that any remnants come out. In some cases, scraping will also be necessary to remove the remnants of the placenta.

Tears and wounds
It is common to get tears and wounds during childbirth. These are assessed on a scale of 1–4. Tears classified as 1 and 2 are sewn up at birth by the midwife and anaesthesia is offered here.

• Grade 1 – Superficial tears in the mucous membrane/vagina and labia. These tears often heal quickly and without permanent pain.
• Grade 2 – Deeper tears of the perineum and vaginal walls. Here, in addition to the skin, muscles, muscle attachments and connective tissue have also been affected and need to be stitched to restore your regular anatomy. This is the most common tear among first-time mothers.
• Grade 3 – Here the external and sometimes the internal rectus muscle is affected. A grade 3 tear is sutured by a specialist doctor in the operating room.
• Grade 4 – At this degree of tear, the rectal muscles and the wall of the rectal canal are damaged. This will be sewn up by a specialist doctor in the operating room. Follow-up and return visits to hospital are always offered for grades 3 and 4 and for complicated grade 2 tears.

Sores in the vagina and rectum need time to heal and this takes a different amount of time depending on how extensive the damage was. Swelling and discomfort are common during the first few weeks. Going for a check-up at your midwifery clinic 6-8 weeks after delivery is a good way to check that the tear has healed as it should and to check your ability to squeeze and your pelvic floor.
Seek help if you think you have an infection or are bothered by the stitches. If you experience discomfort six months after giving birth and/or after you stop breastfeeding, you should seek help at a gynaecological clinic.

Afterwards
Pretty soon after the baby is out, your uterus will begin contracting again. This is called afterpains and can hurt. If you have just given birth, it is more likely that you will feel strong, painful afterpains. They are most commonly felt during breastfeeding, but the pain usually subsides after 3-4 days as the uterus recovers. It may be worth testing whether a heating pad or tens machine relieves and take paracetamol and ibuprofen if necessary.

Breastfeeding and milk production
If you want to breastfeed your child, it is good to be prepared for the fact that it can be a bumpy road before breastfeeding goes smoothly. It is normal to breastfeed a lot in the first 24 hours before the mature milk starts flowing. Have the baby skin-to-skin as much as you can and be mentally prepared to breastfeed 8-12 times/day and more often. The intensity of breastfeeding can come as a shock to the new, tired mother. When the mature milk flows between days 3-5, you can get something called milk stasis, the breasts become like hard bombs and you can feel a little sick. Here is the best thing you can do to breastfeed, preferably following your baby’s cues. If your breasts feel very tense and you need to relieve the pressure in your breasts between feedings, you can take a warm shower while lightly massaging your breasts. Also try using something popularised by Jean Cotterman known as Reverse Pressure Softening, where you place your fingertips around the areola and press for a couple of minutes. This causes the milk and tissue fluid to be pushed backwards, which leads to the nipple and areola softening and the baby can more easily get a good grip around the breast. It is also very common to have sore and tender nipples. If you get sore nipples, you can air them, lubricate them with breast milk and use special creams that can be bought at the pharmacy.
If you need support and tips regarding breastfeeding in the first week after giving birth, you can always call your maternity clinic. Don’t be afraid to seek help from friends, family and healthcare professionals. As with everything else when it comes to a newborn, no one expects you to know everything from day one.
In a way, both you and your baby are new to this world.
Read more about breastfeeding here.

Lack of sleep
When labour is over and all you want to do is sleep, a new chapter begins with nights where you are fully awake and days that run into one. Talk to your partner if you have one about how you can best take care of your home, each other and the baby in those first weeks. Take the opportunity to sleep for a while during the day when the baby sleeps so that you are more ready for a night where you are unsure how many hours of sleep you will get. If you are breastfeeding, it is difficult to share the responsibilities at night, but perhaps your partner can relieve you between breastfeeding sessions. There are many ways to comfort a baby besides your breast and it can be good for your partner to find their own tricks early on. Sleep is essential for all people, so if you feel extra sensitive, unfocused and stressed, it may very well be the lack of sleep that is haunting you. A tip for all parents out there is to take all the recovery you can get. If it’s a 10-minute power nap on the sofa in the middle of the day or a friend or relative coming over and carrying your baby around for a while so you can cook in silence. People often want to help and feel needed, but sometimes it is necessary to ask for it yourself.

Prolapse
Prolapse is when the uterus descends into the vagina, or organs around the vagina push into the vaginal wall. This is due to a weakened pelvic floor. It is common for some form of prolapse to occur, but you may not always be bothered by it and therefore do not need to seek treatment. For others, it can create a feeling of heaviness, chafing or problems when emptying the bladder and bowels.
There are some things you can do yourself to avoid the risk and to alleviate the symptoms of a prolapse. Among other things, doing tension exercises regularly to train the muscles in your pelvic floor, avoid heavy lifting and if you need to lift something heavy, remember to squeeze the muscles in the pelvic floor. It is important to always go to the bathroom immediately if you feel the need to poop. Also remember to eat fibre-rich food and drink plenty of fluids so that your intestines have the best possible conditions.
If you are bothered by something bulging out of your vagina, needing to urinate frequently even though you have just been to the toilet, an inability to empty your bowels properly, having a leaking stool or bleeding that you can’t see the cause of, it is important that you contact a health centre or gynaecological clinic. There is help at hand!

Urinary Tract Infection
In the first two months after childbirth, there is a greater likelihood of getting a urinary tract infection. A burning when you urinate and having to urinate frequently are two common symptoms. Most of the time, the urinary tract infection goes away on its own, but if the symptoms become troublesome, you should contact a health centre and see if antibiotics are needed. Drink plenty of water/fluid if you experience the urge to run to the toilet often. This can cause the urinary tract infection to go away on its own.

Baby blues and postpartum depression
Baby blues is something many new mothers have experienced. Hormones and the adjustment can cause feelings like depression and anxiety to take over. Some do not feel this at all, while others feel a deep sense of sadness and unhappiness. It can be helpful to remind yourself that this is very common and always passes. The so-called “newborn bubble” is in many cases far from perfect, cosy and peaceful all the time. Experiencing life as a roller coaster of emotions during those first weeks with a newborn is a reality for many women. However, if you feel strong feelings of depression, cry a lot and have difficulty bonding with your baby, you may have suffered from postpartum depression. Don’t be afraid to talk to your partner, if you have one, a friend, a family member or your children’s health centre. If the feeling of depression has not gone away after about two weeks and you feel that it is difficult to get up and face the day in the morning, it is time to seek help. Through your children’s health centre, you may be offered contact with a psychologist or doctor, if necessary.

Peeing and pooing after giving birth
It is said that three things must work after a woman gives birth. Pee, pooing and having sex. Not straight away, of course, but it is important to remember that these three things are basic needs and if these are not working properly, it will affect us in one way or another.
Just after the birth, your midwife will want to check that you can urinate. This may feel uncomfortable, sting a little, or not happen at all. For example, if you have had spinal anaesthesia, your ability to urinate may be impaired and only return after a couple of hours. It is important to try to urinate as soon as you feel the need.
Remember to drink plenty of water and eat fibre-rich foods to avoid constipation after childbirth. It can feel uncomfortable to poo, especially if you have stretchmarks. Try holding a pad or washcloth against your perineum when you empty your bowels for the first time. The pelvic floor is weakened after childbirth and small or large amounts of urine can leak when straining. Should this continue to be a problem, it is important that you bring it up at your follow-up with your midwife. Unless the doctor or midwife tells you otherwise, you can start doing tension exercises right after giving birth.

Separated abdominal muscles
Diastasis recti, or stomach muscle separation, is something you may have heard of before. During pregnancy, all layers of abdominal muscles are stretched and weakened. This is to make room for the growing uterus. After childbirth, these eventually find their way back together, but in some cases the connective tissue between the muscles remains stretched and the distance between the muscles becomes too great. Signs that you have separated abdominal muscles can be that your stomach sticks out, your stomach muscles feel weaker, you have problems with your pelvic floor and lower back, problems with urinary incontinence, etc.
It is not dangerous, but it is important to be aware of the condition so that you train your muscles in the right way. Contact a midwife or physiotherapist for an exercise program to strengthen the pelvic floor, obliques and back. In some severe cases, surgery may be needed to recover fully.

No pregnancy or birth is exactly like any other. The same applies to the journey to recovery. Be kind to yourself and let the inner and outer healing process take as long as it needs.