Episode 206 - The First 2 Weeks Postpartum (Part 1)
[0:00] Welcome to the Great Birth Rebellion podcast. I'm your host, Dr. Melanie Jackson. I'm a clinical and research midwife with my PhD, and each episode, I cast a critical eye over current maternity care practice by grappling with research and historical knowledge to help you get the best out of your pregnancy, birth, and postpartum journey. Welcome to today's episode of the Great Birth Rebellion podcast. I'm your host Dr. Melanie Jackson and today I'm talking about the first two weeks after you have your baby. I'm actually not even sure I can fit this into one single episode and so even from the outset here of recording it's quite possible that I'm going to speak for hours. So if that happens this is going to be two episodes. But from the outset, I hope I can fit it into one for you. Otherwise, this is going to be two episodes. You'll find out at the end if I've actually got to split it into two because I'll be looking at the time and thinking, oh gosh, there's no way I can keep covering the rest of this.
[1:06] Postpartum is a massive time in your life. And I've been a midwife for 18 years providing full continuity of care through pregnancy, birth, and postpartum. So I get an intimate look into the lives of women in that first six weeks after they have their baby. And today in this episode, I'm going to tell you everything I would normally tell my own clients for what to expect from the two weeks postpartum, the first two weeks with your baby. Not only from your own body, but from what happens to your baby and the whole emotional.
[1:44] Social relationship journey, physical journey that you're about to go on as
[1:49] you get ready to care for your baby postpartum, but also for yourself. And this episode is sponsored by my dear friend and birth prep extraordinaire, Poppy Child from Pop That Mama. She's a doula and hypnobirthing practitioner and her online hypnobirthing course called The Birth Box has already helped thousands of women get ready for labor. Listen to this recent review of The Birth Box. The woman says, I'm a first-time mom and I gave birth to my beautiful baby boy yesterday. I've been listening to The Birth Box on repeat for the past few months, including the day in which I went into labor. and I had the most empowering birth experience and I can honestly say that listening to the birth box was a huge part of this success.
[2:37] Reframing the pain that you experience during labor can be a purposeful pain instead of a harmful pain and that really helped me to know that. And just being able to surrender to the wild ride that birth is and let my body take over was the most incredible thing. And this is coming from a pelvic floor physiotherapist based here in Australia. She says, I will recommend it to all my patients. And you know me, I'm so picky about what I will endorse, but I do get behind the work that Poppy is doing. And in the birth box, you'll learn tools to help you manage pain and how to stay steady when labor gets intense. It's all about giving you knowledge, confidence and a mindset that actually works when the big day comes and for the big days that will follow.
[3:27] Birth Box is rated five stars across the board and with my code, Melanie, you'll get 25% off. So if you're preparing for birth, go to the checkout. You'll be so glad you did. The link is in the show notes. Use the code Melanie to get your 25% off. Now, of course, this is a massive topic. There are whole entire books and professions dedicated to the care of women in postpartum. So I will try and make reference to as many things as possible, but there's a big, vast difference in what can happen to women and their babies during birth. So although I will do my very best to talk about recovering from a vaginal birth, vacuum or forceps, cesarean section, if you've had a tear and episiotomy, all kinds of things, I'll do my best. But in this episode, I will focus on giving you the basics of recovery post-birth and the basics of adjusting post-birth.
[4:28] Also, I'm coming at this from the angle and the assumption that you and your baby are well enough to return home. There was a whole category of care that needs to be given to women and babies who have a complicated postpartum and who need to stay in hospital for care. That's a really big and different story one that I can't do justice to today so this is for you if you are having a baby maybe spending a few days in hospital and then going home.
[4:59] Potentially feeling completely unprepared and not sure what to expect this is the episode for you about the first two weeks postpartum.
[5:09] So the first thing I need you to know, especially if you're not yet in the postpartum, if you're already in postpartum period, you already know this, but there is a profound gap in the care that you'll receive after you have a baby. Medical society has been very good at capturing pregnancy and birth as a medical event that needs all these medical professionals to be on board and help you and support you. And then once your baby's out, it's almost like they don't care anymore. And there's very few professions who are dedicated to the care of women postpartum. There are services, I'm not going to doubt that, but there are genuine gaps where you actually feel like you don't have the support you need at the time that you need it. If you are in a continuity of care program with a midwife, however.
[5:59] That care gap is less dramatic, especially if you have a private midwife or if you're in an MGP program, midwifery group practice program where you have your own midwife, you're going to fill this gap less. But please know, if you're feeling unsupported or not knowing who to contact if you have an issue, that's a really common problem because society is yet to fill that postpartum gap. There's a little bit of a postpartum care desert and we kind of refer to it as, you know, women fall off the cliff postpartum just into a pit of lack of support that's not a really great way of describing it and you might feel really supported but the best way that you are going to get the support you need postpartum would be if you were in a continuity of care program with a midwife other than that there are midwife midwives or early childhood nurses that have services that could help you however there's still often a gap between accessing those.
[7:04] And the best protocol, though, if you're looking for a care provider postpartum, would be a midwife, if you can get an early childhood nurse, who is supportive of the feeding intentions that you have. The number of times I've heard women seek out care from an early childhood nurse and the nurse gives them advice that is contradictory to what the woman actually wants to do is more times than I can count, but I hope you find a good one. And if you're having feeding issues in the postpartum your GP is not the best protocol for things like that you want to find a lactation consultant so a GP or a doctor is only necessary if you believe there's actually something medically wrong with you or your baby otherwise they're not very well versed in how to care for you in the postpartum period the best they can do is identify whether or not there's a pathological situation going on. Have you got an infection, a urinary tract infection, something medically pathological? You want a GP, but otherwise, a lot of the stuff that's going to happen postpartum is more just you wondering if that's normal and how long will it last and what can I do about it? So you could write a book about all of this stuff. In fact, I am writing a book at the moment called A Guide to a Great Pregnancy. And the truth is, and as I discuss in that book, it's not out yet, but it will be soon.
[8:33] The truth is, is that a great postpartum actually begins with investing early. So through your pregnancy, investing into the things that you will need for postpartum, so before and during pregnancy. And I'm going to explain some of those here.
[8:49] But first, I want to introduce you to this word, matrescence. Now, matrescence describes the transition that your brain, body, life, relationships, that your whole existence is transitioning into a new phase of life. Now, matrescence is like mum puberty. So we liken it to the change that happens in a child as they transition through puberty and into adolescence. Imagine that that's the transition from maybe you don't have any babies yet, maiden, things we call them maiden, to mother.
[9:33] The process of becoming a mother is called matrescence, where you go through pregnancy, birth, postpartum and parenting. That is your matrescent phase and your body and brain changes. We've got podcast episodes on that called Baby Brain with Sarah McKay. She's a neuroscientist who talks about how your brain changes through matrescence. And our brain changes to make us better suited to our new function and role as a parent, as a mother, and our brain changes so we're really good at it. But this comes with profound changes that some women have a lot of trouble adjusting to some women just take it in their stride their matrescence is supported and they transition beautifully others are profoundly confused by what is going on and for these women here's how I explain it to my clients so here's how I describe the process of matrescence it's not a beginning and end thing You are going through matrescence for an undisclosed and unknown period of time until you actually adjust into motherhood.
[10:45] So here's how I explain it. Before you have children, or maybe you've got one child and you're transitioning to two or three or four, however many you've got, we are all going through life juggling balls. That's our life. Maybe you've got a great partner and friends and support people around you who are also helping you to juggle the balls of life. When you get pregnant, you start to notice and pay attention to the balls that are harder to juggle. Maybe you'll choose there's a few balls that you'll need to put down or pass on to somebody else to help you juggle. Nonetheless, we keep juggling, sometimes making quick or slow decisions of which balls we're going to put down, which balls we're going to pick up. Sometimes we're forced to drop balls.
[11:34] Now, this forced drop ball moment happens for almost everybody at the point after you give birth to your baby, imagine all the balls that you have been juggling through life. Imagine almost every single one of them dropping to the ground. You are no longer juggling your balls. You've met this moment of forced dropping the balls. So this is the feeling that you might be happening in the days following having your baby where you feel like you can't really do anything else other than the basics other than go to the toilet eat maybe you can't even shower you're caring for your baby but only just and you're feeling exhausted maybe you're really sore maybe you're also reeling from a birth experience that you're disappointed from. That is one possibility. The other possibility is that you're completely thriving and you're doing fine. I'm trying to give a bit of a spectrum as to what you can experience in postpartum, and it's different for everybody. But for everybody, the balls drop.
[12:46] And how well you start to pick all of them up depends on the support network that you have around you and the preparation that you've already made before you even get into your postpartum period to prepare for this drop ball moment. So if you want to prepare for a nourishing postpartum, assume that all the balls are going to drop. What plan do you have for when the balls drop? Are there people around you? Do you have a great partner? Have you got the capacity to pay for some support? Are your other children old enough that maybe they could pick up some of the balls for you? Maybe you have an amazing capacity and you know that there are some balls that won't get dropped. But if you assume that you're going to drop all the balls and the only balls that you can pick up are the toilet ball, the eating ball, the caring for your baby ball and the sleeping ball, maybe they're the only ones you can focus on for the first two weeks and that is okay and completely normal. However, there are things that will need to be done. Somebody else has to pick up those dropped balls.
[13:54] Now, where the crisis comes for some women and where the real painful rub point comes in this matricent part of life is some women do not want to let go of their previous existence. While you look at yourself before having a baby and see yourself competently and confidently juggling all these balls, achieving all these amazing things, being in control of your life and which balls you're going to juggle and which ones you're going to pick up and put down to all of a sudden being at the mercy of your life circumstance of having a baby where even if you want to pick up some balls, you just can't. And there is a profound loss of identity for some women. Who am I if I'm not juggling those balls? And this can be where matricence becomes really painful for women, especially if motherhood is not something that they chose, but something that they've kind of almost been reluctantly brought into. Some women, this is their whole life's purpose. They want to be a mother. They want to be a parent and they embrace the absolute chaos and the identity shift that goes on through matricence. So of course, some women absolutely embrace this change and love it and enjoy it. And others really struggle to let go of the person that they were when they were juggling all the balls.
[15:19] So you were juggling all the balls, the balls have dropped, you're having some kind of identity crisis and wondering what is life going to be like now?
[15:30] As you go through the early weeks of pregnancy and as your baby gets older and as you become this new and different person, which you will, you have to, you are forever changed by having a baby. You're forever changed by being a parent. Your life will change. Gradually, you'll start to prioritize the balls that need to be picked up early. And then some balls are way out in the distance. You can't quite reach them yet, but you can still see them. Other balls roll straight out of the frame and you think, I don't think I'm ever going to see that ball again. Some of the important balls in your life, maybe the people around you will pick them up. Maybe your partner can pick them up or maybe you've got supportive parents or supportive friends who can juggle some of the balls for you while you adjust to this new life with your new baby.
[16:28] Some balls are right there at your feet and you think, yep, I can pick up this one, this one, this one, and this one. And you'll prioritize the most important ones, the most important ones like caring for your baby, changing your baby's nappy, having a sleep, going to the toilet. Imagine these are all balls that you're juggling.
[16:45] Gradually, you might pick up other balls that are important for you. Maybe you'll soon find some energy to do some small household tasks while you're around. Maybe you'll pack the dishwasher and you think, oh, I just picked up that sort of home care ball. Maybe you will return back to work or your business or whatever it is that you're doing and you'll gradually pick up those balls again. Maybe you will completely embrace motherhood and your balls will become completely different if you're leaving a job or if you're returning to a new job. Whatever your new life circumstance just know you will pick up the balls and you'll prioritize the most important ones but they will look different to your previous life and that identity shift can be the real emotional rub in the early weeks of postpartum because it's a dramatic change but please know it won't last and the easiest way that you can transition through that big huge identity shift and the balls dropped moment is to plan to have people around you who can soften the blow of that balls dropped moment. If you've got people around you who can temporarily or permanently pick up some of the balls that you used to juggle, you're going to feel this transition to be less dramatic and less upsetting. Some women find this really upsetting.
[18:10] So that's what I talk about with the dropped balls analogy. That's my dropped balls analogy. Your balls are on the ground, but you will pick them up. They will just look different. But just know that matrescence changes you. You are moving into motherhood. Your life will look different. How well you accept that and adjust to that will determine how successfully and healthfully you transition through matrescence. So the first thing I would suggest that you do in order to prepare for a healthy and well-adjusted postpartum would be to gather and invest in a village so they say it takes a village to raise a child it also takes a village to support a woman and a mother in her transition through matrescence. However, I have seen women fall into a victim mentality and say, well, I did have a baby and the village did not show up. Where's my village?
[19:11] But they never ask, Have I been a village for other women who are around me? So have you spent the time, the energy and the investment to actually be interested in the community and the people around you enough that you've actually provided support and been in community? Because community and a village is a reciprocal situation. It's not us all existing in islands and then coming out of our homes every now and then to drop off a meal to a postpartum mom. That's not a village. A village and a community is built by consistent relationship sharing, sharing life with each other, caring for each other over a period of time. And then you gradually build a village. So when you have a baby, the village shows up because that's what the village always does. That's what your community always does in times of transition and in times where the balls are on the ground. They come to your aid because you've invested in those relationships. Community and a village is reciprocal. You can't sit in your bed and assume that a magical village will materialize just because you had a baby.
[20:30] There's a responsibility that you have to go out there into the community and find the people who are going to become your village and they will become your village if you become theirs. But if you've either intentionally or accidentally or circumstantially or perhaps you're in a dangerous situation and you've been forcefully isolated from community, then you can't expect the village to suddenly show up. So if you want a gentle and gradual transition into matrescence where you and your baby thrive you will need a support network that would include your partner, family around you, friends around you, a village, a community or potentially people that you pay to be that community, to manufacture a community if you don't have the support around you that you need.
[21:26] That's a little bit of a hard truth but it's a bit of a bugbear of mine when women sort of go well where did all the people go where why aren't people helping me well did you help people because community is a back and forth and relationships are back and forth if you have the time if you're listening to this with enough time intentionally identify the people in your community or go out and find one because they're going to be your biggest asset in postpartum as you transition through matricence into parenthood. And as you gradually start picking up those balls again and finding out who you are as a woman and also as a mother.
[22:07] Okay, so with that said, let's talk through the first two weeks after birth, what's going to happen to you and your baby. And I'm going to try and walk through this chronologically, almost from the minute your placenta is out and your blood loss is controlled and you're sort of settled in with your baby. Try and do this in a chronological way from the minute the baby's born to up to two weeks.
[22:35] So firstly, in ideal circumstances, as soon as your baby is born, they would come straight up onto your chest for uninterrupted skin to skin for at least three hours. And I believe this should be the minimum, at least. And this can be done after vaginal births.
[22:56] After cesarean births and certainly if your baby needs help obviously that could be a time where they need to be briefly separated from you a lot of things for your baby could be done right next to you but the way that maternity care is set up often means that if there's a concern for your baby they might move your baby away from you and there'll be a temporary separation but in ideal circumstances, your baby will be brought skin to skin for the very least three hours of uninterrupted skin to skin time. We call these the three golden hours. However, I think even longer is even more beneficial if you can do that. Because babies who are kept skin to skin in the hours and days following birth, they feed better, they maintain their blood sugar levels better, they have less trouble with adjusting with adequate breathing and heart rate they maintain their temperature better they generally have an easier time of staying warm and they consume they use less energy trying to just keep warm and the the important trifecta when you're caring for a baby from a medical perspective is keeping them warm pink and sweet so warm is temperature regulation.
[24:13] Pink is proper breathing, respiration and cardiac activity. And sweet is that their blood sugar is stable, so they're eating well. But they also need closeness and comfort. And to be with you is the most relaxing and energy-sparing thing your baby can do, is to be skin-to-skin with either parent. Skin-to-skin also facilitates bonding. and actually you feel less apprehensive about your transition into parenthood when your baby is close to you. You will actually maternally want to keep your baby close to you, most likely. Some women maybe they want to create some separation and.
[24:56] It'll be less apprehensive for you to parent with your baby close to you because there's immediate feedback. You don't have to wonder, is my baby okay? Is the baby warm? Is the baby breathing okay? I wonder if it's hungry. The baby's right there. So it's actually a less apprehensive way of initially parenting your young baby is to keep them right close to you skin to skin. So immediately expect that you'll not be separated from your baby. And if your baby is well and unaffected by medications that you might have used through the labor, their instinct and feeding reflexes will be intact. They'll be strong. Your baby will be alert. They'll be able to lift their head and their eyes will be wide open. They actually have a reflex and an instinct to feed. Babies want to live. And so one of the first things that they'll do when they're born after finally getting their breathing and heart rate all regulated. The next thing that we want to do is attach to the breast if you're planning on breastfeeding. So if you are planning on breastfeeding and your baby's on you skin to skin.
[26:05] The only thing you need to do is once the baby kind of wakes and becomes alert, you'll notice the baby doing actions that appear as though it's looking for your breast. I can't go through all of the usual behaviors, but it'll appear as though your baby is actively trying to look for the breast or they'll put their hand in their mouth, which is a good sign too that they're looking for something. And this actually usually happens within the first 60 minutes and usually sooner. In my work as a private midwife, once the baby's come out, it's almost within five to ten minutes, they're looking to the breast and they're latching on if the babies are in good condition. All you really have to do in that scenario is to line the baby's mouth up with your nipple in a very vague way. You don't have to force the baby's face onto your nipple or do anything like that. the baby will make attempts to latch and a well healthy baby could take a while because it's a little bit of a skill and they're quite uncoordinated at first.
[27:09] But if you give the baby free access to the breast and line the baby up well with your nipple, then the baby will likely latch in that early hour after birth, especially if they're skin to skin. But obviously, if your baby's not with you, it can't latch to feed. But expect that that's what's going to happen.
[27:28] Now, the next thing is while that's all happening and you're resting up onto somewhere comfy, was supported by pillows and you've got a nice warm cozy blanket over you and your baby's skin to skin and the baby also has a nice warm blanket over them and maybe the baby's attempting at the breast maybe it's already latched now it's time for the people around you to be doing a few things they need to be shuffling around to find your very first postpartum meal and make it the most nourishing delicious nutrient filled meal possible something warm and stodgy and comfort food I wouldn't be favoring junk food at this time it's a really demanding time on your body you're going to be making milk recovering from the birth you need something really nourishing so while you're sitting holed up with your baby hopefully for hours and days in this early postpartum Somebody should be up finding you the most insanely tasty and nourishing meal possible. And a nice, big, warm drink of something of your choice.
[28:41] And it's going to be your birth victory meal and replenish you after your hard work. It's a chance for you to take.
[28:51] Big breath out. The hard work of birth is done and you are kind of powering up to get ready to care for your baby for the rest of its life. Most births will leave you with this alert feeling where you're hypervigilant to the needs of your baby. This is good. This is a survival mechanism. We are designed as mothers to have this mama bear energy where we just want to keep an eye our kids and make sure that they are safe and provided for and you'll be hormonally wired to do that post-birth. So don't be surprised if even after a very challenging birth or a long birth or a surgical birth.
[29:34] That you are actually feeling incapable of having a sleep because you will just be hyper fixated on your baby. And this is a good thing. This is a normal thing. It's because we are supposed to keep our babies alive and our body makes us super women to be able to do that. So once your baby has a feed, the typical behavior of a baby after its belly is full after birth is to have a big long rest. It could be five, six, seven hours. And then again, the baby's powering up, getting ready for life, recovering from their birth experience and ready for it. So if you can, I would suggest also taking that unique window of opportunity before your baby is going to need you every hour on the hour to also see if you can just rest. You don't necessarily have to sleep if you can't. But certainly if your baby's on your chest and there's people around you and someone's made you this beautiful pillow nest where you're feeling safe and comfortable to have a rest and a bit of shut eye, closing your eyes, turn the lights down and chill out for the next few hours while your baby has a rest, while you have something to eat and also have a rest.
[30:50] It's not really the best time to be welcoming in visitors and introducing the new baby and showing the siblings the new baby, unless of course you've had a home birth, which all of that happens anyway. But if you're in hospital, protect that moment. You're not going to get another rest for a while. So this is what will be happening in those early hours. Now, the other thing that should happen when you support people or your partner or whoever it is, is off getting you the best and biggest meal of your life.
[31:22] The next thing that you need to prepare for is the possibility of afterbirth pains. So they'll pretty much start after the birth if you're going to get them. Not every woman gets afterbirth pains. But basically what's happening is when you're pregnant, your uterus gets huge. It gets massive because it grows a baby. And then almost immediately, it needs to start getting small again. And so once the baby's out, there's obviously a big dramatic change and the placenta's born. There's this big dramatic change where your uterus is shrinking back down. And if you were to feel the position of your uterus in your tummy, it would be likely around the point of your belly button. It shrinks that much almost straight away. And if you were to poke into your belly button and push down a little bit towards your vulva.
[32:18] You can feel a hard uterus ball it feels like a big tennis ball or a big ball in there and if you rub it it gets firmer and it's quite hard and that's good because what your uterus is doing is clamping down and preventing any blood loss from happening at the site where your placenta was attached to your uterus. So all through the pregnancy, the placenta was connected to your uterus, the blood vessels were aligning, and there was a lot of blood supply going to that placenta. But as soon as it comes out, your body has to prevent blood from seeping out of that placental site. Obviously, not all the blood is going to stop coming out, but your body has two specific ways. That it stops you from bleeding. The first is that it can create little micro blood clots at that site and prevent too much blood loss through the blood vessels that have been supplying your placenta.
[33:18] And the other way that it does it is it clamps down like a muscular ball and we call this living ligatures. So the muscle fibers interlock and through those fibers, if you're watching me do the video, you'll be watching my hands do all kinds of things. But through the fibers of your muscle is where the blood vessels run. So if your muscles contract and tighten around those blood vessels, they become cut off. They, you know, they get tied off by the muscle to prevent blood from leaving the blood vessels while it's also working at receding those blood vessels and clotting blood so it doesn't exit through those blood vessels. So that's the reason you'll be getting afterbirth pains. It's your body trying to bring your uterus back down to its pre-pregnant size, which doesn't happen until about, you know, after eight weeks of after having a baby. But at first, it's quite dramatic. It shrinks a lot initially.
[34:18] So it shrinks, shrinks, shrinks down, but it's going to use muscles to prevent too much blood loss. For some women, this can cause afterbirth pains. especially while the baby's feeding at the breast. And the reason for that is that when your baby latches to your breast, the letdown or I guess the hormone that determines the behavior of your nipple, the muscles in your nipple, is oxytocin. And oxytocin is the same hormone that causes your uterus to contract during labor. So when the baby's suckling and there's an increase in the oxytocin levels in your body, your uterus also responds to that oxytocin by contracting it.
[35:04] It's a beautiful way of preventing you from having a postpartum hemorrhage and to make sure your uterus is functioning as it should. However, it can create afterbirth pains. So the very first thing you could do, again, not every woman is going to get afterbirth pains, but the very first thing you could do is while someone's making that meal, if they could also be heating up a heat pack for you and popping that over your belly, it can be a comforting way of kind of dulling down the sensation of those afterbirth pains. Typically the more babies you have the more likely it is that you're going to have afterbirth pains. They're not very common for first babies but typically get a little bit worse each baby that you have. If you have a history of really bad afterbirth pains I would suggest making a plan through your pregnancy about what you're going to do about the afterbirth pains because they will pretty much start after the birth. So you have to have a strategy. Some women are just ready to go for strong pain medication and they are ready for that and they kind of have the baby take the meds and hope to avoid the pains becoming too severe.
[36:21] You might not need pain medication, but you might just need to be ready with things like the heat pack, or you can have some women report using oral arnica, homeopathic arnica to be helpful, and a TENS machine. So if you used a TENS machine for your labor and birth, which is something I talk about, it's a non-pharmaceutical way of helping to work through the pain of contractions is to use a TENS machine. It's also okay to pop those pads on your belly, particularly during a feed is where you're going to feel the most bitey afterbirth pains. You could get ready for a feed with the TENS machine, a heat pack, and possibly if you need actual medical pain relief, taking that sort of 15 or 20 minutes before a feed is going to give you the most effective pain relief. Again, won't happen to everybody. Don't assume you're going to get it, But be prepared just in case. And the good news about these afterbirth patients, if they come at all, is that they usually start the worst they'll ever be, and then they get better over the next two to three days.
[37:31] And the afterbirth pains typically will be gone when your milk comes in, actually. It seems to be the transition point. When the milk starts to come in, then around day three or four, or if you've had babies before, it might be sooner, that seems to mark the end of afterbirth pains. They might still be there a little bit, but manageable, not needing pain relief.
[37:55] And I will talk about what's going to happen to your boobies in a minute too, because there is a period of time in the first week where your mitt will come in we'll talk about that but before we go there i want to talk about wound healing so we've already gone from babies out on your chest having a suckle you're having the initial early rest good nourishing meals heat pack to your belly manage the after birth pains of the you know early postpartum in that initial day and hopefully you're resting in every single micro increment that you can get as few interruptions in these early few days is exactly what you need. Hopefully there are not care providers coming in every four hours to bother you and check on feeding and this and that and that if you're all well and sleeping.
[38:45] Sometimes the postnatal ward can be the least restful place ever. So if you're feeling physically well, you might actually find that the best place to recover is at home and you can ask for early discharge and midwifery care at home instead of in the hospital. And I know that could be a unique and unicorn situation for you, but if you have the opportunity, oh, home is so much more restful than a postnatal ward, depending on your circumstance. If you don't feel safe at home, postnatal ward is where it's at. If you have six other kids at home, maybe the postnatal ward is more restful for you. But typically, in terms of recovery, the postnatal ward is not a restful, quiet or gentle place to recover.
[39:35] Let's talk about wound healing because in this day and age, unfortunately, most women will have some kind of a wound as a result of childbirth. It might be a tear to your perineum. It might be an episiotomy to your perineum. It could be a caesarean wound. There's all kinds of little surgical procedures that might need to happen to you through your birth, not to everyone. And we've got a raft of other episodes of the Great Birth Rebellion podcast that focus around preventing wounds during birth. but certainly it's a women's experience that you might need to recover from something.
[40:23] So after you've been able to have a nice nourishing meal and a rest and you've latched your baby and you're warm and your basic needs are met, you've had a nice shower in that first day after birth. Now it's about making plans to manage and heal the wounds that you've got from birth. So here is my midwifery advice for postpartum wound healing. So what we talk about as healthcare providers is you want functional wound healing which means that you want the tissues that are healing whether or not it's your perineum your surgical wound from a cesarean section if you've had a tear or an episiotomy whatever it is you want functional healing we're much more interested in how that area functions properly than how it appears so So sometimes when we repair your perineum, for example, or you've had an episiotomy and it's repaired, it's repaired for function, not for appearance. So it might look different to what you're used to and it'll look better over time, of course, but you want functional wound healing and functional wound healing means that you heal somewhat actively. Let me talk about that.
[41:45] So let's start with your vulva. If you've had a vaginal birth, whether or not it was with a tear, an episiotomy, or you've had forceps or vacuum.
[41:54] Let's have a look at what you can do in the first few weeks to recover your vulva. All right, first thing is hygiene. So daily shower, you don't need any soaps or special creams or anything. Just water rinsed gently over the area and pat it dry. That's all you need for hygiene. Change your pads every three to four hours depending on your level of blood loss in the early days. You may need to change it more frequently but approximately every three to four hours. Even if you're not bleeding that much don't sit in the same pad all day. Just change it frequently. You want to keep the area as clean as possible. I would suggest this could be confronting for you if you're not used to looking at your vulva. But if you've got a wound down there, part of a healthy recovery is seeing what it looked like at the beginning and then keeping an eye on the healing as it heals.
[43:02] There's a point in time, it's around day three to five, day three, four or five, where women start to describe a tear or an episiotomy repair on their the vulva has feeling kind of tight or itchy or a little bit more achy and uncomfortable. It sounds like they thought it was getting better and then starting to feel a bit not good. This can be really normal. It can actually be a normal sensation of the healing process or maybe you're brewing some kind of infection or wound breakdown because there are some times where a repair is not done well and actually it starts to come apart. This is very rare. I'm just warning you about the possibility that I was saying it's going to happen.
[43:51] So actually looking and seeing what it looks like, Like you don't have to look like aggressively. I would not open the wound or separate your vulva or anything like that or your labia. Just have a look. What does it look like from the outside? Where's redness? Is there any swelling? Can you see any weeping from the wound? Can you actually see any stitches that are there? Just become familiar with what it looks like so that if your sensations change, you actually have a reference point for what it used to look like. So if you're explaining it to your care provider and saying, oh, my perineum actually feels a lot more sore, you could say, but it doesn't look any more red or any more swollen. Or you could say, and compared to yesterday, it looks way more swollen. So your understanding of what it looks like periodically makes a difference. If you don't want to look at it for a long time, you could just ask maybe your partner or somebody to take a daily photo and then you can compare them over time if you need to. It's just a way of becoming familiar with, you know, the wound. You know, if you had a cut or surgery somewhere else, you can see the wound and you can immediately pick up if something's wrong. It's a little bit more tricky in your perineum.
[45:10] So there is... A very small chance that the wound could become infected, it's highly unlikely these days. Your perineum is actually so profusely filled with blood vessels and your immune system is really active down in your perineum. So waste products and infections are really dealt with quite quickly and they're very unlikely. Considering it's in between where where your urine and your poo comes out. It's amazing at how few infections women get in their perineum. But there is a chance of that. And the way you can prevent that is keeping the area clean, changing your pads, keeping an eye out for signs of infection, like swelling or weeping from the wound or additional pain, redness, and resting. Oh my gosh, there's so many things that you can prevent just by resting. And that means just not pushing yourself to do things that you don't feel ready to do. That's all I'm talking about resting. I'm not saying you have to close your eyes and sleep. Just don't force yourself to do anything you absolutely feel like you're not capable of doing. And that includes seeing people or getting up, you know, all kinds of things equal rest.
[46:33] But when you rest, you reduce the chance of infection and you increase the chance that your wound is going to heal faster. And this is the idea of wound healing. You do want a speedy recovery, but you want a good functional one too. And that involves a little bit of activity, but only to the point that you feel capable.
[46:52] The other thing you can do for good wound healing is to avoid sitting directly on it. So try not to sit up cross-legged and directly on where the wound is. So you might end up doing some side lying or resting a bit further back. I would suggest changing positions because, man, your tailbone in postpartum gets so sore for how much sitting you're doing but you're trying not to sit on your perineum but also your bum hole hurts so you're like sitting in all these weird positions and you're trying to feed your baby so your shoulders start hurting and you're also tired and maybe your bladder's full so oh that the early days of tailbone pain I think is just not spoken about enough but try and change positions enough that maybe your tailbone discomfort will be tolerable. I would suggest not putting anything in or on your vagina. That includes, I would avoid sex and any kind of penetration.
[48:01] Some midwives talk about salt washes and witch's hazel and manuka honey and seaweed for wound healing and all these potions and lotions and creams. And do you know what? If you're eating well and you're resting, the chances are is that you have everything your perineum needs to heal without fussing around with putting your finger on the wound and adding new fancy bits and pieces. Because the last thing women want to do is add extra processes to their healing if they don't need it. Honestly, water, rest, and just regular changing of your pads. Don't sit directly on it. Don't mess around with the wound. Don't put your fingers on it. Don't touch it. Don't pull it apart. Just keep the wound together and it's going to heal. You don't have to fuss around. Of course, if you feel like there's an infection brewing or it's a particularly gnarly wound, you might consider applying some things on it to speed up the process, but only in response to actual pathology. If the wound is clean and together and it's not painful, don't mess around with it.
[49:13] But one valuable item that I do think can be really helpful to your healing is having a bottle, maybe like a squirty bottle, a cheap sauce bottle. You can get them from like really cheap shops, clean one that you would normally use for, you know, tomato sauce or some kind of condiment.
[49:37] Have that next to the toilet that you can fill with water. Make it a decent size, like at least 500 mils, I reckon, that you can fill with water. And while you're doing a wee and after a poo, you can spray and wash down your vulva and pat it dry just for a little extra cleanliness so you don't have to shower after every time. It's just a little wash with water, nothing fancy. You don't have to put any extra herbs or anything on it unless you want to. But have that next to the bed.
[50:10] Now, the other thing that's going to help with wound healing is just pelvic floor tightening. Not much, literally a second or two. It's just whenever you remember it, pelvic floor exercises bring blood and movement to the area and can facilitate healing. It might feel counterintuitive to be actively moving a part that's actually got a wound in it, but it can improve the functionality of your healing. This is what I mean by functional healing. A little bit of movement down there with pelvic floor exercises. It doesn't have to be strenuous, just a few little ones, just whenever you remember one, maybe two seconds, not much.
[50:55] Now, the next thing you can do for good wound healing is controlling the swelling. So a wound that's over-swollen is going to heal slower. So you kind of want to speed up the healing process, which is going to prevent an infection and help you feel more comfortable. But if it's swollen, that's going to cause a delay in the wound healing, particularly at your vulva. So to manage swelling, my number one go-to for swelling of your vulva, if there's a wound there or even post-birth, even if you don't have a wound, this is great for swelling or any kind of pain. So, and you don't have to buy expensive things. I would absolutely not recommend buying perineal ice packs, but just think it's a waste of money and resources when instead there's just like really easy household options that.
[51:54] And here I'm going to do a plug for frozen condoms. So a 12-pack of condoms, super cheap, very accessible. Buy one of those, then unravel a condom, fill it with some water. It doesn't have to be huge. Fun story. When the men fill condoms, they always end up being these massive, like, sex toy-sized ice packs. When women fill fill a condom with water they end up being these nice kind of one or two centimeter thick flat maybe about 15 centimeter long ice packs that fit perfectly if you were to lay that over the top of your vulva you don't want a huge penis size ice pack because what What you're going to do with these frozen condoms is lay it over the top of the wound or the swollen part of your vulva, not into your vagina. Do not insert it. You lay it over the top. First, wrap a very thin film, kind of like a paper towel around it. And pop that directly on the swollen or sore area over the wound. Obviously on top of your pad, not behind the pad. You want to feel the coldness. The coldness is where you're going to get the relief.
[53:20] And it'll melt over about 15 or 20 minutes, which is the perfect amount of time for an ice pack. And then they're disposable. You don't have to meet that perineal ice pack ever again. And if you prepare about 12 of them, a single pack of 12 of condoms in your freezer, lay them flat when you're freezing them. And they should create these kind of one or two centimeter size ice packs, about 15 centimeters long. Tie them off at the end, lay them flat and put them in a container and you'll have all of these frozen condom ice packs for you to apply to your perineum to bring down swelling and help manage the pain. Particularly if you've overdone it one day, you might feel a bit tender down there. An ice pack on your perineum is magic postpartum.
[54:13] And if you do feel like the swelling on your perineum or the wound is a bit out of control or it's quite tender, again, you can take paracetamol and ibuprofen postnatally. It's safe for breastfeeding. Obviously, don't overdo it on the doses. Stick to the dosage on the package. But that can help bring swelling down and some pain. Just take that as you need it. Now, I would also suggest not sitting in a body of water. Some women talk about SIDS baths for your perineum or sitting in a bath. I wouldn't suggest that in the early days. Wait until there's some healing that's happened. And also know that if it's an episiotomy, the sensations of healing and the tenderness and swelling and redness, you might need to care for your perineum more intensely over a longer period of time than if you've just had a tear and episiotomy typically takes longer to heal it's more painful to heal more likely to get infected more likely to break down as a wound so you have to be hyper vigilant if you've had an episiotomy be more conscious about rest and pain management and doing all the things I just talked about. Whereas if you've had a tear, then it's more of a comfortable healing process.
[55:41] You may be in the small category of women, three to four percent of women will have a third or fourth degree tear, which starts to evolve.
[55:50] The anal muscle. Again, your experience is going to be different to women who've had a first or second degree tear, but the principles of healing are nonetheless the same. Now, you might be also in the category of women who had a tear, but decided not to have it stitched. Also, completely fine most of the time. If you have a look at episode 127 of the Great Birth Rebellion podcast, we talk all about if you need stitches or don't need stitches for a tear so have a look at that but if you haven't had stitches again all the things I just talked about the healing process will be exactly the same the only thing the stitches do is bring the wound together so your body knows where to heal it but if you didn't have stitches it's because your wound was already sitting together so you don't have to do anything extra special the rest is just as important for you as women who have had stitches, the healing process is the same. In fact, if you haven't had stitches, you're less likely to have the pain associated with the process of having your perineum stitched and definitely less pain than an episiotomy. So that is what you'll need to do in the first two weeks to recover from a perineal tear or a cut. And the follow-up will be different if you've had a third or fourth degree tear. I can't go into the detail of that, but this is the general recovery.
[57:20] Now, if you are a category of woman whose wound is not your perineum, it's actually your belly because you had a caesarean section, here's what you can expect from wound healing that there will be a dressing in place over the top of the wound on the outside for about five to seven days. It's waterproof. It's not supposed to get any moisture in there. So if you notice parts that are coming up and shower water is getting in and it's all wet and lush in there, you need to probably take it off because drying it out is going to be the important part. The dressing should be waterproof and often they're see-through so you can actually keep an eye on the wound to see if there's any redness or bleeding or weeping. But certainly if you feel like your dressing is getting wet inside, you need to speak to your care provider because that needs to be checked and potentially replaced.
[58:15] I would suggest maintaining your pain medication so that you can move comfortably to feed and shower and toilet and to move comfortably enough to prevent blood clots. So a unique risk that doesn't exist for women who had vaginal birth, a unique risk of cesarean section is that because you had surgery, you're at risk of blood clots. The best way to prevent blood clots is to get your muscles moving so you have to still, I'm not talking about doing any kind of major movement, but you can't lie in bed all day long because it hurts. You've got to move because otherwise you put yourself at increased risk of blood clots.
[58:58] But definitely get help if the womb seems red, weeping, bleeding, if you get a fever or any additional deep pain, if it's getting worse, if you feel unwell, if this, you know, you're, the other thing of having a cesarean section is it's not just the skin that's cut. There's seven layers internally all the way into your uterus and then they repair all layers again on the way out. So there is a risk of infection, and that's just unique to a cesarean birth. It's very important that you monitor that wound for signs of infection because you're at risk of sepsis after a surgical procedure.
[59:37] Avoid rubbing the wound. So having any pants that directly sit over the top of it is going to irritate it. It needs to stay dry and you need to be resting as well with just enough movement to prevent blood clots. The other thing you can do to assess for infection is to monitor your vaginal blood loss. So even if you've had a caesarean, you will lose blood in the same way that a woman who's had a vaginal birth. you'll lose blood onto your pad and the color and smell of that can tell you something of what's happening in your uterus. If it smells what we call offensive if you take your pad off and think whoa that smells different or that smells new or you can see discolored like pus looking discharge on your pad it's possible that you have an internal wound infection. So monitor that. And in terms of wound healing, you'll feel like you want to put pressure over the caesarean scar. If you need to do things like cough or laugh, or if you're on the toilet and you're kind of bearing down, or maybe even if you're moving around, you might have this feeling that you want to hold pressure over the wound. And that's okay. You can do that. There are actually little tools that you can use, but the easiest way is if you have a folded up towel or even if you tape a towel flat.
[1:01:05] And use that to apply counterpressure to your abdominal wound if you need to cough, sneeze, laugh, whatever it is you're going to do. If you feel like there's going to be pressure on that wound, you can provide counterpressure. Okay, we are barely even halfway what I want to talk to you about. So 100%, just a heads up, this is going to be two episodes. So if you're in postpartum currently and you need all this information right away, the next episode of the Great Birth Rebellion podcast is going to be connected intimately to this one. It's just a continuation. All right. So that puts me off the hook of rushing through everything because I want to really take my time. But that's what I wanted to tell you about postpartum wound recovery from both vaginal and cesarean. And girls, we are only really just at still day one postpartum, all right?
[1:02:00] And the last three things I'm going to talk about in this episode is surviving the hungry thirsty of the first two weeks after birth, your first wee and your first poo, and what the blood loss expectations are that you can have in the first two weeks postpartum. So let's start with blood loss expectations. All right. So your baby comes out. Well, I already spoke to you about the fact that your uterus clamps down. This is the same thing that's going to happen to you if you have a vaginal birth or a caesarean. It's the same functional process where your uterus clamps down to prevent blood loss from the placental site. However, for the first approximately three to six weeks, you will keep losing blood. Some of it is new blood, some of it's old blood. So usually in the first two days or so, you'll have what feels like quite a heavy period, like menstrual flow. So it's even heavier than that, depending on what your usual expectations are. But you'll have to change your pad roughly every two to three hours to keep up with the amount of blood loss and if you don't want them to overflow. But a top tip here, incontinence nappies, you can buy them at supermarkets or anywhere. You can buy specific postpartum panties, but I often find that they're more expensive because they're more niche. So have a look at what's in your budget.
[1:03:27] But big maternity pads may not quite be enough for the first one to two days, especially if you're going to have a lay down for three or four hours and you've had a nap, you might find that your pad starts to overflow. So your best, best friends in the first two days are an incontinence nappy or the mummy postpartum panties. Just get one package of those. About six to eight of those are plenty enough because soon after the first one or two days you could comfortably wear a maternity pad that's plenty to catch the postpartum blood loss.
[1:04:09] So that will happen in the first two days is the flow will be heavy enough that you'll feel like you're filling a maternity pad around every two to three hours. Now what's abnormal is if blood starts like dripping out of your pad and gushing down your leg. There is something called a secondary postpartum hemorrhage where you can actually have a postpartum hemorrhage in the week following your birth. Very uncommon, but it's something to be aware of as you're managing postpartum blood loss expectations. And we typically say if you're filling a pad every hour, that's too much blood loss. Something could be happening. There might be placental pee stuck in there. There might be membranes still left over. You might have issues with the surgical wound. It could be a sign of an infection. And the other thing that we suggest, call your care provider if you're losing lots of blood clots or if those clots are bigger than the size of a golf ball. That's my usual recommendation to my clients is you may pass some blood clots in the early few days, particularly in the days that you're resting. If you're laying back and your uterus is having the usual blood loss that a uterus has after birth.
[1:05:27] And you're laying down and all that blood is pooling in your uterus and then you stand up and then there's a blood clot that's formed and then that can come out and come out instead of gushing as liquid blood it comes out as a blood clot and it might be followed by a little bit of blood if that happens and nothing else happens it's just the blood clot and there's no excessive other blood loss coming this is pretty normal especially if it's no bigger than a golf ball Maybe there's a few golf ball size ones. But if you're passing multiple large, like tennis ball size clots, that seems a little bit too heavy. Could also be normal for you, but worth checking with your care provider.
[1:06:12] It also makes a difference as to the type of birth you had. And maybe if there are placental pieces stuck or still in your uterus, sometimes your body can pass some placental products after birth in blood clots. And once it's done that's all it's going to do but certainly if you feel like there is blood gushing and it feels like and you're actually feeling symptomatic from it if you feel like there's too much blood loss here's what we would do in hospital is we'd lay you down I would recommend getting somewhere laying down with somebody to care for the baby in case you happen to have a very dramatic event find your uterus at your belly button push down towards your spine I'm doing some little actions if you're watching the video, push down towards your spine and then you want to push down towards your vulva and start rubbing.
[1:07:05] You want to find your fundus, the top of your uterus, and as you start rubbing it quite firmly, you'll feel it cramp up. So you can cause your uterus to start cramping by massaging it. It does respond to that. And that can be a short-term solution if you feel like you are having a postpartum hemorrhage is rubbing your uterus to help clamp it down and prevent any further blood loss while you wait and call for help.
[1:07:33] That's not likely to happen to you, but if it does, that's something you can do. And so expect this kind of blood loss on your pads, maybe some clots, maybe not, out for the first few days. And the mama nappies are the best option for managing that postpartum blood loss. Then you can move to maybe just one package of maternity pads and the rest of the blood loss should be sufficient with regular maternity pads. Some women ask me, can I wear like period undies for blood loss, for postpartum blood loss? I wouldn't suggest it for a few reasons. I don't think they're going to hold enough blood for the early blood loss. Many of them are actually black. And so you can't keep an eye on the color, texture, and amount of blood that you're losing. So a visual look is helpful as you assess your blood loss. Also, we don't really know what is in many of those period undies. There's, I don't know the science that goes into those. But just think about how you feel about having that directly applied properly. To your wound if you've got a wound.
[1:08:50] Anyway I would suggest not using period undies I would suggest using pads. You can change them more frequently and obviously there's less washing the pads are disposable. Just if you're environmentally conscious you could make some different choices of course but this is a short period of a time where you may just need to use disposable things but the white pads are kind of important so keep an eye on your blood loss.
[1:09:16] So after the first two days or so, the blood loss should be super manageable and more like a regular period where maybe you only have to change your pad every four to five hours. And then usually by the end of the week, your blood loss significantly drops off. So you will continue to lose blood and it will change color. Sometimes it'll look like a brownie color. Other times it looked like a light yellow color. It'll just transition and change into more sort of an older blood and different kind of discharge. It's not going to be fresh red blood for much longer than the first week, maybe two weeks. After that, it becomes brown and almost non-existent. You still have to wear a pad because there's still discharge, but it's unlikely to be red blood and fresh blood. The only time where you will get fresh blood after that two weeks is usually women start to feel a bit better and they start to become a little more active and on those days where you're more active you'll notice that you bleed more it's your body saying um not yet babe we are not quite ready so if you have a more active day and then you have an increase in your blood loss that's your body saying, whoop, take it back. You did way too much today. It's a nice clear sign that your body's not quite ready yet to be that active.
[1:10:43] But the first two weeks, expect it's okay if the blood is red. It'll start to transition to older, kind of browner blood towards the end. And it shouldn't really smell offensive. It shouldn't have a strong smell. If you do start to smell something strong or offensive in the blood, it could be a uterine infection. So that's possible for women if they've had a cesarean. But also there's a percentage of women, about 10% of women, could experience a uterine infection, depending on how your birth has gone. If you've had lots of vaginal examinations or forceps, you know, if there's been some kind of interventive birth, you're more likely to get a uterine infection.
[1:11:23] All right, that's blood loss expectations. Okay, before I talk about your first wee and your first poo, I want to talk to you about the hungry thirsty part of postpartum. So this is a high demand circumstance. In fact, probably higher demand if I think about it. Higher demand than any other part of your pregnancy is this first two weeks. Not only are you recovering from giving birth you're also healing because there's probably some kind of wound either on your perineum on your abdomen people talk about the placental wound needing to heal where it came off your uterus your body's just on a massive thing you're in a point where you need to heal but you've also got to make milk to feed your baby.
[1:12:14] And you're getting less sleep than you ever did and you're caring for this new baby maybe it's your first time and you have no idea what you're doing so there's this massive mental burden that you're also dealing with and then this huge shift is going on in your relationship and your identity is on the floor with all the balls you just dropped epic this is a huge moment so the main thing that you need to do other than getting as much rest as possible and gathering the village and support network is to make sure your body is nourished with the most nutritious food and liquids that you can find you will feel hungry because your body is screaming for nourishment and you will feel thirsty because your body is trying to make litres and litres of breast milk in the coming days. So.
[1:13:15] Eat nourishing foods, a low sugar, low processed diet. If you eat heavily processed foods during this time, you'll actually further deplete your body because heavily processed foods like cakes, breads, biscuits, sweet stuff, it actually draws nutrients out of your body just to digest and process it. It's not giving you anything except for some short-term satisfaction and a blood sugar spike it's not giving you any nutrients so consider preparing nourishing freezer meals think stodgy comfort food broths lots of nice cooked warm veggies warm breakfasts some nourishing porridge with seeds and all kinds of you know yummy fatty high protein high fruit high veg foods with some good solid animal proteins hopefully if you're a vegetarian think of what you could replace that with.
[1:14:19] But think about nourishing comfort foods and asking the people around you to keep supplying those because you're not in a position to cook nourishing foods. So either pre-prepare them in the freezer that the people around you can then serve you or ask people to please make nourishing meals that just warm your body and soul. And I would also recommend having a constantly full drink bottle right within hand arms reach that'll be the job of the people around you to make sure that your water bottle is always full and that you've got every warm drink any mama could ever want in this moment of your life just keep it flowing and shameless plug I can absolutely recommend the Great Birth Rebellion thermal mugs and drink bottle. When I chose them, I was specifically thinking about how do these two items nourish women, not only midwives who are going to have a constant warm cup of tea or coffee and also be heavily hydrated, but also postpartum mummers. So the Great Birth Rebellion drink bottles are one liter. They've got a straw, great for birth as well. It's a metal straw with a cleaner, so no plastics involved.
[1:15:43] And it's thermal. So if you want to put cold drink in there, it's going to stay cold. And it's one litre, so it runs out less fast.
[1:15:52] And the thermal mug is a, it's so beautiful and heavy and it's like ceramic. So it feels like you're still kind of drinking from a mug, even if it looks like a takeaway cup. Anyway, these two things need to be by your bedside, whether or not they're the Great Birth Rebellion ones is beside the point. But if you want to support the podcast, get those ones, but also just this constant flow of one-handed nourishing snacks and nourishing meals. And there's all kinds of books you can buy. There's, you know, the first 40 days book has got some beautiful recipes for nourishing postpartum meals. But just know that it's going to be a high demand time, at least the first two weeks, where you might not be capable of getting your own meals and you're relying on the people around you. So if you feel like they're not able to do that, see if you can maybe put time aside during your pregnancy to fill your freezer with nourishing postpartum meals.
[1:16:56] All right, the thing you've all been waiting for, your first wee and your first poop. And we, I feel like we're still only at day one or two here. This is still the early days of postpartum. Balls are still well and truly on the floor. Your bum hole might hurt. You could have a sore tailbone. You're possibly quite exhausted. Hopefully you're being fed beautiful food and you may or may not be having an identity crisis. Sister, this is going to pass. It's just a really wild few days. The other possibility is you are so blissed out that you are just loving life, especially if everybody around you is looking after you. This can be the most incredible and blissful time of your whole life and that is what I hope for you that you're being well cared for and that you are just high on the bliss and oxytocin and the dopamine of having your baby that's what I hope for you if it's becoming challenging it could be for one of these reasons that I've already been talking about but the spectrum is huge don't expect that it's going to be horrible but maybe make as many plans as you possibly can gather your village make it as nourishing as possible. All right let's talk about your first wee and your first poo and then I'll catch you in the next episode of the Great Birth Rebellion where I'm going to keep talking about the first two weeks postpartum.
[1:18:25] Let's talk about wee first because that's the very first thing you will need to do postpartum. It's quite possible that during the birth of your baby, you've already done a poo. So you might not expect one of those, maybe for two days or so. But if you didn't poo during your birth, maybe if you had a cesarean section and that whole exit didn't quite occur at your vulva, then you might poo earlier, day one. But we'll get to that first. Let's do wees because after birth, they're going to say, all right, up you get, time to do your first wee. And that first wee, that first wee after giving birth can be quite apprehensive. If you haven't, some of you might have a catheter in if you've had an epidural or a cesarean section. So a whole different ballgame. You don't have to get up to wee and that might not come out till tomorrow. You might have a catheter in. If you don't have a catheter in and you're going to get up and do your own wee.
[1:19:31] Then just know that your pelvic floor has had quite the experience and you might not have the sensation of weeing the same as before it might just be that you have to sit there and there's a little bit of disconnection between your brain and your pelvic floor and you might feel a little bit numb and weird I can't say what it's going to be like for you most women can wee postpartum but it feels a bit weird and different on the first day. That's okay, totally normal. Your pelvic floor is just actually a little bit different because it just got big to let a baby out.
[1:20:05] You might find it more comforting and easy to wee in the shower with water running over your vulva because that means if it's going to be stinging, you've got water running over it already. But if you're sitting on the toilet.
[1:20:20] Definitely wash over your vulva with a glass. If you're in hospital and you're just searching for something and you haven't got your peri bottle and you weren't really prepared, get a jug, a cup, anything, a drink bottle, and use that to just pour water over your vulva while you weep. You can also ask your care provider where any grazes or tears are because if, for example, you've got tears towards the front near your clitoris, then you might find it's more relieving to lean back to wee. So the urine stream will sort of run down and not up near your clitoris. And you might be able to avoid any labial grazes or clitoral grazes by directing the urine stream backwards instead of forwards at the same time pouring water or spraying water over your vulva while you're wee. That's one way of doing it. Alternatively, if there's tears or grazes further back, you might lean forward so that the urine stream runs forward more in line with your clitoris. Hopefully try to avoid rushing urine over labial grazes. But also staying hydrated will make your urine less dilute. Sorry, no, it'll make your urine more dilute, which will make it less stinging. But also pouring the water over it will help it not sting while you're weeing.
[1:21:48] Depending on how severe the grazers are you might have a little bit of stinging on day one and then nothing well you might have stinging the whole two weeks but certainly don't leave the house until you can wee without your spray peri bottle i would have that constantly full next to wherever next to next to you in the bathroom and, After you wee, fill it up and have it ready for the next wee. That's my top tip. The last thing you want to do is get out of bed postpartum, be busting to go to the toilet and then realize that your peri bottle is empty and then you're standing there holding onto your wee with your pelvic floor that might not quite be ready to do that yet. Try to fill up your peri bottle and terrified that if you wee without your peri bottle, it's going to sting. It's a whole thing. It might not be like this, but I'm just giving you, you know, maybe some context for your first wee post-birth. And so just play it by ear. The first day it's going to feel all weird and mushy, maybe.
[1:22:58] And then in the coming days you'll get more control over your pelvic floor again, and you can, and then while you're weeing, wash water over it. That's the top tips. The other thing is is that you might not feel like you have full sensation to even feel that your blood is full that you need to go to the toilet it's happened to me I didn't even have any tears but I remember standing up about 10 days post-birth I stood up and just we started rushing out of me and I thought what is going on and it occurred to me that my bladder was just over full but I didn't notice and then as soon as I stood up my body just let it go that's the only time it happened and I went oh I really have to pay attention to the fact that I might not have full and proper sensation back yet because I'm still recovering from birth all right that is first wee it's a little bit easier to deal with first we's than first poos first poos if I had.
[1:24:07] A dollar for every time a woman expressed that she was a little bit nervous about her first poo, I reckon half, probably half of my clients have been nervous about their first poo. And to all of them, I say, this is the mantra. It's not going to be as bad as you think it is. Trust me, your first poo after birth is not going to be as bad as you think it is. And that's the mantra. When you're getting up to go for your first poo, I want you to take a big breath out and say, it's not going to be as bad as I think it is. Because that's usually, I'm not going to say always, usually women's experience is that they beat it up in their head. They're terrified about pushing something out of their body, like a poo, because they just pushed a baby and a placenta out, and they think, ugh, I do not want to bear down or push anything out for a little bit of time. However, it doesn't matter if you've had a tear or no tear, episiotomy, cesarean section, you have to poo.
[1:25:11] You can't delay it. You shouldn't delay it. It's an essential part of your existence. It's an essential body function. it's got to happen you cannot avoid it so your mantra it's not going to be as bad as you think it is because that's typically women's experiences they beat it up they think it's going to hurt they think it's going to be bad and then they do it and they get oh it's actually completely fine might feel a little bit tender though because your vagina and your bowels your rectum and your your bowels actually quite close together so when the baby is coming out if you have any vaginal birth when the baby's coming out it kind of does great up against the side of your bowel and create a little bit of a bruised feeling but it shouldn't be so bad that you can't poo it's it shouldn't hurt so much that it feels sore to poo it could be tender and just like a little bit bruised, but not so painful that you can't poop.
[1:26:18] That's unusual. So in the first poo, what you might find is that your pelvic floor is quite relaxed. And that if you do any kind of bearing down to push the poo out, it might feel like you're about to push your vagina out. It might feel like you're about to give birth to your vagina. So here's my suggestion for that.
[1:26:43] Before you start pooing water some toilet paper fold it over create a kind of a little toilet paper pad and then put cup that over your labia and vulva as comfortable as you can and apply pressure obviously don't put it over your anus too because that's where the poo's got to come out just cup it over your vulva and over your perineum and then you can breathe out your poo, hopefully it's soft enough that you can just go with the sensation of pooing. As you're pooing, if you feel like you need to bear down, you can hold your vulva up with this toilet paper pad and it creates a little bit of an artificial pelvic floor where you can protect your pelvic floor and support it during those early poo days so you don't feel like you're about to push out your vagina in the first poo after you give birth. That's my top tip. If you're worried, try that a few times. It creates a little bit of awareness about what your body's capable of. And then as your fear and anxieties about the first poo subside, you might find that you don't need to do that again. It's kind of just as you're testing the waters, a little bit of an insurance policy to just ease your fears.
[1:27:58] Now, if you've got no third or fourth degree tears, it's the first or second degree tear or completely intact, you shouldn't have much discomfort in your first poo. You don't have to worry about anything. The more severe tears...
[1:28:15] The third and fourth degree tears, they involve your anal muscle. But sister, you still need to poo. Okay, you can't avoid the poo. In fact, you make it worse for yourself. The longer that you withhold from actually doing a poo, it's going to be harder for you. You should have, when the repair was done, you should have had advice and care from your care team and a physiotherapist at the hospital as to what to expect in the early days from pooing. But certainly, maintain your pain medication so that you can poo comfortably and reduce that apprehension. You might be offered stool softeners to make sure that your poo doesn't become hard so it's easy to pass. Again, a good wholesome diet, lots of fluid, fruit, vegetables, fiber and nourishing foods will make it so that you don't end up constipated. If you feel like doing a poo, go with the urges. don't withhold. So wait till you feel the urge to go to the toilet and then go with it. Don't withhold. Try not to force the poo out. Breathe, relax. You may find it helpful to have a squatty potty like a little footstool to help get in a position that makes it easier to poop.
[1:29:31] And you want to stay hydrated to prevent constipation. So the poo has to happen. It's all about improving your comfort while you do it. Again, if you've had a cesarean section, the pain medications that you might be on could make you prone to constipation. So you may be offered medications that are going to reduce the chances of that because you still have to poo, sister. But it might be a little bit uncomfortable because there could be gas trapped in your belly from the surgery, which is so uncomfortable. And you can get more gassy from the surgery, but also the pain medication. So stool softeners, conscious eating, and that counterpressure from a towel or something to put pressure over the wound if you feel like you need to bear down for your first poo. The first poo will kind of be the mentally hardest one and hopefully not the physically hardest one, but the mentally hardest one. Once you do it, the usual experience for women is, oh, that was not as bad as I thought it was going to be. Okay, sisters, that is about approximately the first and second day post-birth, a little bit of what you can expect. And next week's episode, we're going to continue this topic of the first two weeks postpartum. I'm your host Dr. Melanie Jackson and this has been the Great Birth Rebellion podcast. I will see you in next week's episode.
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