When expecting a baby, it's obviously hard to think about much past D-Day; that is, delivery day. Everything is about getting to and through the birth. After that, it's all kisses and coos, diapers and delight, right? Well, maybe but there are some important things women should learn about before the birth, just in case there's a problem. While baby is always a parent's number one priority, and we understandably do and should focus on that, mom should also look after herself. After all, if mom is not well, or something critical happens, it impacts baby immensely. So learning about some things that can happen to a woman after giving birth can make things safer and better for the whole family.
As part of that, it's important to have a good and open dialogue with the midwife, ob-gyn or family doc that is handling the birth and postpartum care for mom. A woman should feel free to ask a lot of questions at her appointments, and to help with that sometimes late pregnancy spotty memory, she should probably write them down in advance of her appointments. One important question is to find out what number to call depending on the day and time after birth, if any problems should arise. Maybe that ache or pain is nothing, or perhaps it's ER worthy. It's hard for a new mom to know, because she's new at this, and secondly, she probably didn't go to med school.
15 Bladder Or Kidney Infection
Many women know the risks of getting a UTI or urinary tract infection while pregnant, as there is an increased chance of developing one while expecting a baby. However, it's also a postpartum risk and with all the other lovely postpartum body trauma, it may go unnoticed initially. An untreated bladder infection can very easily lead to a much more serious kidney infection, so it's important to pick up on the signs before it gets to that point. Postpartum bladder infections are more likely if a catheter was used.
Symptoms of a bladder infection include pain when urinating and the increased need to urinate. There may be a sense of an inability to completely drain the bladder as well, or bladder spasms which can be painful. If the bladder infection spreads to the kidneys, symptoms may include pain in the lower back or on the side of the body, plus an overall feeling of being unwell. Drinking plenty of water is a definite must. A simple urinalysis will reveal the culprit and treatment will be with antibiotics; orally for bladder infections and intravenously for kidney infections.
14 Epidural Complications
To many women, an epidural is seen as a godsend in labor, but there can be significant risks and downsides, too. Postpartum, these issues can include patchy numbness, and rarely, permanent nerve damage can happen where the catheter was placed in the back. Another rare occurrence is when spinal fluid leaks causing severe headaches. A blood patch must be done where a bit of blood is injected into the spinal space. A number of mothers experience tenderness where the epidural was placed in the back, but it should last only a few days. Other rare complications include an infection at the injection site, which even more rarely can become abscessed and even lead to permanent nerve damage causing paraplegia. Another rare experience is a hematoma or build up of blood at the injection site, which again could lead to nerve damage and paraplegia. These are very unlikely to happen, however.
13 Excessive Bleeding
Sometimes women have trouble with bleeding after birth. It can be a scary moment, but it's usually a simple thing for doctors to get under control. After my first two labors, I experienced some difficulty with this. The doctor kept coming by and pushing onto my uterus and blood would seemingly gush out. It was both quite uncomfortable and disconcerting. Due to this, I was given IV medications to make the uterus contract. It was like a low level labor for awhile, but it did the trick.
However, bleeding after labor is quite normal so it's important to know just how much blood is too much. If you soak a maxi pad in under an hour, for hours, or if bright red blood is passed for 7 days or more, that's an issue. Or if the blood clots are abnormally large, say in the golf ball vicinity, you need to seek medical attention. Blood loss can cause faintness, or a too-fast pulse. Medication, IV treatment and possibly blood transfusions may be required depending on the severity of the situation.
12 Uterine Infection
There are such things as good bacteria, and the uterus has those. But following birth, sometimes the bacteria can cause an infection. This is more likely to happen if there was PROM (not the junior/senior variety formal), or premature rupture of membranes, or if a woman has a c-section, particularly an emergency one. Uterine infections can cause abdominal pain and high fevers. Other causes include prolonged labor, internal monitoring of the baby during labor, or repeated internal exams in labor. It will usually appear within the first few days after birth, and may cause a general unwell feeling, a foul smelling discharge, and loss of appetite. The treatment is usually IV antibiotics. Never should a woman ignore a fever after birth, because left untreated, these infections can be lethal. Doctors often give women antibiotics prior to a cesarean section delivery to prevent infections.
Many people never hear about postpartum pre-eclampsia, which is not good, because while rare, it is quite serious. The definition of postpartum pre-eclampsia is the same as that during pregnancy; high blood pressure and protein in the urine. While it's usually seen in the first couple days following birth, postpartum pre-eclampsia can occur up to 6 weeks following childbirth. The symptoms (if any are present) are the same as in pregnancy; high blood pressure, severe headaches, changes in vision and swelling especially of the face and limbs. Other signs include tummy pain, especially under the ribs on the right side, nausea with or without vomiting, and decreased urination. There may be a sudden weight gain as well. Treatment is required as soon as possible to prevent dire emergencies such as pulmonary edema, seizures or strokes. Treatment will likely be medicines to lower blood pressure and to prevent seizures.
10 Allergic Reaction
Women giving birth may be given medication to hasten labor, provide pain relief during birth, or for relief following birth. Anytime a person takes medicine, there's an inherent risk of an allergic reaction. Some can be severe, or even life-threatening. Even worse, the person may never have had an issue with medications, even the one used with the allergic reaction, before. Signs of a serious allergic reaction include rash, itching and hives, as well as fever and breathlessness.
A person may wheeze, have itchy, watery eyes or dripping nose. True emergency situations will indicate anaphylaxis and include signs such as nausea and stomach cramps, tightening of the throat and airways, vomiting or diarrhea, dizziness and lightheadedness. Ultimately, it will cause a loss of consciousness, drop in blood pressure and either a weak or rapid pulse. Seizures and death are possible. Allergic reactions must be treated quickly with antihistamines or corticosteroids, and for anaphylaxis, epinephrine injections are needed.
9 Stitches Ripping Out
While pregnant patients are typically told not to worry, your stitches will not come out so go ahead and use the bathroom without worry - I can say with assurance, while rare, it is definitely possible. I know; it happened to me. Mind you, there were some mitigating factors, but it is possible for it to happen. If ever a woman feels a pop in the area, has pain, redness or any "unhappy" looking sutures, she should immediately call her physician and find out what to do next. It may be an allergy or infection, but whatever the cause, stitches should become less an issue each day, and should not be getting worse day by day. Stitches that come out cannot be redone due to risk of infection in most cases. However, in large lacerations, sometimes reconstructive surgeries are in order. If ever a woman feels things don't feel right, she should see her doctor and find out what is going on.
8 Infected Sutures
When a woman has stitches as part of childbirth, whether due to tearing of the perineal tissues or an episiotomy, or from a c-section, there is some risk of infection. It's critical to follow after-care directions given by her medical provider and to report any signs of infection immediately. Signs of infection include redness, swelling, warmth at the site and foul smell, as well as pus or an "angry" looking wound. To prevent infection, the wound should be kept clean, dry and for the perineum, a squeeze bottle may be provided to use after going to the washroom to keep the area clean without painful wiping. Sitz baths may provide some relief as well. For treatment of infected sutures, antibiotics will be standard treatment, as well as providing pain relief. Whether the antibiotics will be orally or intravenously delivered will depend on the severity of the situation.
DVT stands for deep vein thrombosis and is when a blood clot forms in the deep veins of the body, usually the legs. DVT is most often seen in just one leg. The risks of DVT following birth are highest in the first couple months after delivering a baby. Symptoms include a sensation much like a pulled leg muscle, tenderness and warmth in the calf area, and swelling. However, should a blood clot travel to the lungs and cause a pulmonary embolism, the symptoms would include atypical breathlessness, chest pain, coughing up blood, and rapid pulse and breathing. DVT needs immediate treatment, and a pulmonary embolism is potentially fatal and requires emergency care. To prevent DVT, a woman should avoid sitting for long periods without moving around, she should exercise safely and wear support stockings if she's been identified as being at risk.
For those not yet familiar with the lingo, mastitis is a breast infection most often affecting breastfeeding mothers. Symptoms include swelling, breast pain, warmth and redness. While most cases occur within the first few months of breastfeeding, they can happen anytime during lactation. After the initial symptoms appear, often a flu-like malaise will happen to those with the infection. Thankfully, these types of infections are easily treated with antibiotics. Also, breastfeeding can almost always continue throughout the treatment of the infection. In fact, it's very important to completely drain breasts during nursing sessions, and vary the breastfeeding position to ensure breasts are drained properly. Pain relievers, warm compresses and showers, and extra fluids to drink are also good measures to take to fight this postpartum breast infection. Extra rest is an important element in recovering, too.
5 Pulmonary Embolism
When a blood clot affects the main artery of the lung, a pulmonary embolism is possible, and such a clot can cause serious complications. In fact, pulmonary embolism is a main killer of pregnant women. Blood clots are more likely during and after pregnancy because nature seems to know that bleeding is a real risk of birth, so the blood is more prone towards clotting in this time in a woman's life. Additionally, there is the added weight of the baby on mom's veins. Other risk factors include surgery recovery or childbirth recovery where a woman is not up and moving around as much. Those with a history of clotting disorders, those diagnosed with pre-eclampsia and women with a history of stillbirths or babies of low birth weight should be watched more closely for PE. Treatment generally consists of taking anti-coagulants to keep blood thin and less likely to clot. Compression stockings and regular exercise are also helpful in preventing PE.
4 Vulva Hematoma
When blood collects in the vulvar region, it is a vulva hematoma. It's caused by trauma during vaginal birth or a poorly done repair of perineal tearing or episiotomy. The blood comes from the deep veins of that area and has no escape, so it pools. It causes pain and swelling, which affects comfortable sitting and toileting. These problems are more likely to occur when instrument deliveries take place, with vacuum extractors or forceps. Symptoms include discoloration of the tissue, pain concentrated on one side, and pressure can be felt when urinating or on the bowels. Rarely, the bleeding can lead to shock if severe enough. To treat the hematoma, an incision is made, the clots removed and the offending blood vessels are tied off. The area is stitched up and a drain is put in initially. Antibiotics are administered and blood transfusions may be necessary.
3 Uterine Prolapse
This is something any woman has concerns about - after all, the reality of it is that the uterus slips down and protrudes into the vagina, either partially, or completely. This means some of the uterus actually sticks out of the vagina. Long, hard labors, giving birth to multiples and having a number of vaginal births are all factors in uterine prolapse. Also, women who give birth to larger babies are more likely to experience prolapse. Symptoms include the feeling of something slipping into the vagina, painful sex and bleeding, as well as difficulty with urination. Treatment can include doing Kegel pelvic exercises, losing weight, stopping smoking, and surgery if necessary. Some severe cases may require hysterectomies, but that's rare. Some cases cause few symptoms, so conservative treatment is all that's needed.
2 Severe Headaches
Troublesome or severe headaches after birth can be attributed to a number of factors or conditions, some simple and some more serious and concerning. One rather unexpected cause is related to breastfeeding. Some women get what is known as lactation headaches, where when oxytocin levels rise with the milk letdown, a headache occurs. Some also get headaches from overly full breasts. Another cause of postpartum headaches is a continuation of migraines a woman may have experienced prior to pregnancy.
If a woman had some relief from the condition during pregnancy, it was likely due to the rise of estrogen during gestation. Once baby is born, and estrogen levels drop to normal levels, the migraines may well return. Spinal headaches can occur when upright after giving birth in the first few days postpartum if a spinal anesthesia was administered. Finally, the most concerning cause of postpartum headaches is pre-eclampsia, a potentially life-threatening condition. Should a woman have an intense headache, she should see her physician as soon as possible to make certain she doesn't have the condition.
1 Postpartum Depression
Stress, anxiety and huge fluctuations in hormones lead to many women having the baby blues in the first few days to few weeks following birth. Crying jags, feeling downcast, edgy and depressed are signs. Once hormones level off, things should return to the new normal. However, for over half a million new moms in the US annually, postpartum depression doesn't consist of mere blues or last just a few weeks. Postpartum depression or PPD affects 11-20% of women giving birth in the US, and is characterized by excessive crying, mood swings, loss of appetite, sleep problems, feeling worthless, hopeless or guilty and intense anger or edginess. Other symptoms include social withdrawal, lack of interest in normal pursuits, inability to concentrate and feelings of being overwhelmed especially with motherhood.
In severe cases, the mother may think of harming herself or her child. Rarer is postpartum psychosis which involves more severe psychological issues such as hallucinations, obsessive thoughts, and paranoia which can become life-threatening. A mother who experiences milder forms of depression more than a few weeks postpartum should speak to her medical provider. It's not a matter to be ashamed by, afraid to get help for, or consider it a mental weakness or moral flaw. It's a medical issue that is treatable. Postpartum psychosis is an emergency situation and requires immediate care. Those around new moms who seem to struggle with these types of issues should provide support and encourage the mother to get help. Recently, Hayden Panettiere discussed her continued treatment for PPD.