Baby Makes Three: How to Embrace the New Me!

After giving birth to a bundle of joy, it may surprise some that feeling blue seems all she can do. Everyone is excited that you have given birth, but the first few months can be stressful. Learn about maximising physical recovery, managing emotions and intimacy, family planning, breastfeeding and other common post-partum issues. With a bit of knowledge and support, you are ready to embrace the new ‘me’!

PUERPERIUM The 6 week period after the delivery of the baby during which the reproductive organs return to their pre-pregnant state Completed by 6 weeks after delivery Principles Promote healing and recovery of the reproductive organs Establish successful breastfeeding Promote emotional support

Involution of the Uterus The womb after delivery can weigh up to 1kg but to returns to it’s pre-pregnancy state in 6 weeks and weighs less than 100g (60g). Immediate post-delivery, the womb lies 2 FB below the belly button and within less than 2 weeks it returns to below the pelvis • Return of the size of the uterus to its pre-pregnant state • Acclerated by breastfeeding • After pains • Worst in the first 1-2 days, decreases by day 5 • Managed by • Pain killers • Massage • Consult your doctor if the pains are severe •

Causes of delayed involution • Infection • Retained blood clot or tissue • Non-breastfeeding patients • Fibroids • Caesarean section

• Menstruation can begin again by the 5-6th week in non-breastfeeding ladies

Lochia • Consult your doctor when there is • Persistent bleeding • Foul-smelling lochia • Reverse in pattern • How to care for the lochia? • Change sanitary pads often • Hygiene

How It Works? Milk ejection is initiated in the mother's breast by the act of suckling by the baby. The milk ejection reflex (also called let-down reflex) is not always consistent, especially at first. Once a woman is conditioned to nursing, let-down can be triggered by a variety of stimuli, including the sound of any baby. Even thinking about breastfeeding can stimulate this reflex, causing unwanted leakage, or both breasts may give out milk when an infant is feeding from one breast. However, this and other problems often settle after two weeks of feeding. The release of the hormone oxytocin leads to the milk ejection or let-down reflex. Oxytocin stimulates the muscles surrounding the breast to squeeze out the milk. Breastfeeding mothers describe the sensation differently. Some feel a slight tingling, others feel immense amounts of pressure or slight pain/discomfort, and still others do not feel anything different.

A surge of oxytocin also causes the uterus to contract. During breastfeeding, mothers may feel these contractions as afterpains. These may range from period-like cramps to strong labour-like contractions and can be more severe with second and subsequent babies. • Stimulants • Suckling • Crying baby, Thinking about the baby • Let-down reflex • Worsened by • Stress and anxiety • Cracked nipples • More difficult in first time mothers Benefits of breastfeeding As Easy as ABC… BABY • Allergic condition reduced • Best food for infant • Close relationship with mother • Development of IQ, jaws, mouth MOTHER • Economical • Fitness: quick return to pre-pregnancy body shape • Guards against cancer: breast, ovary, uterus • Hemorrhage (postpartum) reduced

Stretch Marks: Will they ever go away? • Dermal tear • Changes in the elastic supportive tissue beneath the skin • The colour lightens 6-12 months after delivery but the texture remains the same. The Bulge: Diverification of the recti Stretching and weakening of the abdominal muscles and connective tissue in the mid-line Typically the separation of the abdominal muscles will lessen within the first year after childbirth, however it is possible to remain after this time. The weakening of these abdominal muscles may also make it difficult to lift objects, and cause lower back pain. Additional complications can manifest in weakened pelvic alignment, poor posture which can result in chronic back pain Post Pregnancy Physique: I can’t fit into my old clothes!  Water retention  Uterus involution  Looser skin and muscles  Diverification of the recti

Battling with my Bladder: I leak when I cough!

Marked diuresis in the first 12 hr after delivery Rule out UTI Urinary retention - Prolonged labour - - traumatic instrumental delivery - - blood clot in the bladder - - tissue swelling st

Nurses will encourage urination in the 1 6 hours after delivery, failing which catheterisationis started Common complaints -

Frequent urination in small amounts Difficulty in initiating urination ‘Pain’ in passing urine

Possible bladder problems - Urinary stress incontinence - Urinary retention - Painful urination Bowel Problems: Poo-ing in Painful! Constipation is common: -

interruption of a normal diet (fasted) dehydration during labour enema Fear in passing motion for fear of disrupting the stitches Piles, anal fissures decreased muscle tone

The woman is allowed to eat after delivery unless under the effects of general anaesthesia Note that certain laxatives like senna aresecreted in breast milk

The Postnatal Examination 1 week-6 weeks after delivery Assess the patient’s mental and physical health and baby’s progress Urinary symptoms Bowel symptoms Sexual function Review pre-existing medical conditions or pregnancy complications Weight Check on wound healing PAP smear Vaccinations Family planning options

Proper technique of latching Off centre: more of the areola below the nipple in your baby’s mouth Lanolin ointment Regular breastfeeding Good suppprt Cold cabbage leave Put a thin cloth over your breast before applying a frozen wet towel, cold gel or ice packs to your breasts for 10-15 mins to reduce the swelling Gently press onto the swollen part of your breasts using the palm of your hand and move all your fingers in a firm,circular motion Working towards the nipple area. - Increase circulation to the sore area - - Help clear the plugged milk ducts and promote milk flow Surgery to drain pus When will my periods resume? - Breastfeeding Some ladies have no periods for the entire period of lactation Others may resume at 3-4 months - Non-breastfeeding As soon as 5-6 weeks after delivery Caring for my body - Exercise - Go slow, step up and maintain - Get a buddy or trainer - Eat healthy foods and hydrate - Supportive undergarments - Skin: Moisturizers and stretchmark creams - Keep a log book and take pictures

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Additional medical help Thermage, Vaser. Surgery if severe

Caring for your bladder -

Hydrate Don’t hold your bladder Hygiene Pelvic floor exercises Consult a doctor Pain on passing urine Persistent stress incontinence after 3 month’s of pelvic floor exercises

KEGEL’S Pelvic Floor Exercises Many pregnant moms experience not making it the bathroom in time, or laughing a little too hard when baby is sitting on your bladder, but many don’t expect the problem to continue after delivery. Postpartum incontinence is quite common, since pelvic floor muscles are very strained during delivery. This will usually resolve in the first few weeks, and you can speed it along by maintaining a strong pelvic floor with pelvic floor exercises during pregnancy and starting Kegal’s exercises immediately after delivery Tone up the muscles of the pelvic floor First, as you are sitting or lying down, try to contract the muscles you would use to stop urinating. You should feel your pelvic muscles squeezing your anus and urethra If your stomach or buttock muscle tighten, you are not exercising the right muscle. Once you learn how to do them, do not practice Kegel exercises at the same time you are urinating more than twice a month. Doing the exercises while you are urinating can weaken your pelvic floor muscles over time. In women, doing Kegel exercises incorrectly or with too much force may cause vaginal muscles to tighten too much. This can cause pain during sexual intercourse. Incontinence will return if you stop doing these exercises.

It may take several months for your incontinence to lessen once you start doing these exercises. Fast: Squeeze and relax, Repeat 10 x Slow: Squeeze and hold for 5-10 sec. Then relax for 10 sec. Repeat 10 x Caring for your bowels -

Keep well-hydrated Allow diet after delivery Fruits and vegetables Mild laxatives (an enema if severe) Painkillers Piles Medication Surgery

Caring for your episiotomy wound -

Clean frequently Keep it dry Avoid squatting and constipationn Sutures drop off after 1-2 weeks Complete healing in 2 weeks Mild analgesics may be needed Sitz bath Post natal ring or toy float (if cannot sit)

Caring for your cesarean section wound - Pain-killers - Antibiotics - Keep the dressing dry and clean - Consider a binder - Anti-scarring creams - See your doctor if - Severe pain - Pus - Fever

Caring for my mental well-being - Supportive family members or friends - Do not isolate yourself - Eat regular healthy meals - Avoid alcohol and caffeine - Exercise - Reduce stressors - Time out! - Seek help! - Counseling - Medication Ask for Help Friends and family members often want to help with new babies. Ask for help with housekeeping and cooking. Let adults you trust rock or walk the baby or change a diaper. Don’t feel you have to do it all yourself. Exercising as little as 10 minutes a day can make you feel better. Try to make exercise part of your daily routine. Stress can make depression worse. Can you remove any sources of stress in your life, even for a little while? Give yourself a break! Don’t put pressure on yourself by trying to keep everything “perfect.” Try to go to bed and get up around the same time every day and develop relaxing bedtime rituals, such as reading or having a warm bath. Talk to other mothers and consider joining a support group. Make time for yourself and for activities you enjoy, even if you don’t feel like making the effort. CONFINEMENT An Asian concept Chinese 30 days Malay 44 days Indians 40 days New mother’s need for additional care and surveillance in the immediate post-partum period. Aims to speed up recovery of the mother and prevent ‘complications’ in the older age. FAMILY PLANNING Having a baby? Many different methods Depends on Breastfeeding Lifestyle choices Mode of delivery of birth control

Planning for the next one… Vaginal delivery Sex can be resumed after 1 month after The bleeding has stopped The stitches have healed Caesarean section Waiting >6 months after the operation may increase the chances of a vaginal delivery in the next pregnancy.