the road to recovery

How to help your mind and body heal after childbirth

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Pregnancy was an amazing physical,psychological and emotional journey. After carrying your baby for all that time, then labor and childbirth, your body—and psyche—now must recuperate. Prepare yourself: It may take longer than you think. "You went through nine months of pregnancy, so you can't expect your body to be back to normal after nine hours or even nine days," says Richard H. Schwarz, M.D., vice chairman for clinical services in the OB-GYN department at Maimonides Medical Center in New York City and past president of the American College of Obstetricians and Gynecologists.

So what can you expect mentally and physically during the first few postpartum weeks? Here's a rundown, along with tips on how to cope.

Mood swings

You're a mom! You have a new baby! So why do you feel so blue? Because you're human. "It's normal for new moms to experience some sadness, tears and irritability during the first few days and weeks after giving birth," Schwarz says. In fact, by some estimates, 80 percent of mothers experience postpartum "blues" for up to two weeks after delivery. Is it any wonder? Your hormones are dipping and surging, you're exhausted, and motherhood may be a bigger adjustment than you expected.

What you can do It can't be said enough: You need sleep. Try to nap when the baby does, once a day at a minimum. If you're breastfeeding, consider sleeping with the baby; doing so will leave you less sleep-deprived since you'll get back to sleep faster after feedings. To keep from feeling overwhelmed, accept all offers of help—and don't be shy about asking for it, either. Make every effort to devote a little time to yourself each day; just taking a 15-minute walk may give you the recharge you need.

If you feel depressed, if your mood swings last longer than about two weeks, or if you have feelings of intense guilt or anxiety, call your doctor immediately. True postpartum depression is relatively rare—occurring in about 10 percent of new mothers—but if you're suffering from it, you'll need treatment. This may include care by a psychiatrist and the temporary use of anti-depressants.

Down-under soreness

If you had to have an episiotomy during delivery or if your perineum tore and needed to be stitched, you may find it uncomfortable to sit, walk, urinate or have bowel movements for at least a week after giving birth. "But even if you don't have stitches, your perineum may sting and be bruised or swollen as a result of pushing the baby out," says Sharon Phelan, M.D., an obstetrics and gynecology professor at the University of New Mexico in Albuquerque and an ACOG spokeswoman.

What you can do If you had an episiotomy, your incision should take about 10 days to heal; discomfort from a stitched perineal tear can take up to six weeks to abate, especially if it was a jagged tear. What can you do to ease the discomfort? "Take sitz baths—sit in a few inches of warm water—for a couple of minutes several times a day," Phelan says. Don't soak for more than a few minutes at a time, or you'll risk introducing infection. And don't use soap or bubble bath, as both can be irritating. Also helpful: Use a squirt bottle to rinse your bottom with warm water after you urinate; use ice packs; and, if sitting is very painful, use an inflatable "donut" or horseshoe-shaped nursing pillow to take pressure off your bottom.

Some women also say that soaking cotton balls in witch hazel and placing them on the perineum for a few minutes helps ease discomfort, as does using a Xylocaine spray (although some doctors don't favor such sprays because of the risk of allergic reaction).

Constipation

Constipation is particularly common among women who have had a Cesarean section because the trauma of surgery slows the intestinal contractions that move waste through the system. (Postoperative narcotic pain medications don't help, either.) But even if you delivered vaginally, it's not unusual to go three or four days without a bowel movement, Phelan says.

What you can do Drink a minimum of eight 8-ounce glasses of fluids daily, more if you're breastfeeding. Also load up on raw fruits and vegetables and other high-fiber foods, such as prunes and prune juice. If this doesn't help, ask your doctor to recommend a mild laxative such as milk of magnesia or a fiber additive such as Metamucil; don't use stronger laxatives or suppositories without your doctor's OK.

Hemorrhoids

Hemorrhoids, or swollen blood vessels around the rectum, usually are the result of constipation or prolonged pushing during labor and can last several weeks.

What you can do Sitz baths and ice packs should provide some relief. Also ask your doctor about using a nonprescription product such as Preparation H or Tucks medicated pads. Or try placing cotton balls soaked in witch hazel on your perineum for a few minutes.

Cramps and bleeding

You may feel cramping as your uterus begins to contract and shrink. The site where the placenta was attached also must heal, which can cause bleeding and discharge, often for up to six weeks. Don't use tampons, since they can introduce infection; wear heavy-duty, overnight sanitary pads instead. Postpartum bleeding usually is heavier than a menstrual period, but if you pass large blood clots or soak more than one pad per hour, or if the bleeding seems to be increasing, call your doctor.

What you can do Breastfeed! Doing so increases the production of oxytocin, a hormone that stimulates the uterus to contract; this helps speed its return to normal size and reduces bleeding. If the cramping is extreme, your doctor or midwife may recommend taking an over-the-counter pain medication such as Tylenol or Advil for a few days.

Some people also swear by chamomile tea. "It's caffeine-free and seems to relieve cramping," says Barbara Hughes, C.N.M., F.A.C.N.M., director of Exempla Certified Nurse-Midwives at Saint Joseph Hospital in Denver and a spokeswoman for the American College of Nurse-Midwives. "We give it to our patients when they're in the recovery room and urge them to drink it in the days and weeks following delivery."

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