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CLAUDINE M. SYLVESTER, M.D., FACOG
West Essex Ob-Gyn Associates, P.A.,Verona
A woman may experience many physical discomforts after childbirth.
Some last days while others continue throughout the first
few months.
Many women find themselves constipated after delivery. Surgery
and pain medicine can slow down the bowels. Narcotic pain
medication should be limited to reduce constipation. To help,
stool softeners can be taken in the hospital and then continued
at home. Walking around as soon as possible will help to
get the bowels moving again. Eating foods high in fiber and
drinking plenty of water will help bowel movements resume
regularity. If unable to have a bowel movement at least every
other day, a physician should be contacted.
Hemorrhoids are a common complication of pregnancy. Straining
with pushing during delivery can worsen hemorrhoids. Medicated
anesthetic sprays or ointments found in a local pharmacy
can help alleviate symptoms. Ointments with cortisone will
decrease the swelling. Sitz baths and cold witch hazel compresses
provide temporary relief.
Within a few months after delivery, most hemorrhoids will
get smaller or go away.
Giving birth can cause a variety of urinary symptoms. Some
women may feel the urge to urinate but can’t go when
they try. Some may feel pain and burning when they do go.
Because the baby’s head/body puts pressure on the bladder,
urethra and the pelvic muscles, they can get stretched and
swollen. Warm sitz baths can be used to decrease the swelling.
Using a squeeze bottle with warm water to spray the genital
region and can trigger the flow of urine.
Some women may have issues with urinary incontinence. In
most cases, the tone of the pelvic muscles will return with
time and the problem will go away. Doing Kegel exercises will
help tighten these muscles. The easiest way to do Kegels is
to attempt to hold the flow of urine while voiding. Do this
for five seconds and then continue voiding. This should be
done approximately three or four times with each void. At
first this may seem difficult. After a few days the correct
muscles to contract are easier to identify. Then Kegels can
be done throughout the day (not just when voiding). Pilates
exercises are also an excellent way to strengthen the pelvic
muscles. An improvement should be apparent after the first
four to six weeks.
Lacerations or abrasions on the labia or outer vagina may
need to be coated with ointment or with premarin vaginal cream
(to be prescribed by your physician). This will decrease burning
during urination.
Women will experience afterbirth pains following delivery.
This is when the uterus contracts and relaxes as it shrinks
back to its normal size. They usually go away in a few days.
Ibuprofen is very effective in reducing these cramps. Pain
after a vaginal delivery is usually related to the perineum.
The perineum is the space between the vagina and rectum. At
first it usually feels numb. Then it can feel swollen and
bruised. Cold packs right after delivery help to reduce the
swelling and provide some pain relief. Chilled witch hazel
pads also help.
A numbing spray or cream may be used after discussion with
the physician. Taking sitz baths in warm water or using a
warm squeeze bottle over this area can be very soothing.
After a cesarean delivery the abdominal incision can be
tender. This pain can be exacerbated by gas and constipation,
which can be partially relieved by walking around. Using ibuprofen
(Motrin®)
and acetaminophen (Tylenol®) after delivery is often effective
in relieving a woman’s pain. Often times she may need
a mild narcotic to aid in the first few weeks of recovery.
This should be discussed with the physician.
Women’s breasts will engorge with milk about two to
four days after delivery. For women who are not breastfeeding
this engorgement can be quite painful but should not last
more than two days. Helpful hints during this time period
include: wear a tight-fitting support bra or chest binder;
do not express any milk (pumping or breast feeding) as this
may provide temporary relief but will signal the breasts to
make more milk; apply ice packs to the breasts to reduce swelling;
and take pain medication when needed. Chilled cabbage leaves
can also be placed around the breasts to help sooth them.
For women who are breastfeeding it may take some time to
avoid the discomforts of breast engorgement. It is important
to establish a schedule of breastfeeding. Once the body recognizes
the feeding pattern it will adjust and the discomfort will
resolve. During the adjustment period a women may run low
fevers. If her temperature exceeds 101 degrees Fahrenheit,
she should call her doctor. The adjustment period usually
takes one to two weeks. If the engorgement is preventing the
baby from latching on, some milk can be expressed by hand
or with a pump to soften the breast just prior to feeding.
Using warm compresses and gentle massage just before nursing
helps to improve milk flow.
It is common in the first few weeks of breastfeeding to experience
sore nipples. Lactation specialists can help to teach proper
nursing techniques to reduce this. Patting the nipples dry
after feeding and cleaning them with a clean cloth can help.
Cotton bra pads are recommended. It is important to change
them when wet. Avoid harsh soaps or perfumes on the breasts.
If a woman has cracked, itchy, red, and burning nipples
she should check the baby for thrush. Thrush is a yeast infection
in the baby’s mouth. The baby will have white patches
in its mouth and usually diaper rash. If thrush is suspected
it is important to get both the mother and baby treated by
the appropriate physicians.
When breastfeeding, it is not uncommon to experience blocked
ducts. If a duct gets clogged with unused milk, a hard and
often tender nodule may form in the breast.
Breastfeeding should be continued from this breast (starting
with this side when feeding). Warm compresses or warm showers
before nursing will help. Massaging this lump while the baby
nurses can also help to unclog the duct. If a blocked duct
does not drain, it can become inflamed and infected. This
is called mastitis. Signs of mastitis are swollen, painful
breasts with red streaks. The breast usually feels hot to
the touch. Women with mastitis usually have fevers and feel
like they are coming down with the flu. Mastitis can be treated
with antibiotics prescribed by the obstetrician. It is important
for women to complete the full amount of antibiotic medication.
During this time it is essential to stay well hydrated and
continue breastfeeding. If nursing is stopped the plugged
duct will get even more inflamed and recovery will take longer.
It is important to understand the baby cannot catch the infection.
By the second month after delivery a woman should feel her
body returning towards its normal state. Any complications
lasting longer than this should be discussed with her physician.
To find an OB/GYN, please call the Saint Barnabas Physician
Referral Service at 1-888-SBHS-123
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