*This content is for general informational and educational purposes only. It is not medical advice, diagnosis, treatment, or a substitute for professional care*You’re nervous and anxious and WHAT THE HECK IS HAPPENING TO YOUR BODY!?
There are plenty of physical and mental shifts during the early stages of postpartum that are very weird and unfamiliar but are somewhat normal and unconcerning. There are some, however, that can be potentially very dangerous. Here’s my biggest advice, coming from an active-licensed, maternity specialized, postpartum nurse (doula hat off and Nurse hat ON) with 15 years of Mother-baby bedside experience (I’ve taken care of thousands of new moms!):
Advice:
If your intuition is telling you that you need to call your doctor or midwife about a symptom, you should always listen to that. As No Doubt sings “I’m just a girl in the world…”, I’m not your medical provider, so please defer to them and their advice, especially if you’ve been given a different set of ‘norms’ outside of the traditional range.
But let’s chat about the ones that you definitely want to call about.
When to call your Provider:
Blood pressure- PRE-ECLAMPSIA- This one is so serious. Life threatening if it gets out of control. Do you remember the episode in Downton Abbey when Lady Sybil heartbreakingly dies after giving birth? That was pre-eclampsia ( that turned into Eclampsia- seizures). How many mothers were lost in past days before we even knew what this was? I’m sure too many. This is a condition that will generally show up within the first few days after birth if it’s going to, but you need to keep an eye out for at least 6 weeks postpartum.
Usually, a mother has a higher potential to experience pre-eclampsia in her postpartum time if she had high blood pressure during her pregnancy or has a history of chronic high blood pressure. These mothers will already be watched closely to mitigate danger. But, even if you’ve never had blood pressure issues in your life or pregnancy, postpartum can weirdly shift the body which creates a small chance (about 1%) that you may experience high blood pressure during this time.
What to look for and When to Call:
Blurry or spotty vision- this is new from your baseline, you’ve got floaters, just generally more blurry or light sensitive.
Rough Headaches that won’t go away with a tylenol and a nap. Make sure to hydrate and eat well to avoid dehydration headaches.
Pain by your liver (put your right hand right under your ribs on your right side)- The pain occurs because the liver swells from reduced blood flow and inflammation, stretching its sensitive outer capsule.
Sudden increased swelling in your face and hands or rapid weight gain from fluid retention- postpartum swelling isn’t abnormal, but the sudden shift can be concerning especially if you had noticed it already decreasing. Normal swelling will generally be more noticeable in the legs and lower body, particularly at the end of a long day- not the face and hands as much.
Also, nausea and vomiting, shortness of breath, decreased urination, and SEIZURES (call 911).
Heavy Bleeding- vaginal bleeding will be normal! Also, expect it to be different than your menstrual periods (if you experience traditional 24-38 day cycles that last a few days). You will most likely experience ‘some’ kind of vaginal discharge for up to 6 weeks.
What to look for
Lochia Rubra- first several days (can be up to day 7ish). Your blood is bright red to dark red and on the heavier side. You may soak a large pad every 2-3 hours and experience some small clots. You may feel some abdominal cramping when you breastfeed or pump which can stimulate some blood gushes (it’s a beautiful symbiotic relationship with your baby! The breastfeeding hormones stimulate the uterus to tighten and squeeze smaller, contracting blood vessels which helps to prevent hemorrhaging and shrink the uterus back to normal size). This is normal, unless your bleeding gets this heavy —> WARNING- if you start soaking a pad every hour or passing clots larger than an egg- Call your DOC.
Lochia Serosa- from day 4 or later ( could be closer to day 7) till about 2ish weeks. This is much pinker —> brown in color. Thinner consistency than before with occasional small clots and gushes when you do big movements or breastfeed/pump.
Lochia Alba- around day 10-14ish lasting for many weeks. This is going to be pale, creamy, yellowish-whitish. This is made of white blood cells, leftover tissue moving out of the uterus and mucus. You’ll probably only need panty liners at this point.
At some point around 1-2 weeks, you may experience a moment of bright red bleeding again. This is caused when the scab that has healed over the large placental wound (think dinner plate sized wound on the wall of your uterus from when the placenta detached). There may be a slight increase in blood volume, but you should still not be soaking a pad in less than an hour or passing egg sized clots.
Other thangs- Call your DOC if —> your discharge smells foul (we’re talkin’ infection here), you have a fever, a big jump in pain, dizziness or lightheadedness, racey heartbeat, shortness of breath, chest pain, or sudden dramatic increase in blood flow on your pad.
Infection- If you’ve experienced a Cesearean section (a significant vaginal tear should also be watched for signs of poor healing) then you’ll want to make sure you’re aware of the the signs of infection as your wound heals. This incision (or vaginal tear) tear should be looked at at least once a day by the same person (you or your partner or your momma… ) for consistency to notice changes.
Taking care of the Incision- confirm with your provider first in case you’re special, but generally these rules apply. Your abdominal dressing should be off by the time you leave the hospital with either steri-strips (little tape bits), staples or superglue holding your skin together. Usually, it is just fine to shower and let soap and water rinse over this area, but Don’t scrub it. Once you’re out of the shower, pat dry and refrain from using any lotions or powders on the incision area (until the doc says it’s healed enough for scar creams or moisturizer). Also, refrain from picking at the steri-strips… they will fall off when they’re ready (several days to a week or so). If your underwear are rubbing against the sensitive area, you can rest a horizontal panty liner along as a barrier from your underwear, but Don’t tape it or seal any dressings over the incision. It needs to air dry versus stay damp (we don’t want a breeding ground for bacteria). If you have staples, they will be removed by your doctor when the skin is healed.
Signs of Infection- keep an eye on that incision every day to notice changes before they become big deals. An infected incision is definitely No Bueno. After surgery, the lower bikini area may be a bit bruised, sore (could be VERY bothersome honestly), or have a burning sensation (from the cut nerves). As days go on, you’ll want to notice changes in color- redness. New redness around the site can indicate infection or inflammation. Separation in the edges- you don’t want the stitched incision line to be separating apart (called dehiscing- yipes). When there is separation, sometimes the incision can ooze and smell- be aware of foul smelling drainage (definitely not a good sign) or bleeding from the site. Swelling around the edges- the skin should be settling in more and not getting more inflamed. Fever (over 100.4 F)- this is never a good sign during postpartum, especially if you have pre-existing wounds. These are all Call your Doc if you haves.
Postpartum Depression- This is a big one that’s finally starting to gain some traction and lose a bit of its taboo.. For some reason it’s so much easier to talk about any conditions concerning any body organs other than the brain. We get all awkward and squirrely when we talk about mental health imbalances- somehow they’re not on the same plane as heart or gallbladder conditions. But the brain can experience some serious mental gymnastics during postpartum. This timeframe has a depth and drastic nature that can culminate in a storm of depression (PPD) or anxiety (PPA)- but it’s not always from what we think. The first few weeks you may feel tearful and cry for no reason, this is usually called baby blues and isn’t technically considered postpartum depression, but you may still feel vulnerable. The factors I list below that attribute to postpartum depression also contribute to baby blues, as well as I’m sure many other factors not listed below. Postpartum depression may take months to really set in, or it may bypass you completely. Just make sure your partner or loved ones know what to be looking for and how to support you best in mitigating these scenarios.
Factors in PPD- Let’s look at the glaring contributors first. Sleep- when in your life do you ever choose to wake up 3+ times a night for at least a half hour, every night, for months on end. Raise your hand if you’re crabby the next day after ONE poor night of sleep while consuming caffeine like it’s a lifeline. However, now you have limits on your stimulant consumption. So, Sleep is poor and Stimulation is in the toilet. Strike 1. When our placenta is birthed right after the baby, your body experiences the single largest, most rapid hormone shift of your life. Plop- there those hormones go in one fell swoop. But to add to the hormonal chaos, your body keeps shifting hormones as your breastmilk comes in over the next several days to weeks. Lots of SHIFTING. Ebbing and Flowing. This is a far cry from puberty or just your monthly cycle, so we are often aghast at how unfamiliar these moods are. Strike 2. Nutrition- So we’re caring for a new sweet, helpless infant and definitely not prioritizing our own nutrition. Our bodies are working overtime to make the richest quality breastmilk to feed this little human, but often at the expense of leeching our own minerals lodged in our bones and teeth and skin. Unless we’re really nourishing ourselves, our bodies will physically feel the drain and imbalance of improper nourishment and deep mineral depletion. Ever get those bouncy restless legs at night that keep you from sleeping? Often, that can be from a magnesium deficiency.. Imagine those kind of deficiencies minutely all over our body.. maybe we’re not physically twitching, but maybe we kinda are. Strike 3. This next one takes me back to Maryland in 2004 when the Cicada Brood X emerged in the millions from underground. They were EVERYWHERE. Then, their shells were everywhere. These perfect crustacean-like pods that looked just like them but had no life anymore. You may wonder why they left a perfectly good house behind on the tree bark? This to me is strike 4 for postpartum mothers. After we birth a baby, society expects us to fit back into our old selves, get our flow again and keep on truckin’. Except we left our shell in that delivery space. It’s no use to us anymore. We have been birthed anew, new skin, a new purpose. We take up a bigger space (maybe literally, but also metaphorically) and we feel uncomfortable fitting back into that old shell. But we’re told we need to and that if we don’t, we’re broken and have a ‘problem’ and should start taking pharmaceuticals to fix it. I’m not knocking meds ( they are life-saving sometimes!), but what I am knocking is the idea that this discomfort in our ‘new skin’ is a ‘problem’. This should be celebrated as a rite of passage, the molting of the old, the embracing of a new shape, the support to be bigger than we ever were before. But we as women have even reached a state where we gaslight ourselves into thinking these feelings are wrong and we’re broken. Really, we are just so disconnected from our own spirit and intuition that we don’t recognize this new self and THAT is VERY disconcerting indeed. This postpartum window necessitates community with other women and mothers. This could be found with your neighbor, with a local breastfeeding support group, new momma yoga, relationship with your therapist or doctor or a new appointment with a behavioral health specialist. These are all important relationships that take supportive steps to mitigate or manage these new feelings. Please be open and share how you’re actually feeling so help can reach you before your wits end.
Sometimes, your brain can create other scenarios that are really ramped and fearful but trend more towards the anxious side (PPA). These brain scenarios can take the shape of envisioning every bad thing happening to your newborn with potentially you as the instigator. I didn’t realize I personally had postpartum anxiety with my first daughter till a year later… imagining tripping down the stairs and my baby flying out of my hands, walking around corners and nailing her head on the wall etc.. PPA is different than PPD, but they both require deep rest, grounding and nourishment, someone to listen and support and sometimes many calls to your provider for safekeeping.
**Insert Uncomfortable moment here- another important aspect to mention here is the potential substance use during this time for mothers. Sometimes the stress can feel so big that the only thing that seems like it might help is a glass of wine at dinner or the leftover oxy pills from your c-section. If this is used as a regular coping technique, the slope often starts to slip and mothers find themselves sliding quickly. A scoping review of perinatal substance use and perinatal depression/anxiety found a consistent bidirectional association: substance use increases the likelihood of depression and anxiety AND higher severity of depression/anxiety increases the risk of substance use. A lot of these substances can have rebound effects as well (you feel anxious, so you drink the alcohol to dim the feelings but then when it wears off the anxiety rebounds back *sometimes worse because you’re more disregulated). Unintentional drug overdose is the leading cause of maternal death in Colorado (we’ve made it through childbirth, we can’t let the pills take us now!!). Please reach out to a provider or doula you trust for some safer coping resources. Another option is the Postpartum Support International Hotline (NOT a crisis line). You can call 1-800-944-4773 to talk to a real person with encouragement and local resources. You can also text “Help” to the same number (for English) or 971-203-7773 for Spanish assistance.
When to call the DOC- If at any point you have feelings or ideas or plans of hurting yourself or your baby, or any other person for that matter, it’s time to call 911 and your provider. Hopefully, your providers have been checking in along the way, and you’ve been comfortable sharing the actual state of your mental health, but sometimes you need to be willing to strongly advocate for yourself. Sometimes it requires changing to a new provider that will Listen to you. Be open with your partner, a close friend, a mom’s group or a therapist so you know you have people in your corner who love you and support you as well. You may have precipitating factors that aren’t listed above, but remember…you are NOT crazy, you are just experiencing the SHIFT. Have grace and love for yourself as your transition. This is an excellent reason to hire a postpartum doula.
Mastitis (Mast- breast/mammary gland, itis- inflammation): Ever got hit by a truck while you had the flu? That’s mastitis for you- a range of conditions related to milk duct narrowing and inflammation of the breast tissue. It is occasionally linked with infection in the milk ducts or the surrounding tissue. Some mothers are prone to mastitis and get it with every newborn while others have never experienced it. It’s not something you want on your bucket list, we’ll say that. There can be many factors that contribute to a higher likelihood of mastitis and most are modifiable, let’s get into it.
Deeper dive of the Risk Factors:
Oversupply- This is a big one! Sometimes we can induce an oversupply because we don’t understand the science of making milk. Milk production is a Supply and Demand process- the more milk removed from the breast, the more the little dairy maids make. For instance, your baby is full but you still have a lot leftover and you pump all the rest out. Now your body believes that you are using all that milk and it quickly hops to making more, thereby precipitating your predicament. It’s a balance of removing just enough to decrease discomfort and prevent inflammation without creating a cycle where you have to pump and remove to keep up with your body’s ever-increasing milk supply (unless that’s what your baby is actually needing and demanding). Chat with your lactation consultant to set up a good plan for milk removal to help mitigate over-production.
Poor Drainage- A major contributing factor is leaving milk sitting in the milk ducts fo too long. This could be a result of oversupply- producing more milk than your baby can consume, ineffective latch that may be related to mouth mechanics or tongue restrictions, abrupt feeding schedule changes (missed a feed, slept longer at night, weaning), poor flange fit, or sleepy baby that does not drain the breast well or ends the feed before being done. This can result in the increase of pressure inside the breast tissue and its ductwork. High pressure can strain the cell wall junctions causing weakness and leaking of milk components into surrounding tissue which then can result in a body response inflammatory cascade. Body Alert, we’ve got a dairy breach! This puts further pressure on the milk ducts causing them to narrow even more due to poor milk flow and inflammation and the vicious cycle leads to mastitis. The leftover rich milk can then be a snack for opportunistic bacteria to start growing an infection.
Microbial Factors/Dysbiosis- Dysbiosis is a change in the internal, breast microbiome (the bacterial playground with kids of all sorts) that contributes to a narrowing of the mammary ducts. This occurs because of a change in bacterial diversity, decrease in anti-inflammatory organisms, and an increase in pathogenic bacteria (the good kids are home sick, the teachers have gone on break and the bullies are taking over the slide). We naturally have certain bacteria that create a biofilm that lines the inner walls of the milk ducts to help support healthy milk flow (biological slip n’ slide). If a shift in this opportunistic bacteria occurs, then they can rapidly multiply and create a much thicker film thereby creating a narrowing in the milk duct possibly resulting in poor drainage (see above for those complications). “The lactating breast is a dynamic gland that responds to internal and external hormonal stimulation”, says the Academy of Breastfeeding Medicine.
Other potential factors: Fatigue, stress, anemia, recent antibiotics (which can disrupt the milk microbiome balance), primiparity (first-time birthing), cesarean birth (often results in a later start to breastfeeding plus more antibiotics etc), or anatomical issues (like, inverted nipples). Nipple damage can be considered more of an association factor instead of a mastitis cause. Sometimes it’s the ‘canary in the coal mine’ for the shifting factors inside the breast. If the latch is poor resulting in damage to the nipples, then milk drainage may be less efficient, resulting in inflammation and dysbiosis in the breast. Smoking and certain systemic conditions can also play a role in some cases.
What to do- Mastitis can often be managed at home and resolve with self care. Really good rest is soo important during this postpartum stage. Inflammation in the body needs sleep and nourishment. So tuck in bed and have your doula bring you some soup. An ongoing relationship with a lactation consultant can also be huge if you know you have some risk-factors. The milk- making journey can shift and change so much over those first few weeks and months that having a professional, familiar with your baseline, can offer so much relief. An ounce of prevention… Reach out if you need some great LC recommendations. Also, these supportive measures can be extremely helpful:
Keep breastfeeding, mastitis is not contagious or harmful to the baby
Minimize pump use
Wear a supportive (not tight) bra
Avoid deep breast massage (this just aggravates the already existing inflammation) and compression, or any devices
Ice breasts or affected area for 15-20 minutes several times a day
Alternate use of Ibuprofen and Tylenol
Chest opening stretches like clasping hands behind your back or laying on a foam roller and doing slow snow angels
When to call the Doc: Give a call if there is no improvement in symptoms within 24-48 hours after implementing the above recommendations. Remember that niggling intuition? If you feel that there is just something “not right”, it’s better to call and get ahead of mastitis before you fall into the pit of despair (Princess Bride anyone? Westley had his own breast pump torture in that forest dungeon). But otherwise, watch out for these symptoms independently or together- red wedge shaped area that is hot, tender, and firm; fever (over 100.4 F), flu-like symptoms (body aches and chills, hit-by-the-truck feeling), pus or blood draining from the nipple, increased pain, hard painful lump in the breast tissue, dizziness, or shiny stretched skin over the hard lump. Ignoring these symptoms will not make them go away, but potentially further them to abscess or sepsis.
Other Thangs: Just some other thoughts to consider and check in with your provider about…
Heaviness in your pelvic area- could be prolapse or a weak/contracted pelvic floor. Pelvic PT is incredibly supportive in postpartum regardless of your type of birth or birthing experience.
Extreme fatigue that’s not improving.
Difficulty emptying your bladder or feeling urges to pee but only peeing a little- keeping the bladder empty is also important to help mitigate uterine bleeding. It’s all connected babes.
Red, painful, hot spot on your leg (usually just one leg)- could be a blot clot (DVT). There is much higher risk during postpartum because your blood clots easier at this time and you’re moving your body less ( ‘We got to move it move it’ as they sing repetitively on the Madagascar movie). These blood clots can break off and travel up to the lungs to cause a pulmonary embolism which is a BIG DEAL. Chat with your doctor to see if you have the cofactors that put you at higher risk.
My purpose of writing this is not to scare you about the murky wiles of postpartum, but to educate you. I love being informed and a topic as big of a deal as birth and childrearing, I feel we need to know how to prepare ourselves so we can have our best experience. Knowledge is power, and in our world these days, sometimes we need to be our best advocate with that knowledge. We do need to know things, because others might not. Then we can also be supporters for other mothers on their learning journey as well. We can let these potentials terrify us; or they can fortify us because now we can prepare, be wise, ask for help, and prevent some serious nastiness from reaping our sacred postpartum window out from under us. This way, our attention can go where it wants to spend its time- on our sweet little newborn and our nourishment and rest. In your preparation, allow yourself to consider the possibility of how a postpartum doula may help… you may be surprised how much it rings true in your bones.
This blog article was peer-reviewed and contributed to by multiple, actively-working, experienced RN’s:
Erin Massey RN, IBCLC
The Lactation Connection (thelactationco.com)
and others.
*Please, do not disregard or delay seeking professional medical advice because of something you read here*
