The moment a child is born, the mother is also born. She never existed before. The woman existed, but the mother, never. A mother is something absolutely new.– Bhagwan Shree Rajneesh
I have been a labor, delivery, and postpartum nurse for nearly 10 years (not sure how that’s even possible) and have seen thousands of births. I am aware of so many of the “happenings” of postpartum however until I experienced it myself did I realize – there were some things that happened during that fourth trimester that even I didn’t know! While there is so much information out there I find that often times we are not as honest with new moms as we should be. Some may see this information as overwhelming or frightening however I think the more you know entering this time period – the more likely you’ll be able to enjoy all the little moments instead of worrying about what is happening to your body. I’m here to keep it real and tell you the things that no one talks about when it comes to the fourth trimester!
1.) The sweats & body odor– my oh my! This was the one thing I was really caught off guard by and no one ever told me I’d wake up soaking my clothes, sheets, and hair! Not only are you sweating, but the body odor is so REAL! Thankfully this really only lasts for a few days to weeks after your baby is born. After birth your body undergoes major hormone shifts. During pregnancy your estrogen and progesterone levels are super high and once baby is born those hormone levels basically plummet. These sweats can sometimes be worse in mamas who are breastfeeding because prolactin (hormone responsible for milk production) levels will be higher which lowers estrogen even more and induces night sweats! After birth there are also major fluid shifts so you may find you’re not only sweating a ton, but peeing a ton too! So what can we do to help?
- Stay hydrated – if you’ve been following along here a while you know I’m going to say 10-12 glasses of water a day while pregnant, postpartum, and breastfeeding! This can help mama stay hydrated and can actually help lessen the intensity of the sweats!
- Line your bed- I am always sending patients home with pregnancy puppy pads as I call them which are basically thin absorbing pads that can be placed in between your bottom sheet and mattress or a mattress liner to protect the mattress. These are helpful directly underneath you as well in those early days at home when bleeding may still be quite heavy.
- Stay cool – wearing breathable and lighter clothing while sleeping and possibly adding a fan or turning on the air conditioner can drastically help the sweats
- Frequent pee breaks – don’t forget to empty your bladder frequently during the postpartum period as this can help remind the uterus to clamp down and prevent bleeding, but also help the body get rid of excess fluids
- Extra clothes – having an extra set of clothes by your bedside can make a whole lot easier to just change into before one of those middle of the night feeds and keep you feeling fresh.
- Shower often – I found myself doing more “body showers” in that postpartum period than ever in my life and this helped me feel so much better!
2.) Bleeding for weeks – one thing I find so many moms caught off guard by is that they will bleed for about 6 weeks after birth! Most often mamas who have had a cesarean birth are confused by this as they often believe they won’t bleed like a mama who has had a vaginal birth. Postpartum bleeding is called lochia and is a combination of mucous, tissue and blood that your womb sheds as it replaces its lining after you’ve given birth. Bleeding will progress and be considered “normal” as seen below.
So what isn’t normal? If you experience any of the following please call your provider ASAP
- Bleeding that worsens after 4 days postpartum
- Clots larger than a golf ball or saturating a pad an hour
- Bleeding associated with dizziness, blurred vision, rapid heart rate, nausea/vomiting, chills
- Foul smelling vaginal discharge
3.) The shakes – oftentimes during or after delivery mamas will experience uncontrollable shaking, shivering, or trembling and I am often asked through chattering teeth “is this normal?” The answer is yes! Labor and postpartum shakes can be chalked up to major hormone and fluid shifts, adrenaline, temperature changes, and certain medications! Some mamas start to experience shaking after epidural placement or once they reach that transitional labor phase, and some may experience nausea and vomiting accompanied with the shakes. Typically when mamas experience the shakes there isn’t much we can do to stop it but we may use warm blankets or warm IV fluids to help ease them a bit. However I always say this usually only occurs in the time surrounding birth so if you experience chills or shaking in the days after birth you would certainly want to mention to your care provider!
4.) You will still look pregnant after baby is born – this is a big one! So many mamas get out of bed the first time after delivering, look down at their belly, back up at me and say.. what the…? Your pre-pregnancy uterus is the size of a pear and throughout your pregnancy will grow to the size of a watermelon! It took you 9 months to grow this beautiful little human, please give yourself grace and understand it make take quite a bit of time for your body to return back to pre-pregnancy status! Leave those pre-baby jeans at home and throw some loose fitting clothing into that hospital bag so you can be comfortable! Click here to see what else should be in your hospital bag and download your free hospital bag checklist!
5.) Swelling– I find so many mamas are caught off guard with how much their body swells AFTER the birth of baby. Most mamas feel like swelling is a symptom only associated with pregnancy, however remember those fluid shifts that occur throughout labor and postpartum! You may find your hands, legs, and feet become swollen sausages towards the end of pregnancy and think yes the end is near. Then after delivery mamas are so confused as to why their swelling has worsened! This swelling is caused by residual swelling from pregnancy, intravenous fluids received during labor, being bed bound, and hormones. Again this is something that can just take time to improve and believe it or not drinking more fluids after birth will actually help your body rid the excess fluids. My other top tips to alleviate postpartum swelling are:
- Do the ABCs with your feet when sitting in bed or feeding baby
- Move around without over doing it
- Change position frequently – try not to sit or stand in one position for too long
- Elevate your legs on a pillow when in bed
- Consider compression stockings
- Reduce the amount of salt in your diet
- Keep cool by dressing in light breathable clothing
Swelling that does not improve or that is accompanied with headache, dizziness, vision changes, abdominal pain, or decreased urine output should be reported to your provider ASAP as these can be signs of postpartum preeclampsia.
6.) Baby blues – this one was huge for me as I have educated new mamas on the baby blues for years, but until I experienced them myself did I realize how little is shared about this wild ride. The baby blues will effect 70-80% of new mamas and yet you hardly hear anyone talk about it – or at least thats the way I felt. Again the baby blues are caused by a variety of things but mostly hormone shifts, lack of sleep, lifestyle changes, and processing of birth events. The baby blues usually start within hours or days after birth and last up to 3 weeks after delivery.
- During this time you may experience:
- Weepiness or crying for no apparent reason
- Insomnia (even when baby is sleeping soundly)
- Mood changes
- Poor concentration
I found that for me the anxiety and the insomnia were the hardest to deal with as I am naturally not anxious so feeling that way made me uneasy plus I knew how important sleeping was yet I couldn’t sleep, which made me more anxious! It was a vicious cycle! At the 2 week postpartum mark I had a breakdown to my husband as I was overwhelmed with visitors, exhausted, and hated the way the baby blues made me feel. My top tips for battling baby blues is: get outside, get your feelings out, try and sleep when you can, adequate self-care, well balanced diet, lots of fluids, and ask for help! If these symptoms progress past the 3 week postpartum mark then please reach out to your provider as this could be a sign of a perinatal mood or anxiety disorder (PMAD.)
7.) Constipation and hemorrhoids – yikes! I talked about this on my Instagram this week and it was quite the talk of the town! While I find that some mamas do quite well in this department – others felt like they were giving birth again except out of their butt! As I had explained this week constipation during pregnancy and postpartum is quite common as there are several hormones that play a role in slowing down our sweet little GI tract. In addition to hormones – fluid shifts, abdominal surgery, limited mobility, and a bit of stress to the system can make our poops out of whack after baby is born! Whether you push your baby out vaginally or have a cesarean birth – your body undergoes some serious changes and the extra pressure on those lower vessels can cause hemorrhoids. I wasn’t prepared for just how uncomfortable this stage would be! You can refer to my post to see my biggest tips for helping that postpartum poop here! However the basics are stick with fiber, keep moving, don’t forget about your stool softeners, don’t strain and try to breathe through the discomfort, most importantly drink lots and lots of fluids! This will also help prevent and worsening of hemorrhoids but you will want to use your witch hazel pads, hemorrhoids creams, sitz baths, and Motrin to help treat the area and alleviate symptoms.
8.) Hair loss and skin changes – of course most of us know that we quite literally “glow” during pregnancy as our skin, hair, and nails are stronger and more beautiful than ever. What you may not know is that with your baby – comes postpartum hair loss and skin changes!
During pregnancy you may or may not notice that your hair actually doesn’t fall out, which is why your hair feels thick and full. However, thanks to those good ol’ hormone shifts, you will find weeks or months after your baby is born that your hair starts falling out, and quite a bit of it! The good news is that this is usually temporary and slowly your little baby hairs will start growing in again. Continuing your prenatal vitamins during the postpartum period can help in decreasing the amount of hair loss.
As far as our beautiful pregnancy skin goes – the extra blood flowing and some hormones make for radiant skin! After delivery however those hormones levels drop, sleep becomes hard to come by, and self-care tends to fly by the wayside. You may find that during that postpartum period you notice yourself breaking out more, have dry spots, stretch marks, or dark splotches on your forehead, upper lip and cheeks. Drinking enough water, wearing sunscreen, and taking care of your skin are some great ways to help your skin out! The good news is again this doesn’t last forever and slowly over time your complexion will go back to normal, however sometimes those stretch marks are there to stay! I always tell my patients, clients, and friends who complain about their stretch marks – you’ve earned each and every one of those stripes and you should be proud of your body for all it has provided you and your baby!
9.) Breast pain and engorgement is real – engorgement is basically a fancy way of saying breast swelling which is caused by an increase in blood flow and milk supply. This typically occurs in the first 3-7 days after baby is born and I think mamas may not realize that whether you are planning on breastfeeding or not- your body will still make milk. Engorgement can make your breasts feel hot, tingling, lumpy, swollen, full, or tight. The human body is amazing in the sense that if you don’t express it or nurse, the milk production will eventually stop. If you’re breastfeeding then you will find that frequent and effective feedings will help alleviate the discomfort of engorgement.
If you are not planning on breastfeeding know that painful engorgement only lasts a few days and you can treat the discomfort by:
- Using a cold compress or ice packs to ease swelling and inflammation
- Take Motrin or Tylenol to help with pain
- Wear a supportive bra that prevents breasts from moving significantly
- Avoid nipple stimulation (turn your back in shower) and don’t express milk
- Place cold cabbage leaves on your breasts (evidence is mixed but this is safe and cheap!)
However if you’re breastfeeding then as I said before frequent and effective feeds will help keep engorgement issues at a minimum. Breast milk supply is hormone driven initially and then it transitions to a supply and demand based system, meaning the more milk you remove from the breast the more milk you make and the less milk you remove the less milk you make. Over the span of a few weeks your baby is going to tell your body how much breastmilk he or she needs and your body will regulate your supply on its own. However until then try these tips to help with engorgement discomfort:
- Hot or warm compresses before and during feeds
- Frequent and effective feeds
- 8 or more feeds in 24 hours
- Hearing swallows
- Adequate number of wet/dirty diapers
- Massage your breasts and do breast compressions while feeding or pumping
- Alternate feeding positions and alternate starting breast with each feed
- Hand express or pump very briefly as this can perpetuate engorgement
- Ice after feedings
- Motrin or Tylenol to help with pain
10.) Contractions will occur not only during labor but also after your baby is born! Oxytocin is the hormone that is responsible for those lovely contractions that we experience during labor and birth. However after our baby is born you may experience “afterbirth-pains” which can be painful for some, and it’s basically just our uterus continuing to contract causing discomfort. Postpartum contractions help decrease bleeding and return our uterus to pre-pregnancy size! All my breastfeeding mamas out there – know that every time you breastfeed your body will be secreting oxytocin so you may experience cramping each time you put baby to breast. It’s also important to note that the more babies you have- the more uncomfortable those “afterbirth” pains can be. The good news is there are a few easy tips to keep postpartum cramping to a minimum:
- Keep your bladder empty – a full bladder can push up against the uterus and irritate it even more to cause more cramping and discomfort, and in severe cases if the uterus is unable to contract you may experience worsening bleeding. My advice is empty your bladder at least every 4 hours even if you feel like you don’t have to go!
- Warm compress or heating pad
- Tylenol or Motrin
- Relaxation – go back to the breathing exercises you learned in your childbirth classes!
While I know this can be frightening to read – know that your precious new baby will always make the highs and lows of postpartum worth it! The postpartum period for some can be the most challenging part of the journey, and while everything we have talked about is “normal” it may not feel normal to you. Having an open line of communication with your provider is a huge piece of the puzzle, and if something doesn’t feel right to you don’t be afraid to speak up and ask questions. Lean into your support, treat yourself like a queen, rest, and get outside. Like everything in motherhood – the fourth trimester is a season, and it can be a tough season, but it doesn’t last forever! Try to enjoy these little things as one day you will look back and realize they were the big things!
Thanks as always for being here and tell me below – what did you wish you knew before your baby was born??