Congratulations on the birth of your baby. New parents may be excited, happy, anxious, energised or tired, and/or feeling emotional after the birth and can commonly experience all of these feelings in one day. These are just a few of the rollercoaster feelings that can be experienced. Your Lead Maternity Carer midwife will be providing postnatal care in the home up to six weeks after the birth. During midwife visiting times, taking the opportunity to talk about feelings, how the recovery from birth is going, how the new parenting experience is shaping-up, and asking questions about anything of interest or of concern is useful and can reduce parental anxiety or concerns. The time after birth is often referred to as the Fourth Trimester as it is considered to be a transitional time when mothers/parents need support for not only the physical recovery from childbirth, but also their emotional responses, support for the adjustment to parenting and access to information about the postpartum period and parenting.
For many women and their whanau the incorporation of traditional birthing practices supports their parenting journey. For example for Māori whānau this can provide a pathway to tino rangatiratanga (autonomy, self-determination, control and power) and this cultural pathway, which incorporates respect for whakapapa (genealogy, kinship) and mātauranga (knowledge, understanding, skill) can support a positive birthing and parenting experience. Tikanga Māori (custom, manner, practice, protocol) support for birth, and the post-birth period can reduce anxiety, and increase connectedness, health and wellbeing.
Healthy nutrition after birth is an important part of postnatal recovery. There is really nothing special that needs to be done apart from eating a variety of healthy foods including seasonal fresh vegetable and fruits and limiting processed foods, and foods with high sugar content. Eat food from each of the following groups every day:
Drink water to thirst – there is no need to force yourself to drink water – use your thirst as a guide. Breastfeeding women do not need to drink extra water to produce breast milk but as breastfeeding women do feel thirsty when feeding it’s good to have a glass of water close by.
If a breastfeeding woman has low iron stores this may lead to the women becoming anaemic as the breast milk will contain enough iron for the baby but the mother’s supply will reduce further. The midwife can advise about supplements if needed.
Breastfeeding can help with losing some weight gained in pregnancy but the degree of weight loss will still be affected by the amount and type of food being consumed.
During pregnancy and after the birth women may be low in iron or their iron stores may be depleted. If you have experienced a heavier than usual blood loss after the birth (PPH – see below) then you may need to increase your iron intake either through diet or with supplements. Iron is needed by your body for many roles, including
Having healthy iron levels helps your recovery after the birth and help your energy levels, tissue healing as well as supporting your physical and mental well being.
For more information on iron in your diet see
The soil in Aotearoa New Zealand is low in iodine which means that some of our foods do not give us all the iodine we need. Iodine is important for baby’s growth and brain development. Foods that contain iodine include seafood, milk, eggs, some cereals and commercially made bread. Commercially made breads contain iodised salt. During pregnancy and while breastfeeding it is difficult to get all the iodine needed from food alone so the Ministry of Health recommends iodine supplements – 1 x 0.150 milligrams (mg) iodine only tablet daily while breastfeeding and this can be purchased from pharmacies. The cost of this supplement is reduced if the Lead Maternity Carer prescribes it. The LMC midwife can provide information about iodine.
The main source of vitamin D in Aotearoa New Zealand is sunlight. Foods that contain vitamin D include, fresh and canned oily fish such as tuna, and sardines, eggs, vitamin D fortified yoghurts and milk. The Ministry of Health recommend that between September and April sun protection is used especially between 10am and 4pm. Between May and August some sun exposure is important so a daily walk or being outdoors with face, arms and hands exposed is recommended. Talk to the LMC midwife about Vitamin D.
The birth of the placenta (whenua/afterbirth) is called the third stage of labour and some bleeding is normal during this stage. There is always vaginal blood loss after childbirth and it sometimes known as the lochia. Blood loss/lochia is a combination of blood, mucous and tissue from the womb/uterus lining that is discharged vaginally after birth. After birth the womb/uterus is assessed regularly to make sure it is well contracted and that bleeding is within normal limits. It is normal for bleeding to last for up to four to six weeks and this blood loss changes colour over time. Initially it is dark red in colour for the first few days after birth and some small blood clots may also be present – this is normal. If any large clots are passed – make sure the midwife knows about this, or talk to the midwife if there are any worries about bleeding. From about four days after birth the blood loss may start to look brown or pinkish in colour. Then the colour changes to whitish-yellow from 3 weeks and up to 6 weeks after the birth. If the blood loss seems excessive, has an offensive smell, or if you are feeling unwell with or without a temperature – talk to your LMC midwife as these could be signs of an infection.
Although the amount of blood loss does decrease over the weeks after birth there may be increases in the amount when getting up in the morning, when physically active or when breastfeeding. Breastfeeding helps the womb/uterus to reduce in size after birth – this is because the hormone oxytocin is released during breastfeeds and this stimulates the womb/uterine muscles to contract. After-pains (due to the contractions of the uterus) can be felt for the first 4 -7 days and they are at their strongest 12-24 hours after the birth.
Passing large clots of blood and/ or heavy bleeding with a blood loss over 500 millilitres during or immediately after the birth of the placenta (whenua/afterbirth) is described as a postpartum haemorrhage (PPH). A postpartum haemorrhage is described as primary if within 24 hours after birth and secondary if after 24 hours and up to 12 weeks post-birth. PPH is an emergency situation as blood pressure can drop quickly and significantly, so finding the cause of PPH and starting treatment is essential. If you experience a postpartum haemorrhage your iron levels will be tested to see whether you might need extra iron or even a blood transfusion to improve your iron levels.
Physical recovery after birth can take time. In terms of the perineum – healing may take up to ten days or longer, depending on whether there are grazes present, stiches have been used on a tear, the type of tear, or if there has been an episiotomy (a cut in the perineum area between the vagina and anus to make the vaginal opening a bit wider – these cuts are not done routinely). The midwife will ask about whether you have any concerns about healing at each visit and can assess the perineum if pain or discomfort has been reported. Ice or cold gel pads can provide some pain relief and if oral pain killers are needed then paracetamol (used as directed) can be used in the first instance. Pelvic floor exercises can help reduce later pain levels too. For women who need more than paracetamol for pain relief – this can be due to episiotomies or severe trauma – oral ibuprofen can be effective – talk to the midwife about pain relief. For more click here.
Birth by caesarean section involves major abdominal surgery so it takes some time to heal after the operation. While in the maternity hospital mobilisation may start within 12 hours after the birth as it’s important to start moving as soon as possible to avoid any complications such as the formation of blood clots in the legs. Mobilisation initially will only involve getting out of the bed into a chair or a short walk around the room. Rest is also important to recovery. Avoiding lifting for up to six weeks after the surgery is a good idea – assistance with lifting children, laundry baskets and groceries is recommended to avoid putting strain on the wound area. When coughing, laughing and sneezing – gently hold your abdomen to reduce the strain on the abdominal muscles. Wear clothes that are loose and do not press on the wound area. Vaginal bleeding may be heavy and red for the first week and then it will become lighter and start to look brown or pinkish in colour. Then the colour changes to whitish-yellow from 3 weeks and up to 6 weeks after the birth.
The wound will usually be along or just below the bikini line and will either have stitches that dissolve by 4-6 weeks, or a long running stitch that is taken out around day 5. Staples may also be used in some situations. The midwife can give you more information if you have any questions. When you leave the hospital the wound area will be covered with a sterile waterproof dressing which can usually stay on for about 7 days. This means it is possible to have showers. Some bruising around the area is common. It can take up to ten weeks for the wound to heal completely – the skin layer takes about ten days usually but the tissues underneath take longer. If any signs of infection are noticed – such as redness, swelling, you feel unwell, there is an offensive smell – talk to your LMC midwife as soon as possible.
In terms of psychological recovery – this might have been an unexpected way to give birth for you and this can result in some women feeling grief and disappointment. Talk to your LMC midwife about your feelings concerning the birth.
Because a caesarean birth involves cutting the muscles of the abdominal wall as well as the womb/uterus – and these muscles are used when sitting upright – it may not only be painful to sit in a driving position but the pain may be severe if braking heavily or when turning a corner. Generally the time from the birth to resuming driving will depend on how you are feeling, the type of car you are driving, and on the advice you have been given by the midwife or obstetrician. Check your car insurance policy for their limits to driving after an operation.
After childbirth restarting sexual activity can generate a range of feelings. These feelings may be related to whether the birth was vaginal or by caesarean, whether it was a complicated birth, whether there are abdominal or perineal stitches, levels of tiredness, and how much post-birth bleeding is happening, for example. There may also be cultural considerations for some families. Health recommendations usually suggest waiting four to six weeks before resuming penetrative vaginal sex but in reality there are a wide range of differences in responses to sex after childbirth and a wide range of individual circumstances
Communication between partners gives an opportunity for both to voice any concerns, and redefining feelings about sex and intimacy will be important if one or both partners are not yet ready. For some parents concerns about contraception and avoiding another pregnancy may play a part. Partners can discuss contraceptive options and their preferred birth control plan with the midwife. A water-based lubricant can help – lower levels of the hormone oestrogen (which is normal) can reduce vaginal lubrication which can cause pain and discomfort. Some degree of discomfort may be expected initially, even with lubrication and careful, gentle sexual activity, but if there are ongoing issues with pain this may need assessment.
An Australian study (https://onlinelibrary.wiley.com/doi/abs/10.1111/birt.12193) which looked at sexual health issues experienced by 1,507 first time mothers in the year after childbirth found that 89% of these women reported some sexual health issues in the first three months following birth. The common issues were described as loss of interest in sex, pain during sex, vaginal tightness and a lack of lubrication. The study also found that women who had caesarean births did not experience less sexual health problems than women who had vaginal births. Recommendations from this study were to discuss sexual health issues with health professionals. The midwife can discuss any issues or concerns women may have during one of their visits to the home.
This link is to information from a UK based organisation – National Childbirth Trust – but the article ‘Sex after a baby: 10 questions to ask yourself’ may be useful –
National Childbirth Trust – https://www.nct.org.uk/life-parent/sex-after-baby/sex-after-baby-10-questions-ask-yourself
The hormone oxytocin is released when breastfeeding, and sensations similar to orgasm can be experienced by some women but this reaction is hormonal and not sexual. These are normal and common experiences. In terms of sexual activity – it is also normal and very common for milk to be released from the breasts during sex so it’s good for both partners to know how likely this is to happen so they are not taken by surprise! If the release of milk upsets either partner then breastfeeding before sexual activity will ensure the breasts are not so full of milk, or wearing pads and a bra is another option. Some breastfeeding women do not enjoy their breasts being touched during sex – it can take time for this feeling to disappear so talk with your partner about this.
Exercising regularly is good for physical and emotional wellbeing and can help with recovery after childbirth. How much exercise, and what kind of exercise, depends on individual circumstances, how much exercise the person is used to and the type of birth experienced. For example, a caesarean birth involves major abdominal surgery so recovery will take longer than after a vaginal birth and getting back into exercise will be slower. It is important not to lift anything heavier than the baby in the first six weeks after a caesarean birth.
Pregnancy hormones will still be affecting the body for quite a few months after birth. Exercise when feeling ready, ‘listen’ to your body and don’t overdo the exercising at first. Check with the midwife about what kinds of exercise will work for you. Strengthening abdominal and pelvic muscles through exercise is important.
Information about pelvic floor exercises –
https://www.healthnavigator.org.nz/health-a-z/p/pelvic-floor-training-women/
and physiotherapy advice after childbirth with pelvic floor exercises included – https://edu.cdhb.health.nz/Patients-Visitors/patient-information-pamphlets/Documents/Physiotherapy%20Advice%20after%20Childbirth.pdf
Walking is a great low impact way to start gentle exercise and it’s easy to take a baby along in either a front pack or a pram. Staying well-hydrated while exercising is important. There are generally no problems with low impact exercise at first or higher impact exercise later, for breastfeeding women. Some babies can be fussy with breastfeeding after their mother has been vigorously exercising due to an increase in lactic acid in the milk – this temporary change in the taste of the milk disappears in an hour or two.
Constipation can be an issue after childbirth so drinking plenty of water and including fibre in the diet, along with avoiding strain on the pelvic floor muscles is important. If there are issues with incontinence of urine the Lead Maternity Carer midwife can make a referral to a physiotherapist.
Link to information about returning to sport or exercise after childbirth – http://www.pelvicfloorfirst.org.au/data/files/PFF_Resources/Returning_to_sport_or_exercise_after_birth_FINAL_-_June_2017.pdf