Difficulties during the postnatal period

After childbirth, your body needs to recover. Unfortunately, this also means facing (physical) difficulties. The amount of issues during this time varies per person and also depends on how the birth was experienced. We list and explain the most common postnatal difficulties for both mother and child.

Common difficulties during the postnatal period

Haemorrhoids are swollen blood vessels around the anus, these often occur during pregnancy or childbirth due to the increased pressure on the vessels. Haemorrhoids are also likely to occur if you are constipated. That is why it is important to drink a lot of water during the postnatal period and eat plenty of high fibre food. In many cases, the haemorrhoids will disappear by themselves, but can often take weeks. There is medication to help along the healing process, we recommend Curanol, which comes in both tablet and ointment form. If the symptoms do not improve after taking medication, please contact your doctor.

After childbirth it is normal when you do not immediately regain full bladder and/or bowel control. You may also experience a heavy sensation in your pelvic floor. This takes time and usually recovers during the first 6 weeks. At the end of the postnatal period, it is recommended to exercise your pelvic floor muscles to speed up the recovery.

The brochure ‘recovery for the pelvis and pelvic floor’ contains information on how to rebuild your pelvic strength is a sensible manner during the first few weeks after the birth.  

After childbirth it is normal to experience blood loss, also known as ‘bleeding’. This is caused by the placenta leaving a wound in the uterus. The blood loss is the heaviest during the first few days after the birth, it is often heavier than a menstrual period and sometimes the bleeding will include clots. During the first few weeks you will notice that the amount of blood loss will reduce slowly. The duration of the blood loss varies greatly for each woman. For some it completely stops after 2-3 weeks, for others it can take 6 weeks. In the beginning the blood will be bright red, this will change to brown and finally to a yellowish discharge. During the first few weeks the amount of blood can vary. If you are more physically active, the flow can be heavier.

When to contact us?

– If the blood loss completely fills a large maternity pad within half an hour

– If you lose 2 clots the size of your fist or many small ones (1 large clot is fine)

– If you are still losing blood after 6 weeks

As long as you are experiencing blood loss, do not use tampons, do not have intercourse, do not have a bath and do not swim.

Something that many women worry about is the possibility of tearing or the need for cutting during the birth. While this is quite understandable, unfortunately it happens on a regular basis. About 80% of women need stitches after giving birth. This can be a sensitive area during the weeks following the birth as the wound is still healing. Stitches may be painful or create a pulling sensation. We use dissolvable stitches, but if they are creating a problem we can remove them.  This can be done from the 6th day after the birth, as the wound has often closed by this point.

It is important to keep the wound clean by rinsing with water after every time you urinate. It may also be helpful to apply a cold compress to the stitches to reduce swelling. In addition, lie on a towel or underlay on the bed every day without underwear, so the air will help the wound dry and heal faster.

Having a child is an emotional rollercoaster for you and your partner. It is a fun and special time, but also intense and overwhelming. It is therefore very common if you are not on a pink cloud after giving birth. In fact, most women will not experience that pink cloud.

You often suffer from lack of sleep; you are still bouncing back from the birth. You are experiencing (physical) discomforts and of course your baby needs round the clock care. That is a lot to be dealing with and therefore quite understandable that you don’t feel your best. During the first 2-3 weeks, many women experience something known as the ‘baby blues’. These are moments when anything can make you cry and everything seems just too much. This is completely normal.

In some cases the baby blues lasts more than 3 weeks. If you feel these moments occupy most of your day or if you feel especially low or irritable, or just not yourself? Please contact us or your GP. This will allow us to help you further.

About 10% of women develop postnatal depression, but discussion about this still carries a stigma amongst women. Under the brochures and links header you will find the brochure; where is my pink cloud?

In the first 24-48 hours following the birth you may experience postnatal contractions. These are caused by the uterus contracting back to its original size/shape. This also helps to reduce further blood loss. So it is very beneficial but can also be very irritating.

If you have given birth before, the postnatal contractions tend to be more uncomfortable. Many women also experience postnatal contractions during breast feeding. The hormone oxytocin is released during breastfeeding and causes uterine contractions.

Taking paracetamol may give you relief. In addition, make sure that you urinate regularly; having a full bladder can increase the discomfort of the contractions.

Breastfeeding can make your breasts sensitive. After all, your nipples are not used to this yet.  During the first week the baby latching on can be painful for about 10-20 seconds but usually eases off by itself. If the pain persists, consider what may be causing it. Cracked nipples are in fact small wounds, possibly caused by the baby latching on incorrectly (e.g. only by the tip of the nipple) or sometimes because of tongue-tie. If breastfeeding hurts, don’t ignore it. Together with the maternity nurse we can assess what the cause might be. In case of persistent pain, it is wise to get advice from a lactation specialist.

A rare but serious complication is thrombosis. Thrombosis is a blood clot that is stuck in a leg blood vessel. It can break loose and cause a pulmonary embolism.

Because you spend a lot of time lying down in bed during the postnatal period, thrombosis is more likely to occur in your legs. Chances increase if you are prone to varicose veins. Therefore, change your position regularly and if possible, have a careful walk around the room from time to time. Should you experience symptoms such as red, swollen legs or red shiny patches on your skin, please contact us as soon as possible on the emergency number.

As soon as you have given birth, your milk production will start. The milk production is stimulated by letting the baby latch on often.

Around the 3rd or 4th day after birth, most women experience breast engorgement. This means that your breasts are very full and feel painful. The engorgement is a signal to your breasts that the maximum amount of breast milk required has been reached. This signal ensures that milk production will decrease a little from now on. This helps to balance the ‘supply and demand’.

Advice for relieving breast engorgement:

  • Breastfeed your baby often, this will relieve the pressure.
  • Your breasts may benefit from cooling or placing cabbage leaves in your bra (the maternity nurse can tell you all about it)
  • Taking paracetamol
  • Your body temperature may rise a little; this is normal but please contact us if this goes above 38 °C.
  • Do not extract (pump) extra milk unless advised by us. This is because pumping will stimulate production and as a result breast engorgement is more likely.

Common issues in a newborn

Cramps are quite common in a baby. These are usually caused by the development of the gastrointestinal system, which can make digestion difficult. Another reason may be the baby being greedy during feeding and swallowing a lot of air. The mother’s diet may be a contributing factor or the baby being intolerant to cow’s milk. Most babies will suffer from cramps during the night. The cramps occur mostly when the baby is between 6-8 weeks and usually disappear by 3-4 months.

How to prevent/relieve?

Allow time for the baby to burp after feeding, take short breaks during feeding. Use a pacifier or finger, have the baby’s legs make cycling motions. Carry the baby with your arm around the tummy or use a heated wheat bag. There are also over the counter remedies such as Infacol, but the effect has not been scientifically proven.  Although some parents swear by it, so you can always try it.

During the first week after the birth, 2 out of 3 babies have jaundice. This is caused by a higher level of bilirubin, which is found in red blood cells. Babies have a different type of red blood cells while still in the womb (haemoglobin). Once born the ‘old’ red blood cells are broken down and a large amount of bilirubin is released all at once. The released bilirubin is normally broken down by the liver and excreted through the intestines. In babies, however, the liver does not yet work on an optimal level. Sometimes the baby does not feed enough during the first few days to ensure the bilirubin to be excreted through urine and faeces. The bilirubin therefore accumulates in the skin, causing the baby to appear ‘yellow’. If the skin appears too yellow, the bilirubin levels in the blood need to be checked. Too much bilirubin can be harmful to the baby.

Levels are measured via a blood test; a small amount of blood is taken from the baby’s heel. If levels are too high, hospital treatment is necessary. This is often done by phototherapy, a blue lamp that converts the bilirubin into a harmless form.

It is normal for almost all babies to lose weight during their first few weeks. Newborns will defecate and urinate regularly while they are not yet feeding much, this naturally causes weight loss.

The maternity nurse keeps an eye on this by weighing the baby every day. If a baby loses too much weight, the nurse will inform us of this. By the 4th day most babies are at their lowest weight. But most will regain their birth weight around 2 weeks.

Sometimes babies suffer from nausea after birth. This can be due to a rapid delivery or they have swallowed some amniotic fluid or blood. If the baby is nauseas, it often resists feeding and sometimes gags or vomits. This is nothing to worry about and the nausea will usually go away by itself within 24-48 hours. When the baby starts vomiting, hold them on their side and gently wipe the mucus from their mouth if necessary.

If the vomit is green, please contact us on the emergency number immediately. If the vomiting lasts longer than 48 hours, please tell us during our maternity visits or ring us.

Aside nutrients from the mother, babies are also passed her hormones. This can cause a pseudo menstruation in a girl. This means a small amount of blood or mucus coming out of the baby’s vagina. Some babies have swollen breasts due to the mother’s hormones. This is harmless and will disappear by itself.

During the postnatal period you may see pimples or redness on your baby’s skin. Because the baby has come from a sterile environment, their skin often reacts to the change in atmosphere by developing these pimples and red spots. To prevent the skin from becoming more irritated, we recommend using non-perfumed detergents and oils during the first few weeks.

The two most common types of pimples are:

  • Milia: Many babies have small white dots around the nose, forehead and cheeks. They are blocked sebaceous glands; in the womb the sebum protected the baby’s skin. Milia are harmless and will disappear on their own.
  • Erythema Toxicum Neonatorum (baby acne): Many babies develop a skin rash during their first week. These are red spots on the skin, sometimes filled with pus. The spots can appear all over the body, except on the face. They are harmless and disappear on their own.

Are you worried about a rash? Please take a picture and contact us for advice. Or we can have a closer look during one of our maternity visits.

Babies regularly suffer from conjunctivitis. Sometimes the tear ducts are blocked or the eyes are irritated. They can be safely cleaned with sterile gauze and water. Clean outwards from the corner of the eye and repeat this several times a day.

If the eyes appear inflamed (red and swollen), please contact us. If the conjunctivitis does not clear after a week, please contact your doctor.

If the baby does not feed enough the first few days, urates may appear in the nappy. These are orange-red coloured urine crystals, a sign of concentrated urine. This is not blood. Once the baby starts feeding regularly and urinating more, these urates will disappear.