6 Postpartum Symptoms That Surprise Women
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What To Expect After Having A Baby
We have all heard about the giant undies and seen the ice pack Tik Toks but below is a list of common postpartum symptoms that women may find surprising as well as tips for how to prepare for the postpartum period. Many changes happen to your body postpartum related to birth and healing as well as the transformative process of early mothering. Women are educated by providers on warning signs prior to hospital discharge but there are a host of bothersome normal symptoms that you may wonder if they are normal as well. Your body post birth is experiencing a host of massive physical and hormonal changes that lead to new sensations, symptoms and challenges. Understanding what is normal and not normal will hopefully reduce your anxiety and help you know when to ask for help. Be sure to watch out for the concerning signs and symptoms after birth which I have provided information on at the end of this post. Be sure to call your provider if you are ever concerned or unsure. Even if what you are experiencing is normal there may be some tips or medications that may help you be more comfortable.
6 postpartum symptoms that women ask about after birth:
Postpartum Sweats
The Timing and Flow of Your First Postpartum Period
Postpartum Cramping
Swelling Post Birth
The Loneliness And Isolation Of Breastfeeding
Vaginal Itching After Birth
Lets get one thing out of the way
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Postpartum Hot Flashes or Sweats
Did you think hot flashes were just for menopause? Think again. When your baby is born and the placenta detaches from your uterine wall it sends a signal to your body that you no longer need to support a pregnancy. The estrogen levels fall following birth and similar symptoms to menopause can occur, including hot flashes. One study (1) showed that a third of women experienced this postpartum bothersome symptom. And similar to menopause women had a higher rate of reporting hot flashes if they had a higher BMI, depressive symptoms, or a lower education level. The good news is that as your hormones stabilize you will experience these symptoms less often. In the meantime dress in layers until the hot flash subsides.
(1) Fertil Steril. 2013 Dec; 100(6): 1667–1672. Prospective Evaluation of Hot Flashes during Pregnancy and Postpartum; Published online 2013 Sep 12. doi: 10.1016/j.fertnstert.2013.08.020
Rebecca C. Thurston, PhD,a,b James F. Luther, MA,b Stephen R. Wisniewski, PhD,b Heather Eng, BA,b and Katherine L. Wisner, MD MSc
The Timing and Flow of Your First Postpartum Period
The timing of your first period after having a baby will be affected by how often you breastfeed your baby. Most women will bleed vaginally postpartum for approximately 6-8 weeks. The postpartum bleeding will taper down over that time transitioning in flow as well as color. Postpartum bleeding, called lochia, will begin as a menses flow and then become light pink and eventually yellow in color before returning to normal. For the mom who is breastfeeding exclusively she will likely not get her first period until 6 months postpartum or after. If breastfeeding frequency becomes irregular or supplemental formula is introduced then a period may return earlier or in a more irregular pattern. When your period does return, the heavy flow of your first period is what shocks most women. The cycles that follow however are typically less intense and a bit lighter in flow than the first. Your uterus has physically changed after carrying a pregnancy so your periods will as well. The first heavy flow is often due to a thickened endometrial lining and a bigger uterus than prior to pregnancy. Track your bleeding and bring any concerns to your provider but if the period is coming at a regular interval you may want to see what the first few are like to know if this is a consistent issue or just the struggle of a first postpartum period.
Postpartum Cramping Of The Uterus
Your uterus is a muscle which has stretched to hold a pregnancy, the muscle contracted during labor, and likely you were aware of your uterus in a whole new way because of the new and uncomfortable sensations of pregnancy and birth. When your baby was born you likely did not consider what your uterus would be doing but surprisingly the contractions continue. That large loose uterus has to cramp and clamp back down to shut off the blood supply that was previously feeding your placenta. The postpartum cramping is also a way to help your uterus return back to normal size. In each subsequent pregnancy your postpartum cramps will be more intense as your uterus is more active and has farther to go to return back to normal size. Your postpartum pain meds like Ibuprofen will help with this type of discomfort. Heads up though, you will likely also feel heightened cramping triggered by activities such as nursing your baby and physical activity.
Swelling Post Birth
For many women swelling in their ankles and hands is expected in the third trimester of pregnancy but they are surprised that it can worsen or even present for the first time postpartum. This postpartum symptom can be a bit tricky though as some postpartum swelling is concerning for a severe complication called postpartum preeclampsia. For approximately one week after birth the hormonal changes cause women to continue to retain water leading to puffy skin, with more noticeable changes in dependent areas or parts of your body which hang such as your lower extremities. Sudden new swelling accompanied by high blood pressure, headache, or vision changes however can be a sign of postpartum preeclampsia so your provider should be notified if you notice any sudden new symptoms. Your provider will help decide if what you are experiencing is normal and if a work up is warranted. See the list of worrisome postpartum warning signs below. Women who have had an especially long hospital stay, induction, or have received IV fluids may notice more swelling as they have been given additional fluids on top of what they are already retaining. Outside of severe postpartum concerns such as pre-eclampsia, the normal retained fluids are naturally excreted with time. You will notice increased urinary volume and sweating as your body sheds the excess fluids. Keep your extremities elevated and be sure to continue hydrating orally however as you need the intake to continue to make breastmilk.
The Loneliness and Isolation Of Breastfeeding
Having a baby is often touted as a joyous time with frequently heard phrases such as “enjoy the snuggles,” and “savor every moment” and “it goes by fast.” While those phrases are not wrong it is often countered by the extreme feelings of sadness and isolation that come with early parenting. Having a new baby makes leaving the house challenging and recovering from your delivery takes longer than most people realize. I often have to remind women who are anxious to get back to their normal routines that they should delay exercise and strenuous activity until 6 weeks postpartum to allow their body to heal. As a result many women feel out of sorts and wonder what they are supposed to be doing and if they are “doing it right.” If you are in a culture without the built in local family support and community you may be left feeling both a bit trapped in your home and alone.
Breastfeeding adds an additional element of isolation as the feeding of a new baby is left to mom alone in the first month especially. Once a breastmilk supply is established and pumping begins around 2 weeks of life, bottles are often introduced at 3-4 weeks old and mom may get a bit more independence. Even when a baby takes bottles though she is beholden to either the baby or the breast pump to maintain her milk supply. For our extroverted friends this can be a hard time! Women who feel modest about exposing their breasts additionally may choose to sit alone in a private room to feed and care for their baby, adding to the loneliness. Some women choose to venture out which is not an easy task. I have a strong memory of finishing my Target “shopping” (aka as me crying amongst the racks and calling my husband who promptly instructed me to “get out of there”) with my first baby and then spending an hour in the parking garage feeding her, changing her before I could leave. I am in DC so parking is not free and I stayed so long I had to pay the parking twice!! Pro tip: Nordstrom has a breastfeeding room. It will feel like an oasis in your adventure out of the house.
A word of encouragement…
One of the biggest lessons I learned after having three kids was that there is no right way to do things so don’t beat yourself up. Babies cry and babies wake up frequently not because you are doing something wrong but because that is what babies do. There is nothing you should be doing in the first few months other than helping your baby transition to the outside world. I encourage you to accept the help offered to you, set small goals, and get some sunshine on a regular basis. When people say enjoy the snuggles I think they mean - you are exactly where you need to be. These phases don't last forever but when its your first you have no context. You did not sign up for a life of isolation… its just for now. I promise you will become more sure of yourself, your parenting choices, and feeding in public over time as the baby gets bigger and stronger.
Vaginal Itch After Birth
Many women complain of postpartum vaginal itching and assume it is an infection such as yeast. The truth is that you should expect a mild level of itching postpartum for 2 reasons - healing and lack of estrogen. If you have had any stitches due to tearing with a vaginal birth the skin will feel itchy as it begins to heal. One clue that this may be what you are experiencing is that the itch is focal and in the specific location of your tear and or repair. If you are not sure go in for an evaluation by your provider and they can confirm that everything is ok. Pus or worsening redness in the places where tears occurred is not normal but a very mild itch may actually be a positive sign of healing. The second cause of itching is a more generalized itch related to low estrogen post birth causing a thinning of the vaginal tissue and a dry sensation on the skin that is more noticeable or uncomfortable for some. The tools provided for you post birth such as a spray bottle, ice pack and a sitz bath are designed to help these areas heal.
Tips for postpartum vaginal care:
For the first two-5 days ice will help reduce pain and swelling
The spray bottle with warm water in it will help you keep the vaginal area clean without wiping
Be sure to pat the vaginal area dry after spraying as moisture can cause skin breakdown
The sitz bath with warm water will be great for the second week postpartum to bring blood flow to the sutures and promote healing.
Sensitivity is normal in the areas of trauma for many months postpartum so be aware that even after the skin visually has healed it may still be sensitive during intercourse for months after.
Breastfeeding prolongs the hormonal shift that can cause vaginal itching or dryness so be aware that some symptoms may persist while you are breastfeeding your baby.
Use lubricant with intercourse, go slow, and talk to your provider if you are concerned that what you are feeling is not normal.
Postpartum Warning Signs & When To Call Your Medical Provider - From The CDC
Headache that won't go away or gets worse with time
Dizziness or fainting
Changes in your vision
Fever of 100.4F or higher
Extreme swelling in your face or hands
Thoughts of harming yourself or your baby
Trouble breathing
Chest pain or a fast beating heart
Severe nausea or throwing up
Severe belly pain that does not go away or worsens
Heavy postpartum bleeding and or clotting
Foul smelling vaginal discharge
Severe swelling redness or pain in your leg or arm
Overwhelming Tiredness
Learn More About How To Prepare For Birth
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