From ‘after pains’ to six weeks of bleeding, what happens after birth is rarely discussed.

Earlier this week we spoke to an obstetrician who answered some of the biggest questions we had about what happens to the female body after childbirth. A number of mothers got in touch afterwards to dispute the advice and claim what actually happens had been played down.

Milli Hill, the author of The Positive Birth Book, founder of the Positive Birth Movement – a network of antenatal discussion groups – and a mum of three shared her thoughts and experiences on the realities of a woman’s life post- childbirth with The Independent.

The physical symptoms

I think this depends hugely on what kind of birth experience you had and how you are feeling about it. By that I don’t necessarily mean whether you had a straightforward vaginal birth or caesarean, because some women who had a caesarean may feel very sore and debilitated whilst others will recover more quickly. Often, in my experience, it is the way a woman feels about the birth emotionally that has a huge impact on her physical recovery, as well as the actual nature of the birth itself. So a woman who had a straightforward birth but did not feel listened to or respected during her labour may recover more slowly than a woman who had a gentle caesarean in which she felt in control of events and well cared for.

After birth, there are sometimes ‘after pains’ for a few hours or even a day or two - no one warns you about these but after my second baby (they are most common after second or subsequent babies), I was mightily annoyed that after all of the hard work of labour was over, I continued to experience pain that felt like contractions, for about 24 hours.

Aside from this, I think we need to take care talking about birth in terms of ‘symptoms’. Birth is an expression of a woman’s body in the absolute peak of health, and in the majority of cases, it does not need to be a medical event. If you have had a positive birth and you are feeling good about it, then you will often feel completely energised and brilliant in the days after you have had your baby. Women need to hear this message too as well as getting information about what might be unpleasant or what might go wrong.

Bleeding

After you have had your baby - regardless of whether you have had a vaginal birth or a caesarean - you will have something that resembles a very heavy period, called Lochia. This can be very heavy in the first few days and you will need to use ‘maternity pads’ (never tampons as this can introduce infection). The pads are just like very thick sanitary towels built for a very heavy flow. Lochia will be bright red initially, and after the first few days it will become lighter in flow and may change to brownish red, but you can expect it to continue for at least two weeks and up to six weeks after the birth.

The effects on the mind

Having a baby brings a huge period of readjustment, your life is literally transformed overnight. For many, it is a time of great happiness and fulfilment but, like every other time in life, it is unrealistic to expect everything to be a bed of roses. Unfortunately, we do not have much support for new mothers in our current society and, once the visits from family and friends are over, it can be a very isolating time - one mother described it to me as ‘solitary confinement’. After my first baby I certainly felt a bit like this - alone in my house with my baby it felt like everyone I knew was at work and I wasn’t really sure what to do with myself. I think women literally have to start again sometimes, making new friends and a new routine to their day and this can be really tough, especially when you are sleep deprived. I think that this social set-up where women are so isolated and unsupported, where they feel overwhelmed with emotions for their baby, and where they feel they have lost much of their former identity, can be as much if not more of a contributor to postnatal depression as ‘hormones’. It would be great if there were more support for mothers and more awareness around postnatal mental health - this is something that as a society we really need to be working towards.

Pain

There can be pain and discomfort for some women depending on what kind of birth they had and how they are feeling about the birth, what level of support they are getting etc. If you have had an instrumental delivery, a difficult birth or a caesarean, then you will feel in pain or discomfort for days or even weeks. But any severe pain should be reported immediately to your midwife or doctor as it could be sign that something is wrong. If you’ve had a straightforward birth you might be feeling a bit tender but I don’t think it’s normal to feel in pain. However, everyone is different. Some people may run a marathon and feel fantastic afterwards, others may take longer to recover.

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I like what renowned American midwife Ina May Gaskin has to say - she points out that she reminds us that labour pain is ‘clean’; when it’s over, it’s over, and it almost always causes no damage to the body. The paradox as she puts it is this: ‘When avoidance of pain becomes the major emphasis of childbirth care… most women have to deal with the pain after their babies are born’. In other words, labour pain may be tough, but recovery from instrumental or caesarean deliveries (which are more likely to happen if you opt for an epidural) can often be even tougher.

The vagina

I think for most women (I’m talking about those who have had a straightforward birth here) their vulva and vagina will look and feel a bit different after birth, but with time and a few ‘pelvic floor exercises’ it will go back to being fairly similar to before. Many women will have a small tear after the birth - this sounds utterly terrifying but in the majority of cases you won’t notice it happening and it will heal well and easily. Severe tears called third or fourth degree tears are another matter and will take longer to heal and will require specialist care - but these are extremely rare, happening in only five per cent of cases for first time mothers and two per cent for those who have had a previous baby. Episiotomies - when a cut is made to the perineum to help the baby out - can also be painful and take time to heal.

The way your body changes

I think it would be very odd if your body didn't change, although, unfortunately, that is our cultural aspiration and expectation. We see celebrity mums on the red carpet, getting praise piled on them for ‘getting their body back’ after ‘only two months!’ and there we are, at home, in our sick splattered pyjamas - it can make us feel like utter failures! Again, everyone is different - but I think the reality for most women is that their body is changed, perhaps in a small way, perhaps in a big way - but either way it is changed. Because of the cultural expectation to look ‘like you never had a baby’, many women have negative feelings about their post-baby bodies, which is a shame, as really we ought to be proud of the amazing achievement of growing and nurturing another human, don’t you think?!

Sex life

This is completely up to the individual. For most new parents sex is pretty low down the list as they have got a tiny, utterly dependent human being to look after 24 hours a day, seven days a week. The baby is usually ‘on you’ a lot of the time, sleeping, feeding etc, and if they finally do nod off in the moses basket, it’s more likely you’ll want to crash out than initiate sex. The standard advice is to wait until your post birth bleeding has stopped so around 3 to 6 weeks, but many wait much longer due to a traumatic birth or simply the demands of parenting and part of the development of your relationship with your partner as a ‘three’ rather than as a couple will probably involve discussing this and navigating your individual needs.

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The afterbirth

[The afterbirth] is much easier than having a baby. The placenta is quite soft and squishy and usually comes out fairly easily, perhaps with just gently pushes if you are having a physiological third stage (when you deliver the placenta naturally and don’t have drugs to make it come out). I actually found it a really satisfying feeling. Sink back and revel in the moment. And have tea and toast.

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