6 Things You'll Be Glad Someone Told You About Pregnancy, Birth & Postpartum: Part II
by Sasha Weigel, RN, CLC, CD(DONA)
This is the second installment of this blog piece.
I sent out a survey to mothers about what they wished someone had told them about the whole process of pregnancy, birth and postpartum. Specifically, I wanted to find out what areas might have distressed or caused concern so that some light could be shed on these topics for future mothers. Much about pregnancy, childbirth and postpartum is openly discussed amongst peers, with OB/GYNs/midwives or easily located in a maternity book. But much is also not covered, is simply not discussed or is seemingly taboo, for no good reason. I’d love to shed some light on some of these topics. Because the last thing you need in pregnancy, birth and postpartum is to feel that something that is utterly normal and expected might be out of the ordinary or problematic. Below are 6 areas that were mentioned to me by women who were surprised or anxious by their discovery.
This list is not intended to diagnose or treat any condition; it is simply informational. Always consult with your Midwife or OB/GYN if you have any questions.
1. Bleeding gums
You may notice some blood when you brush or floss your teeth. It will not be painful, but it might alarm you when you spit and it’s pinkish. Rest assured this is normal. Estrogen and progesterone, two of the main hormones of pregnancy, are the culprits here. They play a role in inflammation and increased blood flow throughout your whole body, in fact. Be aware that estrogen does increase the risk of infection because it can create a bacteria-loving environment. So brush and floss as usual, but be gentle. Be sure to check in with your health care provider and your dentist if you see anything that resembles an infection.
2. When your water breaks
Your water may break spontaneously before contractions begin, or during labor. If it’s during labor, it may break as a result of the pressure caused by your contracting uterus and the descent of your baby into your pelvis. Or, it may be broken by your health care provider: a non-painful procedure called an amniotomy. Regardless of when it breaks, it has startled many moms to discover that your water doesn’t always just pour out in one sudden gush as it can in the movies. It certainly can happen this way… But note that even once this has occurred, you will still continue to leak more amniotic fluid. This is always the surprise: that the water just keeps trickling and will continue until you give birth. That’s because amniotic fluid continues to be made by your body and your baby. So long as the baby is inside you will leek a small amount especially when you stand up, shift positions or sit on the toilet. As the baby moves and descends, pockets of amniotic fluid may be released as well. So, wear a pad if your water has broken and you’re up and moving and bothered by a trickling sensation. If you’re not inclined to be mobile, sitting on a soft towel works well. There also may be a point in labor where you give up caring entirely because you’ve grown accustomed to a constant dribbling ofliquids and your focus is elsewhere. When this becomes the case, you’re likely very close to meeting your baby and this will herald in the finale of all dribbling and trickling!
3. Urinary retention
I’m sorry to say, but the paragraph above was not the end of the discussion on fluids. As you have probably discovered, pregnancy is a juicy state: more blood volume, more urine, more discharge. Well, it doesn’t end right after you deliver your baby. The first week or two postpartum you’ll discover that you’re urinating and sweating more than ever as a way to rid your body of all of the fluids that maintained your pregnancy. Not to mention when your milk comes in: more fluid! But there’s one fluid-related incident worth prepping you for that might be discussed less than some of the other juicy details. It is not uncommon for moms to have trouble urinating for the first time after their baby is born. It is called urinary retention if you are unable to void in approximately a 6-8 hour window post-delivery. This may be caused by a number of issues: 1) an incomplete return of sensation after an epidural, 2) trauma from birth, such as a tear or a scrape, 3) swelling of the vagina/perineum/urethra, 3) psychological/emotional difficulty letting go and relaxing. This can be an uncomfortable, unsettling and often frustrating experience. Your nurse or health care provider will likely offer to give you a urinary catheter to drain your urine at this point. But there are other methods you can try first. Turn off the lights in the bathroom to create a more soothing environment. Turn on the sink faucet and listen to the water run. Use a peri-bottle (squeezy bottle) with warm water to pour over your vagina and perineum to encourage relaxation. Locate the muscles you have done Kegals (pelvic floor exercises) with and try clenching and then releasing them; this can bring your awareness to this part of your body which might encourage you to relax and then void. Sometimes a drop or two of peppermint oil in the toilet water can help as well. Most importantly, just remember to try and relax. There is no rush. You will regain normal urinary function very soon. This is just temporary.
4. Blood clots
As a rule, blood clots. This is part of its design. If it didn’t, the scrape on your knee would continue bleeding and become a far more dangerous situation because of the threat of major blood loss. This clotting function plays a big role in childbirth as well. Something you might not be prepared to see is the passage of blood clots from your vagina after you’ve delivered your baby up to about one week (possibly longer). Immediately after birth, you empty uterus begins to return to the pre-pregnancy state. During this process, extra blood from childbirth that is retained in the uterus or vagina form pea to golf-ball sized clots. Sometimes they look long, stringy and a lot like menstrual blood/tissue. Sometimes they look perfectly round like a grape or plum. Most of the time it is normal to see small blood clots emerge when you pee or after you had a breastfeeding session. However, if you ever see a clot golf-ball sized or larger, or if you ever have any questions about any clots you see, regardless of size, be sure to ask your provider. They could be a sign that you are continuing to bleed and this could be an important safety issue.
5. Postpartum swelling
Where does all of that extra fluid go after you deliver? Much of it comes out along with the emergence of your baby. Much is also sweated or peed out over the course of one to two weeks. But still, there’s a lot of extra fluid that needs to be redistributed. Your extremities tend to be the lucky collecting vessels for this redistributed liquid. You will likely discover that your hands, calves, ankles and feet swell. Sometimes you will also see yourlabia majora (the outer folds of your genitals) and the area just above your pubic bone swell too. You may also see it in your face. It may be a little alarming, but this is normal and expected. Drink a lot of water, this will help flush the swelling away. Also, walk as much as you are able, this helps keep the fluid moving. When you are sitting down, elevate your feet from time to time to relieve those puffy feet. The swelling will calm down in a week or so, sometimes as soon as just a few days. Contact your health care provider if you discover that the swelling is uneven in your legs (i.e. one calf is larger than the other), or if you have any questions whatsoever.
6. Diastasis recti
This is the medical term for the separation of your abdominal muscles to make room for your expanding uterus. After the birth of your baby, you can check to see how far they’ve separated by lying on your back and lifting your head a few inches. Then feel the center vertical line of your belly. Your fingers will discover a dip there: often just one fingerbreadth in width, but occasionally up to 4 fingerbreadths (this is more commonly seen with moms who’ve had multiple babies). This is a normal part of the physiological process of pregnancy. It is something you will likely want to manage, however, so that you resume your pre-pregnancy abdominal strength. You will want strong abdominal muscles to support you as you both carry your infant and your breasts become large and heavy due to breastfeeding. To bring the muscles back toward the center of your belly and largely reduce the gap there, begin performing crunches about 2-4 weeks after you gave birth (6 weeks if you’ve had a cesarean). It is recommended to try for 30 crunches aimed at the center, 30 to your left and 30 to your right. It may take you a while to get up to these numbers, so take your time and be patient with your body.