6 Things You’ll Be Glad Someone Told You About Pregnancy, Birth & Postpartum: Part I

A couple weeks ago I sent out a survey to mothers about what they wished someone had told them about the whole process of pregnancy, birth and new motherhood. 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 illuminate 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. For the sake of length of this blog piece, I’ll be dividing this list into two installments: Part II will be published next week and the truth will be told on 6 more topics. 

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.  Leukorrhea (discharge during pregnancy) 

Unless you have a girlfriend who was eager to share personal details with you, you may not hear much about vaginal discharge during pregnancy. As your pregnancy develops, you will discover that you have an increased amount of thin to milky white thick, mild-smelling to unscented discharge. Stock up on panty liners as you may be replacing them frequently. This discharge is both from the cervical glands helping maintain your mucus plug and also from the lactobacilli (good bacteria) converting sugar into lactic acid in order to keep the vaginal environment acidic. Remember that excessive discharge can also be a sign of an infection or, if it is watery, it could be amniotic fluid. Be sure to consult your provider. 

2.  Hemorrhoids  

You may have heard of developing hemorrhoids from pushing during birth, but did you know that it’s quite common to discover hemorrhoids during pregnancy as well? Hemorrhoids are enlarged, outpouching veins in your rectum, and are in in fact the same thing as varicose veins: the blue, lumpy, tangled looking bunches seen in people’s legs. They range in size, from unnoticeably small to quite large and protruding. These form from straining during defecation and also because the weight of the enlarging uterus puts pressure on the rectum. Pregnant women are more susceptible to hemorrhoids because of the increased amount of the hormone progesterone that circulates in their body. Progesterone relaxes and dilates, and this is specifically what it does to the veins surrounding and inside the rectum. Generally, hemorrhoids do not present a problem unless they are large. To prevent, keep up with physical activity in order to increase gut motility and maintain a diet high in fiber so to prevent hard, compact stool. For comfort measures, try sitz baths, Epsom salts and witch hazel to soothe. Ointments can be found over the counter at any pharmacy. 

3.  Shoe size

An old wives’ tale that feet grow during pregnancy? Actually, no! Believe it or not, your feet can grow anywhere between a half to a full shoe-size larger during the course of your pregnancy. This is due to the relaxin hormone which circulates during pregnancy and loosens joints and ligaments. You may have heard about the joints of the pelvis loosening up a bit during pregnancy which is what leads to the characteristic “waddle.” The same hormone also acts on the feet, causing the ligaments in the feet to soften and relax. Also, as you gain weight during pregnancy, the downward pressure exerted on your feet increases as well. This can reduce the arch of your foot and spread your toes out further. Not a whole lot that can be done about this! Just make sure to give those hard-working feet a good rest when you can.  

4.  The word on poop

Almost as terrifying to many women as an infant emerging from their vagina is the prospect of pooping during delivery. For some, this private act made public can cause major anxiety in anticipation of the labor process. So much so that they might opt for a cesarean section in order to avoid this aspect of labor. On the other hand, some mothers don’t find the idea of pooping to be embarrassing at all. As with everything, there are always a range of feelings about it. I’d like to set the facts straight here on pooping. Having been both a doula for a decade as well as a Labor & Delivery nurse, I’ve seen hundreds of deliveries. Yes, there is often poop. But please understand that the amount of poop is usually very small, although there are always exceptions. I’ll explain. When the second stage of labor begins, also called the pushing phase, the baby is well engaged in your pelvis. To make room for the baby’s considerably large head, the colon and rectum become compressed, often producing a small amount of stool in the process. Also, the act of pushing the baby out requires you to bear down with all your might which can also cause you to defecate. As I said, however, the amount is generally negligible and this is because of the compression of your organs that I mentioned above. If you’re delivering in a hospital setting, the probability of you pushing in the lithotomy position (on your back) is great. If this is the case, your anus is actually buried for the most part in the sheet, towel or chux pad that is beneath you. In which case, no one, except perhaps your attentive nurse, will notice that you’ve produced any stool. Her job is to subtly and swiftly whisk it away to the trash if she does see any, knowing full well that it can be embarrassing and distracting to you to know in excessive detail what’s going on downstairs. Note that if you try to hold back or hold in anything during the pushing phase you’re not doing yourself any favors. Pushing will simply take longer. It’s in your best interest to let go entirely and push with every ounce of energy you have. There’s no pacing yourself in pushing. Push as hard as you can from the start and the sooner the baby will be in your arms and any memory of pooping will be long gone.  

5.  Engorgement

Most women experience breast engorgement about 3 days postpartum. This is one topic that seems to be less under wraps than others. Women expect to get engorged. However, what is perhaps not made known to them is the extent of the discomfort, what to do for relief, and how long it will last. Engorgement is the result of an increased number of blood vessels in the breasts and a general crowding and profusion of colostrum, blood and lymph. Because the colostrum and early milk supply is not flowing substantially yet, there is stasis and backup. This leads to full, firm, taught and painful breasts. The discomfort may range from tolerable to nearly unbearable. Just remember this will last only 24-48 hours, which is not long in the scheme of things, but may feel like eternity in the moment. Your best bet for relief is to take a warm shower and allow the water to fall on your breasts which may elicit a let-down response, producing some milk which can alleviate the congestion some. Try for 10-15 minutes before you plan to breastfeed. Massage can also help loosen things up. Try for massage in the shower, and only press as firmly as is tolerable. Most importantly is to keep your baby breastfeeding; this increases the flow and lessens the stasis and backup. Even though this is not an issue of inflammation per say, you can still take ibuprofen and this will help decrease the acute discomfort. There’s not much you can do to prevent this from occurring save keeping the baby to the breast whenever you notice feeding cues. Also, avoiding pumping in these early postpartum days may decrease your chances of engorgement. Keep in mind that if symptoms persist or are localized and inflamed, you may have an infection. Be sure to consult your provider if you have any questions. Please note if you are not breastfeeding, there are other methods, not discussed here, to decrease your milk supply and manage engorgement. 

6.  Sweating during postpartum

You may be surprised to discover yourself drenched in sweat in your first few days to a week postpartum. Again, this is the result of your pregnancy hormones. Your body produces a large amount of extra fluid as a part of the pregnancy process to help nourish and protect your baby. After you deliver, it’s time to eliminate all that fluid in a process called diuresis. Besides urinating frequently, the body’s best mechanism of fluid removal is perspiration. It’s not uncommon to lose as much as 3 liters a day through urine and sweat. It’s important to remember to drink plenty of water or you can easily become dehydrated. Withholding from drinking in order to limit the amount of urine or sweat you produce is unhealthy and can be dangerous, especially if you’re breastfeeding. Drinking water helps flush out this excess water and increases your milk supply. The only thing you can do is try to stay cool, take showers as needed, dress in loose, comfortable clothing, and drink drink drink!. This sweaty phase will pass soon enough.