Recovery from vaginal or assisted birth
Recovery after vaginal or assisted birth
Recovery from vaginal or assisted birth
Recovery from vaginal or assisted birth
Once you are admitted to the postnatal ward or discharged home from hospital to the care of the community midwife, you can expect that your body will need some time to recover from the birth. Midwives, maternity support workers or nurses may be involved in your care and will carry out routine checks to ensure that you are well. This will include a regular top to toe physical check, including inspection of sutures (stitches).
If you have had a vaginal birth you will be offered pain relief. Read “Commonly used medicines” to find out what painkillers are routinely offered. Read “After pains” and “Perineal after-care” which explains how you can help yourself if you are experiencing after pains or if you have had an episiotomy (cut) or a perineal tear. If you have had an assisted delivery you may need to have a urinary catheter for a few hours. Read “Passing urine” for more information.
It is important to eat well and drink plenty of fluids to promote health and wellbeing after any type of birth.
Healthy eating after birth
Healthy eating after birth
Eating healthily after the birth of your baby is as important as it was during pregnancy. Eating a balanced diet with plenty of clear fluids helps your body to recover. Speak to your midwife, health visitor, infant feeding specialist or GP if you have specific concerns relating to weight loss, diabetes or breastfeeding.
Nutrition after pregnancy from Nutribytes
Carpal tunnel syndrome
Carpal tunnel syndrome
What is Carpal tunnel syndrome (CTS)?
There are eight small bones called the carpal bones in the wrist. These bones form a semi-circle, and a tough band of tissue (the carpal ligament) forms a roof over these bones. This tunnel is known as the ‘carpal tunnel’. Passing through this tunnel are the tendons which move the fingers and thumb and the median nerve. When the median nerve gets compressed (squeezed or pinched) in the tunnel, it causes the symptoms of CTS.
During pregnancy, the body naturally retains more fluid, and swelling of the hands is common. If some of this fluid is localised to the carpal tunnel, this leads to pressure on the median nerve causing the symptoms of CTS. Up to 62% of pregnant women develop CTS. These symptoms are also common after the birth.
What are the common symptoms?
Symptoms are commonly felt in the thumb, index and middle fingers. You may have symptoms in one or both hands. Symptoms may include:- pain in your wrist, palm or forearm
- ‘pins and needles’
- numbness
- weakness caused poor grip or clumsiness
- burning sensations in the fingers
- hands may appear swollen
What can you do to help yourself?
Positioning
Keep your wrists straight to avoid putting pressure on the nerve. You may find wearing a wrist splint useful at night and when resting during the day. Do not put splints on too tightly and do not wear them continuously unless advised.Rest
Reduce all non-essential activities, such as shopping, carrying, lifting and repetititve tasks such as typing and writing.Ice
Using an ice pack over the wrist/hand area may help reduce the swelling and pain. Leave for 10 minutes.Contrast bathing
Using alternating heat and cold can also be helpful to reduce pain and swelling. You can do this by either using an ice pack and hot water bottle wrapped in a tea towel or by dipping your hands in cold or warm water. Alternate between warm and cold for 30 seconds each, for 5-6 minutes, always finishing with the cold. You can do this 3-4 times a day. Precaution: always check the water temperature before immersing your hand.Elevation
When possible, place your wrists on pillows above the level of your heart to reduce swelling. This can be very useful at night – remember not to sleep with your hands under your pillow.Movement/Exercise
These exercises done throughout the day between rest periods may help relieve your symptoms. Aim to do the exercises at least three times every day. 1. Bend and straighten your wrists keeping your fingers straight. Hold each position for 5 seconds and repeat x10:
2. Hand squeeze. Make a release a fist (this can be done with your hands elevated). You could also squeeze a stress ball:
3. Fingers bend and straighten. Forearm upright, wrist and fingers straight. Now hook your fingers down, trying to touch the tips of your fingers to the top of your palm. Straighten again. Repeat 10 times:
General advice
Should your symptoms continue after your baby is born you should speak to your GP who may refer you for assessment and care.Fatigue
Fatigue
It is not uncommon to feel very tired after the birth of your baby. Plenty of rest and a balanced diet can help you on the road to recovery:
Also remember to eat foods that are rich in dietary iron (see related link below). If exhaustion persists for more than a few days speak to your midwife or GP.
Commonly used medicines after birth
Commonly used medicines after birth
1. Analgesics (pain killers)
a) Paracetamol (500mg tablets)
What is it used for? Paracetamol works by relieving pain and lowering high temperature. It can provide effective reliefnfrom mild to moderate pain, including headache, toothache, sore throat, symptomatic relief of rheumatic aches and pains, influenza symptoms and fever. How do I take it? Paracetamol can be taken regularly or when required for pain. Dosage: Adults and young persons aged 12 and over: take 2 tablets up to 4 times per day, as required. The tablets should be taken with water. Take only as much as you need to relieve symptom and leave at least 4 hours between each dose. Do not take more than 8 tablets in 23 hours. What are the side effects? Paracetamol is generally well-tolerated in most people. Is it safe to use while breastfeeding? Paracetamol is commonly used during breastfeeding.b) Co-dydramol
What is it used for? Co-dydramol (10/500 10mg dihydrocodeine and 500mg paracetamol) is a combination of paracetamol and dihydrocodeine. Dihydrocodeine is stronger than paracetamol and is used for the relief of mild to moderate pain. If you have had a caesarean section or moderate pain post-delivery, then you may be given a box of 30 tablets of co-dydramol on discharge from hospital. How do I take it? Dosage: Co-dydramol 1 to 2 tablets every 6 hours when required up to a maximum of 4 times per day. Do not take more than 8 tablets in 24 hours. We recommend that you step down pain relief and substitute these tablets for paracetamol as soon as possible which is usually after 3-4 days. Since these tablets contain paracetamol you should not take any other paracetamol tablets at the same time. Do not drink alcohol whilst taking co-dydramol. What are the side effects? The most common side effects of dihydrocodeine are drowsiness, constipation, feeling sick or dry mouth. You may be advised to take a gentle laxative if you experience constipation whilst taking co-dydramol. Is it safe to use during while breastfeeding? Dihydrocodeine can be used during breastfeeding as a pain killer where paracetamol has not been effective. Use the minimum effective does for the least amount of time. IMPORTANT: Although there is a small dose of dihydrocodeine in these co-dydramol tablets, if you are breastfeeding whilst taking it, inform your midwife immediately if your baby is showing signs of increased drowsiness, difficulty feeding, breathing problems or anything else unusual. Research has shown that some babies may be more susceptible than others to these side effects. If you would like any further information regarding the use of dihydrocodeine while breastfeeding, please discuss it with your midwife/doctor.c) Ibuprofen
What is it used for? Ibuprofen is anti-inflammatory drug used to treat inflammation in a variety of conditions. It is commonly used after birth to help ease pain and inflammation. How do I take it? Swallow tablets whole, with a glass of water. Take the tablets with, or after, food. Dosage: Adults: 400mg three times a day, 8 hours apart, is often prescribed after a procedure. If you have been given a diclofenac suppository after birth or a procedure, you cannot start ibuprofen until 18 hours later. The dose can be reduced to 200mg three times a day when the pain improves. Who should not use ibuprofen? Women with any of the following conditions should consult a doctor, midwife, or pharmacist before taking ibuprofen if there is history of:- asthma or breathing problems
- previous stomach ulcer
- previous reaction to aspirin, diclofenac and other non-steroidal anti-inflammatory drugs (NSAIDs)
- other medical conditions, e.g. kidney disease, heart disease, blood clotting disorders, liver disease.
- pass blood in your faeces (stools/motions)
- pass black tarry stools
- vomit blood or dark particles that look like coffee grounds
- suffer any allergic reaction such as itching, drowsiness, swelling of the face, lips, tongue, mouth or throat, which may in turn cause shortness of breath or difficult swallowing.
2. Ferrous Sulphate (Iron supplements)
What is it used for? Iron supplements are used to treat iron deficiency anaemia. When the body does not get enough iron, it cannot produce the number of normal red blood cells needed to keep you in good health. It is common for women who are pregnant or who have just given birth to have this condition. These medicines work by replacing body iron. Iron is a mineral that the body needs to produce red blood cells. How should I take it? Swallow the tablets who with water. Although iron preparations are best absorbed on an empty stomach, they may be taken after food to reduce the effects on the stomach. Iron supplements should not be taken within one hour before or two hours after eating or drinking the following products: tea, coffee, milk, eggs and wholegrains. These products can reduce the absorption of iron. Dosage: Ferrous sulphate 200 mg tablets Treatment of iron deficiency anaemia: 1 tablet 2-3 times a day. Prevention of iron deficiency anaemia: 1 tablet per day. What are the side effects? Like all medicines, ferrous sulphate tablets may cause side effects, the most common of which are constipation, diarrhoea, stomach pain, feeling sick and blackened stools (faeces). Is it safe to use during breastfeeding? Ferrous sulphate tablets are commonly used safely while breastfeeding. Ensure that you do not take more than the recommended dose. If you cannot tolerate ferrous sulphate tablets, an alternative is available called ferrous fumarate. This is available as a liquid or tablets. The same side effect and safety information applies as above for ferrous sulphate.3. Laxatives
What are they used for? Laxatives are used to treat constipation. What else can I do to prevent becoming constipated? The following hints are helpful in maintaining regular bowel habits:- Eat fibre-containing foods, e.g. wholegrain bread, fruit and vegetables.
- Drink sufficient liquid, preferably water.
- Take regular exercise.
a) Lactulose
Lactulose is a liquid laxative used to treat and prevent constipation. Lactulose can take 2-3 days to have an effect; it is generally considered to be a gentle laxative. Dosage: Usually 10 mls twice daily. It must be taken regularly to have an effect.b) Fybogel (Ispaghula husk)
Fybogel is a high fibre drink that works to increase the fibre in your diet. Increased fibre in the diet helps to gently relieve constipation. Fybogel is considered to be a gentle laxative. It is important to maintain an adequate intake of fluid whilst using Fybogel. Dosage: The usual dose is one sachet mixed with a glass of water, up to twice daily. Is it safe to use Lactulose or Fybogel after birth? Lactulose and Fybogel are not absorbed into the blood and only have a local effect on the gut. Both drugs are generally considered safe to use while breastfeeding, under the advice of a midwife or doctor.4. Blood clot prevention
Enoxaparin (also known as Clexane) is used to prevent blood clots. Blood clots usually present as deep vein thrombosis (DVT) usually in a leg vein, or pulmonary embolism (PE), a blood clot in the lung. Blood clots are more common during pregnancy and some women will be more at risk of blood clots than others. As well as prevention, enoxaparin is also used at higher doses for treatment of DVT and PE. Is it safe to use during breastfeeding? Enoxaparin is given as an injection just beneath the skin (subcutaneous). It is usually injected into a skin fold in your abdomen (stomach) or the upper part of your thigh. If this is not suitable, you may be advised to inject into an alternative site. It should not be injected into your muscles. It may be given either once or twice daily. You should adminster the dose at the time recommended by your doctor. How is exonaparin used after birth/caesarean section? If you have, or develop risk factors at the time of the birth, you may be started on enoxaparin. Examples of possible risk factors would be having a caesarean section or infection. If you were on enoxaparin during pregnancy, your doctor will want you to stay on the same treatment after the birth. They will inform you how long to continue this treatment. How to inject Enoxaparin (Clexane) You will be able to inject enoxaparin once you have been shown how to do so by your doctor or midwife, or by following the instruction leaflet that will be given to you upon discharge. It is a simple process and one that you can do at home. Follow these steps:- Wash and dry your hands.
- Clean the injection site. If someone else is doing it for you it is advisable that they wear gloves.
- Choose the injection site either on the outer aspect of your left or right thigh or your stomach if advised to do so. It is important that you change the site each time. If there is any oozing of blood at the injection site, apply gentle pressure. Do not rub as this may cause bruising.
- Dispose of the syringe in the yellow sharps box provided. This box should be kept out of the reach of other people.
Heart health after giving birth
Heart health after giving birth
Chest pain in pregnancy and/or after your baby’s birth should never be ignored. Some chest pain can be serious and can head to a heart attack, heart failure, cardiac arrest or even death. Most women do not suffer from these conditions during or after pregnancy but it is important to recognise the symptoms and, if you have any of them, to seek treatment quickly.
Pre-exisiting heart conditions
If you have a known heart condition, were born with a congenial heart defect or have been diagnosed with heart disease, your midwife/GP/cardiologist will monitor your heart health before, during and after pregnancy.Symptoms of a heart attack can include:
- central chest pain
- arm pain or numbness
- pain in the jaw, back or shoulders
- nausea
- sweating/clamminess
- breathing difficulties
When should I contact the midwife or doctor?
If you feel unwell, contact your midwife or GP for guidance. If you experience some/all of the above symptoms, dial 999 and ask for an ambulance as yoru heart health needs to be investigated quickly. An ECG monitor and a troponin blood test should be carried out to find out if you have had a heart attack.When am I more likely to have a heart attack?
You are more likely to have a heart attack if you:- have a family history of heart problems
- have high blood pressure
- have high cholesterol
- smoke
- drink excessively
- are obese
Spontaneous Coronary Artery Dissection (SCAD) after birth
Spontaneous Coronary Artery Dissection (SCAD) after birth
SCAD is a rare but serious heart condition that causes a tear or bruise to develop in a coronary (heart) artery resulting in a blockage that prevents normal blood flow. It can cause heart attack, heart failure or cardiac arrest and can be fatal.
SCAD can happen during pregnancy and during the weeks and months after you have given birth. Symptoms can include:
- central chest pain
- arm pain or numbness
- pain in the jaw, back or shoulders
- nausea
- sweating/clamminess
- breathing difficulties
Pressure sores
Pressure sores
Pressure ulcers, also known as bed sores or pressure sores, are areas of damage to the skin and deeper layers of tissue.
Pressure ulcers may cause pain or become infected leading to a longer hospital stay.
Pressure ulcers are caused by a combination of:
Pressure: body weight and some medical equipment can squash the skin and damage the blood supply to the area. Lying or sitting in one position for a long period of time can cause this.
Shearing: sliding down the bed or chair can damage the skin and deeper layers of tissue. The skin may split or break.
Pressure ulcers can develop anywhere in the body but are more commonly found over boney areas such as bottom, heels, elbows, hips, ankles, spine, back of the head and shoulder blades. Usually people can relieve the effects of pressure and shearing by turning in bed and getting out of bed. You may be at risk of developing pressure ulcers if you stay in the same position for too long. Ask your healthcare professional or partner to help you move around safely. Ensure your clothing or bedding is not too tight so that you can move freely.
Early signs of pressure ulcers will appear as: a change in skin colour (redder or darker), change in skin temperature (hotter or colder) discomfort or pain, blistering and skin damage. You can check your own skin for signs of pressure ulcers, if you notice anything different on your skin, please contact your healthcare professional.
Whilst in hospital, your healthcare professional team will perform a risk and skin assessment to see if you are at risk of developing a pressure ulcer. After the birth, you can ask your healthcare professional to look at your skin if you feel any discomfort.
Protect your skin
- Keep your skin clean and dry. Wash your skin every day using mild soap and warm water. Do not use heavily perfumed soap or talcum powder, as these can soak up the skin’s natural oils leading to vulnerable dry areas.
- If you suffer from incontinence please inform your healthcare team as they can assess the best way to support you. Rubbing and massaging skin is bad for it.
- If you are given compression stockings (TEDS) to wear, do not allow them to roll down as this can cause pressure and skin damage. Remove the stockings once a day to wash, moisturise and inspect your skin.
Sepsis after birth
Sepsis after birth
Infection in pregnancy and/or after your baby’s birth should never be ignored. Some infections can progress to a more serious situation known as sepsis, where the infection spreads to the blood stream and through the whole body. If left untreated sepsis can lead to shock, organ failure and death. Whilst most women do not suffer from infection or sepsis during or after pregnancy, it needs to be recognised and treated quickly if they do.
Signs of sepsis
The first signs of infection are usually a rise in your temperature, heart rate and breathing. You may also feel unwell, have chills and flu-like symptoms and a worrying pain in your tummy and/or diarrhoea. Sepsis can progress very quickly so it is important to seek advice if you are concerned about your health.How can infection in pregnancy or after childbirth be prevented?
Good personal hygiene helps. This can include: daily showers/baths, proper hand washing and drying, perineal hygiene to include keeping the perineal area (between the vagina and back passage) clean, dry with frequent changes of maternity/sanitary pads. It is important to wash your hands before and after going to the toilet and changing maternity/sanitary pads.When am I more likely to get an infection or sepsis?
Sepsis may happen in pregnancy or after your baby is born. The risk of getting an infection is increased in the following circumstances:- After having a miscarriage or an ERPC (ERPC – evacuation of retained products of conception is a surgical procedure to remove tissue from the womb)
- Premature rupture of membranes (when your waters break long before your baby is due)
- If your waters break more than 24 hours before your baby is born
- If you develop a urine infection (UTI)
- If your baby was born prematurely/early (before its due date)
- After you have had your baby – this is the most common time for serious infection to develop; especially if you had your baby by an emergency caesarean section, by forceps or vacuum delivery, or if you had a perineal wound or an episiotomy).
When should I contact the midwife or doctor?
You should contact your GP or the maternity unit if you are worried, unwell and/or if you notice any of the following:- Pain/burning on passing urine or struggling to pass urine, this could be a symptom of a urinary tract infection
- Vaginal discharge which may be foul smelling and/or an unusual colour, this could be a sign of a genital tract infection (vaginal/womb infection)
- Abdominal pain that does not seem to be getting better with simple analgesia, this could be a sign of womb/wound infection or abscess
- Chills, flu type symptoms or feeling faint and unwell
- Fast breathing or shortness of breath
- Fast heart rate
- Persistent cough with or with sputum, shortness of breath or chest pain could be a sign of chest infection or pulmonary embolism (blood clot in the lung)
- A wound that is not healing well, broken down or is red
- Severe pain in one area of breast
- Diarrhoea
- Sudden increase in vaginal bleeding (after your baby is born).
