Postpartum: When to Call the Doctor (And When to Chill)
Ah, postpartum: the designated and sacred time after a mother gives birth, and the recovery period as she adjusts to her new baby and new life. As mothers we've all experienced these moments of recovery and adoption as we lean and revel in the beauty (and sometimes, chaos) of motherhood. With 90% of the female population destined to have a child at some point in their life, these important matters are crucial to discuss. Talking about these things literally saves lives. Whether you're a first time mom, or a veteran mom of multiples, everyone's encounters with the intimacy of our bodies in postpartum are as similar as they are different. Working within this dichotomy, how do we know what's truly normal and what may not be? When do we need to call the doctor, and when do we need to chill?
Certainly our experiences will vary, but with careful research and guidance from medical professionals and the antidotes of other mothers, we can have a better sense of what we are dealing with and consequently, what we need. Motherhood is taxing enough, as is. Worrying over our health and the health of our child/children is all consuming. We want to be whole and well as we venture into the depths of motherhood, and maintaining our wellness and sanity is top priority. What should we expect as we venture into the unknown (or less known)? What is normal?!
For the most part, your postpartum experience should be normal, and most should not worry about complications, as they are fairly rare. Still, make sure you’re listening to your body and noticing the signs that something may not be right. So, what are the baseline standards to which we can compare? Here's what we know:
BLEEDING:
What’s normal: Bleeding is normal! No need to call the doctor. Sure, to some it may seem gross, but in reality, it's one of the most normal parts of childbirth (and incidentally, the life of a woman). The bleeding that flows from your uterus is very similar to why you get a normal period cycle every month; your body needs to shed the lining of your uterus and restore what's been lost in the birth of your child. The blood you shed during the postpartum period is filled to the brim with many cool things, including mucus and white blood cells. This bleeding is healthy and normal, albeit sometimes seeming excessive. Don’t freak out, though! What you are experiencing is normal.
Sometimes it may be concerning if you don't know what to expect. But don’t worry--postpartum bleeding at its heaviest should only last about a few weeks, slowing to yellow or white discharge within weeks two and three. If your postpartum bleeding extends beyond a handful of weeks, or includes blood clots larger than half your palm, contact your doctor.
When to get help: bleeding, although normal, should be taken rather seriously, and any concerns should be addressed with your OBGYN (including, but not limited to, high fever, foul-smelling blood, heavy bleeding that extends beyond the second week, dizziness or lightheadedness, or tender feelings along your abdomen). Hemorrhaging is another serious condition that can occur, which is why awareness of your body and bleeding is critical. Several things can increase your bleeding, including increased physical activity, breastfeeding, exercising, or even urination after recovery. Never fear, though, by week six, you should feel (mostly) back to normal. Another important note that plays into the factors of postpartum bleeding is sexual activity after giving birth.
CRAMPING:
What’s normal: your uterus just expanded to the size of a watermelon. It’s no wonder that it needs to recover! You can expect some cramps as it works its way back to its pre-pregnancy size and location. Sometimes the pain can be pretty intense, almost like a contraction. (And you thought you were done with those!) But each cramp should go away after about five minutes. You should have relief in between periodic cramping. Also know that if you’re breastfeeding, expect normal cramping while nursing for the first few weeks. Breastfeeding triggers normal cramping, so don’t think it’s anything that you’re doing wrong!
When to get help: Now let’s talk about abnormal postpartum cramping. Make sure to let your doctor know if you have significant pain that is steady (rather than cramps that come and go). It is not normal to have a constant and intense cramp postpartum.
TEARS AND EPISIOTOMIES
What’s normal: You should expect some amount of tearing postpartum. Yep, most women tear during childbirth. (Sorry if that made you cringe!) And sometimes, doctors make a cut, called an episiotomy, to aid in delivery. That means many women go home with tender parts (and often, some stitches). Most of the time, the tears are minor and heal without issue. Stitches will dissolve on their own. Some discomfort should be expected with tearing and episiotomies, but nothing severe.
When to get help: What you should not be feeling is intense pain. Or seeing discoloration. Tears and episiotomies may become infected. Larger tears are more prone to infection than smaller tears. Big or small, though, seek medical attention if you have a fever, notice foul-smelling discharge or if your pain gets worse instead of better. These are all signs that something could be wrong with the childbirth tearing and/or an episiotomy. Please let your doctor know.
INCONTINENCE (LEAKAGE OF URINE OR BOWEL MOVEMENTS)
What’s normal: You should expect your peeing habits to be a bit off postpartum. These habits were already a bit weird early on during pregnancy, but a lot of women have some urinary leakage at the end of pregnancy and can continue for a few weeks after birth. Kegel exercises can help tighten things up and stop the leaking. Discuss with your doctor if Kegel exercises are right for you postpartum.
When to get help: Here’s what’s not normal postpartum: bowel leakage. We’re talking about poop, not pee here. Bowel leakage is a more serious condition than urinary leakage postpartum. Women who experienced larger tears during delivery are at greater risk of bowel leakage, so be aware. If you have leaking gas or bowel movements, talk to your doctor. In this case, Kegels can make things worse, so make sure to get medical advice before you take up a squeezing regimen.
BLOOD PRESSURE & HEART RATE:
What’s normal: your blood pressure will be checked in the hospital and may happen again the day you leave. When you’re home feeling a little overwhelmed and tired with the newness of motherhood and caring for a newborn is normal. While this might not immediately be on your radar, it's important to discuss. Postpartum preeclampsia is no light thing, and at its worst, can cause severe health complications or even death. Postpartum preeclampsia is a rare condition that occurs when your blood pressure is abnormally high, and excess protein is found in your urine after birth. Most cases of this condition develop within forty-eight hours after giving birth, but some can develop several weeks in. Left untreated, it can cause seizures or even death, in some cases. This condition can often be difficult to self-diagnose, and the symptoms can come on quickly, especially since symptoms can be undetectable during pregnancy and left unnoticed by medical providers.
When to get help: hypertension that equals to 140/90 or greater, severe headaches, substantial changes in vision (including total loss of vision, blurred vision, or severe light sensitivity), upper abdominal pain (especially if it's under the ribs on the right side of your body), and decreased or painful urination. The causes of postpartum preeclampsia aren’t fully known, but there are certain risk factors that might preclude you to having this condition. High blood pressure during pregnancy, obesity, pregnancy with twins or triplets, a preexisting chronic high blood pressure issue, and diabetes (type one or two). The ramifications of this condition is stark, including seizures, fluid in the lungs, strokes, blood vessel blockages, and the destruction of red blood cells (HELLP syndrome).
It’s better to be over-cautious than under-cautious, and if you feel you’re experiencing any symptoms that could possibly lead to a life-threatening condition, don’t ever be afraid to contact your doctor or OBGYN about your concerns. In addition to postpartum preeclampsia, you should watch out for other conditions as well, including infections, blood clots, mastitis, and hemorrhaging (which we’ve already discussed). The complications to look out for, beyond what has already been discussed, includes red streaks or lumps on your breasts, severe pain in the lower abdomen, odorous discharge or blood, chills or clammy skin, fast breathing, accelerated heart rate, feeling disoriented or confused, and any sort of extreme pain or discomfort beyond what is considered normal.
Let’s talk now about the effect that giving birth has on your body, and what to expect in the weeks to come beyond postpartum bleeding and various complications. First off, it’s completely normal to have perineum pain after giving birth, which is something that isn’t widely discussed. Veins in the anus can “pop”, causing throbbing and itching that may at times feel rather uncomfortable. Hemorrhoids are common, so you shouldn’t freak out if this affects you. It is completely normal. Defecating postpartum can be difficult, and sometimes scary. But know that these effects won’t last forever, and you will find relief as the days go on. Another effect of pregnancy that isn’t talked enough about is the external vaginal pain that is the result of tears during birth giving. Peri bottles after urinating are your best friend here. Gentleness and sensitivity are key. Give yourself grace as you deal with these potential postpartum issues.
Just know that as the days go on, you will recover more and more every day. Motherhood is taxing, and takes a toll. But the beauty that springs forth from such a beautiful experience is more than worth it. The key here is listening to your body, not being afraid to address concerns, and foremost, putting yourself and your safety first. It seems counterintuitive, as society bombards us with the idea that mothers come second. But sadly enough, this mindset kills. This article only touches on the baseline of postpartum struggles, the tip of the iceberg if you will, but it goes so much deeper than that. Your physical health is important, dear mama. And I hope if you take away anything from this article, it is this.
The takeaway? Listen to your body, mama!