What to expect when you're expecting (167 page)

Bloodshot eyes; black-and-blue marks around eyes, on cheeks, elsewhere, from too-vigorous pushing

Sweating, and lots of it, particularly at night

Breast discomfort and engorgement beginning around the third or fourth day postpartum

Sore or cracked nipples, if you’re breastfeeding

Emotionally

Elation, blues, or swings between the two

New-mom jitters; trepidation about caring for your new baby, especially if you’re a first timer

Frustration, if you’re having a hard time getting started breastfeeding

A feeling of being overwhelmed by the physical, emotional, and logistical challenges facing you

Excitement about starting your new life with your new baby

“I expected some bleeding after delivery, but when I got out of bed for the first time and saw the blood running down my legs, I was a little freaked out.”

Grab a pile of pads, and relax. This discharge of leftover blood, mucus, and tissue from your uterus, known as lochia, is normally as heavy as (and often heavier than) a menstrual period for the first three to ten postpartum days. It may total up to 2 cups before it begins to taper off, and at times it may seem pretty profuse. A sudden gush when you stand up in the first few days is normal—it’s just the flow that accumulates when you’ve been lying down or sitting. Because blood and an occasional blood clot are the predominant ingredients of lochia during the immediate postpartum period, your discharge can be quite red for anywhere from five days to three weeks, gradually turning to a watery pink, then to brown, and finally to a yellowish white. Maxipads, not tampons, should be used to absorb the flow, which may continue on and off for just a couple of weeks or as long as six weeks. In some women, light bleeding continues for three months. The flow is different for everyone.

Breastfeeding—and/or intravenous Pitocin (oxytocin), which is routinely ordered by some doctors following delivery—may reduce the flow of lochia by encouraging uterine contractions. These postdelivery contractions help shrink the uterus back to its normal size more quickly while pinching off exposed blood vessels at the site where the placenta separated from the uterus. For more about these contractions, see the next question.

If you’re in the hospital or birthing center and you think your bleeding may be excessive, notify a nurse. If you experience what seems to be abnormally heavy bleeding (see
page 569
) once you’re home, call your practitioner without delay; if you can’t reach him or her, go to the emergency room (in the hospital where you delivered, if possible).

“I’ve been having crampy pains in my abdomen, especially when I’m nursing. What’s that about?”

Thought you’d felt the last of those contractions? Unfortunately, they don’t end immediately with delivery—and neither does the discomfort they cause. Those so-called afterpains are triggered by the contractions of the uterus as it shrinks (from about 2
¹
/
₃
pounds to just a couple of ounces) and makes its normal descent back into the pelvis following the birth of your baby. You can keep track of the shrinking size of your uterus by pressing lightly below your navel. By the end of six weeks, you probably won’t feel it at all.

Afterpains can definitely be a pain, but they do good work. Besides helping the uterus find its way back to its usual size and location, those contractions help slow normal postpartum bleeding. They’re likely to be more of a pain in women whose uterine muscles are lacking in tone because of previous births or excessive stretching (as with a multiple pregnancy). Afterpains can be more pronounced during nursing, when contraction-stimulating oxytocin is released (a good thing, actually, since it means your uterus is shrinking faster) and/or if you’ve had intravenous Pitocin (oxytocin) following delivery.

The pains should subside naturally within four to seven days. In the meantime, acetaminophen (Tylenol) should provide relief. If it doesn’t, or if the pains persist for more than a week, see your practitioner to rule out other postpartum problems, including infection.

“I didn’t have an episiotomy, and I didn’t tear. Why am I so sore down below?”

You can’t expect some 7 pounds of baby to pass unnoticed. Even if your perineum was left neatly intact during the baby’s arrival, that area has still been stretched, bruised, and generally traumatized, and discomfort, ranging from mild to not so mild, is the very normal result. The pain may be worse when you cough or sneeze, and you may even find that it hurts to sit down for a few days. You can try the same tips given in the next answer for women with post-tear pain.

It’s also possible that in pushing your baby out, you developed hemorrhoids and, possibly, anal fissures, which can range from uncomfortable to extremely painful. See
page 272
for tips on dealing with hemorrhoids.

“I tore during delivery and now I’m incredibly sore. Could my stitches be infected?”