What to expect when you're expecting (184 page)

This period will typically (but not always) be followed by one of hypothyroidism (too little thyroid hormone). With hypothyroidism, fatigue continues, along with depression (longer lasting and often more severe than typical baby blues), muscle aches, excessive hair loss, dry skin, cold intolerance, poor memory, and an inability to lose weight.

If your postpartum symptoms seem to be more pronounced and persistent than you would have expected, and especially if they are preventing you from eating, sleeping, and enjoying your new baby, check with your practitioner. Tests can determine whether PPT is the cause of your troubles. Be sure to mention any history of thyroid problems in your family, since there is a very strong genetic link.

Most women recover from PPT within a year after delivery. In the meantime, treatment with supplementary thyroid hormone can help them feel much better much faster. About 25 percent of women who have the condition, however, remain hypothyroid, requiring lifetime treatment (which is as easy as taking a pill every day and having a yearly blood test). Even in those who recover spontaneously, thyroiditis is likely to recur during or after subsequent pregnancies. Some may develop hypothyroidism or Graves disease (hyperthyroidism) later in life. For this reason, it makes sense for women who have had PPT to have a yearly thyroid screening and, if they are planning another pregnancy, to be screened in the preconception period and during pregnancy (because an untreated thyroid condition can interfere with conception and cause problems during pregnancy).

Some women, instead of (or in addition to) feeling depressed postpartum, feel extremely anxious or fearful, sometimes experiencing panic attacks that include rapid heartbeat and breathing, hot or cold flashes, chest pain, dizziness, and shaking. These symptoms also require prompt treatment by a qualified therapist, which may include medication.

About 30 percent of women suffering from PPD also exhibit signs of postpartum obsessive-compulsive disorder (PPOCD), though PPOCD can also occur by itself. Symptoms of PPOCD include obsessive-compulsive behaviors, such as waking up every 15 minutes to make sure the baby is still breathing, furious housecleaning, or having obsessive thoughts about harming the newborn (such as throwing the baby out the window or dropping him or her down the stairs). Women suffering from PPOCD are appalled by their gruesome and violent thoughts, though they won’t act on them (only those suffering from postpartum psychosis might; see below). Still, they can be so afraid of losing control and following through with these impulses that they may end up neglecting their babies. Like PPD, treatment for PPOCD includes a combination of antidepressants and therapy. If you’re having obsessive thoughts and/or behaviors, be sure to get help by telling your practitioner about your symptoms.

Much more rare and much more serious than PPD is postpartum psychosis. Its symptoms include loss of reality, hallucinations, and/or delusions. If you’re experiencing suicidal, violent, or aggressive feelings, are hearing voices or seeing things, or have other signs of psychosis, call your doctor and go to the emergency room immediately. Don’t underplay what you’re feeling, and don’t be put off by reassurances that such feelings are normal during the postpartum period—they’re not. To be sure you don’t act out any dangerous feelings while you’re waiting for help, try to get a neighbor, relative, or friend to stay with you or put your baby in a safe place (such as the crib).

“I knew I wouldn’t be ready for a bikini right after delivery, but I still look six months pregnant two weeks later.”

Though childbirth produces more rapid weight loss than any diet you’ll find on the bestseller lists (an average of 12 pounds overnight), most women don’t find it quite rapid enough. Particularly after they catch a glimpse of their paunchy postpartum profiles in the mirror.

The fact is, no one comes out of the delivery room looking much slimmer than when they went in. Part of the reason for that protruding postpartum abdomen is your still-enlarged uterus, which will be reduced to prepregnancy size by the end of six weeks, reducing your girth in the process. Another reason for your belly bloat might be leftover fluids, which should be flushing out soon. But the rest of the problem lies in those stretched-out abdominal muscles and skin, which will likely take some effort to tone up. (See Getting Back into Shape,
page 465
.)

As hard as it might be to put it out of your mind, don’t even think about the shape your body’s in during the first six weeks postpartum, especially if you’re breastfeeding. This is a recovery period, during which ample nutrition (and rest) is important for both energy and resistance to infection. Sticking to a healthy postpartum diet should start you on the way to slow, steady weight loss. If, after six weeks, you aren’t losing any weight, you can start cutting back somewhat on calories. If you’re nursing, don’t go overboard. Eating too few calories can reduce milk production, and burning fat too quickly can release toxins into the blood, which can end up in your breast milk. If you’re not nursing, you can go on a sensible, well-balanced weight-loss diet six weeks postpartum.

Some women find that the extra pounds melt off while they’re breastfeeding; others are dismayed to find the scale doesn’t budge. If the latter turns out to be the case with you, don’t despair; you’ll be able to shed any remaining excess poundage once you’ve weaned your baby.

How quickly you return to your prepregnant weight will also depend on how many pounds you put on during pregnancy. If you didn’t gain much more than 25 to 35 pounds, you’ll likely be able to pack away those pregnancy jeans in a few months, without strenuous dieting. If you gained 35 or more pounds, you may find it takes more effort and more time—anywhere from 10 months to 2 years—to return to prepregnancy weight and your skinny jeans.

Either way, give yourself a break—and give yourself some time. Remember, it took you nine months to gain that pregnancy weight, and it may take at least that long to take it off.

“It’s been a week since my C-section. What can I expect now?”

While you’ve definitely come a long way since you were wheeled into recovery, like every new mom you still have some recuperation ahead of you in the next few weeks. Keep in mind that the more conscientious you are about getting the rest you need now—as well as about following your practitioner’s instructions—the shorter that recuperation time will ultimately be. In the meantime, you can expect:

Little or no pain.
Most of it should have dissipated by now. But if you do hurt, some acetaminophen (Tylenol) should do the trick.

Progressive improvement.
Your scar will be sore and sensitive for a few weeks, but it will improve steadily. A light dressing may protect it from irritation, and you will probably be more comfortable wearing loose clothing that doesn’t rub. Occasional sensations of pulling or twitching and other brief pains around the incision site are a normal part of healing and eventually subside. Itchiness may follow—ask your practitioner to recommend an anti-itch ointment that you can apply. The numbness surrounding the scar will last longer, possibly several months. Lumpiness in the scar tissue will probably diminish, and the scar may turn pink or purple before it finally fades.

If pain becomes persistent, if the area around the incision turns an angry red, or if a brown, gray, green, or yellow discharge oozes from the wound, call your doctor. The incision may have become infected. (A small amount of clear fluid discharge is usually normal, but report it to your physician anyway.)

A four-week wait (at least) for sex.
The guidelines are pretty much the same as they are for those who’ve delivered vaginally, though how well your incision is healing may also be factored into how long you’ll need to wait. See the next question for more.

To get moving.
Once you’re free of pain, you’ll be able to begin exercising. Kegel exercises are still important even if you delivered with your perineum intact, because pregnancy took its toll on those pelvic floor muscles. Concentrate, too, on exercises that tighten the abdominal muscles. (See Getting Back into Shape,
page 465
.) Make “slow and steady” your motto; get into a program gradually and continue it daily. Expect it to take several months before you’re back to your old self.

“When can we start having sex again?”

That’s at least partly up to you, though you’ll also want to include your practitioner in the decision (probably not in the heat of the moment). Couples are typically advised to pick up where they left off whenever the woman feels physically ready—usually around four weeks postpartum, though some practitioners give the green light to sex as early as two weeks postpartum, and others still follow the old six-week rule routinely. In certain circumstances (for instance, if healing has been slow or you had an infection), your practitioner may recommend waiting longer. If your practitioner still has you in a holding pattern, but you think you’re ready to move forward, ask if there’s a reason why you shouldn’t. If there isn’t, ask your practitioner if you can get busy earlier. If it turns out there is a reason why sex might not be safe yet, hit the cold shower—though maybe together—and wait for clearance. Keep in mind that time will fly when you’re caring for a newborn. In the meantime, satisfy each other with lovemaking that doesn’t involve penetration.

“My midwife told me I can start having sex, but I’m afraid it’s going to hurt. Plus, to be honest, I’m really not in the mood.”

Doing “it” isn’t topping your to-do list these days—or, more likely, isn’t even making the top 20? No surprise there (or down there). Most women lose that loving feeling during the postpartum period—and beyond—for a variety of reasons. First, as you already suspect, postpartum sex can be more pain than pleasure—especially if you delivered vaginally, but, surprisingly, even if you labored and then had a C-section. After all, your vagina has just been stretched to its earthly limits, and possibly torn or surgically cut and sutured to boot—leaving you too sore to sit, never mind contemplate sex. Your natural lubrications haven’t turned on yet, making you feel uncomfortably dry where you’d rather be moist—especially if you’re breastfeeding. Adding to the pain potential: Low levels of estrogen cause the vaginal tissue to remain thin, and thin is not in as far as vaginas are concerned.

But your libido has other problems to contend with postpartum besides the physical ones: Your understandable preoccupation with a very little and very needy person, who is given to waking up with a full diaper and an empty tummy at the least opportune times. Not to mention a number of other very effective mood killers (the pungent smell of day-old spit-up on your sheets, the pile of dirty baby clothes at the foot of your bed, the baby oil on your nightstand where there used to be massage oil, the fact that you can’t remember when you had your last shower). It’s no wonder sex isn’t on the schedule.

Will you ever live to make love again? Absolutely. Like everything else in your new and often overwhelming life, it’ll just take time and patience (especially from your partner, who’s almost certainly ready for this dry spell to end). So wait until you’re feeling ready, or help yourself get ready with the following tips:

Lubricate.
Using K-Y jelly, Astroglide, or another lubricant until your own natural secretions return can reduce pain and, ideally, increase pleasure. Buy them in economy sizes, so you’ll be more likely to use them liberally—on both of you.

Loosen up.
Speaking of lubrication, drinking a small glass of wine can also help you unwind—and keep you from tensing up and experiencing pain during intercourse (just make sure you drink it right after a feeding if you’re nursing). Another great way to loosen up is massage, so request one prior to closing the deal.

Craving More?

For much more information on easing back into sex, birth control, and enjoying the first year, see
What to Expect the First Year.

Warm up.
Of course, your partner’s probably as eager as he’s ever been to get down to business. But though he may not need much—if any—foreplay, you definitely do. So ask for it. And then ask for some more. The greater the effort he puts into warming you up (time permitting before baby wakes up again, of course), the better the main event will be for both of you.

Tell it like it is.
You know what hurts and what feels good, but your partner doesn’t unless you provide him a clearly marked map (“Turn left … no, right … no, down … up just a smidge—there, perfect!”). So speak up when you’d like things to heat up.

Position properly.
Experiment and find a position that puts less pressure on any tender areas and gives you control over the depth of penetration (this is one time when deeper will definitely not be better). Woman-on-top (if you have the energy) or side-to-side positions are both great postpartum picks for those reasons. Whoever’s in charge of the strides, make sure they’re performed at a comfortably slow speed.

Pump it up.
No, not that kind of pumping. Pump blood and restore muscle tone to your vagina by doing the exercise you’re probably sick of hearing about (but should keep doing anyway): Kegels. Do them day and night (and don’t forget to do them when you’re doing “it,” too, since that squeeze will please you both).

Find alternative means of gratification.
If you’re not having fun yet through intercourse, seek sexual satisfaction through mutual masturbation or oral sex. Or if you’re both too pooped to pop, find pleasure in just being together. There’s absolutely nothing wrong (and everything right) about lying in bed together, cuddling, kissing, and swapping baby stories.