After the Birth: Your Recovery in the First Six Weeks

Warning Signs for Mothers

Most serious problems after birth happen in the first week, but some appear up to six weeks later. Put this list on the fridge and show it to whoever is helping at home, so they know when to act.

For any sign in the first column, come to The Limi Hospital now. If you cannot get there quickly, go to the nearest emergency department. Have someone else drive, and take your antenatal and delivery notes.

Bleeding After Birth

After every birth, vaginal or caesarean, the womb sheds its lining as a discharge called lochia. For the first few days it is bright or dark red and heavy, like a heavy period, and small clots are common. Over the next week or two it becomes pinkish-brown, and then yellow-white. It usually stops by four to six weeks. It may get a little heavier for a while when you are more active, or during breastfeeding.

• Use sanitary pads, not tampons, for the first six weeks, and change them at least every four hours.
• Watch the amount. Needing a fresh pad every hour, large clots, or bleeding that gets heavier instead of lighter are not normal.
• Notice the smell. Lochia smells like a period. A bad smell, especially with fever or tummy pain, can mean infection in the womb.

Stitches and Tears

Many women have a tear or a cut (episiotomy) that is stitched after a vaginal birth. The stitches usually dissolve on their own, and the area heals in two to three weeks, though it can stay tender for longer.

1. Keep it clean. Wash with clean water once or twice a day and after passing stool, from front to back. Pat dry with a clean cloth.
2. Pour warm, not hot, water over the area while you pass urine if it stings.
3. Change pads often and wash your hands before and after.
4. Sit on a soft cushion or lie on your side to take the pressure off.
5. Look for infection: increasing pain, swelling, pus or a bad smell. See a doctor or midwife that day.

After a Caesarean

A caesarean is major surgery. Recovery takes at least six weeks, even when you feel well sooner.

• Wound care. Follow the instructions you were given about the dressing and when stitches or clips come out. Afterwards, wash the wound gently with water, pat it dry, and wear loose clothes and high cotton underwear.
• Moving. Get up and walk a little, several times a day, from the first day; it lowers the risk of blood clots. Hold a pillow against the wound when you cough, laugh or get up.
• Lifting. Avoid lifting anything heavier than your baby for about six weeks. Let others carry buckets of water, shopping and older children.
• Driving and exercise. Ask at your check; most women wait around six weeks.
• Signs of wound infection: redness spreading from the cut, swelling, pus, the wound opening, pain that gets worse, or fever. See a doctor the same day.

Pain, Bowels and Bladder

Pain

Afterpains — cramps as the womb shrinks — are common in the first days, especially during breastfeeding and after a second or later baby. Pain from stitches or a wound should ease day by day. Ask the midwife or doctor which pain relief is suitable while you are breastfeeding, and take it as prescribed or as the pack says. Codeine is not recommended when breastfeeding. Pain that is getting worse, not better, needs checking.

Bowels

The first stool can take a few days and many women fear it will hurt. It will not damage stitches. Drink plenty, eat fruit, vegetables, beans and whole grains, walk a little, and do not strain; holding a clean pad against the stitches can help. Piles (haemorrhoids) are common and usually settle. Tell the midwife if you have not opened your bowels by day three or four.

Bladder and the Pelvic Floor

Leaking a little urine when you cough, laugh or lift is common after birth. Pelvic floor exercises help, and you can start them as soon as you feel ready, even after a caesarean:

1. Squeeze and lift the muscles you would use to stop passing urine and wind at the same time.
2. Hold for a few seconds, building up to 10 seconds, then relax fully.
3. Repeat up to 10 times, three times a day. Add 10 quick squeezes.

Keep going for at least three months. If leaking of urine, wind or stool is not getting better, tell your doctor — it can be treated, and you do not have to live with it.

Rest, Food and Help at Home

• Sleep when the baby sleeps, at least once in the day. Let visitors wait.
• Eat regular, varied meals: beans, eggs, fish, meat, leafy vegetables such as ugwu and spinach, fruit, and whole grains. Hot soups and pepper soup are fine.
• Drink to thirst, more if you are breastfeeding. Keep a cup of water where you feed.
• Carry on any iron or other tablets you were prescribed until the clinic says stop.
• Let people help with cooking, washing, older children and night-time nappies. Omugwo and the other traditions of a mother or relative coming to help are a real gift; ask them to take on the work so you can rest and feed.

Your Feelings

Baby Blues

Most new mothers have a few days, often starting around day three to five, of feeling weepy, anxious, irritable or overwhelmed, alongside joy. This is the baby blues. It is linked to hormone changes and exhaustion, and passes within about two weeks. Rest, food, company and reassurance are the treatment.

Postnatal Depression

Postnatal depression affects at least 1 in 10 mothers, and fathers can have it too. It can start any time in the first year. Signs include feeling low or empty most of the day, losing interest in things, not enjoying the baby, feeling guilty or worthless, being unable to sleep even when the baby sleeps, constant worry, or feeling you are a bad mother. It is common, treatable, and not caused by weakness, a lack of faith or a spiritual attack. Talking treatments and, when needed, medicines that are safe in breastfeeding help most women recover. Prayer and your faith community can be a real support alongside treatment. If low mood lasts more than two weeks, tell your doctor, midwife or the baby's clinic.

Postpartum Psychosis

Rarely — about 1 or 2 in every 1,000 births — a mother becomes suddenly and severely unwell, usually in the first two weeks. She may be confused, not sleep at all, seem unusually excited or fearful, hear or see things that are not there, or have strange ideas about herself or the baby. This is a medical emergency. Stay with her, keep the baby safe with another adult, and bring her to The Limi Hospital now, or to the nearest emergency department if you cannot get there quickly. With prompt treatment women recover.

For Fathers and Family

The people around a new mother shape how well she recovers. Here is what to do.

• Take on the work: meals, washing, cleaning, older children, and bringing the baby to her for feeds at night.
• Protect her rest. Limit visitors in the first weeks, and ask those who come to help rather than be served.
• Learn the warning signs on this page, and act on them without waiting to be asked.
• Notice her mood, ask how she is, and listen without judging. If she seems low for more than two weeks, help her see a doctor.
• Hold the baby skin to skin, change nappies and bathe the baby. Fathers who do this bond with their baby too.
• Look after yourself. Fathers can also feel low or overwhelmed; talk to someone.

The Six-Week Check and Birth Spacing

The World Health Organization recommends that every mother and baby have several postnatal checks: in the first day, around day three, between one and two weeks, and at six weeks. At the six-week check the doctor or midwife will ask about bleeding, healing, bladder and bowels, your mood and feeding, check your blood pressure, and talk about contraception. Bring any questions, even ones that feel embarrassing.

You can become pregnant again before your periods return, and in women who are not fully breastfeeding this can happen within a month of the birth. Breastfeeding only protects you reliably if all three are true: the baby is under six months, is fed only breast milk day and night, and your periods have not come back. The World Health Organization advises waiting at least two years after a birth before the next pregnancy, which is healthier for you, the new baby and the one you have. Many methods are safe while breastfeeding; ask at your postnatal check or family planning clinic.

Traditions and What Is Safe

Families across Nigeria have long, loving traditions for caring for a new mother. Most are good for her. A few can cause harm.

Questions Mothers Ask