On Health Postpartum

Whether a woman nurses or not, the first lot of mature milk will still be produced and her breasts will pass through a stage of engorgement when they are hard, hot, and painful. Dr. Birdsall recommends vitamin B6 and sage as natural remedies used to suppress lactation (the production of milk), if desired. Cabbage leaves are wonderful for taking the heat out of engorged breasts. A couple of leaves can be torn off and placed under the bra. The leaves are removed and discarded when they become warm and replaced with new ones.

If a woman is not nursing, menstruation resumes in one to two months. A breast-feeding mother can expect her period to begin in several months to a year or two after the birth, depending on how long she continues to nurse.

The Father’s Participation
The father’s response to the newborn will depend on how settled he is, his experience with infant care, medical and financial pressures, and the preconceived expectations he has of himself and the new mother. The introduction of a new family member, whether a first or additional child, often sets up a love triangle among mother, father, and baby. With the mother focusing her attention on her infant, together with disrupted sleep, a change in sexual patterns, and less freedom as a couple, it is normal for her partner to feel displaced and perhaps resentful of the new baby. However, with a little bit of planning, he can share in welcoming the new child to the world and enhance bonding time with the baby.

Before the birth, time with the child can be arranged by helping to prepare and freeze meals ahead of time, ensuring extra help during the first week or two after the birth from family, friends, or hired help, and learning about infant care. If possible, the father should consider taking some time off from work after the baby’s birth in order to spend precious moments with his new family.

Many fathers are present during their child’s birth and even assist in this process. Once the baby is delivered, the father can help in baby care such as changing, dressing, bathing, and bringing the baby to the mother for nursing. When the baby is old enough, the mother may consider pumping her milk so the father can take over one nighttime feeding with a bottle. This will not only give the mother more uninterrupted sleep, but allows the father to more closely bond with the baby. This same strategy can be used when the mother wants to leave the house by herself or return to work. For fathers who feel left out of the natural mother-child bond during the first few months, it is reassuring to know that this will gradually change as the child gets older and grows more independent. If the father develops a positive attitude toward the baby in the beginning, this will help foster a healthy, happy relationship within the entire family.

Postpartum Changes and Care
Pregnancy, labor, and delivery are taxing on a woman’s body. It is important to recognize this. How the mother cares for herself after the baby comes depends on the nature of her delivery, whether the baby was born in the hospital, a birthing center, or at home, and whether or not there were any complications. If a woman is discharged early or her baby is born at home, she will need help with household tasks so she can devote her first postpartum week to bonding with her newborn and recovering from the birth. In fact, comments Helen Burst, “One of the nice things about home birth is that the couple assumes that responsibility (of caring for the baby) right from the beginning.”

Women who have no complications can usually get up and move around shortly after birth. Not to do so, explains Burst, is physically and mentally unhealthy. A woman must take care of herself postpartum “and part of taking care of yourself is getting up and around.”

It is also important to do postpartum exercises, which should include Kegels to strengthen the pelvic muscles. It is, of course, more difficult to adhere to this plan when other children are present. Women who are having their second or third child may take longer to recover than with their first. The mother should be guided by her own body and activities such as work, sex, housework, and exercise should be resumed only when she feels ready. In Western culture, people have demanding schedules and are used to instant results. It is therefore important for a woman to be aware of the stress her body has endured and the recovery it must make. Lack of sleep, nursing, and child care make extra demands on her body. Pacing oneself and taking slow steps are key in maintaining normal activities and optimum health.

Nutrition while nursing remains as important as during pregnancy. Eating a varied diet with plenty of whole foods and fluids still applies. Aggressive dieting during this time of healing and nurturing is detrimental to the health of both mother and baby.

Care of the Perineum: Correct perineal care is essential in order to prevent infection, particularly if an episiotomy was performed or a tear occurred and stitches were made. Douching and tampons should be avoided during this period. For the first 24 hours, 30 minutes of ice packs placed on the perineum with a cloth in between, followed by 15 minutes of rest, helps reduce swelling. After the first day, heat in the form of a hot water bottle or heating lamp (not ultraviolet or sunlamp) should replace cold treatment. Warm water sitz baths (20 minutes) are also helpful. Witch hazel or essential oil of lavender applied to a sanitary napkin can help with swelling.

Urination during the first week may be difficult and painful. Cleansing the perineum after urination will help. Warm water should be applied using a peri bottle available from the hospital or midwife. Women should always wash and wipe from the front to the back toward the rectum to avoid reinfection. Constipation may occur and/or bowel movements may be painful. To keep stools soft, drink a lot of fluids and eat plenty of fiber such as fresh fruits and vegetables.

Sleeping: Adjusting to a new sleeping schedule is probably the most important habit to acquire. Exhaustion from the delivery and frequent awakenings for night feeding is inevitable. New mothers should nap when the baby is sleeping and go to bed early.

Healing Remedies: In addition to rest and sound eating habits, overall recovery and healing can be enhanced by using Chinese medicines, homeopathic remedies, and nutrient supplementation, according to Dr. Dittman. He adds that acupuncture is effective in balancing hormones and strengthening the qi (the body’s vital life energy) by retonifying the spleen, liver, kidneys, and uterus. In addition, Dr. Dittman recommends manipulating muscles, tendons, and ligaments using cheng kua, an ancient Chinese method. Prenatal vitamins and minerals can be continued. Vitamin C, zinc, and beta carotene during the first week will accelerate healing of perineal wounds. The homeopathic remedy Arnica is helpful during the first few days immediately following birth and is indicated for injuries, shock, trauma, and bruising.

Sex and Birth Control After the Birth

It is advisable to wait 6-8 weeks before resuming sexual intercourse. Some health professionals believe that it is possible to get a uterine infection from early intercourse. However, a woman must determine for herself when she is ready. Thirty years ago, when Helen Burst graduated from nursing school, episiotomies were a regular procedure and left most women with stitches and a sore perineum. “Most women didn’t feel like having sexual intercourse for 4-6 weeks because of the episiotomy,” Burst recalls. “I learned many of them were having sex before I saw them at six weeks postpartum.” Consequently, Burst decided that family planning discussions were necessary before the scheduled six-week checkup. She maintains that a woman should resume sexual relations when she feels ready.

Engorged breasts may also diminish a woman’s sexual desire. Sexual drive, however, varies among new mothers from no or diminished libido to normal or enhanced drive. This is an area where communication between sexual partners is important. Many things can contribute to decreased libido including depression, anxiety, irritability, fatigue, pain, nursing, interruptions, and fear of pregnancy. Planning for intimacy can offset some of the frustrations of lovemaking. As with so many other areas of adjustment, sleep is one of the best aphrodisiacs—it softens the edges of irritability and feeds the libido. Sex for many new parents may get designated to bedtime when both partners are exhausted. A few hours of sleep before lovemaking may help. Hiring a babysitter away from home in the middle of the day when mother and father are more rested can also help partners resume sexual activity and intimacy.

A woman’s natural vaginal lubrication may decrease during this time. Using an artificial lubricant, such as vegetable oil or KY jelly, can eliminate painful intercourse. Use sexual positions that don’t irritate the healing perineum or press on engorged breasts. Be aware that a slack vagina will tighten with time and the help of Kegel exercises.

Probably the most important thing to feed a healthy sex life is a healthy relationship. Parents are often taught that children come first. But if a marriage or relationship is not attended to, there is no family. Partners should get out by themselves on a regular basis and find ways to attend to each other emotionally and not just sexually. Setting aside 10-15 minutes per day for discussing the events of the day is a pleasant way for partners to connect.

While breast-feeding appears to suppress ovulation somewhat and help in the spacing of children, it is not a guaranteed form of birth control. The baby’s frequent sucking while nursing initiates the release of hormones that appear to suspend menstruation and ovulation.110 However, it is possible to ovulate and become fertile before menstruation returns. There are several effective and safe forms of birth control that can be used, such as natural family planning, which involves the daily charting of fertility signs (basal body temperature, consistency of the cervical mucus, and positioning and width of opening of the cervix), and condoms and other barrier methods such as a diaphragm used with spermicidals. Do not use oral contraceptives while nursing.