This steroid hormone is nothing short of magical. Released in the brain, oxytocin moves down to your pituitary gland and then enters your bloodstream where it travels to tissues as distant as the uterus. Oxytocin works on sev- eral tissues but most specifically on genital, uterine and vaginal tissues. It is the catalyst that stimulates the muscles in the walls of your womb to contract during childbirth. It will continue to stimulate your uterus to contract for the next six weeks.
It is also known as the “cuddle hormone”. It’s the hormone that is triggered when your genitals are stimulated and its levels increase five-fold before orgasm when it stimulates mild contractions (like a small pumping action) of your uterus and fallopian tubes. These little flutters actually promote conception.
The hormone also triggers lactation and prompts the ‘let down’ reflex. It is responsible for helping individuals forge strong emotional bonds. Mothers often have an overwhelming feeling of love with this hormone coursing through their veins. It can be directed at your partner, not necessarily your child.
This is a steroid hormone and its levels vary over your reproductive cycle. As its name suggests (pro-gestation) it’s critical to pregnancy and nursing. Its volumes are highest during pregnancy as it works to relax the muscle tis- sue in your body. It causes your ligaments to stretch and every fibre to become more pliable. It works to normalise or restore changes to the body caused by oestrogen. These effects include normalising blood clotting and vascular tone, zinc and copper levels, cell oxygen levels and use of fat stores for energy.
The placenta is both the seat of your baby’s life and the most powerful hormone delivery system to your body. After you deliver this, the change in your hormones is nothing short of spectacular.
· Within three hours of delivery, the level of oestrogen in your body will have dropped by a staggering ninety per cent.
· This is the hormone that encourages your cells to retain water, to stretch and to relax. Its quick decline will start a process of water elimination from your body that is discussed later in the chapter.
· Within three days, oestrogen will have reached pre-pregnancy levels, a tenfold reduction over three days.
· As your oestrogen drops, you will get a surge of oxytocin. This hormone starts flooding into your body in buckets during labour and birth.
The incredible change in your hormone levels will take an emotional toll as well. You will feel overwhelmed and weepy. Combine that with debilitating fatigue and physical exhaustion and the term “baby blues” makes it sound trite in the extreme. You may find yourself weeping buckets watching the Discovery Channel or slumped snivelling on the floor as a visitor arrives. A combination of sleep deprivation, hormones gone berserk and the sudden overwhelming responsibility of this little baby, all crash down on you.
Added to that, you may be contending with pain, bruising, stitches, the remnants of heavy analgesic drugs knocking around in your liver and meddling in-laws who could rock the centered soul of the Dalai Llama.
From the moment of the birth, your body is trying to shed the excess water it accumulated during pregnancy. The fluid stored by your body is rapidly being eliminated through your blood stream and lymphatic system. Over the next few days, your body will eliminate two to four litres of water. There are only two channels it can use – sweat and urine. Sweating increases when you breastfeed.
Your body, particularly your kidneys, is working like a pressure cooker to get things back under control and your bladder is the rather small outlet valve. It will take two to eight weeks for your bladder to recover completely, and about seven per cent of women develop stress incontinence after delivery. If you act quickly and give it the best chance of recovery, your likelihood of getting off scot free increases.
Let’s be frank. Your bladder may never be quite the same again. (Another secret your antenatal lecturer forgot to mention?) Its supporting muscles may have taken a serious knock with the pressure of a long pregnancy. All your pelvic organs were under huge and sustained pressure from the pregnancy and then additional pressure from the actual birth.
Bladder Do's and Don't
· Don’t hold it in: This is not the time to test your control. A full bladder is going to add additional strain to a stretched muscle and can impair the contractions of your uterus. Bed pan, catheter or the good old john, just get it out.
· Do empty your bladder completely.
· Don’t stop drinking water: Ironically, drinking water helps reduce water retention, not increase it.
· Do start Kegel exercises as soon as you can: A few hours after birth is not too soon and forever is not long enough.
Kidneys : Clean Bean
Your kidneys are the organs that cleanse your body’s blood. Only seven centimetres long, they hold twenty-five per cent of your blood at any given time.
Every minute over a litre of blood passes through them. They process 1 500 litres a day and clean all the blood in your entire body every fifty minutes.
The kidneys pass urine to your bladder. They can store two cups of liquid at a time and generally fill up and need to be emptied every three to four hours. During a 24-hour period, you will produce 1.5 litres of liquid.
Just A Jump to The Left - Internal Organs
Most of your internal organs are moving back into place fast. They’ve shifted upwards, sideways or to the back to make room for your growing uterus and your baby. Suddenly, that mass has gone and your organs can’t wait to get back to where they belong. Acid reflux will stop immediately, but expect a lot of farts and rumblings as your intestines drop back down into your belly cavity and things start to shift back into place. Your pulse rate returns to its pre-pregnancy rate in one or two days and the increased volume of blood returns to normal levels in approximately a week. By week six, your cardiovascular system will be back to normal, which is when you will be given the go-ahead to exercise vigorously.
Having just done the biggest push of their lives, most women are not keen to flex their sphincter muscle ever again. Some new mothers go the next morning like clockwork, but other women won’t have a bowel movement for the first two to three days. A number of factors fuel a possible sphincter lock including inactivity or bed rest, drugs, dehydration, fear and hormones. If you are prone to constipation keep a close eye on this. Don’t wake up when ten days have passed and you are facing A Serious Situation. Constipation must be avoided at all costs and you need to act quickly with a stool softener or laxative to get things moving. See Chapter 3 for fast-acting and longer-term remedies.
Hello Dolly - Boobs
Hello Dolly! Every part of your body, except your breasts, will start downsizing.
They will start by producing the first milk, colostrum, which will last for two to four days. This clear, almost salty liquid supplies your baby with antibodies and a bit of nosh to tide it over. But colostrum is not food and your baby will drop weight over the first forty-eight hours as it perfects its latching and lets your breasts know how much milk it needs. And then suddenly ... Wham. Some prankster attached a tank of helium to your boobs and hit full throttle. Your breasts realise what they were born to do : produce milk.
• Engorgement. Phwoar! Yes
• Totally lopsided breasts.
• Lumps the size of an apricot.
Call the Doc if :
• A section of either breast feels hot, hard and tender to the touch.
• You have a fever.
· Your husband is going to want to try a suckle at some time, poor boy. Be gentle.
· Take some photos. It’s not often you will be a busty Rubenesque beauty with alabaster breasts.
· Keep your baby away from a dummy for the first two weeks. Your baby needs all the food he or she can get. It’s exhausting business sucking that hard and you don’t want to waste that energy, especially if you have engorged breasts that need relief through regular emptying.
· Infections are common in the early days of breastfeeding as bacteria can enter the body through the milk ducts. These will be treated with antibiotics.
· Place one of your baby’s waterproof sheets on your bed where you will sleep and breastfeed. It saves you having to replace the mattress later on.
What if I’m not Mother Milk?
Choosing not to breastfeed or having to abandon breastfeeding is an emotional event and the first week will be a painful one as your oxytocin withdraws and, eventually, your milk dries up. You will not escape the first few days of engorgement before your lactation ends, but there is medication on the market to make your milk dry up faster.
There are two types of “anti-hormone” pills available. Both work to counteract the hormones in your body and are available on prescription.
Bromocriptine (trades as Parlodel) is an older, nevertheless effective, drug. It requires a course of a week to ten days of medication.
Cabergoline (trades as Dostinex) is a newer generation drug and a single tablet is effective in drying up your milk.
To decrease the chance of engorgement:
· Wear a tight-fitting bra or sports bra as soon after delivery as possible.
· Do not stimulate your breasts in any way, whether through massage, friction or hot showers.
Your milk should dry up within two weeks after giving birth. If you decide to reverse your decision, contact your caregiver as your breasts can be stimulated to produce milk again.
Recovery from a C-Section
Your experience of a C-section can be a blissful relief or a traumatic change of tack and chances are your recovery will reflect your degree of surprise at ending up on the metal slab.
Planned or not, if you are recovering from a C-section birth, doctors maintain that you are in for a significantly longer recovery time. Caesarean births are much safer now, but they still bear a higher risk than natural deliveries.
This is firstly due to risk of infection, and it is why the hospital stay after a Caesarean birth is usually twice as long as after a vaginal birth (usually three or four days). There are two types of incisions and scars – a “bikini” or a vertical midline incision. A vertical incision is a far safer operation carrying a lower risk of infection, but it is cosmetically less appealing, leaving you with a scar that runs from belly button to pelvis.
The second risk is from the anaesthesia. Although spinal anaesthetics have increased dramatically in safety over the last five years, a C-section has a fifteen times higher maternal death rate than natural delivery. Your body is under the influence of sig- nificant drugs that control your vital functions such as your blood pressure and heart function. Obstetricians agree that a planned C-section is safer than an emergency event. This is mainly due to the fact that obstetricians have their choice of anaesthetist and nurses if it is planned, whereas you may not be getting the best possible staff at 3am on a Sunday.
· Post-operative infection will be swiftly treated with antibiotics.
· You have had major surgery and now is a good time to respect your body and take as much time as you need to let it heal.
· You will be under medical care and closely monitored, but take responsibility for your own health and ask questions.
· Talk about how it all ended up. You may be contending with anger towards your doctor and feelings of inadequacy or disappointment. Or you may just feel relief that both you and your baby came through safely. It’s important to discuss with your obstetrician why the decision for surgery was made and to realise that close to twenty per cent of births do not go according to plan.
From C to sexy
· Get up and moving: Get out of bed and start walking around the corridors as soon as you can. This will get the drugs moving out of your system and start your metabolism going. New mothers used to be under house arrest for six weeks, but increasing numbers of obstetricians say exercising will boost your healing capacity. We are not talking putting on your running shoes, more like taking a stroll to the shop.
· Get adequate pain relief. There are no prizes for martyrs. The most commonly prescribed drug for post-operative pain relief is Voltaren (Diclofanac). You have the choice of taking either a pure anti-inflammatory or a painkiller. A painkiller is a cocktail of drugs that will combine anti-inflammatory and pain-relief medications and is more effective in pain relief. Painkillers do, however, carry side-effects such as drowsiness or constipation. Your safest bet, as in pregnancy, is paracetemol. Avoid any drug with codeine – it’s a morphine derivative and opiate and should not be taken while pregnant or nursing. Avoid aspirin as it has a powerful blood-thinning capacity and carries an increased risk of postpartum bleeding. Time your doses so they are not directly before you breastfeed.
· Easy on the cookies: More sophisticated analgesics mean you are no longer on a liquid diet for a week after a C-section. But still, the drugs used during surgery will temporarily paralyse your intestines so you are at even greater risk of constipation. Your primary concern is avoiding constipation. A few hours after surgery, attempt to swallow some sips of water. When you can tolerate liquids, without significant nausea or vomiting, move to a semi-solid, like soup. When all that stays down and you have passed a bowel movement easily, move on to soft, solid foods. Rumbling in the stomach and intestines is a good sign and means there is movement and your stomach function is starting up again.
Call your obstetrician if you experience any of the following :
· Fever with a temperature of 38°C/100.4°F or above.
· Increased pain, swelling, redness or discharge from your episiotomy or Caesarean-section incision.
· Soaking through more than one sanitary pad an hour.
· Smelly discharge.
· Passing apricot-sized clots.
· Tender, warm, reddened breasts.
· A burning feeling when you pee.
· Increased swelling in legs or arms.
· Any unusual pain.
Take a Bow
No matter how your birth turned out, the most important thing is that you and your baby are safe and healthy. This is a triumph. We are so sanitised with modern medical management that it’s easy to forget that you have just lived through a monumental physical achievement. Not only should the physical risk of the birth be honoured but also the fact that your body has grown, nurtured and held a baby for nine months and delivered it safely. Your heart has fed its heart and you have held it in a space of incredible love. It’s nothing short of spectacular. Motherhood is a massive, tough, exhilarating emotional vortex. It never ends, but you get better at handling it. Trust yourself. If you think things are not okay, act fast.