​Six Rules for Health

1. Trust your gut. If something does not feel right, don’t ignore it.
2. Don’t feel any guilt about calling a midwife or obstetrician at any time of day or night if you have any urgent concerns.  They are not doing you a favour: this is their job
3. Don’t self-diagnose or suffer in silence. The chances are everything is normal, but a quick call to your doctor will put your mind at rest.

​4. Choose how much you share with your partner. There are many other people you can talk to if you feel intimate discussions on incontinence may be too much. Try your mother, a friend or your family doctor.
5. Get a second opinion. The most important opinion is your own. There are as many solutions as there are problems. Go online and do some research. Talk to people who have done things differently then find your own way.
6. Act fast. Healthy or not, you are vulnerable postpartum. Your usual rock- solid immune system may not kick in, so don’t wait to act.
 
Remember those days of lying in bed nursing a cold with a DVD and some asprin? Over. Remember long mustard baths to ease aching muscles? Finished. Recovery time? No more.  The good thing is that you will get on with healing in record time and few complications fall into the category ‘long-term’.   Let’s look at some of the bodily changes you may experience.
 
Anxiety and paranoia
 
The rapidly changing state of your body and radical change in your life can lead to all sorts of paranoia and anxiety. If you are worried, check it out with your nurse, but just trust that all sorts of strange things are going to happen and you are probably totally okay. Also see Nightmare in the A-Z coming up and Chapter Eight on Depression.
Your obstetrician is your first point of call. The delivery fee covers all complications and visits up to your six-week checkup. If you cannot get hold of him, leave a message with the receptionist or call the emergency number, and he will get back to you. Do not feel he is inaccessible or too busy to bother with what you think is a small complaint. This is the most critical time in caring for you, and he is best placed to advise you on treatment for any complication, from a cold to a serious problem.
 
Bruised or broken tailbone
 
This can be incredibly painful and can be a result of a narrow pelvis or the baby moving down in an unusual position.  Prepare yourself for the possibility of a long recovery, as there is nothing you can do to speed up the healing of this impossible-to-set bone. Get pain relief from your doctor.
This is one injury to take lying down. Don’t sit on your tailbone. Either lie on your side or get a sitting ring. Heat takes the pain away temporarily, but you want to ice the area rather, to reduce swelling.

Back pain
 
Some women experience severe back pain after the birth. Others experience immediate relief from pain they had in pregnancy. 
The back pain could just be bruising and sore muscles from a long and difficult labour. A mustard bath, arnica back rub or hot- water bottle can bring relief.
It could also be a posture strain from your weakened abdominal muscles. This will persist until you rebuild those muscles. If you had a vaginal delivery, start doing stomach exercises immediately. 
Pay attention to breastfeeding techniques. Make sure you are not slouching to get your baby into position. Rather stick to lying down if you are placing pressure on your back. 
Hours of holding three or four kilos can put strain on your back. Watch your movements to make sure you are not under strain.
 
Bruised eyes
 
Looking a bit like Benicio Del Toro? This is a direct result of labour. It’s caused by the strain of pushing during the second phase. The tiny capillaries in your eyes can rupture causing bloodshot eyes. Black eyes are the result of the capillaries under your eyes rupturing. Both will heal within two weeks, but you are not going to look your glowing best in the photos. Ice packs, tea bags or a hunk of cold meat will reduce swelling. Arnica helps with bruise recovery.
 
Bigger feet
 
Not fitting back into your Nine-West Kitten heels?
Swelling of the feet is partly due to water retention, partly due to a loosening of ligaments in your body and that includes the ones that hold your foot bones together. The swelling due to water retention will go down within a month of birth, but the bad news is those ligaments are not going to pull the bones back into place. The even worse news is – your feet can get bigger with every pregnancy.  See Swelling for treatment tips.
 
Carpal tunnel syndrome
 
This feels a bit like your hand is mildly paralysed and you can have pain in the ligaments that sit on the inside of your wrist. If this develops soon after the birth, it is directly related to water retention. Your wrist ligaments are enveloped in water and this area can become swollen along with the rest of your extremities. This puts pressure on the nerves that control your hand.
 
·       Immobilise your wrist whenever you can with a splint from a physio.
·       Reduce water retention by keeping hydrated. See other tips under Swelling
·       Take fast-absorbing magnesium before bed.
·       Supplement with twenty-five milligrams to fifty milligrams a day of Vitamin B complex.
 
As your baby grows, your hand ligaments take strain, with the weight of picking her up continually. This will be exacerbated if you tend to favour one arm.  Practise using the other arm, until it gains strength and you can carry your child with equal dexterity with either arm.
Give your hands a break. Stop using your hands and pick your baby up using your entire arm.  Yoga works on balancing the body, which is what you need to overcome a one-side weakness. Rub arnica cream or gel into the ligament and manually massage it to increase blood flow to the area.
 
Cracked nipples
 
Imagine a paper cut on your nipple. That’s what cracked nipples feel like. The good news is they heal fast. They can arrive at any point and are not restricted to the first few months. In fact, as the sucking mechanism grows stronger, the likelihood of this complication developing increases. The most natural remedy is to run your own breast milk over your  nipples. Calendula cream also hastens healing. Try honey, rosewater or almond oil or commercial lanolin preparations. Remember to wash these  remedies off before feeding.
Quite a few beauty salons offer laser treatments on your nipples. These are effective and a few sessions of a low-grade laser will stimulate the regeneration of your skin cells and promote healing.
 
TIP - Don’t lock the bathroom door in the first few weeks. No matter how badly you don’t want any accidental walk-ins when you are crouching in the nick, you are still in recovery. You don’t want to pass out and not be able to get help.
 
Constipation
 
This can cause very unfunny discomfort if left for too long.
 
Get moving:
 
·       Don’t wait to act. The longer you wait, the bigger the stool. You can kick-start the process with a stool softener or a mild laxative. Check with the pharmacy.
·       Once you have had a movement, keep a close eye on things. Remember that prevention is better than cure.
·       Move fast onto a longer-term prevention of constipation by increasing fresh fruit and fibre in your diet and staying away from refined wheat products. You need to get to a point where you are not using drugs to go to the loo.
·       Drink lots of water and add linseeds to your salads and cereal.
·       Exercise will also get things moving.
·       If you have had a C-section, your bowels will be particularly sluggish, as they are slow to come round from the analgesic. It’s prudent not to move on to solids until you have passed at least two bowel movements.
 
Engorgement
 
There is a difference between having full breasts and engorged breasts. It’s like Marilyn Monroe vs Pamela Anderson.   Breastfeeding consultants say there is no need to ever get engorged. That may be true if you never leave the house and have milk on tap.
Engorged breasts are painful, the skin is taut and fragile, your nipples feel tight and your entire breast aches. This is a familiar place for all breastfeeding moms. Any change in the routine or the baby’s continual growth spurts will lead to engorgement. The most important thing is to deflate those mammas.
 
Under Pressure :
 
·       Nurse frequently, express or manually milk your breasts.
·       If you recognise engorgement early enough, slap those cold cabbage leaves in your bra.
·       Pay particular attention to moving any lumps down, towards the nipple and out while nursing or expressing.
·       You can also try mixing the juice of marigold leaves with vine- gar and dipping your breasts into it.
·       Try a damp cloth steeped in cool water containing a few drops of lavender or fennel oil.
·       Remember that applying heat may make you feel temporarily better, but it will exacerbate swelling.
 
Episiotomy scar
 
An episiotomy is a medical intervention by an obstetrician or midwife with a pair of scissors, while a tear is a natural process. The damage can range from a small nick to a rip-roaring tear that goes from vagina to rectum.
 
There are four degrees of tearing
 
1.     Your skin will tear.
2.     The skin and perineal muscle will rupture.
3.     Your skin, perineal muscle and anal sphincter (this is the muscle that controls your wind and bowel movements) all tear.
4.     All of the above tear, plus your rectal mucosa. This is the skin around your bowel.
 
Any injury of third or fourth degrees will be stitched under an anaesthetic by an obstetrician.
It is not a big procedure but is absolutely critical as the success of your stitching will be what prevents you having fecal incontinence through damage to the muscles controlling your bowels. Most obstetricians cut in the European style by making a J-shaped cut at a 45 degree angle (mediolateral) towards your leg, whereas US-style is a cut heading down- wards towards your bum. The former heals  with more pain, but the latter has a greater risk of tearing further into a third or fourth degree wound.
It is going to be itchy and sore as hell as the skin heals. Healing should take six weeks in theory, but some women report pain from their scar for up to two years. The perineum is also the seat of your base chakra, the center-point of your sexual organs and a hugely emotional part of the body. Don’t underestimate the vulnerability you feel around this area.
 
Avoid Infection
 
You don’t want to even think about it getting infected.
 
·       Clean every few hours, with cotton wool dipped in a diluted antiseptic solution like Savlon or Dettol. If this is too painful, use a little squirt bottle or bidet.
·       Dip your tail in regular sitz (salt water) baths once you get the go-ahead from your doctor.
·       Always wipe and wash from front to back.
·       Keep the stitches dry. First prize would be to walk around bottomless, not easy with postpartum bleeding. Dry them with a hairdryer.
 
Reduce the Pain
 
·       Get an ice pack on the area, as soon as possible, to reduce or minimise swelling.
·       Keep off your butt.
·       Pour tepid water between your legs as you pee.  This will dilute the urine and minimise the stinging. If even this is painful, pee while you are in the bath. Relax, it’s totally hygienic. You can also use the bidet.
·       Ask about localised antiseptic creams, iodine creams or painkillers.
·       Don’t get constipated. Drink lots of water and take a laxative or stool softener if needed to get your through the early  days.
 
If you had a third or fourth degree wound you will be advised to have a C-section for your next birth, as you run a significant risk of developing fecal incontinence should you deliver with the scar.
 
TIP : Kegels bring oxygenated blood to the area and boost healing.
 
Fecal incontinence
 
The bottom line? Fecal incontinence means you’ll have trouble controlling bowel movements, or gas, for some time after the birth. It’s not common at all and usually only seen in women who have had a forceps delivery or a fourth degree tear that cuts into the anal sphincter. It’s a low blow, but you will get the control back in a few months with some work.  Severity will range from needing a nappy to uncontrollable farts. It’s a good reason to stay at home.   It can also be caused by a rectal prolapse. This requires a longer-term treatment. See Prolapse bulge.
Get cracking with those Kegel exercises, fast.   Consult a specialist physio to help you work on those muscles.
 
Fever
 
Any temperature of 38ºC/100.4ºF or above or any flu-like symptoms, should be reported immediately to your doctor.  This is the first indication of an infection. Any infection of the placental site, bladder, stitches or breasts needs to be dealt with swiftly with antibiotics. You can get milk fever on the third or fourth day. This will feel like a low-grade cold with a slight rise in body temperature but will only last around twenty-four hours.
 
Hair loss
 
This will kick in from month three, and it can fall out in clumps or just slowly move from your head on to your brush. It’s due to another hormonal change from pregnancy, when hair should be thick and radiant, to post-pregnancy. Hair loss should diminish by month six and return to normal by month twelve. Relax. You are not going to end up looking like Bruce Willis. But if your hair is looking ratty and dreadful, consider going short and chic for a while.