Mother’s Postpartum Visit and Mental Health
Regardless of the delivery method, a new mother needs time to recover mentally and physically. Your body has just gone through something remarkable, you have started a new life. After 9 months of waiting, you are probably excited because you are finally home with your baby and everything is so new. Much of your attention and energy will be directed toward the baby in the coming weeks and months, but don’t forget to take care of yourself.
Early detection of various physical and mental conditions can increase the quality of your health and well-being after childbirth, as well as your ability to care for yourself and your newborn. At this point, the midwife’s follow-up home visit and postpartum check-up play an important primary and supportive role, in terms of your health and well-being.
What is done at the postpartum check-up?
Before resuming sexual activity, it is recommended that you go to the gynaecologist or midwife who monitored your pregnancy for a postpartum check-up, 6-8 weeks after giving birth.
The purpose of a postpartum check-up is to assess your mental and physical recovery after childbirth, reflect on the experience of pregnancy, childbirth and the postpartum period, plan the next contraceptive method and give recommendations supporting health and well-being.
During the check-up, the midwife will examine you, during which she will assess the condition of your vagina and perineum, the postpartum recovery of the cervix and uterus, the healing of possible tears, the condition of the mucous membrane and your recovery. She will also check your breasts and stomach.
The time to resume sexual activity after childbirth is very individual. In general, it is recommended that you not start having sex before the postpartum discharge from the uterus and vagina has finished, which usually lasts about 6-8 weeks.
Women who do not breastfeed start ovulating approximately 4-6 weeks after childbirth when a new pregnancy becomes possible. For mothers who exclusively breastfeed, ovulation and menstruation are generally delayed for up to a year or more after childbirth. However, sometimes a breastfeeding woman ovulates, menstruates and conceives just as quickly as a non-breastfeeding mother, so avoiding unwanted pregnancy is very important. That's why various methods of preventing pregnancy are discussed. If you have already decided which method you want to use, a corresponding prescription will be written for you. Until the decision is made, we recommend using a condom. The spiral can be used 6-8 weeks after delivery.
Postpartum recovery
Postpartum recovery has its challenges. It is very normal to feel that your body is not recovering fast enough. The more you allow your body to rest, the better it will recover. Even if you can only eat, sleep and take care of your child, that is enough.
During the first six weeks, pay attention to your body. You may be a little tired and focused on your baby, but try to notice the changes in your body. You will feel an improvement every day but resist the temptation to try harder. At this point, over-exertion can delay recovery. Focus on a varied diet, drinking plenty of water (especially if you’re breastfeeding) and getting enough rest. In this way, postpartum recovery will be quicker.
Physical postpartum changes that affect how you feel
Uterine regression and painful uterine contractions
During pregnancy, your uterus has grown a lot to provide a comfortable growing environment for your baby. After childbirth, the regression of the uterus begins. The uterus begins to contract, i.e. shrink to its normal pre-pregnancy size. Contractions cause pain in the lower abdomen and lumbar region. Contractions are caused by the hormone oxytocin, which is released in the body, especially during breastfeeding, so you may feel the pain more strongly during breastfeeding. In the first days after childbirth, you will feel stronger pain, but as the uterus gradually decreases in size, the pain also eases. First-time mothers may perceive postpartum uterine contractions as a weak pain, while women who have had numerous births may experience significantly stronger pain. Paracetamol can be used to relieve pain.
Postpartum discharge - lochia
After delivering the placenta, the uterus's inner surface begins to regenerate, during which a larger amount of lochia is secreted in the first few days. Therefore, the use of sanitary napkins with the highest possible absorbency is recommended. The lochia will remain red for the first few days, but as the uterus regresses and heals, the lochia gradually turns brown, until finally, it becomes white. Lochia is secreted for about 6-8 weeks and has a very characteristic smell, which is why personal hygiene is very important.
Healing of genital swelling and tears
The genitals, which are stretched during childbirth, are swollen and often painful. Tears may have occurred and may have been stitched depending on their extent. If tears did not occur or were very small and did not require suturing, the swelling and soreness usually subside within a few days. Tears and stitches usually take a few weeks to heal. Dissolving materials are used in suturing, so the stitches fall off by themselves as the wound heals. Healing is facilitated by washing with clean running water and gently drying after going to the toilet, frequent changing of sanitary napkins and airing. Healing is also accelerated by applying, for example, sea buckthorn oil. If sitting and getting out of bed is difficult or even painful at first, breastfeeding while lying down or sitting on only one buttock will help the tears heal.
Constipation and haemorrhoids
At the end of pregnancy, constipation and haemorrhoids which can be very painful, are of great concern to many women. During the postpartum period, the trouble may continue, because there are additional tears and stitches, and you have to strain to empty the bowels. Haemorrhoids can often form (or enlarge) from pushing during labour, making relieving yourself even more uncomfortable and scary. It is especially important at this time to monitor the consumption of an adequate amount of liquid, fibre-rich foods, and acidified dairy products as well as ensure a varied diet to relieve constipation and promote bowel movement. In the case of extensive sutures, strong pushing is not allowed and, if necessary, the use of laxatives is recommended (e.g. Microlax or Duphalac).
Painful breastfeeding and breast engorgement
Breastfeeding is a very natural activity, but for many women, breastfeeding is painful in the first few days, because the breasts are not yet accustomed to the strong pressure of a suckling baby. The first technique to relieve painful breastfeeding is to adjust the breastfeeding position. If the baby’s position on the breast is wrong, they cannot grab the breast correctly with an open mouth, and the incorrect grip causes overstretching of the breast and nipple, which in turn causes pain to the mother. It is good to consult a midwife or lactation consultant, who will check and correct the breastfeeding position and the baby’s sucking technique. Often, all that is needed is a slight adjustment of the position or the suction technique to relieve the pain. However, if the nipples are red, sensitive and cracks have appeared, then airing, breast creams and compresses, which you can find over the counter in pharmacies, can aid healing.
The first breast milk, or colostrum, is already present in the breast from about the 16th week of pregnancy, but the breast does not produce a large amount of breast milk yet, because the baby has not been born. In the first few days after birth, colostrum is immediately produced by the breasts. The amount of colostrum is small, but it is rich in proteins and antibodies, providing enough nutrition for the baby. About 3-5 days after giving birth, the amount of breast milk begins to increase, the so-called “real milk” is being produced, and many women experience breast engorgement, with the breasts becoming large, hot, painful and tight. Breast engorgement can be relieved by warming the breast before breastfeeding. For example, take a warm shower or warm the breast with a heating bag and pump a little breast milk out of the breast before offering the breast to the baby. This makes it easier for the baby to access breast milk. If the breasts are tight and painful even after breastfeeding, you could continue to breastfeed often and, if necessary, pump out a little breast milk to ease the tightness. After breastfeeding, cool compresses, such as a cool cabbage leaf, can be placed on the breast for a short time.
Sadness
In addition to physical changes during the postpartum period, the new mother also experiences changes in her mood and ability to cope. Postpartum feelings of being depressed, tired, and anxious are not unusual. The body recovers from pregnancy and childbirth and needs time to adapt. Immediately after giving birth, nearly 90% of women experience maternal depression; ambivalent feelings starting from overflowing joy to anxiety and crying spells. During the first days, this is normal and can be explained by the hormonal changes after childbirth, the mental and physical effort experienced during childbirth and the uncertainty of new challenges.
If you have been feeling depressed, anxious and worried about yourself and your baby for longer than two weeks, be sure to talk to your midwife, gynaecologist or family physician, because you may have postpartum depression and in this case, you need more mental health support. If necessary, the midwife will involve a pregnancy crisis counsellor, who will involve other mental health specialists.
Postnatal care and mental health
Pregnancy and the postpartum period is a transitional time for women and families to adapt to physical, psychological and social changes and a new situation in their lives. At this point, early recognition of the needs of the woman and the family is of great importance to support adaptation and prevent the manifestation and complications of potential health problems of the woman and the child.
The midwife monitors the family after the birth, depending on the individual needs of the woman and the newborn, taking into account the mental and physical health of the mother, breastfeeding, problems in coping with the newborn, social problems, adaptation and health disorders of the newborn. Individual monitoring and support are planned for women and newborns in a risk group.