The truth about recovery

Oh dear, recovery.  Why do we always feel so uninformed regarding pregnancy/labor/birth recovery?? I thought I was informed having had classes on women's health, but I was so surprised at what recovery entailed with my first birth.  Of course, circumstances caused recovery to be worse than expected, but I just felt so clueless during those first few weeks.  Without further ado, let's dive in to the nitty gritty:

You get a massage a few times during your hospital stay

And it's not the peaceful massage on your back that you totally deserve.  It's called a fundal massage and it does not feel great because it is basically a uterus massage on your already-tender abdomen to make sure big clots are making their exit and not preventing healing as your uterus shrinks.

Speaking of shrinking uteruses...

There's also this unspoken fact that contractions continue postpartum. They're not as strong, but they tend to be worse if this baby is a second or third child.  Breastfeeding also causes a release of oxytocin, a naturally occurring hormone (Pitocin mimics this hormone) that causes contractions. I distinctly remember being shocked right after delivering my daughter and feeling those contractions with breastfeeding.

And now about breastfeeding

Ok, ladies, this is how it is- some ladies have tender nipples and other ladies don't. That's it.  Breastfeeding hurt like the dickens for me every time and made me want to say @#!?!*^#$ for the first 2-3 weeks.  It was longer with my son.  The nurses and lactation consultants for my first-time breastfeeding woes with my son kept telling me that "if it hurts, then you're doing it wrong. WRONG WRONG WRONG." So I sucked it up and tried to not cry for the first few weeks (believe me, there were tears shed), and finally, after a few weeks, it gradually improved until it didn't hurt anymore. **I should add that what was painful about it was the initial "latch" ** With my daughter, a wonderful nurse came to talk to me the morning after right after a lactation consultant told me that breastfeeding shouldn't hurt and said, "Honey, I don't care what they say.  I can't imagine breastfeeding NOT hurting- there's a baby constantly sucking on your nipples and you're not used to that. It will be a little painful, just count to 10 and it should be better by then." So there. I counted to 10 every time and she was right, the pain began to subside each time and made the experience much more tolerable. Though, I did get a horrible tension headache from tensing up so much for fear of pain...

You don't bounce back instantly. 

I figured I'd be tired and beat after a long labor.  I thought, hmmm I'll bet I'll feel better within the next week or two. Nope.  As I've learned, recovery can take weeks, maybe even months, and you won't feel like you have your old body back for quite awhile. This varies for every mom.  For me, I've had two experiences so far.  With my son, I didn't feel like I was truly getting better until about 6 weeks postpartum.  This is because of the blood loss, birth canal trauma, two bouts of mastitis, and breastfeeding troubles. I saw notable improvement after 3-4 weeks, but right after 6 weeks, I can remember thinking I got this. I never did feel quite like myself until a year after my daughter was born.  Recovery with my daughter was much better.  I felt better after about a week and fairly well-healed by one month postpartum.

Down below probably doesn't feel great

If you just pushed a baby out, you'll probably have some swelling.  Both hospitals I delivered at provided nice long ice packs and pack of Tucks to line them with and that provided great relief.  Tucks contains witch hazel, which comes from a plant (called... you guessed it, witch hazel...) and is great for pain relief for skin irritations. It's a fairly natural cleanser too.  The swelling can last a day to several days depending on how long you pushed for and any other tissue trauma such as forceps use. You will probably given a little squirt bottle that can be filled with warm soapy water so that you can clean your lady parts after going to the bathroom.  You'll want to take that home.

Blood

Postpartum bleeding (lochia) varies for all women, usually much shorter for c-section moms.  Don't be surprised at the large clots that can pass (unless they're softball-sized or larger.. your provider will want to know). Your uterus is purging all the extra linings and trying to clot and shrink back to the right size. I think mine lasted about one week of heavier bleeding and another week of light/spotting. If you don't recall from my last post, just know that you will receive a couple pairs of extremely stretchy (meaning, they'll fit both a petite lady and plus size lady) panties and sanitary pads that are basically diapers that don't close around your legs.

Bladder Control

I remember having to run to the bathroom when recovering from son's delivery because I was pretty sure I was going to pee in my super stretchy undies I just got. Ha.  Your pelvic floor muscles are just worn out from pushing a baby out, so just keep practicing your Kegels to strengthen them again.  For some ladies, this lasts awhile, others may not even experience it.

You may fear going #2

No one likes to fear a bowel movement, but your nethers may be swollen and you may have had stitches placed for tearing, so the first bowel movement can be scary.  Most postpartum protocols for providers include a stool softener regimen 2-3 times a day.  Don't be afraid.

Hair loss

Perhaps you read about this, perhaps not, but hair loss is common.  I feel like I'm always shedding when my hair is longer than 2 inches, but I did notice an increase in the amount of hair I was pulling out during showers the first few months.  I never did get any bald spots and you likely won't either. Go get a haircut and your nails done a few weeks postpartum and you'll feel like a new woman ;)

Emotions May Run High

Your body is going to go through drastic changes in a extremely short period of time, so chances are, you may being feeling a lot.... feeling ecstatic, feeling blue, feeling angry, feeling nothing short of asylum-crazy at times. There's a lot of anxiety being a parent of a newborn too- are they sleeping? wait, are they breathing?! Oh good. But did they eat enough??! Both times I have felt a surge of these extreme emotions on and off- it lasted the first two months for me. Thankfully, it would usually just be a short amount of time, like a few hours, here and there each week.

** Please also realize that postpartum depression is real and not just the "baby blues" though. While it's normal to feel some depression, it is not normal to feel like you have no control over yourself or thoughts to the point where you fear you may actually cause harm to yourself or another.  This can vary from feeling like your problems will dissolve if you just run away to feeling even suicidal.  Seek professional medical attention if you feel this way.

The fact is your body will be different postpartum.  There is no simpler truth about recovery.  You will feel strong emotions at times through the first year, especially if you breastfeed- breastfeeding affects every mom differently, which includes crazy hormonal shifts that affect your body mentally and physically. It's ok. It's normal. You may feel like crying one day because your husband didn't say the right thing or because dinner wasn't made on time.  Or perhaps you'll be suddenly so flippin' upset that someone said something that felt offensive even though it wasn't. Just remember, ok, crazy hormones are trying to control me right now. But you got this.  You'll get through it, I promise! Try to accept the new normal and appreciate your capabilities.  There may come a day when you feel like your pre-baby self, but for now, focus on all the great things, like a new baby :)

I really enjoyed writing my blog series and can't believe I'm done!   Thanks for reading, I have been surprised by how many times this blog has been viewed in just the past month when I first started! I am planning on continuing the blog in a few weeks sharing birth stories from now on and any other motherhood related items that cross my brain. Good luck with your labors and recovery!

Cesarean (C-section) Birth

Some women will have to opt for a cesarean section (c-section) as an alternative for childbirth.  There are numerous reasons, the most common being that a vaginal birth is less safe or impossible for the mother to do.  Fortunately, we have modern medicine now and a c-section is fairly routine, typically a 30 minute surgery with about 1-2 hours of recovery post surgery.

I will be honest, I do not have any experience with a cesarean section- I was really close to having one with my son, but then other means were used to get him out.  However, I would still like to go over basic information regarding c-sections so that you can get a general idea of what to expect.

C-sections can go two ways: scheduled and unplanned. Your doctor will weigh the risks and advantages of both a c-section and vaginal delivery and determine what is safest for you. Side note: I know that there's always some documentary or news article about the alarming increasing rates of c-sections, but let me just say- don't judge.  We may not know why someone chose to have an elective c-section but it's none of our business to begin with.  Most doctors will make an informed decision about your health- after all, it's their job to provide care.

Once decided that you are going the c-section route (let's say this is a planned procedure and not emergent), your day will go something like this: fasting 8-12 hours before surgery, arriving at the hospital at your scheduled time, and then receiving anesthesia.  I believe a spinal block is preferred over an epidural and is more common (just a quick note- epidurals are like an IV in that a small tube is left in your spine and spinal blocks are one-time shots into the spinal fluid. We will discuss this in more detail in an upcoming post). You will also have a urinary catheter placed so that your bladder can have relief while you have little control as well as an IV to receive medications and fluids through. After all prepped, it's surgery time! The operating room (OR) looks like any OR and your doctor, an anesthesiologist, and a team of nurses and scrub techs will be there.  Everyone has a purpose, so don't worry, you're not on display for any reason.  Most providers put up a privacy curtain to block your view and your partner will typically be allowed to be present at your side.  They will provide him/her with a pair of surgical scrubs too.

Now from your perspective, you may just feel a little pressure (or nothing) and then hear a baby cry after a few minutes. You may become a little nauseous- this is normal. But so much more is going on! There is a lot of precision and care when performing a c-section.

At this point in medicine, c-sections will typically have a curved transverse (horizontal) incision, sometimes called a "bikini cut" made in the low abdomen instead of a vertical incision. Studies have shown that there is less abdominal pain and a faster recovery with the transverse cut and it is also less noticeable in the long run.  Vertical incisions are more common in emergent situations, but even so, many doctors are able to do a transverse incision emergently too.  Here's a visual aid:

thanks for being realistic, Baby Center, by including the stretch marks! Moms can appreciate this.

A scalpel is used and after the incision to the skin, the doctor will cut through the adipose (fat) tissue, then the fascia, which covers the abdominal muscles, and then the abdominal muscles midline (which runs vertically) can be pulled apart and held open. The peritoneum is what lines everyone's abdomens and "encases" your innards.  This thin layer is then cut as well, exposing the bladder and uterus.  The bladder is kind of in front of the uterus, so the team will pull it downward and out of the way, giving a clear picture of the uterus.  Once the uterine incision is made, the delivery is much like a vaginal delivery in that the head will come out gently as the rest of the baby is guided out.  The umbilical cord will be clamped and cut, parents get to say hi to baby, and then baby is whisked away to get cleaned up and assessed.  The doctor will gently pull the placenta out and begin to close you up.  Closing the incisions will be much like the initial procedure in reverse, but of course much slower.  First the uterus is sutured and then the peritoneum suturing is actually commonly skipped as studies have shown that this step is not necessary and can prevent complications of the uterus or bladder adhering to it.  The abdominal muscles can be left alone or have 2-3 sutures to help it "remember" where to heal, and then the fascia is carefully closed.  The fascia is like the glue in the abdoment, holding it all together.  The fat can also be skipped when suturing, and then the skin will be carefully stitched, stapled, or glued.  All internal sutures will dissolve on their own.  Did you note that there are seven layers to get through? 

Watch an animated c-section here and skip to 2:09 to visualize the procedure:

I'm not sure why, but this baby is not delivered head first- maybe just the positioning...

Following the end of the procedure, you will be wheeled to a post-op recovery room where a nurse can monitor your vital signs as anesthesia wears off. Once decided that you are stable, 1-2 hours later, you can be wheeled back to your postpartum recovery room to join your new addition and family! Expect to stay for at least 3 days in the hospital.  This obviously varies between patients- I have heard of some women staying for only 2 days too because they were recovering really well and their hospital protocol was more flexible.  If I were you and I just had abdominal surgery, I'd be happy to stay for three days in the hospital with my baby and not have to fret about everyday things like laundry and dishes. Just sayin'.

The recovery of a c-section is much like a vaginal birth recovery- we will go more in depth in an upcoming post- but some things you can expect are vaginal bleeding still and a particularly sore abdomen.  Remember, as routine as a c-section is, it is still abdominal surgery! Many women stay in bed for at least the first half of the day post c-section, if not the whole day.  Your urine catheter and IV will be removed within 24 hours and you will likely need to be supervised when first getting in and out of bed.  Passing gas is normal and a good thing as it shows your bowels are "waking up" from the anesthesia.  You may want a postpartum abdominal binder/support (Belly Bandit is the only one I can think of, but there are many brands)- this is somewhat of a hype in that you probably won't get that celebrity beach body from this alone, but it acts as a good splint/brace for everyday things like getting out of bed, sneezing, light lifting, etc.  I have also heard of women using these with vaginal childbirth too.  Pain medications you will receive will be much like vaginal childbirth- narcotics, tylenol, ibuprofen. 

Almost like a smile with those starry eyes.... courtesy to Google Image search for "real c-section scar."

Having a baby should be an empowering experience whatever the route they arrive.  You should feel accomplished about your pregnancy more than anything else and embrace the fact that you are a mama to a snuggly newborn! 

*information courtesy of Dr. Dileo and Lalaena Gonzalez from Babble.com and also Mayo Clinc.

Expectations of a normal vaginal birth

Today, I am sharing with you what you can expect during a normal vaginal birth. We will mostly go over different terms the nurses and docs will throw around as well as some other terms that only some "seasoned" mothers will be familiar with.

First things fist, what are common signs that your body is preparing for labor soon 

• the baby will drop which just means that the baby will move into "go-time" position by dropping deeper into your pelvis *hopefully* head first.  Some women notice, others not so much. I couldn't really feel a difference because by that time, I was feeling just a little smaller than a beluga whale. However, I had at least a dozen people (mostly my coworkers who were also nurses or providers) tell me that I had "dropped."
• more regular Braxton-Hicks contractions.  These "practice contractions" occur throughout the pregnancy though, so don't count on these too much. If they aren't regular and increasing in strength or frequency, then it's just your uterus doing some exercising.
• Mucous plug. I just remember being disgusted each time I discovered my mucous plug had come out. It's basically a "cork" in your uterus opening and the release of it generally means labor is soon.  Now, each body is different and soon might be tomorrow or perhaps a week.
• Dilation and effacement- your cervix may be ripening (or softening if ripening sounds too much like fruit) and prepping for baby to make its debut.  Dilation is the cervical opening widening and effacement is the cervix getting shorter/thinner. I will cover more on this in the next section below. Take a look at this video clip to visualize it better:

Signs that labor is about to begin or very near:

• Your water bag breaks.  The amniotic sac is the thin membrane that lines the uterus, is attached to the placenta, and holds the baby and all the amniotic fluid.  This can rupture on its own before any contractions are ever felt (less common) and it could be a trickle of fluid or gush depending where the baby's head/body is.  Providers sometimes rupture the sac by assistance or they will let it break on its own, depending on their practice methods.  Call your provider as soon as this happens as each one will have a specific protocol they follow.
• Contractions, the rhythmic movement of the uterine muscles that move the baby down, will be more frequent, about 3-5 minutes apart, and will increase in strength over the duration of time. This is key.  It can be confusing to any mom when contractions are felt and they feel strong but then go away.  The usual pattern is increased strength and frequency. For me, contractions felt like menstrual cramps that radiated upwards through my whole abdomen and, later in labor, to my low back as well.  Depending on the birthing method you choose, your contractions could feel different (pain vs pressure).

Let's take a moment to discuss dilation and effacement again.  You will hear these terms throughout your pregnancy and on Facebook statuses of laboring moms.  Right? "______ is at 6 cm now and 80%!!! Baby will be here soon!!" Dilation/effacement can occur weeks before labor actually begins though! For example, I had been having irregular contractions around 35 or 36 weeks and my doctor thought she'd just check and I was already 3 cm.  By two days before I went into labor at 38 weeks, I was 5 cm dilated- just walking around and working, halfway done with labor (ha! If only labor could be something we multitasked). To deliver, you must be dilated completely and go from 0 cm to 10 cm and be 100% (or close) effaced (paper thin).

One more term you will hear during labor is +/- station. This refers to where the baby's head is at in your pelvis.  Generally, you will here a range from -3 to +3. -3 is at the very top of your pelvis and +3 is when the baby is "crowning." Crowning is the visibility of the top of the baby's head beginning to peak out.  Here is another visual aid for fetal stations: 

We are so close to the actual birth now! Just to refresh you from previous pregnancy readings, labor comes in three stages (four if you're in nursing school).  The first is when productive contractions begin and you are awaiting complete dilation and effacement.  The second stage is actively pushing the baby out resulting with the delivery, and the third is the delivery of the placenta.  You will likely hear all about the ring of fire if you are researching med-free births- it is the reported burning sensation a woman feels as she is crowning and the skin is stretched to capacity.  Note that I say "reported" because I personally did not feel it during my med-free birth experience.  Some providers consider recovery as the fourth stage, but you probably won't hear this that often.  

So when the baby is coming out, your provider will try to as gently as possible guide the head out first.  Babies have flexible skulls that mold to the shape of your birth canal as they exit, hence some babies have coneheads when born.  Also, our coccyx bone (tailbone) is flexible, albeit somewhat limited, but can generally accommodate a baby.  After the head is out, your provider will untangle the umbilical cord that is sometimes wrapped around the baby, and guide one shoulder out at a time.  After the shoulders, the baby will come out more quickly.  Keep in mind, you are pushing during this time, often with your provider saying "push now, hang on, ok push again, wait," etc.  You may have a little more control with an epidural but without any medication, you may feel little control as your body goes into autopilot mode.  Time to visualize the birth with the following clip (don't you love the classical music accompanying the videos?):

The placenta will deliver on its own between 15-30 minutes postpartum (after birth). Sometimes the provider will tug on it gently to help it come out.  So that's what a normal delivery looks like! Complications, often minor, can arise at any point and interventions will be necessary.  Some common interventions during the second stage (pushing):

• forceps: if baby is posterior, gravity is working against you, or perhaps just  "stuck," your provider may suggest forceps use.  They look like giant metal salad tongs.
• vacuum: it is what it says and looks like- a baby head vacuum.  The suction may be just enough to help pull the head out, the widest part of the baby. 
  *just my personal input- I would try to avoid forceps at all costs if I could do my first delivery all over.  It is very invasive and will cause more tearing deeper inside, which makes recovery worse.  Nonetheless, if it can't be avoided due to safety, then take the forceps.
• episiotomy: this is an assisted cut to your perineum, the skin that is between the vagina and anus.  This will stretch thinly during the second stage and sometimes tear on its own (see this site more on the degrees of tearing) but if the provider feels that the natural tearing may be worse than an assisted cut, they will perform an episiotomy.
• amniotomy (or artificial rupture of membranes): this is when the provider ruptures your membranes/water bag.  The tool used looks a lot like a large crochet hook.

Common pain medications and other meds used during or to induce labor:

• epidural/spinal block
• IV or IM (muscle injection) narcotics- a common one is Nubain but I have also heard of morphine being used
• pitocin- also nicknamed "pit." Many women either have labor induced with this or if their labor is not progressing fast enough, they will be started on it.  It increases the strength and frequency of contractions. Sometimes a shot after delivery will be given just as protocol for postpartum bleeding or if there is a little excessive bleeding, an IV infusion will be started postpartum.
• prostaglandins- medication inserted into the vagina to induce labor. Cervidil is the most common one I know of.  Prostaglandins are naturally occurring hormones that when stimulated help soften the cervix and kickstart dilation/effacement.  A common protocol with this one is being admitted just before bedtime to induce labor overnight.  If labor doesn't start, than other induction methods will be used.
• other induction methods I know of: is the use of a Foley catheter.  A Foley catheter is typically used to drain the bladder.  It has a balloon near the tip and instead of inserting it into the urethra, it is inserted into the vagina and the balloon is inflated in the opening of the cervix, applying pressure to it to hopefully start the natural release of prostaglandins. Membrane sweep- or also called "stripping the membranes.  This is done in the office, often when the provider suspects labor is nearing and only if you are term and dilated to 1 cm or more.  The provider will use their finger and sweep along the inside of the cervix to manually pull the membranes away from the cervix.  This can also stimulate the release of prostaglandins

Before I end this post, I want to share a little about the, *ahem*, less glamorous aspects of a vaginal childbirth:

• you're often naked or really exposed.  Your va-jay-jay is everyone's business and really, you probably won't care after a couple of hours and a little fatigue.
• there can be poop involved.  It happens. But don't worry, your nurse will be really professional and probably not even make a comment cleaning you up because it happens to many women. And it'll be so fast, you may not even know it ever happened. Seriously, you're pushing like you're about to have the largest bowel movement of your life.
• you may say crazy things or get angry at loved ones
• you may get nauseous and need to expel some contents out of your stomach
• Feel free to comment below about other less glamorous things

Hoping this is another helpful post, let me know if you have any questions and I will do my best to answer you or find the correct answer!