What your Postpartum Nurse wants you to know!
As an OB nurse I am honored to get to spend time with patients during some of the most emotion packed days of their lives... and it’s truly a special privilege, really. But what my patients, or our patients really, because I feel I can speak for most all OB nurses when I say... What our patients don’t know is, we don’t stop thinking about you when our shift ends. We think about how you’re doing at home... how that first night went, how the transition is going with big bro/sis, how you’re coping with the leaking, the bleeding, the sleep deprivation.... all of it. Plain and simple... we may “only” spend a shift or a couple of shifts with you, but you stick with us long after we clock out. And, here’s *some* of what we would like you to know as you leave the hospital.
Let’s chat about your placenta...
Did you look at it? Do you remember delivering it?
If so, you might remember seeing something about the size of a deflated volleyball.. give or take a bit. You might remember having to give another “little” push to help deliver it... maybe even a bit of pain as you did so. Now, with all of that in mind... think about where that detached from? You have a wound that size in your uterus. Yep... about a volleyball size wound, a wound that needs time to heal. You are bleeding because your uterus is clamping down (hello postpartum cramps) preventing excessive bleeding and trying to heal that wound... the place where your placenta was once attached. The just? Don’t feel rushed to get back to “normal.” Take time to rest... like lounge on the couch, cuddle baby rest. It’s okay, YOU need time to heal too. Don’t be afraid to ask for time for you... this is true for both c-section AND vaginal births. No matter which exit your baby came through, your uterus needs to heal from the placenta detaching. Take the time to do so. There is no magic number of days, weeks, or months that works for everyone... listen to your body and rest if it says that’s what you need.
Let’s also discuss... pooping postpartum...
Maybe you’ve heard horror stories, maybe you’ve experienced it with a precious baby, or maybe you aren’t worried at all. Let’s just put it this way, sh*t happens, it’s going to happen. Let’s just talk about how to *prepare* for it. Stool softeners are great! Odds are you got one daily while in the hospital... it’s A-okay to keep that up until pooping doesn’t make you nervous anymore, again that time frame can range for everyone. It’s probably not a far stretch to guess that many of the momma’s going home have some stitches from tearing, probably making it extra nerve racking... take it slow, know that usually the first time is the worst and that it doesn’t last forever. Hemorrhoid cream, over the counter stool softeners, staying hydrated, and reminding yourself that you just had a whole baby should help you feel prepared to have your first, second, third, etc. poops post-baby. You got this momma.
While we’re in the area... burning while peeing.
We touched on tears/stitches above... this is in that ballpark as well. Honestly, there could be a few reasons it burns while you pee... my first thought is an abrasion (kind of like rug burn or scrape) from that beautiful head making its why out. So essentially, you could have a small wound in your urethral and urine would irritate that. Another reason... irritation from your foley if you had one... for an epidural or c-section momma, or even a momma who had trouble pee postpartum in the hospital. So, what can you do to help said burning? Use a peri-bottle with warm water WHILE you are peeing, this will help dilute your urine and cause less burning at the site... also, stay hydrated (good for so many reasons postpartum). And, I have to add, as a healthcare provider... stay in touch with your provider, whether it be an OB, Midwife, or Family Med Doc... burning while peeing can be entirely normal during postpartum, but there is always some risk for infection, so keep a close eye on it and call if it seems to stick around and/or gets worse instead of better, it could be a sign of a UTI.
Because our bodies are affected all over when having babies, let’s move on up to your breasts. Engorgement... this is no joke ladies. Let’s chit-chat here a bit.
First time momma’s... this is probably going to surprise you... and second/third/multiple time momma’s, it can get even worse with consecutive babies. When your milk comes in, it usually COMES IN... like bowling balls planted nicely on your chest. This can be rough. Take a deep breath, we can help. While dealing with engorgement there are lots of little tips and tricks... also, it’s kind of counter intuitive. You might think... on my goodness I’m so full, I need to empty my breasts, I’ll pump. Insert emoji scrunchie face... honestly, probably not the best idea. If you are engorged and you pump until “empty” you just told your body you need ALL that milk and she will, in turn make all of it back for you, and it becomes a viscous cycle. Instead, while dealing with engorgement; put that baby to breast again and again and again, it seems crazy, but that baby is efficient and having him/her at your breast is going to help with relief and it’s going to help regulate your supply... baby will take what he/she needs. Also, use heat and ice... moist heat (warm wash clothes, hot shower, soaking in a tub) will help with let-down to let your body release some of that milk. You can also hand express to relieve fullness... at this stage in the game it’s more beneficial to hand express than to pump. BUT, to each momma their own, and you need to find what works for you and what is comfortable for you. SO, if you really feel you must pump.. use a tip from one of my favorite lactation counselors... instead of pumping for a set amount of minutes, pump until you feel your breasts soften enough for some comfort. This tip (with hand expression or pumping) can be helpful while trying to latch a baby to an engorged breast... soften the breast enough for them to be able to latch on, then let them do the rest. Long and short... engorgement can be a rocky road, literally. Take it one feeding at time, lots of baby at breast, ice, some expression, and lots of deep breathing, and grace towards yourself. You’re doing a great job momma.
And side note for engorgement for formula feeding momma... this is like exact opposite for you. Your milk will most likely still come in, to help with “drying up” wear a tight fitting bra, use ice for discomfort, and don’t stimulate your breasts at all. Any sort of expression will tell your body you need the milk and you start the cycle of keeping the engorgement. Tight bra, ice, no expression. Also, you too give yourself a pat on the back! YOU made a choice about the best way for you to feed your baby! Great job momma!
Before we move away from your breasts... mastitis. Ouch ouch ouch. This can get serious quick ladies so let’s not joke. Put baby to breast often or if you are strictly pumping do your best to stay on schedule. Mastitis is an infection of the breast tissue and it’s important you don’t stay “full” too long while you have it. Signs and symptoms of mastitis include redness of the breast tissue, warmth in a central location, fever, pain, inflammation, flu-like symptoms, and you could get streaking (kind of like red lines) on your breasts. It is generally very painful and most times will require an oral antibiotic to treat, though in really serious cases could require hospital readmission. Again, listen to your body, keep in touch with a lactation counselor and/or your provider, they would be great (and needed) to help diagnose and treat, if necessary. And remember... if it happens, this too shall pass. This is hard momma, but so are you.
Preeclampsia Postpartum... wait what? You had the baby, don’t have to worry about this anymore... wrong! Preeclampsia can happen up to six weeks postpartum. Be on the look-out for a sudden increase in swelling, especially in your face and hands. Seeing spots, dizziness, headache that doesn’t go away with treatment, and really just feeling like overall “crum” or “off” could be signs of preeclampsia. Preeclampsia can cause severe high blood pressure and in serious cases seizures, so pay attention to how you are feeling and call your provider if you notice any of these symptoms.
Woah... there’s quite a bit of information, and really it still only scrapes the top. I didn’t even really touch on all of the emotional changes you’ll go through, but that could be an entirely separate book. In a brief summary... take the time to heal yourself, to get to know baby, and listen to the changes still happening within your body. Don’t just worry about baby’s weight and pees and poops, watch for your own healing... have you drank enough water today? Do you have a clean pad on? Has that headache gone away? Is the freezer packed with ice packs and the microwave ready for a heat pack? Don’t be shy about saying you need help, and always feel comfortable reaching out to ask questions. We, your nurses, lactation counselors, and providers, think about you even after you go home and we want you to feel supported and cared for, even if through the phone or a clinic visit. You aren’t alone. We care. You got this... even if “this” is a helping hand.
**Disclaimer, I’m an OB nurse, and everything I wrote about I learned through my practice, I don’t have specific articles to site or source and my tips shouldn’t be mistaken for medical advice. I’m thrilled to have been given the opportunity to write this post and ALWAYS happy to talk postpartum, but I also support the patient-provider relationship and if you have a medical question, definitely reach out and get the medical help you may need... and then look to me for support, I’ll be there with open arms.