Postnatal wellbeing and support

Although new breastfeeding mothers may experience sore or cracked nipples, these problems can be overcome. Proper attachment and positioning techniques, regular and effective breast care, strategies to manage sore or cracked nipples and seeking professional advice and assistance when required, can all help.

Mastitis is the term that describes inflammation of the breast. It may appear as a tender, hot, red area on your breast or it may start with flu-like symptoms such as shivers, fever and aches and pains. It affects 1-2 in 10 women in the first few weeks of breastfeeding but can occur at any time and it’s one of the main reasons women might stop breastfeeding. Inflammatory mastitis can quickly turn into the more serious condition called infective mastitis if left untreated. This in turn can lead to serious complications such as breast abscesses that may require surgical drainage. Please seek professional advice early because early recognition and prompt treatment are vital.

The most common cause of mastitis is obstructed milk ducts due to engorgement or incomplete emptying of the breast. You are more susceptible to mastitis if you have damaged nipples because infection can enter the breast more easily. The management of mastitis involves breastfeeding the affected breast to relieve the blockage, pain relief, rest and other supportive measures. If there is no improvement using these strategies then antibiotics may be required.

Please see the Resources under Postnatal problems and possible complications for more detailed information from the Australian Breastfeeding association on the management of sore, cracked nipples and mastitis.

If you required stitches following the birth or had a caesarean, you will most likely have a painful, tender perineum or abdomen in the first couple of days. Perineal pain is particularly common in women after a forceps or vacuum birth or an episiotomy or this was your first baby. Warm baths, use of cold packs and running cold water on the area, Panadol and pelvic floor exercises can all help to relieve perineal pain and improve wound healing after childbirth. Perineal stitches don’t usually need to be removed; they will simply dissolve over several weeks. If you have had a caesarean, the stitches usually dissolve or are removed by the end of the first week. Some women may have ongoing perineal pain following childbirth so if you have any concerns please discuss these with your obstetrician and/or GP.

Perineal wounds and caesarean abdominal wounds can also become infected. Many women undergoing caesarean birth these days are given antibiotics prior to surgery to reduce the risk of infection. However, wound infections can still occur after childbirth. Increased redness, gaping stitches, a feeling of heat, any pus-like discharge or signs that the wound is breaking down rather than healing, can all indicate a wound infection. You may also experience shivers or fever. Changing your sanitary pads regularly and having frequent washes and keeping the wound dry may reduce the risk of infection. Antibiotics may be required and very rarely the wound may need to be cleaned and redressed.

A rare complication following childbirth is haematoma formation. A haematoma is a collection of blood in the tissues underneath the wound due to a small tear or bleeding blood vessel. It can occur in the vagina, vulval area, perineum or under the stitches. Signs of a haematoma may include swelling, a shiny or bluish tinge to the overlying skin and pain. Treatment may involve lancing the haematoma to release the collection of blood or removing the stitches, repairing the bleeding blood vessel and restitching the wound.

Nearly half of all childbearing women may experience backache in the weeks after the birth. The hormones of pregnancy that cause softening of the ligaments and joints and stretching of the abdominal muscles by the growing uterus all contribute to pelvic and posture instability. For most women the condition improves naturally over the postnatal period as their bodies return to a non-pregnant state, but for others it can take months. Women who have had caesareans and/or epidurals seem to experience backache more commonly following childbirth but the reasons are not always clear.

You can obtain instructions for back care exercises from your midwife and hospital physiotherapist during the postnatal period. The video Postnatal Exercises in this section also provides very practical advice. Improving your general fitness will also help you to cope with the physical demands of caring for your baby. Most back pain may be relieved with supportive measures such as gentle exercise and stretching, good posture and lifting techniques, massage, Panadol, water and heat application, but please seek advice from your doctor if pain persists.

You may experience urinary problems in the early postnatal period whether you had a vaginal or caesarean birth. Difficulty in passing urine, stinging, discomfort, leakage of urine when you cough or sneeze or lift something, and retention of urine or incomplete bladder emptying, are some of the more common problems that usually resolve within a few days as your body recovers from pregnancy and birth. Please discuss any issues with your midwife, who can advise and assist in this regard. Doing pelvic floor exercises regularly following childbirth, regardless of whether you have had a vaginal birth or caesarean, may help to prevent or improve urinary incontinence, prolapses of the pelvic floor, constipation, perineal healing and return of sexual function. Rarely, bladder problems may persist and require additional supportive management or treatment. About 2-3 in 10 women may go on to experience urinary incontinence for months or longer. Please see your doctor if these problems don’t resolve.

Urinary incontinence within the first three months occurs in about 10-20 per cent of new mothers. The severity varies from one or two episodes with lifting or coughing to uncontrollable incontinence.

Many women experience constipation during pregnancy, due to the relaxing effect on the bowel by the pregnancy hormone progesterone. Constipation may remain a problem after the baby is born, particularly when the perineal or abdominal area may be swollen and painful. It can affect 1 in 5 women in the first few weeks after birth. Women are often fearful of opening their bowels if they have stitches or have had a caesarean. Putting it off may make it worse so please discuss your options with your midwife if you experience problems with constipation. There are a number of ways to manage this problem. Drinking plenty of fluids, especially when breastfeeding; eating a diet high in fibre and taking fibre supplements, fresh fruit and vegetables; and practising gentle exercise regularly, can all help to minimise constipation. If these strategies are not sufficient your midwife can provide other assistance in the form of laxatives or suppositories.

Haemorrhoids are swollen veins in or around your back passage, which can be very painful and bleed. Haemorrhoids can affect women during pregnancy and after childbirth and usually resolve within a few days of giving birth. Sometimes they may cause considerable pain and discomfort and rarely may take several months to resolve. A long second stage of labour, a big baby and an assisted birth may lead to a higher incidence of haemorrhoids. In the first couple of days after the birth, cold packs can give some relief by reducing the swelling and pain. Haemorrhoid ointments can also be of help. Avoid constipation and straining during bowel motions by maintaining a diet high in fibre, drinking plenty of fluids and doing gentle exercise. Occasionally, haemorrhoids may require surgical treatment. Please discuss this with your doctor if your haemorrhoids are not responding to simple treatments.

Some women may experience a temporary loss of bowel control following childbirth that is likely to improve within days once the swelling and pain have decreased. Having a long labour, birthing a large baby, having an assisted birth and large perineal tears may all be associated with this problem. Pelvic floor exercises may improve both bowel and urinary loss of control. If you experience this problem please see your midwife and/or obstetrician for advice and support.

During pregnancy women carry more fluid and there is a natural dilution of the mother’s blood that lowers the concentration of haemoglobin. However, about 1 in 10 women not taking iron supplements in pregnancy are anaemic; that is, their haemoglobin level is less than 110 grams per litre, as measured by a blood test. Haemoglobin is the oxygen carrying component of your red blood cells and your body needs iron and vitamin B12 to produce healthy red blood cells. When this is low, you may feel weak and dizzy, have heart palpitations or feel breathless and look pale. Anaemia following childbirth may be exacerbated by pre-existing conditions, anaemia in pregnancy and blood loss during childbirth. The signs and symptoms of anaemia may be initially masked when women naturally feel tired and look pale following childbirth. It is important to detect anaemia (by blood tests) early so it can be treated. Ongoing anaemia can interfere with lactation, a mother’s ability to care for her baby due to associated weakness and make her more susceptible to infections. Depending on the level of anaemia, increasing iron-rich foods in the diet and taking iron supplements can boost your body’s haemoglobin and iron stores. Rarely, if a woman has experienced a large postpartum haemorrhage, a blood transfusion may be required.

In the Labour and Birth section we discussed postpartum haemorrhage (PPH) as being a possible complication in the first 24 hours following birth. Another form of PPH, called secondary PPH, can cause bleeding at any time after 24 hours and during the six-week postnatal period. Possible causes of secondary PPH include retained fragments of placenta or membranes or a large blood clot and/or infection in the uterus. Women who have had a manual removal of placenta or PPH immediately after childbirth may be at increased risk of secondary PPH. The bleeding may be excessive or prolonged in nature. Other signs and symptoms may include tenderness or pain in the abdomen and flu-like symptoms such as shiveriness, sweating and fever. If this occurs in hospital please call your midwife immediately. If you experience bleeding again after it had stopped or more bleeding than you expect at home, please call your doctor. Call an ambulance immediately on 000 if the bleeding is excessive or you feel very unwell. The steps taken to treat this bleeding are similar to those for excessive bleeding immediately after childbirth. You may also need antibiotics, more blood tests and an exploratory operation to remove any retained placental fragments.

After childbirth, your body will undergo many physical and hormonal changes. These normal changes, coupled with the demands of caring for a new baby, may trigger headaches. These headaches should respond to rest, relaxation and mild pain relieving medications such as Panadol. If you experienced migraines prior to becoming pregnant, these may return due to a decrease in pregnancy hormones so please see your doctor about this. Sometimes headache may be a sign of more serious conditions that you should be aware of.

Dural puncture may occur as a result of the epidural or spinal needle puncturing the tissue cover that surrounds the spinal cord and spinal fluid (called the dura mater). When this occurs, the spinal fluid leaks out of the hole made in the dura. It occurs in approximately 1 in 100 epidural blocks; but not all patients experiencing dural puncture develop a headache. The likelihood of developing a headache is related to the size of the epidural or spinal needle used and age of the patient (younger patients have a higher risk).

Around half of patients that have had a dural puncture will develop a post-dural puncture headache. The headache usually develops within 48 hours but may occur later. The headache typically starts when the patient sits upright or stands and gets better when s/he is lying flat. It commonly feels like a dull, pressure-like headache affecting any part of the head and can also extend to the neck and upper back. Other symptoms may include mild hearing loss, ringing in the ears, double vision and neck stiffness. There may also be nausea, vomiting and pain in the eyes on looking at the light (photophobia). If you experience any of these signs and symptoms after an epidural or spinal block please inform your midwife and obstetrician immediately and they can liaise with your Anaesthetist. Treatment usually involves an epidural injection to seal the puncture site in the dura and bed rest.

If you have pre-eclampsia during your pregnancy, it usually resolves following childbirth. Rarely, pre-eclampsia can manifest following childbirth. Some women who have high blood pressure (a reading of 140/90 or more) during pregnancy may go on to experience high blood pressure following the birth. Severe headaches, particularly if accompanied by blurred vision, flashes of light, sudden swelling of your eyes or face, upper abdominal pain, nausea and vomiting, are all possible signs and symptoms of pre-eclampsia. A more severe form called eclampsia is characterised by convulsions and it may manifest up to four weeks after childbirth.

Your midwife and obstetrician will monitor your condition and blood pressure after childbirth and you may need to be prescribed medications to lower your blood pressure if it is high. If you experience any of these signs or symptoms at home following discharge from the hospital please seek medical advice and assistance. An ambulance should be called if you experience a convulsion.

During pregnancy and following childbirth it is not uncommon for women to experience lower leg discomfort, varicose veins, cramps, and/or swollen ankles and feet. These usually resolve over the course of the postnatal period with supportive measures such as elevating your feet, taking gentle exercise, avoiding standing for long periods and wearing support stockings. There is another condition you should be aware of called deep vein thrombosis or blood clots in the legs.

Pregnancy increases the risk of blood clots because the veins dilate; slowing blood flow and the blood is naturally more likely to clot as a form of protection against bleeding in pregnancy and during childbirth. Lying in bed for long periods of time, being inactive and becoming dehydrated can exacerbate this slowing down and thickening of the blood in the veins. Increased heat, redness, severe pain or one-sided swelling in the legs and particularly in the calves, may indicate the presence of blood clots in the legs. Blood clots in the legs can also break off and travel up to the lungs and cause a life threatening condition called pulmonary embolism.

For this reason, it is important to mobilise early and remain active after childbirth and maintain adequate fluid intake. If you are older, overweight, had a caesarean birth, have a family history of blood clotting disorders or have any pre-existing medical or pregnancy related conditions, this risk is further increased. Your obstetrician may prescribe preventive measures, such as compression stockings or blood thinning medications if you have any risk factors. If you experience any of the signs and symptoms of blood clots in the legs after discharge from hospital please seek medical advice urgently.