Post-Pregnancy Problems Part I, or, the less joyful things that can come with your Bundle Of Joy

Dr. Edmund Bruce-Gardner

Postpartum Pain

NOTE: Due to the subject matter, some of the language and images in this blog post may be a bit... ...earthy. 
I imagine you are reading this because you or someone close to you is pregnant, in which case you are probably not going to be weirded-out by descriptions of basic biological processes and structures.  If you are, I would recommend care with choice of your reading matter!

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This is an immense topic, which we will have to deal with in several blogs, if my past history of wordiness is any indicator!

Pain after giving birth (postpartum, in the medical speak) is influenced by a number of factors.

As you would be aware if you read my last blog on the topic (or if you are or have been pregnant yourself!), pregnancy is a time of huge changes for the body.  As we have seen, this can create issues in the way that we move and hold ourselves.  

Now consider that those changes take place very rapidly on a lifetime scale, but pale in comparison to how quickly the body has to change back after the process of delivering the baby, itself an extremely traumatic event for the body, from a technical point of view.  

The Great Miracle Of Life is a lot more miraculous from a theoretical, removed perspective than it is up close and personal! 
​Well, perhaps it is no less miraculous, but a 'miracle' conjures up an image of something that, well, just happens; and perhaps misses how much bloody* effort, discomfort, and emotion go into the whole affair. ​

*I put in that 'bloody' as an emphatic figure of speech, but it is of course rather literal as well

So pain after giving birth may be due to the process of of childbirth, or parturition, and this may especially be the case after a long, 'natural' (a nice euphemism for vaginal, rather than Caesarean section (surgical), delivery) birth, but is certainly not avoided by going the surgical route.  This is certainly an issue when a long, difficult natural birth ends up with surgical delivery due to complications - then you can get the issues associated with either!

It is extremely important that you discuss any pain after childbirth with your obstetrician, midwife, or other (relevant) healthcare providers. 

Immediately following delivery, pain, bleeding/discharge, abdominal tenderness and even fever are all entirely possible and completely normal, but should always be checked out in case they are due to complications of birth:

Endometritis
An inflammatory condition of the lining of the womb, usually due to infection.  It is more likely with incomplete delivery of the placenta or other retained products of conception  (RPOC) such as membranes or other tissue from the foetus.

This is linked with another cause of pain and other symptoms: infection.  Your obstetrician or midwife will be extremely unlikely to let you go home if you show any signs of infection, so hopefully that is not what is causing your pain now (and to read this blog!).

​Uterine inversion
​This is when the uterus, or womb, gets turned partially or completely inside out, often because the placenta has remained attached and pulls on it.  This is rare, but can be associated with severe haemorrhaging (bleeding) and shock.  Again, it is extremely unlikely that you will have been allowed to go home if there is a chance this happened during your labour.
​This was the most Safe For Life image I could find! Google 'uterine inversion' at your peril if you have a weak stomach!

Unrecognised visceral (organ) injury
A lot of force goes into getting your baby from inside the womb to the outside world [through a relatively small opening].  A rare complication of giving birth is injuring one or more of the internal organs in your abdominal or pelvic cavity.  

A more common, and more benign, related source of pain during or after childbirth is urinary retention, that is, a full bladder. ​

Internal tears/bleeding
It is possible to graze or tear the lining of the vagina, which is about as painful as it sounds.  It is also common to stretch or even tear the perineum, the area between your vagina and rectum.  This postpartum pain may be exacerbated if your doctor performed an episiotomy, where they make a small cut in this area to help the baby out.
​Again, a certain amount of pain in these areas is normal, and if you think about what just went on there, even likely, but the amount (and colour) of any bleeding should be monitored.

Note, this is a *simulated* image of an episiotomy, so you can uncross your legs now...

The flow should taper off after a few days, and if you get any large flows after this time, report them to your doctor.

Ice will be your friend here, whether the cut/graze/swelling is internal or external.

Contractions
Having pushed the baby out, the uterus is still not back to its pre-pregnancy size.  Afterpains for a few days following delivery are normal, and may feel like amped-up versions of the cramps you get with your period.  If you breastfeed, you may notice these pains more then; as breastfeeding releases hormones that cause the uterus to contract.

And then there is what I call the Feeling Like You've Been Hit By A Truck Syndrome.
Even with a fairly short, uncomplicated labour, you will be sore in places you didn't even know existed.
Your abdominal muscles were stretched further than they have ever known, just from being pregnant. They then had to contract hard enough to push a moving, struggling being through a canal that is much too small for it.

Watching contractions is fascinating from a certain perspective, the whole body seems to ripple and clench in perfect timing and unison, and even muscles that are very far from the actual action will be joining in helping to give that extra bit of 'squeeze'.

So again, it is fairly natural to feel sore, ache-y and exhausted - and that's before your new arrival keeps you up for the next three nights or so!

These are not the only potential consequences of becoming a new mother. 

​Sore, leaky breasts as your milk comes in (and the pain of blocked ducts​ if you are unlucky enough to experience those), night sweats as your body expels the retained fluid from pregnancy, headaches (which may be from the hormone levels changing) constipation and hair loss are all likely over the coming days and weeks.

Next, we will have a look at the way your body bounces back from pregnancy - or tries to - and the particular issues and problems that can arise from holding, changing and feeding the new addition to your life.