Date issued: August 2021
Review date: August 2023
Ref: C-429 v2
Caring for myself following childbirth
What everyone needs to know after childbirth
Childbirth is a life-changing event that can result in a wide range of new feelings, behaviours and changes to your body.
The health care team that provide care, advice and support after the birth could include midwives, care assistants, health visitors, doctors, GPs and physiotherapists. They may visit you at home or in your children’s centre. At each postnatal visit your midwife will check to see if you have any problems or symptoms. Please discuss any worries or questions you have with your team.
The first contact with your health care team after discharge from hospital or after your homebirth will be a phone call the following day, before 3pm. At this point your postnatal visits will be arranged (The call may come from a ‘withheld’ number so please keep your phone turned on).
Most people will experience some degree of discomfort or pain following childbirth. Your perineum may be uncomfortable, swollen, tender or bruised. Following a caesarean birth your abdomen will feel tender and bruised.
Everyone heals at a different rate and this booklet will give you a number of ways you can help yourself to get comfortable, promote healing and recognise problems.
Having a baby is a big life event; you may feel more vulnerable and worry more. It's natural to experience a range of emotions during pregnancy and after giving birth. But if any difficult feelings start to have a big effect on your day-to-day life, you might be experiencing a perinatal mental health problem.
This may be new mental health problem, or an episode of a problem you've experienced in the past. It’s not uncommon to experience a mental health problem for the first time in pregnancy or after giving birth.
If you have previously had a mental health problem you are more likely to experience poor mental health during pregnancy and up to a year following the birth. Signs of depression and anxiety include:
Feeling sad and hopeless
Negative thoughts about yourself
Sleeping too much or too little
Lack of interest or pleasure in doing things
Thoughts of self-harm
Feeling anxious, nervous or on edge
Unable to stop/control worrying
You can talk to your midwife, GP or health visitor at any time if you are concerned about your mental health. They have access to lots of help and support and will be keen to ensure you get the right help.
See end of booklet for local self-referral to local mental health services.
Our local parents MVP group want our new mums to remember that social media falsely portrays new motherhood.
Social media ‘perfect’ does not represent ‘reality’
What are perineal & caesarean birth wounds?
During a vaginal birth, the perineum (the area between the vagina and your anus) stretches to make room for the baby and this will make the muscles and skin thinner. As the baby is born the perineum can sometimes tear or you may have required a cut to the perineum (episiotomy).
Minor tearing to the perineum or the labia (the folds of skin around the vagina) or a cut occurs in 85 out of 100 vaginal births. These are known as 1st, 2nd degree, labial tears or an episiotomy. Most of the time these are easily repaired with stitches and they heal well.
In a small number of cases the tear extends to involve the anus (the muscles and mucosa in the bottom). These are known as 3rd and 4th degree severe tears (see later in booklet).
Most of the time, perineal trauma heals reasonably quickly with no long-term problems. Tears will be repaired, if necessary, as soon as possible following childbirth to minimise risk of blood loss and infection.
Dissolvable stitches are used to suture the perineum; they start to dissolve after day 10 and will be fully absorbed by 42 days. They do not need to be removed. The stitches themselves are usually hidden so there are often none to see.
A caesarean birth is a cut made on your abdomen (tummy) and womb and is repaired in different ways, either with dissolvable stitches or a removable stitch in the skin to come out around day 5.
Your caesarean dressing will either be a standard dressing which remains for up to 5 days (unless it is soaked through) when your midwife will review the wound. Or a PICO dressing with linked battery pack (inflates and deflates), this will be used if your BMI is over 35, you have diabetes or are at higher risk of a wound infection. This is removed at 5-7days also.
It takes approximately 6 weeks for your caesarean scar to heal fully. It may feel tender, itchy and numb in the first few weeks and can heal to be pink or red and slightly raised. Once healed, it should not be excessively painful or sensitive or prevent you from doing any of your everyday activities.
Looking after yourself is important to aid the healing of either perineal tears or after a caesarean birth and reduces the risk of infection.
Wash your hands before and after going to the toilet. This helps prevent throat/mouth bacteria from being transferred to your wound.
Change your sanitary towel regularly or at each visit to the toilet.
Wear loose fitting clothing i.e., no tight jeans until you have healed. Avoid seams and pressure from clothing or underwear rubbing on the wound.
Keep the area clean, dry and exposed when possible.
Avoid salt, antiseptics or perfumed products as these can cause irritation.
If you have required perineal sutures, wash & dry the area 2-3 times a day, as well as after every bowel movement.
For example, rinse your perineum by pouring a jug of warm water over yourself after using the toilet. Run a shallow bath or have a quick shower. Make sure you dry yourself with a disposable kitchen towel or a fresh towel that guests and your family haven’t used. Sharing towels with your family or guests can contain hidden germs. Don’t dry with a hairdryer as this can dry out the wound too much.
Perineal grazes can sting when passing urine, so having a jug or bottle of water next to the toilet to pour over the area as you are passing urine is helpful.
If you have a labial tear it is advised to separate the labia every time you wash by running a finger gently between these delicate folds of skin to discourage them from fusing together.
Drinking plenty of water will dilute your urine which will reduce stinging.
Recovering from a caesarean birth:
The first 6 weeks are when the initial healing takes place. The wound needs time to heal on the inside, even if it appears healed on the outside quite quickly.
You may find some activities are more difficult, remember to listen to your body and stop if anything is painful.
- Avoid standing still for long periods (30 mins or more), particularly in the early days after your operation.
- Support the incision with your hand or a towel when you cough, sneeze or laugh.
- When getting out of bed roll onto your side first then push up with your arms. You should then do this in reverse when getting back into bed (see end of booklet ‘movement 1’).
- Avoid heavy lifting, anything heavy is advised against e.g., pushing or carrying a bag of groceries.
- Daily walking is advised as this improves blood flow and promotes healing. Starting with short distances and building up gradually.
- Driving after a caesarean birth depends on feeling well enough and your car insurance covering you. Most suggest waiting 6 weeks and feeling well enough to drive.
Clexane & Teds
After having a baby, you are at risk of developing blood clots in your legs and lungs. This is referred to as a venous thromboembolism and it can be life threatening. If you are at increased risk of developing a blood clot, an individual care plan will be included in your postnatal purple pack and you will be advised to;
Keep well hydrated
Keep mobile, begin to move as early as possible as it will aid your recovery
Wear compression stockings, also known as TED stockings
Have a daily injection of Clexane (a drug which thins your blood), the duration of the treatment will vary from 10 days to 6 weeks and the dose will vary depending on your risks.
Signs and actions for a blood clot include:
Swelling, Redness & pain in your calf muscle.
Call 111, GP or maternity triage the same day.
Breathlessness, chest pain, cough and collapse.
o to the emergency department immediately.
My wound feels uncomfortable or painful
To relieve discomfort following childbirth try:
Ibuprofen and paracetamol, these are safe to take when breastfeeding. Check with your midwife if you are unsure. Avoid codeine as it can cause constipation and is not recommended with breastfeeding.
Cooling gel pads have been shown to be effective in reducing perineal pain, bruising and swelling. Gel pads are more hygienic than homemade icepacks.
Aromatherapy oils may assist healing but must be diluted in a base oil. Specialist advice should always be sought before use.
Find a comfortable position for feeding before you commence a feed. A soft chair or lying on your side can help reduce pain.
Roll in and out of bed carefully (see appendix 1).
Care for your back (appendix 2).
If you have had a caesarean birth, support your wound while you cough with your hand.
Start gentle pelvic floor muscle exercises and deep abdominal muscle exercises when you feel able (see further in booklet and appendix 3).
What’s normal and when to seek help
If the pain does not improve or it gets worse in the days and weeks following birth, please inform your midwife or GP straight away so you can be reviewed. Increased pain may be a sign of infection or severe bruising, and you may require additional pain relief.
You will be asked about any perineal or abdominal pain, discomfort or smelly discharge at each appointment. It is beneficial for you that the midwife inspects your wound/dressing at each contact she has with you after delivery as problems can then be picked up early.
If you have any of the signs below, please let your midwife know, see your GP or ring triage on the same day:
An increase in pain or excessive pain that isn’t getting better as the days go on despite simple pain relieving tablets.
An unpleasant smell that was not there before.
Feeling hot & shivery, or like you are coming down with the flu.
Increased bleeding from you vagina after it has reduced or heavy bleeding that does nt settle after a few days.
Pain or swelling in your legs sometimes with shortness of breath or chest pain.
Maternity Triage, (24hr, 7days a week) 01752 430200, Emergency 999
If you have any concerns about how your perineum has healed or if your perineal wound has broken down or still hurts by 8 weeks, you should be followed up in the midwife led specialist ‘Perineal Clinic’. Your midwife, MSW, health visitor or GP can refer you to this. Please also report any faecal incontinence (leaking poo) or loss of bladder sensation to enable specialist follow up.
From mid-way through your pregnancy colostrum will be present in your breasts. This is the first milk that your body produces. Around three to four days after birth, the colostrum changes and becomes mature milk and this change may make your breasts feel heavy, tender and uncomfortable. This can also be a time when you may feel low and tearful. Please be reassured that this will pass quickly, be kind to yourself and remember to talk to those around you for support.
Mastitis is an inflammation of breast tissue that sometimes involves an infection. The inflammation results in breast pain, swelling, warmth and redness. You might also have fever and chills. During this time some women find it helpful to follow the below advice
Soak a cloth in warm water and place it on your breast to help relieve the pain, a warm shower or bath may also help
Rest and drink lots of fluids
Wear a good supportive, non-underwired bra
If you are breastfeeding, continue to breastfeed
Start feeds with the sore breast first
Express milk from your breast in between feeds
Massage your breast to clear any blockages – stroke from the lumpy or sore area towards your nipple to help the milk flow
Any fever or general ‘flu like’ symptoms in the few weeks post delivery should be reported to your GP or maternity triage straight away.
Remember to talk to a member of the midwifery team if you need any support or guidance.
Bowel movements (going for a poo) can make many women feel anxious when they have perineal stitches, especially after a 3rd or 4th degree tear. Unfortunately, constipation can be increased in times of anxiety.
Normal bowel habits should resume after the first few days after childbirth. You may find it beneficial to use kitchen roll and your hand to support your perineum whilst having your bowels open.
Haemorrhoids (piles) are lumps inside and around your anus (bottom) common after childbirth and the symptoms can be relieved with a suitable cream available from the pharmacy. They can be treated by keeping bowel movements soft and avoiding constipation.
Avoid constipation by:
Drinking plenty of fluid. If breastfeeding your fluid requirement will increase so, take a bottle of water with you when you go out and put drinks out ready where you know you’ll be feeding your baby at home.
Eating regular meals and not skipping breakfast- this can get your bowels working.
Avoid hurrying meals.
Avoid processed foods and food with a high fat content.
Eat a diet with a healthy amount of both soluble fibre (fruit & vegetables), and insoluble fibre (cereals and wholegrains). Aim for 5 portions of fruit & veg a day.
Try and do some exercise every day.
Establish a bowel habit i.e., same time every day, after breakfast or a hot drink.
Avoid excessive straining.
Sit in the correct position by placing your feet on a stool so that your knees are higher than your hips.
Ask your GP for a gentle stool softener if you remain constipated or haemorrhoids don’t improve.
Pelvic floor exercises
The pelvic floor is a vital set of muscles that help support your internal organs such as your bladder, bowel and womb, they maintain continence (control over urine, wind and faeces) and prevent prolapse (when organs slip from their normal position causing a bulge in the vagina).
Pregnancy changes your body shape and posture in so many ways. Whether you have had a vaginal or caesarean birth your muscles have been stretched and it is important to get them working well again. Building up the pelvic floor may take months, but any changes you experience during labour or delivery will repair faster and more effectively if you do these exercises.
Doing these exercises daily will help you to return to full health again after delivery, and these exercises performed lifelong will also ensure you prevent future back, prolapse and incontinence problems.
An increasing level of research is now showing that these exercises are a great prevention as well as a cure.
If performed during pregnancy you have 62% lower chance of developing continence issues later during pregnancy and 29% reduction in problems at 3-6 months after giving birth (Woodley et al 2020).
An increasing level of research is now showing that these exercises are a great prevention as well as a cure.
If performed during pregnancy you have 62% lower chance of developing continence issues later during pregnancy and 29% reduction in problems at 3-6 months after giving birth (Woodley et al 2020).
How to do Pelvic floor exercises
Squeeze the muscles around your back passage as if you are trying to stop yourself from passing wind. Whilst you hold, tighten and lift the front muscles as if you are stopping yourself from passing urine. It should feel like a squeeze and lift inside.
Try to maintain the hold for as many seconds as you can (maximum count of 10). Repeat the exercise up to ten times. It is important to let your muscles fully relax back to their starting position between each squeeze. The exercises are likely to be a challenge initially, start with what you can and build up.
It is important to also do quick pelvic floor exercises. Repeat step 1 but this time squeeze for one second then relax for one second. Start by doing sets of ten and try to increase the amount each day, up to twenty.
You may feel some of your tummy muscles working but the muscles in your buttocks and thighs should stay relaxed. Avoid holding your breath, moving your face or clenching your teeth. Nobody should be able to tell you are doing it.
In the early days, you may feel nothing is working, don’t panic this is very normal. Keep going and you will soon feel the muscles working.
Carry out your exercise whilst sitting or lying down.
Try and tie the exercises in with something you do on a regular basis, for example clicking the remote control or kettle. You should carry out this exercise more than 3 times a day.
Many apps are now available to aid you with your pelvic floor exercises, including an NHS app called the ‘Squeezy’ app which costs £2.99 to download. This app provides information and exercise plans which allow you to record your progress. It also helps to remind you to carry out the exercises. After a while you will find you do your exercises without thinking about it.
How do I know if I am doing this correctly?
If you are doing the exercises correctly your perineum (the bit of skin between your vagina and back passage) should lift slightly as you squeeze. You can check this by resting your
finger on your perineum as you perform the exercise and feel for movement, look in a mirror to see the movement.
See below for self-referral details if you require further physio support for these exercises.
How soon can we resume sex?
Everyone is different and there is no ‘right’ or ‘wrong’ time to begin. This decision is based on when you both feel ready both physically and mentally.
Sexual activity may mean not having full penetrative sex for a period of time, you may find you are both extremely tired and you may fear discomfort or your partner may be afraid of hurting you. But it is ok to try if you wish to.
Lubricating gel can be helpful.
If you have an intact perineum, grazes or do not require stitches, your perineum may still need time to heal and will remain bruised and sensitive to touch for several weeks following the birth.
All of us are different so do not compare yourself with others if you are finding it is taking longer to return to your previous sex life. However, there should be no long-term discomfort associated with sexual intercourse following childbirth. If you are concerned, please speak to your GP.
It's possible to become pregnant again very soon after the birth of a baby, even if you're breastfeeding and even if your periods have not returned.
You usually release an egg (ovulate) about 2 weeks before your period starts, so it's possible to get pregnant before you have a period.
Contraception choices immediately after birth. At any time after the birth of your baby and while also breastfeeding, as long as you have no medical risks, you can use:
a contraceptive implant (more than 99% effective)
a contraceptive injection (more than 99% effective)
the progestogen only pill (99% effective if taken correctly)
male condoms (98% effective if used correctly)
female condoms (95% effective if used correctly)
3 weeks after birth. If you're not breastfeeding and your healthcare professional has checked you have no medical risk factors for a blood clot in a vein, you can start to use the:
- combined pill (more than 99% effective if taken correctly)
- vaginal ring (more than 99% effective if used correctly)
- contraceptive patch (more than 99% effective if used correctly)
But if you're breastfeeding, have certain health conditions, or a risk of blood clots, you'll usually be advised to delay using the combined pill, ring or patch.
4 weeks after birth. You can choose to have an:
- IUD (intrauterine device) (more than 99% effective)
- IUS (intrauterine system) (more than 99% effective)
Please see websites at the end of this booklet for more information about each of these options.
Severe (3rd & 4th degree) tears
Obstetric anal sphincter injuries (OASI) are 3rd and 4th degree severe tears that are sustained while your baby is being born, involving the anal sphincter at the bottom of your back passage. These types of tears affect about 3 in 100 women during childbirth.
Due to the higher potential for longer term complications, all women sustaining 3rd or 4th degree tears are followed up in a specialist perineal/OASI clinic at around 2 weeks (virtual appointment) and 6-9 weeks (face to face appointment) after giving birth. This will be booked for you while you are on delivery suite and you will receive a follow up letter and text before the appointments.
Please talk to your midwife or maternity triage if you have concerns in the meantime.
- At the OASI Clinic you will be seen by a specialist midwife and women’s health physiotherapist. We aim to answer your queries, check the progress of your healing and provide recommendations for the longer term.
Prior to the appointment you will be asked to fill in a symptoms questionnaire to highlight any problems you may be having.
It is important that you
Keep the area clean and dry to reduce the chance of infection.
Take the course of antibiotics in full if they have been prescribed at the time of suturing and follow section 5 if you show signs of infection.
Prevent constipation as outlined in section 6; this is vital as straining can disrupt the repair. Laxatives will have been prescribed for the first 2 weeks but please read above advice and contact your GP for a further prescription if you become constipated in the 6 months following childbirth while the tear is healing.
Pelvic floor exercises are protective against incontinence, make a start and we will support you further at your appointment.
Around 6 months after your delivery, you will be sent an anal physiology appointment from the Colorectal Department. This is an important test to check that the tear has healed properly and will also help inform decisions on mode of delivery for future births.
In the longer term please contact your GP or self-refer to physio if you have difficulty holding when you feel the urge to open your bowels, have poor control when passing wind or have leakage from the bowel and they will refer you back to the hospital to see a specialist.
Please also see MASIC (Mothers with anal sphincter injuries in childbirth) for support www.masic.org.uk.
What is birth trauma?
Birth trauma is a shorthand phrase for post-traumatic stress disorder (PTSD) after childbirth.
PTSD was first identified amongst soldiers returning from the Vietnam War, and most people still think of it as a condition experienced by soldiers. In fact, PTSD can follow any traumatic event – such as being in a car accident, being sexually abused or having a very difficult birth. It can also happen to people who have witnessed a traumatic event.
In most cases, what makes birth traumatic is the fear that you or your baby are going to die. We very often see birth trauma in people who have lost a lot of blood, for example, or who had to have an emergency caesarean birth because their baby’s heartrate suddenly dipped. Not everyone who has experienced a difficult birth or a traumatic experience will have long lasting effects from birth trauma however, some people may be significantly affected by birth trauma. It is a completely normal response, and not a sign of weakness. Birth trauma is also involuntary: brain scans show a difference between the brains of people with PTSD and those without. PTSD is not something that can be cured by “pulling yourself together” or “focusing on the positive”.
Symptoms of birth trauma:
Re-experiencing the traumatic event through flashbacks, nightmares or intrusive memories. These make you feel distressed and panicky.
Feeling hypervigilant, this may mean you are constantly alert. For example constantly checking baby in case something dreadful has happened.
Avoiding situations which trigger negative thoughts and feelings.
Feeling low and unhappy with feelings of guilt around the birth or a sense of loss.
Problems with bonding and attachment.
If any of these thoughts or feelings are bothering you, please discuss them with your Midwife, Health Visitor or GP who may offer you a referral to talking therapies or the Perinatal Team may be helpful.
The BTA (Birth Trauma Association) also offers you support and will show you that you are far from alone www.birthtraumaassociation.org.uk
Plymouth Birth Afterthoughts Service
Becoming a parent is a challenging time. For some of you the transition into parenthood can be made more difficult if there are unresolved issues around the birth experience.
It maybe that for you it was traumatic, have poor memory of events or simply didn’t understand some of the processes or actions taken.
If you gave birth in Plymouth (or the surrounding areas) you can make an appointment with our Birth Afterthoughts service to talk through the events to enable clarification, fill the gaps and answer your questions.
You are welcome to bring a partner or friend with you.
Email email@example.com with your full name, your date of birth, the date you gave birth and a contact number to make an appointment with one of our midwives. Alternatively, you can call 01752 431336 (leaving the same information if answer phone).
What’s normal longer term and when to seek help?
8 weeks plus after delivery
You should be pain free.
Vaginal bleeding should have stopped.
Any incisions/tears you may have had should have healed (for severe tears see section 11): consult your GP if you have concerns.
You should have control over your bladder and bowels (passing urine and going for a poo).
You should be ready to increase your activity levels.
What is NOT normal? A symptom check list;
Ongoing back, pelvis, groin or abdominal pain
Leaking urine, wind or stool with laughing, coughing, jumping, sneezing, lifting, walking, running etc.
Pressure or bulging in your vagina or rectum.
Difficulty doing any of your everyday activities because of pain, leakage or pressure
A gap running down the length of your tummy, bulging or doming of your abdomen during any exercise/activity like this.
See www.youtube.com/user/plymouthnhsphysio for a video of how to perform this test
If you have a symptom from this list 8 weeks after delivery, they do not usually go away by themselves and you should get some help and advice from a physiotherapist or GP.
A physiotherapist will assess your posture, movement and muscle control and explain their recommendations and treatment.
You can self-refer to physiotherapy in Plymouth or Cornwall
Search for: physiotherapy + self-referral form + cornwall/plymouth
Click on the Physiotherapy Department self-referral form.
Return to exercise gradually and enjoy it, there are many health benefits to be gained. Ligaments will still be softer for up to 5 months after delivery so take care not to start high impact too soon, for example running and jumping.
Brisk Walking: is an excellent form of exercise. If you are walking with a pram, ensure your pram handles are at a height that enables you to maintain a good posture.
Swimming: you can start this after 7 consecutive days clear of any vaginal bleeding / discharge. If you have had a caesarean birth it would be wise to have your 8 week check first.
Listen to your body & be kind to yourself
Everyone’s journey is different
Do not overdo it
If you do not have any of the symptoms from the checklist in the previous section, you can start these exercises.
With all these exercises, breathe in, breathe out and engage deep abdominals and pelvic floor muscles before moving. Maintain relaxed breathing throughout the exercises. Repeat each exercise 5-10 times
Single leg table top
Lift one leg so the hip and knee rest at 90 degrees. Gently lower and repeat on the other side
On your hands and knees with wrists positioned below shoulders, knees below hips and back in neutral position. Allow the tummy to relax, breathe in to prepare, breathe out and gently lift your belly button to your spine and squeeze pelvic floor muscles. Breathe in to hold, breathe out and slowly release.
You can make this exercise harder when you are ready by following the pictures and lifting alternate arms, then alternate legs and finally trying opposite arm and leg lifts.
Abdominal muscle exercises
These muscles stretch during pregnancy and need toning up to flatten your tummy and draw in your waist. They support your back to prevent backache.
Deep abdominal hold
Rest in any position with knees bent.
Breathe in gently and as you breathe out draw in your tummy and hold in for ten seconds. Keep breathing.
Try to do another five or as many as you can.
Draw in your tummy as below and flatten the hollow of your back to tilt your pelvis.
Hold this position for five seconds. Let go.
Repeat five times or as many times as you can.
Movement 1. The right way to roll in & out of bed
Roll onto your side with knees bent. Push with your elbow and arm whilst your legs drop over the edge of the bed the edge
Movement 2. Caring for your back
The ligaments that stretch during pregnancy take up to six months to return to normal.
Think about your posture, when sitting, support your back so you are comfortable.
When standing, walk upright and hold in your tummy and pelvic floor muscles to support your back. Try to avoid lifting heavy objects.
Don’t sit in a slumped posture
Sit up tall and use towels or pillows for support
Maternity Voices Partnership explained
We need your help to improve maternity services in Devon.
There are different ways of participating depending on your interests and available time, you could:
• Represent families by attending meetings and focus groups
• Collect maternity stories, experiences, insights and recommendations from your community, which we can feedback on your behalf.
• Host a local gathering. We want views from the different geographies of Devon (this could be through an existing group you already attend e.g., a baby group, or perhaps you have an idea for your own gathering)
• Champion a particular aspect of maternity services. Perhaps you are passionate about homebirths, or as a dad you are interested in support for fathers.
• Be involved in maternity service quality improvement initiatives, for example, a ‘Walk the Patch’ in your local maternity unit.
What do I need to do next?
All the below websites are here to support your recovery:
NHS Choices www.nhs.uk
NICE (National Institute for Health and Clinical Excellence) www.nice.org
RCM (Royal College of Midwives)
RCOG (Royal College of Obstetrician and Gynaecologists) www.rcog.org.uk/en/patients/tears/
Bladder and Bowel foundation www.bladderandbowelfoundation.org
Mental health support sites
Please choice option below to which you live within:
Masic- supporting women with severe injuries from childbirth www.masic.org