When Recovery Is Rough
By Marsden Wagner, M.D., M.S.
There is always a period of healing from childbirth, but births with unexpected complications may mean additional physical challenges for new mothers. Those who’ve had Cesarean sections, for instance, are recovering from major abdominal surgery and will need extra support for several weeks or months.
If you’ve undergone any kind of interventions during labor and birth, your recovery may also involve coming to terms with strong feelings about what happened.
Inducing and Augmenting Drugs
Serious postpartum hemorrhages are slightly more common among women who’ve had their labors induced or augmented by drugs. This makes sense though, because the purpose of the drugs is to stimulate stronger and faster uterine contractions and sometimes the uterine muscle can run out of gas and lose its ability to contract. The serious hemorrhage usually occurs because the uterus is atonic – meaning it has lost its ability to contract – and therefore isn’t shutting down and squeezing against the raw surfaces.
Your healthcare practitioners will give you instructions on reasons you should call them or go to the emergency room in the immediate period following birth. If you do not hemorrhage within 24 hours of birth, chances are good that it’s not going to happen. It’s even unlikely after a few hours.
Inducing and augmenting drugs are metabolized and out of your system within a few hours of taking them – evidence of this is that your contractions cease. Therefore, they cannot be passed to your baby through your breast milk.
Due to transmission through the placenta, babies whose mothers were given epidural medications tend to be sluggish when they are born. The drugs pass out of their systems within a few hours. However, more than one study suggests that newborn infants born following epidural anesthesia may continue with a mild degree of neurological difficulty for some time after birth. Like the inducing and augmenting drugs, epidural drugs are out of the mother’s system within a few hours, so there is no risk of passing them along to the baby again during breastfeeding.
Postpartum symptoms in women having an epidural vary enormously. They range from no aftereffects to mild headaches and backaches or severe headaches and backaches. About 10 percent of women suffer to one degree or another from headaches and backaches that linger for a few weeks. Occasionally (about 1 percent of the time), the headaches and backaches go on for a year. In rare instances, women have been temporarily or permanently paralyzed from being given an epidural.
During natural birth, a woman becomes bruised and sore. With instrumental birth using forceps or a vacuum extractor, the bruising and soreness she feels are magnified. You can expect pain and discomfort that lasts for weeks, and possibly greater vaginal discharge. Lacerations may lead to longer-lasting urinary and fecal incontinence.
The baby needs time to recover from these invasive, head-squeezing procedures as well. The baby’s head is likely to be bruised and swollen after instrumental birth and, for a few days, he or she may be lethargic and less good at nursing than otherwise.
Natural tears of the perineum produce less pain and bleeding than episiotomies do. Where the doctor or midwife cuts, and then sutures the perineum, there is a wound that has the potential to become infected if you are not careful. Pain may continue for several days. Treat this wound like other surgical wounds: Clean it, don’t fuss with it, and keep it dry. Occasionally, the pain persists for months and painful sexual intercourse may result. In this case, see your doctor.
Major surgery takes months to heal. Problems that can arise at different stages in the healing process include bleeding, infections, adhesions (aggressive and binding scarring inside your abdomen), pain and stiffness, and numbness around the surgical site. As with an episiotomy, you should follow the rules of good hygiene in regard to your stitches: Keep the wound clean and dry, and don’t fuss with it. If an infection develops, see a medical doctor and do as suggested, which might mean taking antibiotics.
Usually over-the-counter pain medication – acetaminophen (for example, Tylenol) or ibuprofen (for example, Motrin or Advil) – are sufficient to handle discomfort. If you have more severe or persistent pain, speak with your physician. Numbness should go away as your severed nerves heal. You may, however, feel some itching sensations in the process.
Mild exercise, such as frequent moving about and walking and stretching of your extremities, is important even in the earliest phase of healing, because it reduces the chances of adhesions forming. A common long-term complication of C-section, adhesions can be avoided if you start moving around and prevent the scars from locking other tissues of your body into place, thus limiting your range of motion.
Some women may feel down or a bit sad after childbirth, and women who had a bad time during childbirth or who have a sick child are even more likely to feel sad. This is natural, and most often it really isn’t a medical problem. Research studies show that many women have negative feelings about themselves when birth “goes wrong” and when they receive callous treatment from caregivers.
Lots of mothers feel mood swings following childbirth, because their hormones are cresting and falling more than usual. Postpartum feelings can range from elation to severe depression and everywhere in between. Around a third of women typically feel sad off and on for several weeks after birth. While many women feel disabling, symptomatic clinical depression months after the fact, only around one or two women per thousand develop a psychosis that requires hospitalization. If sadness is severe and persistent, and if a woman’s mind is filled with self-destructive thoughts, she should see a professional who can assess her condition.
If you feel depressed, be aware that healthcare providers know you are not pretending to feel bad. You are not a wimp, a sissy or a failure for hurting. Your feelings are probably triggered by hormonal shifts and can be regulated through diet, exercise, rest and support. Medication would be a final solution and does not generally need to be prescribed for life transitions.
Cesarean section is a risk factor for depression, as are having a difficult birth and lack of family support. Isolation of a new mother – someone who is hormonally destabilized, exhausted, and overwhelmed by her circumstances – is a strong risk factor. Therefore, seek company. Find someone genuinely supportive to listen to your feelings without judgment. This can make a big difference. Join a group of other women like you who have infants and want mutual support. Your doctor, midwife, hospital or birthing center may be able to help you locate such a group. Or you could search for a group of like-minded women on the Internet.
Grieving for the Birth You Wanted
Former childbirth educator Leslie Whitcomb states, “I used to do postpartum adjustment counseling with women who had a birth go wrong for one reason or another. Short of the loss of the baby, what really caused them trouble and affected bonding with the baby was their loss of choice. It may have been caused either by their bodies or by the actions of the medical establishment. But the thing for which they needed emotional healing was having the choice of how to give birth taken away from them.
“Sadly, when the medical establishment runs over a woman she often feels like it’s her fault. I noticed that many women didn’t get angry with a nurse or doctor who disempowered them, but rather felt like they themselves had failed. To heal, women needed to look at the loss of the childbirth scenario they had planned to experience and grieve.
“There was a need for a woman who had a medically necessary Cesarean section, for instance, to look at her sense of failure. Finally, she realized that she was a successful mother because she let herself be cut to have a healthy child. That’s the ultimate goal.”