My 'Fourth' Trimester - Natural Delivery Postpartum Recovery

I wanted to share my experiences with postpartum recovery during my first pregnancy. However, 2 years back, I am just a first time mum struggling with postpartum care, trying to put in place what I learnt from parentcraft lessons I attended and trying to juggle the roles of being a mother, wife, daughter and a full time employee. I did not engage any confinement nanny and settled my confinement meals with Tian Wei Signature.

I will be honest. I am so tired everyday to the extent that I do not have the time.

But today, embarking on this motherhood journey for a second time, I am definitely more prepared. With the extra time I get in the afternoons when both my darlings are taking their afternoon naps, I am typing this post. I hope it benefits any mummies-to-be on what they can expect after their baby pops from "the oven".

Alert: The focus of this article would be on the care of the MUMMY and the physical care which I would be mentioning would be more appropriate for mummies-to-be who are giving birth via natural delivery instead of C-section.

I will be touching on the postpartum care in 4 main sections based on the changes observed in mummies' bodies after natural birth.

1) My Boobs : During pregnancy, we already see the physical changes happening - darkening of the aerolas, enlarged and heavy boobs and sometimes abit of soreness. Whether you choose to feed via breastfeeding, pumping breast milk or feeding infant formula powder, your boobs will definitely swell. If you think that's all, let's just say this is only the beginning.

• During my first pregnancy, I had issues of flat nipples (Read more about how I deal with flat nipples in this post) and had a tough time mastering breastfeeding and managing engorgement. The good thing that comes out of breastfeeding is that my nipples are no longer flat.
• Another big issue which I encountered were leaking boobs. Leaking usually happens when I have huge let downs, the term that is used to describe that sensation felt when the surge of milk bursting out from the boobs. I had experiences of leaking boobs when I slept longer than planned, after my hot baths, eaten milk stimulating food such as lactation cookies and fenugreek supplements and sometimes when i'm thinking about baby. My bra and clothes would have patches of breast milk and they stink after sometime. It's important to change regularly and practice good hygiene.
• In this second pregnancy, I faced new challenges such as having sore and wounded nipples from the baby's latching in first week of confinement. Each time MeiMeiOOPS latch, I would scream out loud from within. Honestly, it's super painful and makes me tear at times... and a part of me just wanted to give up on breastfeeding straightaway. I kept persisting on because I kept reminding myself the goodness of breastfeeding and convenience of it once baby and I get through this first horrible stage. 

Reminded of this very classic illustration by Natalie Jomard about breastfeeding

What I do to care for my boobs:

• Buy larger size bras (like duh....) and be comfortable. I got my maternity bras from Bove because they have a brick and motar store at Suntec City that allows me to try on the sizes before I purchase. 
• Wear nursing pads to prevent leaking boobs from staining your shirts and bedsheets. My personal favourite brand is the ones from Lasinoh. It's thin and it sticks on well. The soft texture of the pads prevent chafing of the nipples. Most importantly, they are super absorbent which means NO LEAKS. I do not need nursing pads after the first / second month once milk supply regulates so my advice is do not over-purchase and stock up too much of these.

• Massage your boobs from the outside to the inside, towards the nipples in a circular motion to loosen up the swelling and reduce the swelling of the nipples by pinching the aerola area. This can prevent my boobs from getting into the engorgement stage, which can be SUPER painful. 
• For breastfeeding mummies like myself, I strongly encourage this website kellymom.com . The website is very easy to read and solve alot of my FAQ about breastfeeding during my first pregnancy.
• Use a breast pump to relieve the hardness of the boobs. There were moments whereby my baby does not latch at all for 5 consecutive hours and both boobs become almost solid hard rocks. A short 10-15 minutes pump would relief you from the hardness and also allow you to have some extra milk for days when you need to run some errands without baby in future. Some mummies may rave about using methods like power pumping to increase milk supply but I'm not a fan of that. You may end up having loads and loads of milk but you also need to think about freezer storage space for these milk packs and you may feel letdowns (and engorgement) more regularly as the boobs are stimulated to produce more than needed. 
• Use nipple cream to reduce soreness of the nipples due to baby's latching / expressing of milk. My personal favorite brand is this Medela purelan100. It's not too sticky and easy to apply. It's also 100 percent safe for babies to breastfeed directly after application. I find this really helpful in the first 2-3 weeks of breastfeeding whereby the nipples are still super tender and sensitive and get wounded easily (sometimes even bleeding) from constant stimulation from pumps and/or babies. Applying this cream after every breastfeeding session allows the wounds to recover quicker. When the nipples are used to the constant stimulation, this would not be necessary.

• If you intend to feed formula immediately, there are medication that can help you to wean in a less painful way. Speak to your gynae/lactation consultant about it. I'm not an expert in this area as I'm a breastfeeding mummy!

2) My Vagina :The care for the vagina area is such a sensitive topic to talk about because it's our private area afterall. But it is actually the most important area to look out for after a natural delivery. Think about it, a baby of approximately 3kg just came out from that part of my body and the gynae had done an episiotomy (which is a surgical cut at the vagina) during childbirth to quicken the delivery process followed by stitches. So basically, I am wounded. As per any other surgical cuts, proper care is required to ensure the wound heals well and that there are no infections.

• The impact of an episiotomy is crazy. Some of those which I had experienced included fears of peeing and pooping, unspeakable pain from standing up, sitting down and bending down etc, fears of having the wound infected and fears of anal fissure due to hard stools. I remembered waiting for a whopping 6 hours after delivery before I finally tried to go to the toilet to pee. In my case, the nurse would accompany me to the toilet for my first pee and I would just look at her with puppy eyes and tell her "I can't pee." LOL.... and slowly as the pee drizzle drop by drop, I can only heave a big sigh of relief that I conquered the stage of "first pee".
• In addition to the above, I had to deal with the constant menstruating and contraction of womb after delivery. These discomfort continued to haunt me for about 2 weeks before it subsided.
• There is also an increased frequency in peeing after delivery. I read up about this and it seems like it is my body's natural way of getting rid of those water retention and excess fluid accumulated during the pregnancy. 

What I do to care for my vagina area:

• In the first week, I took pain killers prescribed by the gynae to help me with pain management. I avoided carrying heavy items such as my first child (haha!) and heavy bags.
• As breastfeeding would require me to sit at the same place for about 20 minutes per session, I also ensure I'm nursing at a comfortable position that is not pressing on the wound.
• My gynae prescribed procanol lotion, a local anesthetic which can help to reduce pain and possibilities of infection. I am asked to apply that on the wound after every pee/poop session. After application, there would be this stinging sensation and momentary pain.
• As I mentioned, the frequency of peeing increased. Good hygiene care is important to reduce the risk of infection. I followed the hospital's recommendation of washing up the private part area after every toilet visit and to apply the procanol lotion accordingly. I also change pads frequently. If you are into Chinese confinement practices, one school of thought is that women cannot touch water/ bathe after delivery because 'wind' will enter the body. Well, in this case,  you have to touch water unless you want to risk any chance of infections. 
• There should be no sexual intercourse during the entire recovery process, which could be at least a month. This is common sense (I hope) but important for the daddies-to-be.

3) My Physical Care: The physical discomforts from the third trimester (Read more about my third trimester woes in this blog post) had taken a toll on me by week 39 and my anxieties were shooting up with every passing day. The moment my baby pops out from my tummy safely, I am just filled with joy and gratitude. However, as the adrenaline rush wears off, I started to feel depressed about the changes in my physical outlook due to the pregnancy.

Image by Elvie x Hazel Mead 

• The weight gain and the inability to shed off those weight gain immediately is torturing. During my first pregnancy, I gained a total of 18kg and in my second pregnancy, I gained a total of 14kg at the time of delivery. Sadly, even after delivery, I still look very much pregnant. after delivery and my stomach looks like I'm about 4-5 months pregnant. I continue to wear maternity clothing because I'm still too big to fit into my usual clothing. 
• There are also changes in the physical outlook such as some visible stretch marks, saggy boobs, weakened pelvic and bladder (note: leaking urine), swelling legs (due to the water retention) and postpartum hair loss. Gosh hair loss... I remember getting so fed up with seeing my hair drop each time I wash my hair and it took me almost a year to get past that stage.

What I do to care for my physical care:

• Embrace the changes first. And then work on it.
• Doing postnatal exercise could help with weight loss. The focus of these exercises focus on the lower abdominal area, pelvic and tummy.
• Although breastfeeding is said to help with the weight loss, I don't really see that happening during my first pregnancy. Exercise, drink plenty of fluids and not over-eating is still the best way to keep the weight in check.
• Engage postnatal massage services which can help your body muscles to relax, relieve engorged boobs and also reduce the water retention in postpartum recovery. It is most effective to have the post-natal massage 7 days after natural delivery, which is something I did during my first pregnancy. Sadly, in this second pregnancy, I give birth during the circuit breaker period due to Covid-19 and postnatal massage is listed as one of the non-essential services. I am waiting for the circuit breaker to be lifted so that I can have my massage done with Postnatal Massage Singapore.
• Do note that application of stretch mark creams is most effective if you apply it throughout the pregnancy and post pregnancy.
• I did my daily bath as part of my good hygiene practices using this herbal bath pack.

There are various brands out there but this is the one that I am using.

4) My Mental Health : The mental stress from coping with motherhood can be overwhelming and this is  especially so for first time mummies. I was overwhelmed by the amount of advice, confinement rules that I am required to adhere to while trying to cope with the physical care of my body and learning how to manage the care of the baby. So let's not neglect our mental health.

• I'm not sure if its my maternal instincts or if its the hormonal changes. But basically, I find myself being very attached to the baby. There's always fears about how my baby is coping especially when newborns are so vulnerable. In the first month, my first born had issues with prolonged jaundice (jaundice lasting for more than 1 month) because he contracted staph virus. I remember feeling helpless while looking at him being so yellow and I had difficulties sleeping when he had to be admitted into hospital for 3d2n phototherapy session. All I could think of in my mind is my baby and wondering if its our inadequacy that led to him being hospitalized. 

Comic by Karen Keiman (https://www.huffpost.com/entry/comics-struggle-post-partum-depression_n_5a0db5b4e4b0c0b2f2f85fab)

• I have not been able to sleep more than 4 hours each time and wakes up at the slightest sound made by the baby. Sometimes it's not about the baby but because of my engorged boobs. That brings tears too.
• I also get flustered easily whenever I hear baby cries, especially those high pitch screeching ones when he goes for those prick test and injections. But now with my second child, I am less flustered when it comes to hearing such cries.
• The mental stress of managing with confinement related do's and don'ts had also been one of the most challenging and stressful issue to deal with. While everyone who provided advice is doing so for my own good, I found it really stressful when what they say contradicts with what I think is making me comfortable.

Comic by Karen Keiman (https://www.huffpost.com/entry/comics-struggle-post-partum-depression_n_5a0db5b4e4b0c0b2f2f85fab)

What I do to care for my mental health?

• The main key is self-care and not being too hard on yourself. Ask for help when you need to.
• Even though certain do's and don'ts contradicts in your belief, if its doable and manageable, just do it because I'm sure they originate from the past for good reasons. However, if you are given medical advice by doctors to stop certain practices, please follow your doctor rather than any other "informal advice" from relatives, friends, massage therapist, confinement lady and any other possible people.
• Accepting that I am not perfect and sometimes I really need to learn through the hard way. Motherhood is a lifelong journey. I sometimes doubt the decisions I make but hey, it's okay to make mistakes as long as baby's health and safety is not compromised.
• Talk to people I can trust about all these thoughts and decide by myself what is best for me.

With all that I had shared, I would also like to comment that every mummy's experience and bodily changes may differ. While it may seem scary to learn that these are the multiple changes which your body is undergoing and that they can create so much physical discomfort, most of these discomfort is only in the first 2 weeks after delivery.

One last note: Always seek advice from your gynae regarding recovery of the wounds and any other abnormalities you observed of yourself. Every question is important and there's not such thing as a stupid question. I remember asking the doctor about this odd looking lump at my anus area after the delivery and I learnt that that is just hemorrhoids and it would go away after a while.

I'm not sure if I may have left out anything. Feel free to share more experiences with other fellow mummies through your comments in this post. Do share this post with potential mummies-to-be who may benefit from these prior knowledge on how to care for themselves. =)

Tata,
Mrs OOPS