After Having A Baby

What happens after giving birth?

Your body goes through lots of changes in the weeks after giving birth. You may have heard the terms postpartum and postnatal used to describe the time after birth. Postpartum is the time right after you give birth. Postnatal describes the 6 weeks after you give birth. During this time your body is returning to how it was before pregnancy - it usually takes much longer than 6 weeks to feel back to normal. You should have a postnatal check-up when your baby is about 6 weeks old. You can have your check up at your GP or at a Family Planning NSW clinic. This visit is a good time to talk about contraception, sleep patterns, breastfeeding and any stresses you are experiencing with the adjustment to caring for a baby. Information on common issues during this time is provided below.

Bleeding after delivery

Women bleed from the vagina after giving birth - this bleeding is called lochia. The bleeding will become lighter over the 4-6 weeks after you give birth and become a pink or brown colour. If you are not breastfeeding you may get your first period 4 weeks after giving birth. If you are breastfeeding you will usually get your period about 28 weeks after birth - this is different for every woman. Sometimes it is sooner, sometimes later, and some women do not get any periods while they are breastfeeding.

Contraception

If you are not breastfeeding

If you want to avoid another pregnancy you should use contraception - you should use contraception from 21 days after giving birth. It is ok to use types of contraception such as condoms, progestogen-only pills or the contraceptive implant. If you want to use a combined hormonal contraceptive pill you will be advised to wait 3 to 6 weeks after giving birth because of the increased chance of blood clots at this time. It is generally advised that you wait until around 8 to 12 weeks after birth before having an IUD insertion.

If you want to start using contraception right away you can use:

• the contraceptive implant
• the progestogen injection
• the progestogen-only pill
• condoms

If you are breastfeeding

Breastfeeding can be used as a method of contraception called the lactational amenorrhoea method (LAM) if:

• you are fully breastfeeding throughout the day and night; AND
• your periods have not started; AND
• it is less than 6 months since you had your baby - your baby should not have any supplements except water

If you use this method you are still at a low risk of pregnancy - if you do not wish to fall pregnant you should use another type of contraception. While you are breastfeeding you can use:

• the progestogen-only pill
• the progestogen injection
• the contraceptive implant
• an IUD - wait until about 8 to 12 weeks after birth before having an IUD insertion
• the combined hormonal contraceptive pill (the Pill) – while there is no evidence of any harm to the baby or an effect on the breastmilk many women wait until the baby is 6 months before starting the Pill.

Postpartum sexuality

There is no right or wrong time to start having sex again - you may feel like having sex again soon after giving birth or it may take much longer. Whether you feel like having sex or not depends on many things. You may have bruising or swelling in your vulva and vagina - this area can be sore for weeks or months. It may be sore for longer if you have had stitches for a tear or an episiotomy (a cut made on the vulva to ease the baby’s birth). This can cause pain during vaginal sex. It is a good idea to not have vaginal sex until the area is comfortable to touch. You can try other forms of sexual activity.

The hormonal changes that happen after you give birth can add to discomfort during sex. The vagina feels drier after birth - this can last for 2-3 months if you are not breastfeeding. It can be much longer if you are breastfeeding. Water-based lubricants and vaginal moisturisers from the pharmacy can be helpful. If that does not work, you can talk to your doctor about oestrogen cream or pessaries which may be useful. Your vaginal muscles may tighten too much when you have vaginal sex - this is called vaginismus. If you have this you may need to see a physiotherapist or clinical psychologist to help you with some muscle relaxation exercises.

If you are breastfeeding you may feel less like having sex because your breasts may be sore. You may have milk come from your breasts during arousal and orgasm - if you do not want this to happen you can breastfeed before sex.

Some things can make you feel less like having sex - these can include:

• tiredness and lack of sleep
• changing roles and relationships with your partner and your family
• being worried about not being sexually attractive

This is very normal - you can talk to your GP if you are worried and they may suggest that you see a counsellor or sex therapist for help. You can see them alone or as a couple.

Pelvic floor muscle weakness

All women are advised to do pelvic floor exercises during pregnancy and after birth. Strengthening the pelvic floor muscles can:

• help reduce leaking urine when you cough, sneeze or exercise
• prevent prolapse - prolapse is where your uterus, bladder or bowel sag into your vagina

The pelvic floor muscles are sometimes stretched during pregnancy and childbirth. This means there can be less feeling for a man and woman when they have sex. Pelvic floor exercises can help.

Postnatal depression

Up to 80% of women get the 'baby blues' soon after the birth of a baby - the baby blues is when you feel tearful, anxious and have mood swings. You can get the baby blues in the first week after giving birth - women get the baby blues because of the stress that comes with labour and birth and the changing hormone levels after giving birth. These symptoms should get better in the first week after birth. Most of the time you will feel better with rest.

Sometimes these feelings can be more severe and last for longer - if they are, you may have postnatal depression. Postnatal depression is when you feel depressed for more than 2 weeks after birth and these feelings make it hard for you to do normal activities of day to day living. Postnatal depression affects up to one in seven to ten women and is more common after a first pregnancy. If you think you may have postnatal depression or are concerned about your mood you should talk to your GP.

For more information

Family Planning NSW Talkline – www.fpnsw.org.au/talkline or 1300 658 886
National Relay Service (for deaf people) – 13 36 77
TIS National's interpreting service – 131 450
Visit your nearest Family Planning NSW clinic – www.fpnsw.org.au/clinics
Postnatal depression – www.blackdoginstitute.org.au or www.beyondblue.org.au
Pregnancy, Birth and Baby – 1800 882 436 or www.pregnancybirthbaby.org.au
ASSERT NSW (Australian Society of Sex Educators Researchers and Therapists) – 02 9212 2348 or www.assertnsw.org.au