The postpartum period can be a very emotional time for women. The body has undergone a great deal of physical stress and it is quite normal for mental health to go up and down during the first few weeks. In this guide, we will go through common symptoms that can occur during childbirth. Remember that the journey to feeling well is individual and any symptoms will be experienced differently from person to person.

In this guide after childbirth:

• Bleeding from the vagina
• Fractures and wounds
• Afterbirth
• Breastfeeding and milk production
• Sleep deprivation
• Fallout
• Urinary tract infection
• Baby blues and postpartum depression
• Peeing and pooping after childbirth
• Split abdominal muscles

Bleeding from the vagina

Everyone bleeds from the vagina after childbirth. This is called discharge and comes from the wound left by the placenta after it has detached from the uterine wall. The discharge starts as a heavy period, then becomes more brownish and finally lighter before it stops. During the 6-8 weeks that bleeding is common, the smell and consistency of the bleeding may also vary.
After giving birth, your uterus is particularly sensitive and susceptible to bacteria, which increases the risk of infection. An infection of the uterus is treated with antibiotics and in some cases the woman may need to be hospitalized to receive antibiotics in a drip directly into the bloodstream.

As you are particularly susceptible to infection during this time, you should avoid bathing, do not use vaginal protection (tampons or menstrual cups) and remember to use condoms during sex. However, you should avoid sexual intercourse while you have fresh bleeding. On 1177 you can read about infection of the uterus after childbirth.

If you are worried, you can seek care through a health center or a midwife's office. However, go to an emergency room or a gynecological emergency room if one or more of the statements apply to your condition:

- You are bleeding more than you did in the first 24 hours after giving birth.
- There are many or large clots of blood coming from the vagina.
- You have a fever above 38.5 and pain in your lower abdomen. It feels sore when you press on your uterus.
- Your rejection will be very smelly.
- You are tired and have a headache along with any of the symptoms above.

Sometimes the uterus does not contract properly, or there may be remnants of the placenta inside the uterus. If this is the case, you will be given a medicine to cause contractions so that any remains come out. In some cases, scraping is also needed to get the remains of the placenta out.

Ruptures and wounds after childbirth

It is common for ruptures and wounds to occur during childbirth. These are assessed on a scale from grade 1-4. Lacerations classified as 1 and 2 are stitched at the birth by the midwife and anesthesia is offered.

- Grade 1: Superficial tears of the mucosa/sheath and labia. These tears often heal quickly and without permanent damage.

- Grade 2: Deeper tears of the perineum and vaginal walls. In addition to the skin, the muscles, muscle attachments and connective tissue have been affected and need stitches to restore normal anatomy. This is the most common tear among primiparous women.

- Grade 3: This involves the external and sometimes the internal rectus muscle. A grade 3 tear is stitched by a specialist doctor in the operating room.

- Grade 4: In this grade of rupture, the rectal muscles and the wall of the rectal canal are damaged. This is stitched by a specialist doctor in the operating room. Follow-up and return visits to hospital are always offered for grades 3 and 4 and for complicated grade 2.

Wounds in the vagina and rectum need time to heal and this takes different amounts of time depending on the extent of the injury. Swelling and discomfort are common in the first few weeks. Going for a follow-up visit to your midwife's office 6-8 weeks after giving birth is a good way to see if the tear has healed properly and to check your ability to squat and your pelvic floor.
Seek help if you think you have an infection or are bothered by the stitches. If you are experiencing problems 6 months after giving birth and/or after you have stopped breastfeeding, you should seek help at a gynecological clinic.

Afterbirth

Soon after the baby is out, the uterus will start the job of contracting again. This is called afterbirth and can be painful. If you are a preemie, you are more likely to experience strong, painful afterpains. They are usually felt more during breastfeeding, but the pain usually subsides after 3-4 days as the uterus recovers. It may be worth testing whether a heating pad or tens device relieves and taking Alvedon and Ipren if necessary.

Breastfeeding and milk production

If you want to breastfeed your baby, it is good to be prepared for a bumpy road before breastfeeding works well. It is normal to breastfeed a lot in the first few days before the mature milk flows. Keep your baby skin-to-skin as much as you can and be mentally prepared to breastfeed 8-12 times a day and more.

The intensity of breastfeeding can come as a shock to the tired new mother. When the mature milk runs out between days 3-5, you may experience something called milk stasis, your breasts become hard and you may feel a little sick. Here's the best thing you can do to breastfeed on, ideally on baby's cues. If your breasts feel very tense and you need to relieve the pressure in your breasts between feedings, you can take a warm shower while gently massaging your breasts. Also try using something called the *cotterman's grip*, where you place your fingertips around the areola and squeeze for a few minutes. This simply pushes the milk and tissue fluid backwards, softening the nipple and perineum and making it easier for the baby to get a good grip on the breast.

Sore and tender nipples are also very common. For sore nipples, you can air them, lubricate them with breast milk and use special creams available at the pharmacy.

If you need support and advice on breastfeeding in the first week after giving birth, you can always call your maternity ward. Dare to ask for help from friends, family and health professionals. As with everything else when it comes to a newborn, no one expects you to know everything from day one. In a way, both you and your baby are new to this world.

Read more about breastfeeding here.

Sleep deprivation

When the birth is over and all you want to do is sleep, a new chapter begins with night wakings and days that blend into one. Talk to your partner, if you have one, about how you can best take care of your home, each other and your baby in the early days. Take the opportunity to sleep for a while during the day when the baby is sleeping so that you are more prepared for a night with an unclear number of hours of sleep. If you are breastfeeding, it is difficult to share responsibilities at night, but perhaps your partner can relieve you between breastfeeding sessions. There are many ways to comfort a baby besides the breast and it can be helpful for your partner to find their own ways early on. Sleep is essential for everyone, so if you're feeling extra sensitive, unfocused and stressed, it could well be the lack of sleep that's haunting you. A tip for all parents out there is to take all the rest you can get. Whether it's a 10-minute power nap on the couch in the middle of the day or having a friend or relative come over and carry the baby around for a while so you can cook in silence. People often want to help and feel needed, but sometimes you have to reach out and ask for it yourself.

Fallout

A prolapse is when the uterus sinks into the vagina, or organs around the vagina bulge into the vaginal wall. This is due to a weakened pelvic floor. It is common for some form of prolapse to develop, but you may not always be bothered by it and therefore not need to seek medical attention. For others, it can cause a feeling of heaviness, chafing or problems emptying the bladder and bowel.

There are a number of things you can do to avoid the risk and to alleviate the symptoms of prolapse. These include doing squatting exercises regularly to train your pelvic floor muscles, avoiding heavy lifting, and if you need to lift heavy weights, remember to squeeze your pelvic floor muscles. It is important to always go to the bathroom immediately if you feel the need to poop. Also remember to eat fiber-rich foods and drink plenty of fluids to give your gut the best possible conditions.
If you are bothered by a bulge in your vaginal opening, frequent need to pee even though you have just been to the toilet, inability to empty your bowels properly, leakage of stool or unrecognizable bleeding, it is important that you contact a health centre or gynaecological clinic. There is good help available!

Urinary tract infection

In the first two months after childbirth, urinary tract infections are more common than usual. Sweating when you urinate and having to urinate frequently are two common symptoms. Urinary tract infections usually go away on their own, but if the symptoms become troublesome, you should contact a health center to see if antibiotics are needed. Drink plenty of water/fluids if you experience urgency and run to the toilet frequently. This may make the UTI go away on its own.

Baby blues and postpartum depression

The three-day cry or baby blues is something many new mothers have experienced. The hormones and transition can cause feelings of sadness and anxiety to take over. Some don't feel this at all, while others feel a deep sense of sadness and unhappiness. It can be helpful to remind yourself that this is very common and always passes. The so-called "baby bubble" is in many cases far from perfect, cozy and peaceful all the time.

Life is a rollercoaster of emotions in the early days with a newborn and this is the reality for many women. However, if you feel strong feelings of depression, cry a lot and find it difficult to bond with your baby, you may be suffering from postpartum depression. Don't be afraid to talk to your potential partner, a friend, a family member or your health visitor. If the feeling of depression hasn't passed after about two weeks and you find it difficult to get up and face the day in the morning, it's time to seek help. Through your BVC, you may be offered contact with a psychologist or doctor if needed.

Peeing and pooping after childbirth

It is said that three things shall function after a woman has given birth. Peeing, pooping and having sex. Not right at the beginning of course, but it is important to remember that these three things are basic needs and if they do not work, we will be affected in one way or another.

Just after giving birth, the midwife will want to see that you can pee. This may feel uncomfortable, sting a little or not be possible at all. For example, if you have had a spinal anesthetic, your ability to pee may be reduced and only return after a few hours. It is important to try to pee as soon as you feel the need.

Remember to drink plenty of water and eat high-fiber foods to avoid constipation after giving birth. Pooping can be uncomfortable, especially if you have a tear. Try holding a pad or washcloth against your perineum when emptying your bowels for the first time. The pelvic floor is weakened after childbirth, and small or large amounts of urine may leak out when straining. If this continues to be a problem, it is important that you bring it up at your follow-up appointment with the midwife. Unless your doctor or midwife tells you otherwise, you can start practicing squatting exercises immediately after giving birth.

Split abdominal muscles

Diastasis Recti, or abdominal muscle separation, is something you may have heard of before. During pregnancy, all the layers of abdominal muscles stretch and become weakened. This is to make room for the growing uterus. After giving birth, these eventually find their way back together, but in some cases the connective tissue between the muscles remains stretched and the distance between the muscles becomes too large. Signs that you have split abdominal muscles may be that your stomach bulges outwards, your abdominal muscles feel weaker, you have problems with your pelvic floor and lumbar spine, problems with urinary incontinence, etc.
It is not dangerous, but it is important to be aware of the condition so that you train your muscles properly. Consult a midwife or physiotherapist for an exercise program to strengthen the pelvic floor, oblique abdominal muscles and back. In some severe cases, surgery is needed to fully recover.

There is no pregnancy or birth that is exactly like any other. The same goes for the journey towards feeling recovered. Be kind to yourself and let the internal and external healing process take its time.