Rooming in
Most hospitals nowadays allow rooming in. This means that mother and baby are in the same room. The mother can begin learning to care for her baby at once and gain confidence in doing so. Breast-feeding is often more successful, too, and the baby can follow its own individual rhythm. Its father, brothers and sisters can also get to know it.
Lying in
The lying in period lasts until the body has completely recovered from the changes caused by pregnancy and birth, usually about 6-12 weeks. During this time the uterus reverts to its normal size and may contract during breast-feeding. You will continue to bleed after the birth, rather more than during a normal period. By about the end of the second week the discharge will be quite pale. If it smells bad or continuous to be bloody and heavy, you may have an infection.
You should get on your feet as soon as possible after the birth. This stimulates your circulation and keeps your bowel movements regular. Mothers who have had an episiotomy will find it difficult to sit. The wound will heal better if given regular warm hand showers. Be particularly fussy about your personal cleanliness at this stage. Avoid taking baths and take showers instead.
Postnatal check-up
You will still be on the clinic’s books until you have been for your postnatal check-up. This examination is important to check that there are no ulcers around the uterine orifice or any signs of inflammation. Often disorders are to begin with slight and almost without any symptoms. The postnatal check-up is made 5-12 weeks after the birth, and you will need a certificate proving you have had it in order to obtain your maternity benefit.
Family planning
Because of the hormone changes after the birth, the mother may not feel like sex for a while. There is, however, no reason why you should not have sexual intercourse if you both want it and it is not painful. There may be vaginal dryness, soreness and irritation for a long time after the birth, but you can ease this by using a lubricant such as those sold at the chemist’s, cooking oil, non-perfumed skin cream or Vaseline.
The main means of contraception while you are still breast feeding are a condom, coil or sterilisation, since these do not affect either your milk or your baby. Before choosing sterilisation, remember that it cannot be reversed. Chemical contraceptive gels, foams and suppositories may cause irritation. You will probably need a different-sized diaphragm from before the birth, so you will have to be refitted and you will need to use contraceptive gel as well. If you do not breast feed your baby at all, you may ovulate as early as about 30 days after the birth. In this case you can start taking contraceptive pills three weeks after the birth or your first period. It is not recommendable to start taking pills before this due to the higher risk of thrombosis.
The body of the mother will undergo great hormone changes immediately after the birth. As a result, you will start producing milk and you will become very sensitive to your baby’s needs. Breast-feeding immediately the baby is born is a natural way of making the womb contract and reducing the bleeding. Breast-feeding will also postpone your periods for a while, which will help you to recover from any anaemia caused by the birth. Breast-feeding provides 98% protection against conception if the following three conditions are all met: (1) less than 6 months have passed since the birth, (2) you are breast feeding regularly and not giving the baby any supplementary food, (3) your periods have not started again. You should, however, take further precautions the moment one of these conditions is no longer met. You may begin to ovulate before your first period, so think about contraception in good time.
A condom will provide protection against inflammation and is a good form of contraception after the birth. There are no side effects, apart from rare cases of allergy to natural rubber. A copper coil can in special circumstances be fitted immediately after the birth (10 -30 minutes after the placenta has come away), but this is better left until your postnatal check-up, because it is then more likely to stay in place. A coil provides protection against conception for five years and also provides “morning after” protection if fitted within five days of unprotected sex.
Contraceptives containing progesterone only will not reduce your milk or affect your baby. These include mini-pills, subcutaneous hormone capsules, hormone coils and progesterone injections. The advantage of a hormone coil is that its influence is purely local and very little hormone is released into the blood. Ordinary contraceptive pills also contain oestrogen, which reduces the milk production.
If, despite all your precautions, the contraceptive fails or you have sex without any contraception at all, you can still try taking “morning after” pills issued on prescription or in some cases by the nurse at the family planning clinic. These pills contain the same hormones as the pills taken before intercourse, and the hormones in them also pass into your milk. Over the short term they are not known to harm the baby, but it may be a good idea to empty your breasts and throw the milk away for one or two days before breast feeding again. “Morning after” pills are only a one-off emergency measure and are not intended for regular use. They should be taken as soon as possible, and within 72 hours of unprotected sex at the latest. If started in time, this form of contraception works in 98 per cent of cases.
Getting back into shape
Pregnancy and birth make your muscles slack and alter your posture, so start doing exercises straight away. You may have difficulty controlling your bladder or bowels on making a sudden movement, for example. Many are concerned about their looks, about how to get back to their former shape. Strengthening your tummy and pelvis muscles will also help your back. It is best to rest and relax on the day after the birth, but by the second day you can start gradually getting back into shape. If you have had a caesarean section, do not start exercising until the wound has healed. The better you look after yourself, the better you will be able to cope.
Some health centres and maternity hospitals run postnatal exercise groups.
Here are a few exercise sequences. You should do them a couple of times a day, and relax in between. Begin carefully at your own pace. Breathe evenly while you are doing them.
Pelvic muscles
Your pelvic muscles will have been severely strained if you have given birth to several children, the babies have been large, the pushing stage has been long, you have had twins or more, you smoke, you are greatly overweight and/or you do a lot of sport involving jumping. The muscles may, on the other hand, be slack if you suffer from varicose veins or piles.
You can begin exercising your pelvic muscles within 24 hours of the birth. First do a finger test:
1.Wash your hands.
2.Cover your index and middle fingers with a lubricant (such as cooking oil).
3. Press your fingers together and gently push them 3 -5 cm into your vagina.
4. Relax for a moment.
5. Then squeeze your fingers with the vagina. Squeeze and relax.
6. Remove your fingers and wash your hands.
If you felt you raised your vagina while squeezing and your fingers moved up and down as you squeezed and relaxed, you still have some strength left in your muscles. It is nevertheless worth exercising them from time to time, because strong muscles are always an advantage. If you cannot feel the squeeze, or if you have difficulty controlling your bladder, or if your sensations seem weak during sexual intercourse, it is worth making an appointment to see your gynaecologist.
If you have difficulty finding your muscles, tense and relax your tummy, thigh and buttock muscles a few times and then try again. Keep your fingers in your vagina while you try to identify the right muscle groups. Try various positions: sitting, lying on your back or side, on your tummy, or in a squatting position. Do your exercises five times a day: as part of your daily routine. You can flex your tummy, thigh and buttock muscles on your way to work, during coffee breaks, while cleaning, while queuing at the checkout. Once you’ve got the hang of it, no one will notice. But remember to have one day off a week, and to do only one type of exercise at a time, otherwise you will tire.
- Identification exercises. Close your anus gently (count to five) and slowly relax (count to ten). Repeat three times. Close your anus and at the same time close your vagina and hold your urine while counting to five (the contraction will proceed in waves from back to middle to front). Then relax, counting to ten (front – middle-back). Repeat three times.
- Speed exercises. You need quick pelvic muscle reflexes when you cough or sneeze and to hold your urine. Exercise them by making quick, brisk contractions, immediately relaxing and repeating the exercise. Start by doing this 10 times. Gradually increase the number of times.
- Endurance tests. Imagine you’ve got a round object at the entrance to the vagina. Gradually haul it in, as far as it will go, then tense and keep the object inside you while at the same time withholding your urine and faeces (counting to five). Then slowly release the object. Count to ten and then repeat the exercise three times, counting to ten in between. Gradually increase the number of times.
- Strength exercises. Quickly haul the object up your vagina as far as it will go, hold it there while you count five and then release it. Relax while you count to ten. Repeat three times. Gradually increase the number of times. If you don’t seem to be making any progress, consult an expert. Many health centres and private medical centres have equipment and staff trained to treat dysfunction of the pelvic muscles. You can also buy exercising kits with instructions for how