What to Expect After Baby: The Postpartum Experience

Bringing a baby into the world is a moment of wonder and joy, but what comes next can feel overwhelming and unpredictable. In a recent episode of Your Wellness Solution, Jodie Piccirillo, a board-certified APRN at Foundation OB/GYN in Nashua, New Hampshire, sheds light on the physical and emotional journey new moms face after childbirth.

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Complete Transcript of What to Expect After Baby: The Postpartum Experience with Jodie Piccirillo, APRN:

Scott Webb (Host): There are a variety of postpartum physical and mental health issues that women might experience, and most of them are completely normal. I'm joined today by Jodie Piccirillo. She's a board-certified advanced practice registered nurse, and she's here to tell us what new moms can expect after delivery, and when they should be concerned, and speak with their providers.

This is Your Wellness Solution, the podcast by Elliot Health System and Southern New Hampshire Health, members of Solution Health. I'm Scott Webb. Jodie, it's so nice to have your time today. We're going to talk about what moms and families can expect right after delivery, when they get home, and what they can do about it. So, let's start there. What can a patient expect immediately after delivery?

Jodie Piccirillo: There are a number of things that you can expect. First of all, there's overall elation and wonderment when you look at your baby. But some of the physical things are shivering, and I think it's very surprising. That can last over an hour, with a lot of shaking, shivering.

You're going to have cramping immediately after delivery. The uterus is trying to return back to a non-pregnant state. So, you're going to have these contractions as the muscle tries to constrict to prevent bleeding. And this is called involution of the uterus. Some people call them afterpains. They're the same thing. You're going to have the nurses come in and massage the uterus to ensure that it's firm and that the contracting is occurring as it should. This can be a little bit uncomfortable. Immediately after the birth, you're going to see that the uterus is a little bit high. And then, you're going to see it change to about the belly button. It will go right to what they may call the umbilicus. And then, it will start to shrink every single day, a little below the belly button.

You're going to have bleeding immediately after the birth. Initially, it's very heavy, but your nurse will assess the uterine size, firmness, and the rate that it's going down. Your activity level may affect the rate and flow of your bleeding. So if you get up to go to the bathroom, you might notice that you're bleeding a little bit more. The first few days, it's bright red, and then it goes to brown, then a watery pink, then a yellowish white. This is all normal. Sometimes the yellowish white can scare a postpartum mom, thinking that it's a sign of infection, but that is normal lochia or normal bleeding after birth.

The vagina and the perineum, you might have a little tear or what we call an episiotomy, which is a surgical cut toward the rectum. It can be swollen and painful. In the first 24 hours, we'll put ice, and you can use some non-steroidal anti-inflammatories to reduce the pain and swelling. After that, we want to incorporate heat. Heat is going to help promote healing, and I can't say enough about using a sitz bath. That's something that you can sit in warm water, and it really brings blood flow to the site, and it helps with relaxation. It helps you to resume normal bowel function. You're also probably going to incorporate some stool softeners. You're going to use a peri bottle every time you go to the bathroom, a little bottle to cleanse the area, because it is somewhat sensitive.

You may notice the first 24 to 72 hours, oftentimes when you're still in the hospital, the breasts fill with milk and they can become hard and painful. If you're breastfeeding, you want to breastfeed frequently. Warm soaks help you with the discomfort that's associated with engorgement. If you're not breastfeeding, you want to avoid stimulating the breasts. Don't pump. You want to use ice and non-steroidals, and a good support bra.

Host: So, Jodie, then let's talk about when moms are back home, right? So, you're talking about the first 24 to 72, but when they get back home, when will they feel, let's call it back to normal?

Jodie Piccirillo: Well, I'm going to tell you, you're going to be extremely fatigued, because most of us aren't used to getting up every two hours for a feeding. So, aside from the fatigue, and make sure you ask for help whenever you can, there are going to be some things you physical changes that you might note that people don't tell you about.

The first one to five months after having a baby, a lot of times, you'll have hair loss. You'll go in the shower and see a lot of hair in the drain, and that can be somewhat unnerving. It returns back to normal around six to 15 months. As far as the weight loss, you probably will lose around 13 or so pounds in the beginning. Half of your weight gain is lost in the first six weeks. So, please, don't be hard on yourselves as far as weight loss. And moms that aren't breastfeeding, you will probably go back to ovulating by 12 weeks or getting your period back. And moms that are breastfeeding, it's usually modulated by your own maternal nutrition, your intensity of your breastfeeding. But about 40% of women who breastfeed will start to get their menses back by six months or so postpartum.

Sometimes you can have some incontinence initially, where you feel related to pushing, and sometimes there's a little neuromuscular injury. There can be some incontinence, which I say be a little bit patient, but you will get back to yourself by the first year. As far as sexual intercourse, we usually don't talk about that until the six-week visit with your provider. When you are breastfeeding, there are lower levels of estrogen and higher levels of prolactin. So, there will be more vaginal dryness noted in the breastfeeding moms.

As far as resumption of normal sexual activity, it can take some time. You've got to realize that your body's been through a lot. And along with these physical changes, you've got the fatigue and you've got the fact that your body is producing milk along with all of those.

Host: So, let's talk about baby blues, right? I've heard that term before, baby blues. And I don't know if that's like something just short of postpartum depression, but in general, you know, we've been talking here about sort of the physical postpartum, let's talk about the mental side of this, the baby blues. Maybe you can tell us more about that.

Jodie Piccirillo: A lot of people will talk about the baby blues, and they are a very, very normal event that occurs following the birth of a baby, usually around the second or third week. And you've got to realize you've got a real change in the hormones. Prior to this, your body was supporting another human being. And now, once you are no longer pregnant, along with producing milk if you're a breastfeeding mom, and the changes associated with now being a postpartum mom, you can feel teary. You can feel that you could cry at any moment. And you're very, very, very fatigued. Your emotions are on a high, high level initially. And the baby blues are normal. They're self-limiting. They go away.

If you notice following birth, there's an increase in depression, you really feel depressed, you feel a lack of connection to your infant, if you feel hopeless, these are things that are real red flags where we say, "Please call your provider." We are all trained in evaluation. We would talk to a patient over the phone. We use a scale to determine how you're doing. If it happens in the evenings or at night, you can always call over to Labor and Delivery, and you'll be able to speak to someone. But if it goes beyond the regular emotional rollercoaster that occurs a week or so following birth, if it turns into depression, hopelessness, you feel that you are not bonding, we really want you to give us a call.

Host: Yeah, that sounds right, Jodie, that when baby blues become something more, definitely reach out. And when should a patient be concerned, and when should they seek medical help?

Jodie Piccirillo: So aside from what we just talked about with the baby blues, we would want you to call us if you have an increased fever, vomiting, new-onset pain, feeling faint, severe headaches or vision changes, shortness of breath, or chest pain. These can be signs and symptoms of something serious, and we would want you to call us so we can evaluate these complications post-delivery of your baby.

Host: Yeah, definitely. Things that just, as you sort of identified here today, things that are normal. If things just feel beyond that, feel abnormal, obviously, there's help available, and we would want moms and families to reach out. I'd just give you a chance here at the end, what resources can we share with listeners if they're suffering from postpartum or just have questions?

Jodie Piccirillo: You can always call your OB-GYN office. And as I stated, post hours, you will always reach a person at the end of the phone. They do offer some courses here at Southern New Hampshire, if you look at the Birth Center website, and they'll be able to assist you with some of the topics that you feel that you want to go into more in-depth.

Host: Well, I really appreciate your time today and your expertise. It's a great topic. As I told you before we got rolling here, I'm a dad. I have a couple of kids. Always great to share this information. So, thanks so much.

Jodie Piccirillo: Thank you so much for having me.

Host: And for more information, go to snhhealth.org and search Foundation OB/GYN. That's Foundation OB/GYN. And if you enjoyed this podcast, please be sure to tell a friend and share on social media. This is Your Wellness Solution, the podcast by Elliot Health System and Southern New Hampshire Health, members of Solution Health. I'm Scott Webb. Stay well, and we'll talk again next time.