1. Postpartum blues
Common issues:
Postpartum blues is normal, it usually happens within the first week after delivery. It can be very overwhelming to be a new mother, many other mothers are dealing with the same issues.
Causes - physical exhaustion, sleep deprivation, pain from delivery, social stressors
Symptoms - crying, insomnia, taking it out on your husband (try not to), moodiness, anxiety, irritability
Deal with it:
Remind yourself this is transitory. If you can get a family member or a confinement nanny to help you in baby's first month, it would lessen your load by a lot.
ALWAYS try to accept help and support if they are available
Do not try to take on everything yourself
Deep breathing exercises (count to 10 while taking a deep breath in)
Look at your baby constantly
Look for doctor when:
Prolonged or more severe symptoms. If there is fear of harm coming to oneself or to the baby - see a doctor.
Symptoms persisting for more than 2 weeks
Negative feelings towards baby
Suicidal thoughts
Delusions or hallucinations
2. Breastfeeding issues
Common issues:
Different women have different babies and different breasts... but the postpartum changes in the breast are all the same.
Latching difficulties - baby does not want to suck, inverted nipple, painful suck
Breast engorgement - painful and rock hard
Plugged ducts - sharp poking pains in the breast
Sore nipples - from poor latch on or positioning
Deal with it:
Latching difficulties
Positioning is everything so mother should hold breast during attachment initially and draw baby to breast.
Position the nipple pointing towards the soft palate
Newborn should take most of areola into mouth
Try different positions - you might end up preferring a particular one
Get a breastfeeding pillow - very useful
Breast engorgement
Early breastfeeding initiation from birth - usually the hospital will help you with this.
Unrestricted feeding day and night
If latch on is an issue and baby is not removing milk fast enough from the breasts, consider a breast pump to ease the engorgement
Massage around breasts (breast, nipple, areola) one round before using pump
Make sure pump is fitted to the areola
Try hand-expressing technique as another alternative
Plugged ducts
Use 2 fingers to identify localised lumps in breasts and try to break them up by massaging.
Massage affected areas during feed or in shower
Temporarily increase feeding/ pumping frequency
Position infant so his/ her chin is near area of concern
Look out for milk blisters - block the exit of drainage over areola
Sore nipples
If cracked, take baby off breast temporarily to let nipple heal and hand express (not pump), feed expressed milk.
Pre and post-feeds, express milk to soften areola or try nipple moisturisers
Use breast shells over tender nipples to stop clothes from rubbing on it
Ensure correct latch onto breast
Keep nipples dry
Look for doctor when:
Generally, if there is fever, severe breast pain, redness or painful breast lump... your initially breastfeeding problems may be progressing to infection.
Mastitis - one sided red painful breast
Breast abscess - localised painful lump in breast
Bloody nipple discharge
Actually if you need help with latching skills or massaging techniques or unsure with how to use a breast pump - a lactation consultant would be extremely helpful.
3. Sleeping problems
Common issues:
Newborns feed frequently up to 1-2 hourly... which often results in poor sleep for mummies and daddies. Even when they are not directly feeding, they have to be burped, cleaned, diapers changed, bathed... and don't forget about regular chores!
Deal with it:
Again, this is transitory! Your baby will eventually learn how to sleep through the night.
Get someone else to help with night time feedings
Take daytime naps when baby is sleeping - do not use the time to do chores
If baby falls asleep very quickly when latching, can consider breast pumping and bottle feeding baby greater milk quantity so he/she sleeps longer.
Be careful if using lying down position when latching baby at night - if you fall asleep you can crush your baby!
Look for doctor when:
Insomnia issues start to wear you down... and possibly culminating in post-partum depression (see above).
4. Pelvic issues
Common issues:
If you have just undergone normal vaginal delivery or had an episiotomy, you are likely to experience all kinds of pelvic discomfort.
Perineal pain - pain in area between vagina and anus
Urinary incontinence - leakage of urine when coughing/ sneezing/ heavy lifting
Constipation and piles - especially if you tend to minimise passing motion because of perineal pain
Deal with it:
Perineal pain
This will improve with time but will require regular good perineal hygiene. Episiotomy scars can take up to 2-3 weeks to heal.
Sitz bath = shallow plastic basin filled with warm water for you to sit down in, can position it over toilet bowl
Change sanitary pad regularly - will be soaked especially post-delivery
Clean perineum from front to back
Squirt bottle to squirt warm water over perineum
Anaesthetic sprays and anti-inflammatory painkillers
Urinary incontinence
This likely has started for you even during pregnancy already... unfortunately it extends into the post-partum period.
Bladder training - frequent voluntary voiding to keep bladder volume low, can start at every 2 hours and then increase time between scheduled voids by 30min-1h
Kegel exercises - contracting pelvic floor muscles, try 10 contractions for 6-8s each for 3 sets, done about 3 times a week, do total for 3 months
Constipation and piles
This could also have started in your pregnancy, but if during delivery you had a tear involving your anal sphincter, it is likely to make it worse.
Diet changes for good roughage
Drink plenty of water
Stool softeners for few weeks
Do not try suppositories or enemas
Look for doctor when:
There is increased pain or swelling, fever, foul smelling vaginal discharge. If you notice a pelvic lump dropping out of the vagina it could mean pelvic organ prolapse.
5. Hand numbness
Common issues:
This is likely from carpal tunnel syndrome which is compression of the median nerve as it passes through carpal tunnel in wrist.
Causes - post-delivery swelling, repetitive wrist injury from caring for baby
Symptoms - numbness or poking sensation over thumb, index and middle fingers
Deal with it
Try some conservative methods first and see if it improves.
Wrist splint
Anti-inflammatory pain medications
Get help in looking after baby to rest your wrist
Look for doctor when:
The symptoms are not improving or worsening despite conservative methods above, you start having poor grip or dropping things. You might need a steroid injection or a minor surgical procedure. Mine was so bad and I had it in both hands so I needed a steroid injection in the end.
* I am a Family Physician working in a humble practice in Singapore... now in addition to that, I have become a mother. This has considerably changed the way I practice medicine, in particular the paediatric and OG areas. Read back here for occasional anecdotes.
Ok so I MUST qualify this article is for informational purposes only and is not tailor-made for any single individual. Most of it is a combination of personal experience and some relevant medical knowledge. Always seek the advice of your own doctor if you have any further questions on your health.
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