Postpartum: the unexpected tsunami (First wave, physical damage)

[dropcap letter=”T”]

he 40 weeks of gestation and physical transformation of pregnancy result in childbirth, which is like braking, skidding and body spinning. In the next 40 days, it is necessary to order up the at full speed, re-adjusting to normal the cardiovascular, respiratory, urinary, immune, hormonal and reproductive systems, and of course also skin and tissues. There are wounds and lochia, pain in the perineal points or in the surgical intervention of caesarean section, urine loss, constipation, haemorrhoids, difficulty walking and even sitting, weakness and exhaustion. In parallel, the production of milk starts, which goes through a chaotic phase until it is regulated only with the demand of the baby. Cracks appear, pain in the nipples and, often, mastitis or abscesses. In addition, there is a new (and unknown) person in the family that does not differentiate day from night, that eats every 3 hours and needs attention 24/7, making rest impossible. Physical pain is the first wave of the tsunami that impacts on the life of the woman after childbirth. But it does not come alone. Behind it, the emotional wave hits, as powerful or more than the first.

“I knew that the first month is very intense and that you are exhausted but, as much as you expect it, the maelstrom surpasses you: it is too much happening at the same time,” says Virginia (Amsterdam, mother at 37). The same explains Nuria (Lleida, mother at 37), who felt “overwhelmed” with the arrival of their first child. “Everything caught me by surprise. Even not sleeping. I knew I could not sleep for a while, but I was not aware of what that would make me feel”, she recalls. Physical exhaustion is a common element in narratives, along with pain and fear. But also is a new overcoming capacity. “What surprised me the most was the strength and power that I had. I was completely exhausted, but I kept going on”, explains Saskia (Eindhoven, mother at 31). As Mireia points out (Lleida, mother at 33), what surprises is “the ability to forget the pain and preoccupations of childbirth when postpartum arrives”.

PAIN IN THE POSTPARTUM, AN UNEXPECTED CHALLENGE

“Nobody prepares you for pain, especially after the first postpartum”, explains Mercedes (Madrid, mother at 30, 32 and 35). “Nobody told me in depth about the points, the pain they would cause, how to overcome the first days with that stinging”. Going through caesarean surgery does not improve the situation. For Alex (New York, mother at 37), the worst of the first two weeks was precisely “physical pain” after a complicated postoperative period. “That moment when my body realized that I had undergone surgery, that I tried to start breastfeeding, that I had the catheter removed and I had trouble urinating, in addition to the pain related to breastfeeding when things do not go as they should… wow. ”

Wow is a good onomatopoeia to describe the start of breastfeeding, which is not always as easy as one would like. Mireia recalls the experience: “with the rise of milk, my breasts became hard, red and very very hot. I did not know what was happening, I thought everything was going as it should, but a friend midwife revealed that this was not normal. My breasts produced more milk than what my son was breastfeeding, congesting the milk ducts and causing a quite intense pain”. Saskia, who had the same thing, would have liked to “know how breastfeeding and lactation work during the first days” to try to avoid those complications.

Despite the effort and sacrifice involved, breastfeeding is a deeply emotional and unique experience for many women. In the case of Mireia, “time passed, milk production was regulated, and everything improved. At last I was able to enjoy breastfeeding, to look with the eyes of a mother in love while my little one was fed, feeling a huge sense of love and a great instinct of protection”. And she adds: “when I am pregnant of the second child, I’ll count again on breastfeeding”. For Mercedes, “the woman’s body is magical. Being able to feed a baby that you have carried within 9 months is something that only women can experience. It’s like a unique power”. That innate yet unknown capacity of her own body was what most surprised Alex: “my breasts becoming a source of food for my son, synchronizing with him, with the milk that I created matching his demand… I find it surreal even though it has happened to all the women who have been mothers before me”.

THE FEAR OF CHILDBIRTH ECLIPSES THE POSTPARTUM

“In the preparation courses for childbirth, I remember how a mother burst into tears saying that nobody explains to you the hardest part of the puerperium: stitches, haemorrhoids, fatigue”, remembers Mercedes. In this sense, Alex points out: “I think that many women are not prepared for what happens after childbirth and that makes it a very difficult time and a transition for them”. In an unavoidably convulsive moment, why do many women find it unforeseen? Rosa Alzuria -nurse at ICS (Institut Català de la Salut) and Assistant Professor of Nursing at the UdL (Universitat de Lleida)- ensures that pregnant women are given all possible information “because information is power and know what and how you can help activate resources previously”. But, after more than a decade accompanying pregnant and puerperal women, she has reached a conclusion: “pregnant women are absorbed by childbirth. I think the fear of pain, and worrying about everything that needs to go well, eclipses postpartum. The information is available to them, but I believe that is not their priority”.

They confirm it. “I think I did get enough information”, says Virginia. “What happens is that I did not register it in my head. My main obsession was delivery, I focused more on it. I think that this happens to many women. It’s as if the fear of childbirth nullifies our ability to process postpartum information”. Teresa (Madrid, mother at 36) verbalizes the same thing: “In the course of preparation for childbirth they explain it to you, but my concern was delivery and everything else would come”. She adds: “People told me it was hard, but maybe I needed to be told more clearly or in some way that would call my attention”.

Would anything have changed to know more about it? Anna (Balaguer, mother at 29, 31 and 36) thinks so: “Having more information makes the process more bearable, because knowing what you are facing and visualizing it always helps to do it; perhaps not in a better way, but with the assurance that you are doing well, without hesitation”*.

* Insecurity and other postpartum emotions, protagonists of Postpartum: the unexpected tsunami (Second wave, the emotional damage)

FROM MOTHER TO MOTHER (I)

Although right now what may worry you the most is delivery, that’s the simple part. Read, inform yourself, ask people… It is a hard stage and little sleep, ask for help and lean on the people around you. Teresa

Give yourself time, do not exhaust your body too much during the first weeks. It needs time. Saskia

Take the time and support you need to enjoy your baby and your family. Allow yourself the recovery you need and deserve in order to be the best possible mother from the start. Alex

It will be a hard, visceral experience and you will realize what the word “tiredness” really means. Let yourself help. All this will pass, believe me, and then you will meet the true love of your life. Nuria