10 Things That Happened to Me After Childbirth

Warning: this post contains lots of details around bleeding, toilet visits and sex after childbirth. 

The postpartum period (the time after childbirth) is a time that is often described as a baby-bubble – where all the focus is on cosying up with your new little human as the rest of the world kind of disappears. Throughout my first pregnancy, I didn’t think too much about the time after birth – with only one session with my midwife and one parental class to prepare for breastfeeding. I was not fully prepared for what was going to come – and perhaps I could never be prepared enough – but there were a few things that happened to me, my body and my baby that I wish I had known before giving birth. I am not writing this post to ‘scare’ you, but to help prepare you, at least a bit, for what can happen in those first few days and months after birth.

1. You can’t plan your childbirth

I had written up a birth plan and really thought through what I did and didn’t want during childbirth. I had read about different methods of pain relief and had opted for a natural birth. I was looking forward to handling the pain with a warm bath, using gravity to speed up labor and get into a zen zone during birth. However, despite my greatest efforts to avoid medication and medical intervention, I ended up with morphine in a hospital bed and a room full of midwives and doctors when my daughter was born with the help of a vacuum. You can read my full story here.

Although you may not be able to plan your childbirth, you can prepare by reading up on your options and thinking through different scenarios. It’s important to keep an open mind and to have an environment where you feel safe. If things don’t go as you had hoped or expected, demand to talk to your midwife or doctor about it.

2. Postpartum breastfeeding pain – not in your breasts!

After birth your uterus needs to start contracting again to pull together and stop bleeding. Breastfeeding is a natural way to help speed up a woman’s recovery after childbirth – which is fantastic! However, the pain of postpartum uterine contractions during those first latches at the hospital and during the first few days, was not expected. I needed pain relief during my first breastfeeding sessions in the first week after childbirth.

3. Your first toilet visits can be a nightmare

After popping out a baby from your vagina, having to pee or poop can be very scary. The only thing you don’t want to do is to put any more pressure on your open wound and it may feel like you are on the verge of turning inside out! Holding a pad to relieve the pressure can help you as you relieve yourself. This does pass, quicker than you may think when you’re sitting on the toilet seat in fear after delivery.

4. You bleed, and you may bleed a LOT

I bled a lot – although not more than what’s ‘normal’. At the hospital I was given unrestricted access to huge pads that barely fit in a pair of regular panties, and despite the size of these diaper-like beauties, I still left stains in the hospital bed 30 hours after birth. The bleeding escalates during those postpartum uterine contractions, so when you get up after breastfeeding those first times, be ready for the flood. However, this too does decline and eventually turns into a brownish mucus in the weeks after birth, to end at around 5-6 weeks postpartum.

One week after giving birth I was beginning to feel better. My blood pressure had been incredibly low and my energy levels limited my movement to staying inside for the most part (although I did walk home from the hospital… what on earth was I thinking?!). However, on that Thursday I called the hospital in a state of worry after a bathroom visit when my vagina had just handed me a ball of thick blood – the size of a golf ball. “Oh, that’s just coagulated blood. That’s completely normal,” the midwife on the other end of the phone told me. So, how come I was not aware of any of this normalcy?

5. You may wake up in a huge puddle of breastmilk

I was ready for my breasts to swell up and to become hard as stone in that third or fourth day after birth when the milk starts it’s high-level production. The body is amazing. I was not ready to wake up in the morning with aching and leaking breasts and notice that I was soaked in breastmilk. Neither was I ready for the power of my breasts to squirt a TV-screen from 1,5 meters away when my newborn stopped latching. There were several other lessons that I learned about breastfeeding, but this was definitely one of the most surprising.

Want to know more about the difficulties of breastfeeding? This is a great article on The Guardian.

6. You still can’t wear your pre-pregnancy clothes

Although this may be a small problem, it was a major concern for me. I was looking forward to getting into my pre-pregnancy wardrobe and pampering myself with a bigger range of clothes to wear, to feel fresh and comfortable in my new life as a mother. I hadn’t thought so much about how everything I was going to wear had to be breastfeeding friendly. You need clothes that can zip up, button down, or be lifted up to reveal your nipples for your little one to nurse. Also, you may still not fit into those favorite jeans, and may need to continue wearing maternity tights to comfortably sit and breastfeed your baby. When you’re in a hormonal haze and sleep deprived there are little things that make a big difference, so prepare yourself with some items that make YOU feel like YOU.

7. Getting “back” to your pre-pregnancy body may never happen

While we are on that subject, your baby-belly doesn’t just disappear and your body changes in ways you wouldn’t expect. I was incredibly comfortable in my body when I was pregnant – I felt gorgeous. I had not expected that it would be so difficult to embrace my post-pregnancy self – which isn’t so strange given that women’s bodies are constantly objectified everywhere we look. With time I am accepting my stretch-marks and my saggy skin and now that I’m in my second pregnancy, I’m just utterly in awe of my body and what it can do! I believe that that feeling will continue into this second postpartum period, as I am more prepared of what awaits me. Expect your body to change and be grateful for it.

8. Sex can hurt

After pregnancy and childbirth sex might be the last thing on you mind, but eventually intimacy with your loved one is something that you miss – as there is a baby sucking out most of the energy from you. And once you feel ready to have sex again it will most probably not feel the same, especially if you have scarred tissue. Thankfully there are many ways to be intimate. Take your time and talk about it with your partner. If you have prolonged problems speak to your midwife about it! This too should pass.

9. You may lose your hair – lots of it

After about 4 months postpartum I started losing hair. My fluffy pregnancy hair suddenly disappeared and I was afraid I was balding for good. Not only did my hair fall out in clumps, the texture of my hair definitely changed. And come to think of it – my skin also changed. I’ve never ever had as dry skin as I had that winter after birth, trying to remedy my body with coconut oil with no result.

10. Not all babies get into a routine

My baby was a great sleeper in the first 3 months, then became a mega-eater and non-sleeper at 4 months. Just when I felt that we were getting the hang of things, my baby changed and so did her mood. I found out about The Wonder Weeks (which deserves it’s own blog post!), which helped me understand her development and be humble to the changes in her little life.

There are several other realities about the time after childbirth which I was fortunately spared from. For the most part you just don’t know what may happen and it is good to be aware of what can take place to prepare as much as possible and be aware of any serious symptoms. The good thing is that these things too shall pass and here I am in my third trimester with my second baby trying to prepare again for childbirth and the upcoming baby bubble.

Read more posts on Girls’ Globe about the postpartum period: 

Witnessing the Start of Life: Why I want to be a midwife

I start my shift at 2 pm on a Sunday afternoon. Outside the sun is shining, spring has finally arrived. My patient of the day is a 19-year-old woman who is expecting her first child. She has had contractions for the past two days and today it’s finally time to give birth. For the next seven hours, I will be with her on her journey to give birth, a journey that consists of both joy and despair. Moments where the pain is so tough that she wants to give up, but also moments where she feels the strength and thinks “I can do this!”

At the end of the shift the baby finally arrives, a long-awaited little life. The joy in the room can not be mistaken – and the magical moment comes, when the woman sees her baby for the first time. Relatives streams into the room, everyone wants to congratulate and meet the new family member. The delivery room turns into a celebration!

And in the middle of all this, I stand, a midwifery student trying to get all the pieces together, trying to learn this craft. The role of a midwife in the delivery room is so central, at the same time I’m just a person in the periphery. I don’t want to take up too much space, I would rather try to understand the woman’s needs, support when needed, and always be prepared if the worst was to happen.

I learn from the best. Experienced midwives sharing their knowledge in a generous and supportive way. They lead me to believe in myself, that I will actually cope with this difficult task. For it is not simple, it is a risky journey that pregnant women worldwide undergo.

And the goal for all midwives is clear -a healthy mother and a healthy baby. That is the heart of midwifery.

The day after I meet the woman and her baby in the maternity ward. We talk about the delivery, what was good and what was difficult. I want her to feel that she did an amazing job, that giving birth to a child is not easy, but she got through it. The birth is not a trip down a straight road, it goes over hills and valleys, contains feelings of both hope and despair. We women have to talk more about what we have done well, see our own strength and to see the strength in one another.

On my way out of the room, I turn around. The woman is sitting with her newborn baby in her arms, the happiness in her eyes is palpable. This is what makes all of the worth it – all the hard work, all the blood, sweat and tears that I have shared during my midwifery training. To be there, witnessing when it all begins, and doing it on the front row is a privilege that can not be described with words. And suddenly I just know, this is what I want to do for the rest of my life.

The woman and baby are not pictured in the cover photo. Cover photo credit: Matt Johnson (Flickr/CC)

NJF

Girls’ Globe will be providing live coverage from the NJF Congress in Gothenburg, Sweden. Follow the conversations here on girlsglobe.org and through the hashtag #midwives4all on Twitter and Instagram. Learn more through the following links:

Women Inspire: Nozema Pul

This post is the second in a series of interviews from women and girls at the Georgetown Public Hospital Corporation (GPHC) in Georgetown, Guyana.

I’m here in Georgetown, Guyana to conduct interviews with inspiring women and girls and to listen to their stories. I recently met Nozema Pul, 41, in the GPHC maternity ward. Nozema was days, or possibly hours, away from giving birth. But being the shero that she is, she agreed to share with me her thoughts on motherhood, her dreams for her children, and advice for young girls.

What does being a mother mean to you?

A: Happiness. It means happiness.

How has your mother influenced your life?

A: My mother was a loving, caring and thoughtful mom. She taught me all about the good things in life. She raised me the right way, as a mother should. She gave me everything that she could afford in order to make me happy.

What do you wish for your children?

A: I wish for lots of happiness. I wish that they follow Christ and to have faith. I want them to be a good person and treat others as they want to be treated, not to be rude. I hope they are thoughtful and dedicated. But most of all, I want them to make the most out of life.

How did you first learn about reproductive and sexual health?

A: I was about 10 years old and I read about it in school.

Did you have easy access to family planning? What were the challenges?

A: No, access to family planning was not easy. I learned it from friends, family members, teachers, and others. I learned about contraception, condoms, and protecting oneself from sexually transmitted diseases, and not to have many children – especially one right after another. I learned that I needed to wait 6 to 7 weeks before planning the next pregnancy. It was challenging because I had to  learn much about family planning by myself. I had to learn how to find doctors by myself and what family planning and pregnancy entailed. I was scared.

What are the challenges you have faced as mother?

“I love making my children happy. I want to give them everything they deserve as my mother did for me.”

A: I had my first child at 17. It was very hard. I didn’t know how to raise a child, but I was living with my mother and she taught me how to be a good mom. I learned from her and how she brought me up.

How can we make sure all babies and mothers survive and thrive?

A: Mothers and pregnant women should go out and talk to the right people to get the correct advice for their children so they know how to love and care for their child when the time comes.

What is your favorite part of being a mother?

A: I love making my children happy. I want to give them everything they deserve as my mother did for me. I want to teach them kindness, how to treat people, and not to be rude.

What advice can you give to young girls about pregnancy?

A: Do not get pregnant early. Get educated, stay in school, and get a good job. Get your own home and everything you want. Get a degree so you can stand up for yourself. Don’t be a single parent because it is very hard.

No photos were permitted inside the maternity ward.

India’s Newborn Action Plan

Globally, 2.9 million newborns die within the first month of life. India, with a population totalling 17.5 percent of the global population, accounts for a startling 27 percent of the global newborn mortality rate with over 780,000 newborn deaths every year, the highest newborn mortality rate in the world. On September 17th, India launched its national Newborn Action Plan (INAP) to stop and reverse this disturbing trend.

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Image c/o Gates Foundation

Based on the findings and strategies promoted in The Lancet’s Every Newborn series, INAP aims to reduce India’s newborn mortality rate from its current 29 deaths per 1,000 births to under 10 deaths per 1,000 births by 2030. In order to accomplish this goal, INAP focuses on improving the following six evidence-based, effective strategies:

  1. Preconception and antenatal care
  2. Care during labor and childbirth
  3. Immediate newborn care
  4. Care of healthy newborns
  5. Care of small and sick newborns
  6. Care beyond newborn survival

Additionally, the issue of gendercide does not go ignored. Because a girl’s family traditionally must pay a dowry in order to marry, families – especially in poorer regions – favor having boys over girls. As a result, each month approximately 50,000 female fetuses are aborted or killed at birth, thrown into rivers, or simply left to die. An estimated one million girls in India “disappear” every year. With INAP, the Health Ministry takes this long-standing tradition of gender-bias into account and aims to eliminate gender-based differences in newborn health care.

“These are preventable deaths and now we have an action plan for preventing them.” – Harsh Vardhan, India Health Minister

Although India as a whole is on track to achieve Millennium Development Goals (MDGs) 4 and 5 (reducing child mortality and maternal mortality by two-thirds and three-quarters respectively), MDG success is not consistent across the country. For example, the state of Kerala already has a neonatal mortality rate of seven deaths per 1,000 births, yet the poorer states of Bihar, UP, Madhya Pradesh and Rajasthan are far behind, with a combined neonatal mortality rate amounting to 56 percent of such deaths nationwide.

“Healthy mothers and healthy children are crucial for India to realize the demographic dividend.” – Melinda Gates

It is important to emphasize that India’s efforts to reduce the newborn mortality rate are not limited to merely survival. With the launch of INAP, the Health Ministry will focus increased attention on improving the health and lives of both healthy and sick newborns. In a country where shunning those with disabilities, neuro-developmental delays, and birth defects is not uncommon, recognizing the value of all newborns, both sick and healthy, is a major step in the right direction.

With support from the Bill & Melinda Gates Foundation, the World Health Organization and UNICEF, India’s Health Ministry is confident in its ability to reduce newborn deaths nationwide – and if India’s INAP efforts echo the success of its anti-polio campaign, the future for India’s newborns looks promising.

 

Faces of Courage: Images of mothers and their children by Mark Tuschman

Mother weighing her baby at a clinic outside of Meru, Kenya
Mother weighing her baby at a clinic outside of Meru, Kenya

Mark Tuschman is an award winning photographer who has traveled extensively intentionally for many foundations, NGOs and corporate social responsibility programs. He has a passionate interest in promoting the basic human rights of women and girls and plans to publish a book: Faces of Courage: Intimate Portraits of Women on the Edge documenting the lack of autonomy of women and girls in the developing world and all the efforts being made to empower them. For more info, please see his Facebook  and Kickstarter pages.

This past April I had the good fortune to go to Kenya to document some of the programs for Management Sciences for Health as part of winning the Grand Jury Prize for the photo contest they co-sponsored with socialdocumentary.net.

Much of their work involves making sure that clinics have the medications and vaccinations they need to keep their patients healthy. I was quite impressed by the robustness and size of so many of the infants at the clinics yet there was a downside to it too. Quite a few of the mothers that I photographed near Meru and Embu clinics were no more than 15 or 16 years old. They were unwed, had very little schooling and now at their very young age, they had the responsibility of raising a child, with little hope for any further education or economic opportunities. I was certainly heartened to see how well the babies were taken care of with proper nutrition and vaccinations, but there seems to be a big need for keeping young girls in school and providing them with safe methods of contraception.

Through photography, I want to pay tribute to the women I have met and to the millions of other women who share their lack of autonomy over their own lives and bodies. I hope the photos I take will bring these women and their stories to the forefront of world consciousness. Below are the photos I took while visiting the maternal and infant health clinics in Kisumu and Meru, Kenya. As you will see from the photos- the clinics are providing excellent and necessary care for mothers and their infants, but the age of many of the new mothers shows the urgent need for enhanced access to education and contraceptives in Kenya.

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Acting on the Call: Ending Preventable Maternal and Child Deaths

USAID Administrator Raj Shah and Girls' Globe blogger Elisabeth Epstein. Photo c/o the amazing Nicole Schiegg, Consultant for the United Nation's Every Woman Every Child campaign
USAID Administrator Raj Shah and Girls’ Globe blogger Elisabeth Epstein. Photo c/o the amazing Nicole Schiegg, Consultant for the United Nation’s Every Woman Every Child campaign.

On Wednesday, I had the exciting opportunity to attend the Acting on the Call event at which governments, organizations and advocates alike joined forces to emphasize the urgency of including a global focus, strategy and goals for ending preventable maternal and child deaths in the post-2015 agenda.

At the event, the United States Agency of International Development (USAID) launched its Acting on the Call Action Plan and its 2014-2020 Maternal Health Vision for Action.

The Action Plan outlines five strategic focus areas and actions:

  1. Increase efforts in countries that account for the largest share of under-five deaths;
  2. Reach the most underserved populations;
  3. Target priority causes of mortality with innovation efforts and interventions poised to go at scale;
  4. Invest beyond health programs to include empowering women and supporting an enabling environment; and
  5. Create transparency and mutual accountability at all levels, with strengthened commitment to common metrics for tracking purposes.

The Vision highlights the importance of enabling and mobilizing individuals and communities; advancing quality and respectful care; and strengthening health systems and continuous learning. Included in the policy is the goal to end preventable maternal mortality (EPMM) with a target maternal mortality ratio (MMR) of less than 50 maternal deaths per 100,000 live births by 2035. To put that in perspective, the 2010 global MMR was over 200 deaths per 100,000 live births.

In order to achieve the targets stated in the Vision, USAID is committed to supporting ten strategic drivers:

  1. Improve individual, household, and community behaviors and norms;
  2. Improve equity of access to and use of services by the most vulnerable;
  3. Strengthen integration of maternal health services with family planning;
  4. Scale up quality maternal and fetal health care;
  5. Prevent, diagnose, and treat the indirect causes of maternal mortality and poor birth outcomes;
  6. Increase focus on averting and addressing maternal morbidity and disability;
  7. Advance choice and respectful maternity care and improve working conditions for providers;
  8. Strengthen and support health systems;
  9. Promote data for decision-making and accountability; and
  10. Promote innovation and research for policy and programs.

Even though the world has made considerable progress in the past two and a half decades, we must remember that 289,000 women worldwide still die each year as a result of pregnancy and childbirth – the majority of whom live in developing nations.

When a mother dies as a result of pregnancy or childbirth, it threatens her newborn’s chance of survival, lowers her other children’s chances for survival and education, and hurts her family and her country’s prosperity.” – Raj Shah, USAID Administrator

However, the conversation must not stop with maternal deaths. An estimated 190 million women become pregnant each year. Of those 190 million pregnancies, only 122 million result in a live birth and of those 122 million live births, 10 percent suffer from complications and disabilities. Stillbirths, miscarriages and abortions have thus far gone relatively uncounted and unnoticed in global and regional development programs.

The good news is that the issue of newborn health is gaining momentum. In addition to the wonderful and engaging event with hundreds of changemakers in Washington, DC, TIME Magazine brought attention to newborn health by predominantly featuring a photograph of a premature infant on its June cover along with the headline and related article, ‘Saving Preemies.’ The Lancet, an esteemed medical journal, also recently published its Every Newborn Series, a series of reports that now serve as the foundation for the Every Newborn Action Plan (ENAP) – a plan that calls for a renewed global commitment to dramatically improve the health and survival of newborn babies and women and end preventable stillbirths within our generation.

Key findings from the series include:

  • Increasing the amount, availability and accessibility of skilled birth attendants can save 3 million lives by 2025.
  • Newborn deaths account for 44 percent of under-5 deaths.
  • Almost 50 percent of stillbirths occur during labor.
  • 1 million babies die on the day they are born, mostly from preventable causes.
  • More than 75 percent of newborn deaths are in South Asia and sub-Saharan Africa.
  • It would take only USD $1.15 per person to save 3 million women, newborns and stillbirths by 2025.
  • Every year, 2.9 million newborn babies die and 2.6 million are stillborn.

Rather than reading organizations’ commitments to end preventable maternal and newborn deaths, I wanted to hear them from the source. I interviewed several high-ranking officials from development entities and asked them how their organization plans to commit to deliver for women’s and children’s health.

Raj Shah, USAID Administrator

Lisa Schectman, Director of Policy and Advocacy at WaterAid America

Purnima Mane, President and CEO of Pathfinder International

An Instagram interview is a wonderful tool to share organizational commitments in a lightning fast manner. However, I wanted to know more. In order to garner a deeper understanding, I recorded podcast interviews with several more attendees:

Stephanie Lynn Bowen, Senior Communications Manager for Mobile Alliance for Maternal Action (MAMA)

Q: What are some of the broader economic, health and social benefits that arise when you invest in women’s and children’s health?

Lisa Schechtman, Director of Policy and Advocacy at WaterAid America

Q: The global community has made significant progress in saving the lives of women and children. What do you think stands out as a key accomplishment?

Kate Dodson, Vice President for Global Health at the United Nations Foundation

Q: Remaining gaps can be solved through partnership. Where is political will and commitment for women’s and children’s health needed most?

Going forward, the world must remember and, more importantly, act upon these and other commitments to end preventable maternal and child deaths. We can and must do more for women and newborns. If global leaders, organizations and advocates continue this shared fight for justice, I am sure that one day in the not too distant future I will be able to proudly say that the issue of ending preventable maternal and child deaths is a thing of the past – and that I was lucky enough to help.

2014-06-25Read more about ending preventable maternal and child deaths:

Special thanks goes out to Matt Matassa and Anne McNulty of FHI360 for letting me borrow their camera and recording equipment!

Girls’ Globe will be at the Third Partners Forum in Johannesburg for the Partnership for Maternal, Newborn and Child Health, taking place on 30 June – 1 July 2014. Follow the discussion on Twitter via #PMNCHLive and @PMNCH and sign up for the Daily Delivery for up-to-date news from Johannesburg!