Woman's physical recovery in the 1st hour after the birth
Congratulations! You have had one of life's most profound experiences. If this is your first child, your life will be turned upside down! It is important to give yourself time to adjust. You have a new person in your life, new roles for you and your partner, and changes in your body.
The process of labour and giving birth is extremely hard physical work and emotionally demanding at times. How the woman physically recovers and feels during the 4th stage of labour will depend on how long or short the labour was, what type of birth she had, if there were any complications, if she had pain relief and how your baby is after the birth.
Every woman will react in a different way, emotionally after the birth. As will every partner and support person. It is not uncommon to have feelings of excitement and joy, mixed with sheer relief and exhaustion that she has "done it" and the baby is here.
Women are often acutely aware of the physical and emotional demands of where the labour took them and the hard work it demanded of them. Partners and support people are usually overtaken with emotion and admiration for the woman and overwhelmed with relief that they can soon rest, as their job of supporting is close to completion.
Some common physical signs can include:
|Emotions of the woman|
* Relief that you have your baby in your arms and that you are both OK.
* Overwhelmed at the sheer enormity of what you and your baby have just achieved.
* Joy at touching and meeting your child.
* Love for your child and your partner.
* Feeling shocked or stunned if the labour and birth were quick or quite painful, not wanting to be touched or moved.
* Tears, as you release a mixture of emotions.
* Laughing with love and joy or laughing and crying at the same time.
* Tired and not wanting to do any more - not even to push the placenta out or get up and shower after the birth.
* Concerned about how you will be able to protect and look after this little being, a sense of enormous responsibility.
* Concerned or frightened if there is something wrong with the baby.
* Concerned or guilty if you do not want to hold your baby or be near them.
* Disappointed if there is a problem with 3rd stage of delivery.
* Frightened if you are bleeding heavily.
* Invincible knowing that if you can get through birth you can do anything!
Emotions of the partner/support person
* Relief that both your partner (or the woman you are supporting) and the baby are OK.
* Love for your partner and child.
* Excited that your child has finally arrived, wanting to ring everyone.
* Disbelief, am I really a father?
* An enormous sense of responsibility for your new family.
* Wonderful to be able to share something so amazing with the person you love, glad you were there.
* Total admiration for your partner, proud of her and what she has done.
* Concern if there are problems with either the woman or your baby.
* Exhausted and wanting to sleep if the labour has been long and hard.
* A special moment as the new member is welcomed to the family.
Alert and euphoric.
The hormones of labour and birth are amazing things. For many women, after barely being able to lift your head off the pillow, the birth of the baby can make you feel suddenly alert and unable to rest, even if the labour was long and exhausting. In fact it is not unusual to find the mother literally 'buzzing' with 'after the birth glow' an hour after the birth and her partner and support people to be asleep in the chair!
For many women this 'euphoria' can last up to a couple of days, with many finding it difficult to sleep and needing to 'share their experience' with anyone who will listen. Exhausted.
For a few women their body will literally 'run out of steam' feeling wrung out and exhausted after the birth. They may not have the energy or the inclination to hold their baby immediately. If this is the case follow your needs, your partner or support person can hold the baby close by for you. You may need some space to rest, eat some food and drink fluids or maybe you feel you need some nurturing.
Ask for your shoulders, hands or feet to be massaged or just to be held. A marathon runner would! Bleeding.
For the woman, bleeding after the birth is an expected physical sign. How much you bleed can be a bit of a surprise. The bleeding in the hour after the birth can be significantly heavier than a normal period, usually soaking a large pad every half an hour or so. The bleeding will settle in a few hours and your caregiver will usually check it regularly. If you are concerned about your blood loss ask for guidance from your caregiver. Empty.
As the woman's body physically empties of her baby and the placenta, some women can experience a mixture of feelings. These can include a profound and unexplainable feeling of loss and physical emptiness, as their body undergoes a transition from sustaining and nourishing their baby within, to their child arriving into their arms. Weak and light headed and feeling faint.
Women can feel weak and exhausted, especially following a vigorous, lengthy 2nd stage of pushing. It is also normal to feel a little lightheaded after losing the expected 200 to 400 mls of blood. This is the same for people who donate blood at the blood bank and why the blood bank offers them refreshments and a rest period before leaving to resume any daily activities.
In the hour after the birth the woman's body has to readjust after the blood loss that accompanies giving birth. She needs time to rest, have refreshments and drink plenty of fluids (water if possible) to help her body to stabilise, usually delaying any move to the shower or getting up for prolonged periods until she is feeling OK (generally after 45 minutes to an hour or so).
If you decide to have some champagne or other alcohol soon after the birth, it is wise for the woman to limit it to about half a glass or so as the alcohol can lower your blood pressure further and contribute to you feeling faint when you get up.
For a minority of women, the light-headedness and weakness may persist for a few hours (or a few days) if the bleeding was heavier than normal or her haemoglobin blood level was low before the birth (she was anaemic).
Hungry and thirsty. In the hour after the birth, most women will feel ravenously hungry and thirsty, needing to eat and drink after hours of eating and drinking very little. Remember to pack some favourite foods and treats for after the birth. Hospital food can be very basic!
If you have been given an injection of Syntometrine to routinely manage the 3rd stage of the labour, then you may not feel hungry at all, instead feeling nauseated and possibly vomiting.
Eager to remove drips and epidurals etc. If you have needed to have a drip in your vein, the baby monitored, an epidural catheter inserted into your back and / or a catheter placed into your bladder to keep it empty, then you will probably be keen to 'shed' all these attachments as soon as possible.
If the bleeding is within normal range, the catheter should be able to be removed soon after the placenta has been delivered (some caregivers will remove it when you are pushing your baby out). The epidural catheter can also be taken out soon after the birth and depending on how long ago the epidural medication was given or stopped, it will take an hour or so for the effects to wear off and for the woman to be able to stand and take her own weight to walk out to the shower.
Many caregivers will leave the intravenous (IV) drip in the vein until the woman passes urine (usually within an hour or two of the birth) in case the bleeding becomes heavy after the placenta has been expelled. If this does not happen the fluid connected to the drip may be taken down and the IV cannula capped off and left in the vein, as a small attachment strapped to the arm about 2 cms in length. After the woman passes urine, the IV cannula is removed. Leaving the cannula in allows for the fluids to be restarted if necessary, without having to reinsert the needle.
Uncomfortable, stingy and cramping. Many women will feel uncomfortable in the first hour after birth. Perhaps their back aches, their anus or genitals feel sore, swollen or are stinging, they are experiencing cramping or afterpains, their throat is sore from making noise in the birth or their muscles are generally tired and aching.
You may wish to ask your caregiver for some mild painkilling tablets, use a heat pack for your back or cramps. Utilise some homoeopathic remedies or ask your support people to pull out one last massage! Often a warm shower once you are feeling better also helps.
Tired and disinterested. For women who were given a narcotic injection (such as Pethidine) within a couple of hours before the birth, they may feel tired, lethargic or even 'doped out' to a degree and totally disinterested in the events happening around them or their new baby. They may need to sleep for a couple of hours to allow the drug to wear off completely. Your partner or support person can hold your baby as you rest or sleep.
Feeling like you need a shower. Birth is not a neat and tidy process and many women are keen to shower and freshen up once they are feeling able to get up. Your caregiver will often change the sheets, removing any wet and soiled linen and make you as comfortable as possible until you are ready to shower. It can be great to freshen up, change your clothes and clean your teeth after the birth and feel a little 'human' again.
If you had your baby at home, ask your partner or support person to put fresh clean sheets on your bed. It feels wonderful getting into clean bedding after a shower with your new baby and partner.
Shivery and shaky. It is not uncommon for the woman to get 'the shakes' or to shiver after she gives birth. It is a normal physical response to the energy needed to have your baby. The woman may benefit from a warm blanket (most delivery suites and birth centres have a linen warmer for this purpose, as well as warm bunny rugs for the baby) and making sure all the wet linen is removed from under her, having a warm drink and something to eat. If you are in the bath or shower, getting out and being dry and warm will help. Some people will use the homoeopathic remedies such as Rescue Remedy or Emergency Essence.
Getting sensation back. If the woman has had an epidural then it may take an hour or more to get the full sensation back into her lower body. Some women will feel like they have their full sensation but their legs still feel 'heavy'. This means the anaesthetic is still working.
Take care not to try and get up without your caregiver. If the epidural has not worn off your legs will collapse underneath you as you try to stand. Even if you are able to walk you will probably need your partner, support person or caregiver to stay with you in the shower just in case, or possibly sit on a plastic seat in the shower to support you.
Sensitive not wanting to be touched or put the baby on the breast. A few women will feel a little 'shell shocked' after they give birth, being reluctant to move, be touched or to feed and hold their baby. It may be that they are coming to terms with the birth and this can be especially the case if the birth was unusually quick, there was an unexpected complication or more painful than expected.
Be patient with her, let her take the time and space to adjust. The partner or support person can hold the baby until the woman is ready. Perhaps your caregiver will be able to delay putting in stitches (if they are needed) until you feel you can cope with being touched. Some women will use a homoeopathic remedy called Arnica, when feeling this way. Check with your homoeopath before the birth.
The hour after birth is the beginning of getting to know your new son or daughter. It is a special, exciting time, full of mixed emotions and physical readjustment for the woman. After completing the amazing task of giving birth, the woman is still in need of physical and emotional support. She may instigate this support herself or be a little overwhelmed, needing her partner or support person to help meet her needs. The following are some support strategies for the woman herself as well as her partner or support people. You can read your own (and each other's as well if you like!)
Self support strategies for the woman
Just as every woman's physical recovery will vary during the 1st hour after the birth, so too will her support needs. Some women will be euphoric and full of energy, while others will feel weak or sensitive and reluctant to move. Sometimes the new baby can easily (and unintentionally) absorb the focus of your partner or support people and you may need to gently remind them that you still need their attention and support. Communicating your needs is one way to support yourself.
How able you are to support yourself during the 4th stage of labour will depend on many things. For example:
- How long or short the labour was.
- What type of birth you had.
- If there were any complications.
- If you had pain relief, and / or
- If the baby is well after the birth.
You may feel exhausted and weak. Your vagina and perineum can feel bruised and sore, more so if any stitches were necessary. Care will be needed when moving around, so take it easy at first. Physical assistance will be required to move onto clean bedding, eat and drink, shower and feed your baby. Even if you are feeling like you are on an invincible high, don't underestimate the enormous experience your body has just been through and the adjustment it is still undertaking.
The following are a few suggestions that may assist you in supporting yourself:
Communication. You will still need your partner or support person's physical and emotional strength and support in the 1st hour after the birth. They could require some input and direction from you regarding your needs at this point. They too will probably be feeling a rush of adrenaline and an array of emotions as well as physical tiredness, but you are still a priority.
Your caregiver will usually remain with you until after the placenta has been delivered and you and your baby are stabilised. They will normally help make you dry and comfortable (and respectable) before attending to their other duties. However, occasionally your caregiver may be caring for more than one woman in labour and may need to attend to the other woman, leaving you, your partner and baby alone for short periods. While this is not common, it can occur if the ward is busy, and some women can be left feeling physically uncomfortable or emotionally vulnerable at this time. Alternatively, your caregiver(s) may be preoccupied with caring for your baby if the baby is unwell.
In these circumstances you may need to voice your needs and concerns to your partner or support person or ask them to find a caregiver who is not busy to give you a hand. Perhaps your partner could find some extra blankets if you are feeling exposed or cold. If the sheets underneath you are making you feel cold or uncomfortable, then ask them to place a dry towel underneath you or go outside to the midwives' station to ask for guidance.
NOTE: Don't ask your partner or support person to remove your legs from stirrups without the guidance and help of your caregiver. This needs to be done correctly to avoid nerve and ligament strain.
If you are worried about the amount of blood loss or your baby's health, ask (or buzz) for help straight away, don't wait for your caregiver to return. Sometimes women can feel unsure about what they can and can't do, if their caregiver is out of the room for a while. Asking your partner or support person to seek out help can clarify what you need to be done and what they are able to do while waiting. You may feel you need reassurance with a cuddle from your partner or support person at this time.
Food and fluids. Women often feel very hungry and thirsty soon after giving birth. It is unlikely though that you will have the energy or the inclination to 'pop' straight up after giving birth to make a 'cuppa' (cup of tea or coffee), and even if you do you should not! Ask your partner or support person to get you a cold or warm drink, depending on your desire.
If you are hungry - eat! Your body has been working on its reserves and may be feeling quite depleted at this time. You can request a hospital meal or have something that you have brought in from home to eat. Your support person or a visiting friend or relative may be able to organise some take away, if it is a decent hour and close by. Or you could ring for 'hospital delivery'.
Environment. Some people plan for a specific environment during the 1st hour after the birth. For example dim lighting, people to talk quietly, breastfeeding soon after the birth and no immediate weighing or baby measurements to be taken. It is important to remind your partner, support person and staff of your wishes, if there have not been complications.
Physical help to the toilet or shower. It is best to have someone physically help you to the toilet and into and out of the shower when these needs arise. Experiencing shaking legs and feeling weak are common sensations, particularly if you were standing or squatting for long periods during the labour. Remember that bathroom floors are usually tiled and can cause injuries if you fall. If you had an epidural, feelings of numbness with an inability to stand or walk may persist for an hour or two after the birth.
Getting comfortable. In the 1st hour women can start to become aware of discomfort in their lower back, genitals and anus. Ask for help to get yourself comfortable, especially if you are attempting to latch the baby for a breastfeed. Use extra pillows and place them where you need them. Lower or lift the bed head if it is adjustable. If you bottom and perineum are sore, lie on your side or back to take the pressure off these areas. Some women will take a homoeopathic remedy (such as Arnica) for bruising and to help with the healing.
Heat and ice packs. Heat and ice packs can be both soothing and supportive during the 1st hour after the birth. If you are experiencing cramping of the uterus, called 'afterpains', heat packs can be placed on the your lower belly, the same as they are used for labour pains.
Small ice packs can be placed on, or inside a sanitary pad and then gently eased onto the genital area or further back to cover the anus if you have haemorrhoids. These can assist with swelling as well as cooling any discomfort. It is best to apply these for an hour (or less) then have a break for an hour (or more), rather than leaving them on for long periods of time, as they can slow the blood flow to the area and inhibit healing.
Some hospitals prepare 'frozen fingers' (made from surgical gloves filled with water, then the fingers are tied off at the end and frozen). These can be used after any stitches are inserted. If the caregiver is too busy to get heat or ice packs for you, then ask your partner or support person to obtain them. If at home it is handy to have some sort of small ice packs pre-made in the freezer 'just in case'.
Asking for pain relief. It may be that after the birth you will feel like you need to take some pain killing tablets, even if you had no pain relief up till this point! Many women will feel tender and swollen around the genitals, perineum and anus. Some women may experience pain around the coccyx and sacrum area, particularly if the baby was in a posterior position or the woman was lying on her back for long periods of time during the labour and birth. If it is not your first baby it is common to experience cramping 'after pains', especially when you breastfeed.
Asking your caregiver about taking some mild painkillers, such as paracetamol, or non-steroidal anti-inflammatory tablets (usually used for menstrual pain) if having afterpains. If you plan on labouring and birthing at home, make sure you have something recommended by your caregiver in the house in case you need them. Combining pain relief with heat and ice packs will usually bring some relief for these common discomforts.
Partner and support person support strategies for the woman
As the woman's partner or support person, your physical and emotional support of her will need to continue during the 1st hour following the birth, with the same unconditional love as given throughout the preceding labour. It is not uncommon for partners and support people to unintentionally pull back or shut down their support upon the arrival of the new baby.
The focus can easily shift from the woman to the baby, with the woman being 'forgotten' in a sense, as the excitement of seeing the baby and contacting relatives overtakes the emotions. It may be that the subconscious perception of it 'being over' can also lead to overlooking her physical and emotional needs.
Watch and listen, let her guide you. If she seems tired or overwhelmed, ask her what she needs. She may be glowing after the birth and feeling like she can do anything or she may feel 'shell-shocked', needing time and space to catch up with what has happened. Emotionally she may be on a high, but physically her body has undergone the equivalent to a triathlon or two! She may need time to integrate the labour and birth or she may need to rest. Try and remain sensitive to her needs at this amazing time and of course shower her with admiration.
It is important for you to physically help her as much as possible and support her if she is feeling fragile. Stay close by in case she feels light headed. If she does not wish to hold her baby immediately, offer to hold the baby close by until she is ready.
The following are some suggestions that may assist you in your role as a support person during the 1st hour after the birth:
Awareness of her needs. The caregiver will usually remain present until after the placenta has been delivered and mother and baby are stabilised, normally helping the woman to be dry and comfortable (and respectable) before attending to their other duties. However, occasionally the caregiver may be caring for more than one woman in labour and may need to attend to other woman, leaving you, the woman and the baby alone for short periods.
While this is not common, it can occur if the ward is busy, and some women can be left feeling physically uncomfortable or emotionally vulnerable. Alternatively, caregiver(s), and you, may be preoccupied with the baby, if the baby is unwell. In these circumstances you will need to be aware of the woman's needs.
If she is feeling cold or exposed (especially if parts of her body are not covered) find some extra blankets, if you don't know where the blankets are kept, ask at the midwives station outside. If the sheets underneath her are wet from blood or amniotic fluid, gently place some dry towels underneath her.
NOTE: Don't remove her legs from stirrups, or stop her if she attempts to do this herself, as this needs to be done by 2 people in the correct manner to avoid nerve and ligament strain.
If you are worried about the amount of bleeding or the baby's health, ask (or buzz) for help straight away, don't wait for the caregiver to return. Sometimes partners and support people can feel unsure about what they can and can't do when the caregiver is out of the room for a while. If you feel or sense that something is 'not right' trust your instincts and seek out help from another caregiver outside.
If the woman is looking a little vulnerable or overwhelmed, stay close by and give her a cuddle, as you both adjust to the reality that the baby has finally arrived.
Food and fluids. It is usually not until the partner or support people mention a cup of tea or cold drinks and food that the woman realises how hungry she actually is. When getting this for yourself, ask the woman what she would like. Sometimes a hospital meal can be arranged or you could offer her something you have already packed from home.
Asking if you can hold the baby close by, while she eats and drinks will also help. The authors have seen ice cream treats magically appear from an esky (also known as an icebox or chillybin) at this time, devoured with appreciation by the woman and her partner!
Environment. Some people plan for a specific environment during the 1st hour after the birth. For example dim lighting, people to talk quietly, breastfeeding soon after the birth and no immediate weighing or baby measurements to be taken. If you had made plans for this time, be aware of implementing these requests. Ask staff to talk softly, play a piece of music that you have picked out or read a welcoming poem for your baby.
Physical help to the toilet or shower. Women often feel a bit weak and shaky when they first get up after the birth - particularly if they have been standing or squatting for long periods throughout the labour. If she had an epidural, her legs can feel numb and she will not be able to support her own weight for an hour or more. If her blood pressure is slightly low or her blood loss was more than normal, she can feel very light headed and possibly faint.
Be guided by your caregiver and ask them if it is OK for her to get up. Be sure to take her by the arm and walk her to the toilet or in and out of the shower. Sit her on a plastic chair in the shower if she feels weak, and sit with her while she showers. Wrap her in a towel and dry her gently. Help her dry her legs and to put on her underwear (so she doesn't have to bend down). Help her into clean clothes if she needs this. Walk her back to bed or to a chair in the room. Your physical support can help her to avoid fainting or falling onto a hard, tiled floor in the bathroom.
Heat and ice packs. Heat and ice packs can be both soothing and supportive for the woman during the 1st hour after the birth. She may be experiencing cramping of the uterus, called 'afterpains', especially if this is not her first child. Heat packs can be placed on her lower belly, the same as they were used for labour pains.
Small ice packs can be placed on, or inside a sanitary pad and then gently eased onto the woman's genital area. These can assist with swelling as well as cooling any discomfort and can be used after any stitches have been inserted. It is best to apply these for up to an hour then have a break for at least an hour, rather than leaving them on for long periods of time, as they can slow the blood flow to the area and inhibit healing.
Some hospitals prepare 'frozen fingers' (made from surgical gloves filled with water, then the fingers are tied off at the end and frozen). If the caregiver is too busy to get heat or ice packs for you, then ask them where they are kept or how they are made up and get them yourself. If the baby was born at home, it is handy to have some sort of small ice packs pre-made in the freezer 'just in case'.
Helping her to get comfortable. In the 1st hour after the birth, women can start to become aware of feeling tender and sore in the lower back, genital area and bottom. If she is sitting up, suggest that she try lying on her side or back, to help take the direct pressure off these areas. Use extra pillows and place them where she needs them.
Pamper her now with your love and admiration as well as making her comfortable. After she has showered and dressed in fresh clothing help her into bed. Arrange her pillows, lower or lift head of the bed head if it is adjustable. Help her tie or clip her hair back if it is falling over her face. Do a 'body check' - just as you did during the labour. Guide her to relax her whole body. Some women like to take homoeopathic remedies, (such as Arnica) for bruising and to help with the healing.
Even after all the previous support strategies have been implemented, some women will still experience pain to the point that they will need some type of pain killing tablets, such as paracetamol. Ask her if she needs this, so you can then ask your caregiver about what is suitable for her to take. If the baby was born at home, make sure you have something recommended by your caregiver in the house in case you need them (otherwise it will mean a trip to the all night chemist!). Combining pain relief with heat and ice packs will usually bring relief for most of her discomforts.
Supporting yourself. While the woman is still a priority for support soon after the birth, it is also important to support yourself. Have something to eat, rest with your baby if the woman needs to have stitches or is eating. Some birthplaces have facilities for the partner to stay with the woman after the birth. If this is the case you could consider all curling up together for a nap before you go home. Take into consideration the timing of calling relatives and friends and how long it will be before they are 'on the doorstep' to visit. You may wish to delay calling them or ask them to wait a while before coming.
Some partners find they have a headache or feel well themselves. You may consider taking paracetamol with you just in case. You may want to ask another support person (if you have one) to swap shoulder massages. Some partners will take a Bach remedy such as rescue remedy or emergency essence.