"When will I be Normal?" The Physical Changes of Post-Partum

Late in your third trimester of pregnancy, you may wonder if you will ever again be able to tie your own shoes or get out of the easy-chair without great effort. Certainly, your body has undergone amazing growth and change during pregnancy, and it can be hard to picture being "your old self" once again. However, during the days and weeks following childbirth (postpartum), you will experience rapid physical and hormonal changes.

1. Uterus
   • The uterus will take approximately six weeks to return to its pre-pregnant size. This change, called involution, is accomplished through contractions. The contractions are necessary for maintaining firmness of the uterus and for preventing excessive blood loss from the placental site. You or your nurse may "massage" your abdomen to stimulate uterine contractions; breastfeeding also stimulates contractions because of the hormones involved. Often, mothers having their first babies do not feel these contractions, but with subsequent births, they will feel them, particularly for the first few days and especially when nursing. Relaxation and/or slow breathing will be beneficial during these afterpains.
   • You will have lochia, or vaginal bleeding following birth. This flow from the uterus will start out heavy and bright red for the first few days, then will gradually get lighter in colour and will dimish in amount. This may take anywhere from two to eight weeks. What you need to watch for is a return to bright red bleeding, an increase in the amount of flow, or the presence of large clots; contact your doctor to be on the safe side. It could simply be that you have overexerted yourself, but could also be a sign of uterine infection.

2. Perineum
   • If you have had stitches for an episiotomy or tear, you will of course have some discomfort. Healing is usually complete within four weeks; discomfort with intercourse may persist for several months, however. Self-care during this time focuses on preventing infection and promoting healing: try ice packs for the first day, then a warm tub after that (even without stitches, you may have some swelling or even bruising, and the ice-then-warmth routine really helps). Be sure to keep the perineum clean, and make a habit of doing "Kegel" exercises (pelvic floor contractions) regularly throughout the day.

3. Cesarean Recovery
   • The first few days are the most difficult, and you will likely need pain medication for your incision. You can expect to be sore and weak, but extra help at home for a few weeks will allow you to recover more quickly.
   • You will need extra help finding comfortable positions for breastfeeding, and you will benefit greatly from exercises specifically designed to aid cesarean recovery. Your nurse
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