How long will I bleed for after having a baby?
Some people don’t know that they will bleed for up to 6 weeks after giving birth. This bleeding is known as lochia and is much like an extended period, but is generally heavier initially. The ‘blood’ also contains uterine lining and mucous/discharge. The uterus has to work hard to contract back down to its pre-pregnancy size. You may find that your bleeding is heavier after breastfeeding as the hormone oxytocin that enables milk to flow is also responsible for uterine contractions. Also, when being more active, upright and mobile you may see your bleeding increase slightly.
It is generally advised to use thick maternity pads and avoid tampons or menstrual cups during this time to allow the lochia to easily leave the body. You may have some tears or grazes that are healing and the genital tract is at risk of infection if not kept clean. Wash externally every day just with water (no soap!), pat the area dry with a clean towel or kitchen paper and change pads frequently.
If your bleeding is excessively heavy (for example, you are changing pads that are completely soaked every hour) or you are passing large clots it is important to speak to your midwife or doctor. Occasionally, a piece of placenta or a bit of the membranes from around the baby are left inside after childbirth and this can cause heavier bleeding and infection. If you have unusual discharge or the odour is offensive also seek advice.
It is important to ensure you are eating an iron-rich diet during this time. This includes meat (if you eat it), leafy green vegetables, fish, eggs, pulses, nuts and dried fruit. Most women will lose up to 500ml of blood at birth and this is seen as normal but along with the postpartum bleeding this can leave you feeling lacking in energy (along with adjusting to life with a newborn).
What causes skin changes in pregnancy?
In pregnancy the placenta produces higher levels of Melanocyte-Stimulating hormones, which influence the production of Melanin. Melanin is what causes pigmentation in the skin and leads to various skin changes such as darker nipples, melasma (skin discolouration also known as ‘the mask of pregnancy’) and linea nigra. Linea nigra occurs in around 75% of pregnancies and is the dark line that runs vertically up the abdomen from pubic area to belly button. It tends to fade after the pregnancy but can take a little while to completely disappear.
Is discharge normal?
If you have read my post on the cervix you will already know the answer to this question! For some reason the topic of discharge is a bit of a taboo. People seem to find the idea of it as gross or a symptom of something being wrong. But discharge is completely natural and normal. Discharge is actually the cervical fluid I speak about in this post and varies in consistency and amount depending on which stage in your cycle you are. Slippery and stretchy like egg white – hello ovulation! Thicker, white and sticky – you’ve probably just finished your period.
Another thing – a vagina smells like a vagina. It is good to get to know what is a normal odour for your vagina and it can vary slightly throughout your cycle due to hormonal changes. Healthy discharge does not have a strong smell or colour, so if you suspect something isn’t quite right trust your gut and get it checked. Imbalances in the vaginal pH (which is naturally acidic) can lead to infections such as Bacterial Vaginosis (characterised by a fishy smell and greyish discharge), or thrush. These can also be accompanied by itching and burning but are easily treated. Unusual discharge can also be a sign of a sexually transmitted infection.
It is normal in pregnancy to have (quite dramatically) increased amounts of discharge. Again, as long as it does not have an offensive smell and is either clear/whitish it is healthy and normal.
The vagina is self-cleaning. It has its very own eco-system of bacteria – yes bacteria is not always a bad thing! This helps it to maintain the naturally acidic environment and actually protect itself from infections. This is why it is really important not to clean inside the vagina as you will wash away all this good bacteria that is doing its best to keep your vagina happy and healthy. Washing with soap inside the vagina or douching will increase your risks of infections such as BV and thrush as it upsets the natural pH. Washing externally with a mild soap is ok, but even this will irritate some people as the skin is very sensitive in this area. Washing simply with water should be sufficient.
And remember: vaginas smell like vaginas! Your natural smell is not something to be embarrassed by. In fact, vaginal secretions contain hormones known as copulin which act as pheromones! So your natural scent is actually alluring to your sexual partner.
Should I remove my pubic hair before I give birth?
There was a time when all women were shaved and given an enema when they arrived at hospital in labour. Thankfully we have come a long way from such oppressive and unnecessary practices. I am very much aware from the variety of vulvas that I encounter that women often choose to remove their pubic hair in preparation for giving birth. I am not delving into a discussion regarding the somewhat political subject of pubic hair… but I would like to clarify:
- Pubic hair is natural
- Pubic hair is normal
Pubic hair has a role in protecting your genitals against bacteria and preventing friction. What someone chooses to do with their pubic hair is absolutely 100% their personal decision. However, it is worth noting that removing pubic hair generally leaves hair follicles irritated and inflamed. This can increase your risk of infection in an area that is a naturally warm and moist environment. Recent research has found no benefit to routinely shaving before labour.
On a practical note, it also becomes increasingly difficult to physically and logistically remove your pubic hair when you have a large baby bump in the way and cannot actually see your feet let alone your vulva!
Whatever your decision, it is certainly not expected that you should trim or remove your pubic hair prior to giving birth.
What happens when my waters break?
Note: I will be referring to waters breaking in the context of a term pregnancy (more than 37 weeks), as this is considered a normal time for this to happen.
We have all seen the movies where a woman is in the middle of a supermarket, an enormous gush of water splatters on the floor and she is immediately in full-blown labour. Cue manic dash to the hospital, arriving just in time for baby to be born! This is a very dramatic version of events, and I am sure that this has happened to some people. But it is not a typical scenario and slightly dramatised…
The waters, also known as ‘amniotic fluid’ or ‘liquor’, surround the baby within the amniotic sac. When there is a weakness in the sac, normally due to increasing pressure at the end of the pregnancy and hormonal changes, it can break and the waters leak out. This is not always a big gush, as sometimes the baby’s head is low in the pelvis and acts as a plug only allowing a small amount of water to leak out as they move. Sometimes the waters break behind the baby, known as a ‘hindwater leak’ and again just a small amount of water leaks out. It might feel like you have peed yourself! But the difference is, it will keep leaking despite your best attempts at holding your pelvic floor… Once broken the waters will continue to leak out until the baby is born.
The waters can break:
- Before labour
- During labour
- At the birth of the baby
The baby can even be born ‘en caul’ meaning that the amniotic sac is still intact when the baby is born. The sac can then be broken and there is no harm to the baby. They will take their first breath once exposed to the air around them.
The waters breaking are not an indicator of the ‘stage’ of labour or how soon the baby will arrive. As said above, they can pretty much break at any time in a normal labour.
Sex in pregnancy
There are a lot of myths and fears about having sex in pregnancy. Sex in pregnancy is perfectly safe and a healthy element to most relationships. Penetrative sex specifically will not harm your baby in any way; the baby will not come into contact with your partner’s penis/ finger/ any object as the cervix is between the vagina and the uterus.
Some women find that they have a greater desire for sex during pregnancy due to changes in hormones (oestrogen and progesterone) and increased blood flow to their breasts and genitals. Vaginal secretions can also increase in pregnancy due to hormonal changes. Equally, some people will not feel like having sex when pregnant or at certain times during their pregnancy for a multitude of reasons: discomfort, changes in the relationship with their changing body, stress, to name but a few.
When you orgasm there is a surge of the hormone oxytocin. This is the same hormone that makes your uterus contract in labour. However, this does not mean having sex will make you go into labour if your body is not ready to. There is no evidence that having sex in pregnancy causes premature labour. You may experience what are known as ‘Braxton Hicks’ contractions after orgasm. The muscles in the uterus tighten and go hard. It can be a strange sensation so if worried try to use relaxation techniques to relax until it passes.
It is safe to use a vibrator or sex toys in pregnancy. If you have been told specifically to avoid penetrative sex then this applies to using toys as well. Follow the same rules that you would when using these in a non-pregnant state! Wash after use, read the instructions.
If having sex with a new partner it is important to still use condoms/ barrier methods to avoid sexually transmitted infections, as these can be particularly dangerous for an unborn baby.
When it is not recommended to have sex in pregnancy:
- If you have had any heavy vaginal bleeding. Having sex may cause further bleeding or may be related to a low-lying placenta.
- If your waters have broken as it may increase the risk of infection. Remember there is a mucous plug that seals the cervix and keeps your baby’s environment sterile, so if your waters have broken this protection is no longer present.
- If you have a history of cervical dysfunction or weakness (when the cervix struggles to stay closed during pregnancy). You would only know this if you have experienced this in a previous pregnancy.
- If you don’t want to have sex!
Speak to your midwife or doctor if you have any questions or concerns about having sex in pregnancy.
Will I shit myself during labour?
Hands down one of the questions I get asked the most (admittedly mostly by my friends) is: ‘Will I shit myself during labour?’
I don’t know what it is exactly that makes so many women worry about this more than any other part of giving birth. I think possibly it is because going to the toilet is one of the most private things we do, and it is rarely, if ever, a moment that we share with other people!
The answer I generally give is… yes, you probably will. Not necessarily. But it’s likely. And here’s why it is nothing to worry about, and actually quite exciting:
When your baby moves down through the pelvis, there comes a point when their head will be so low that it is literally pressing on the rectum as it moves down inside the vagina. It is normal at this stage to have an urge to poo. It might be that there is a stool in the rectum and you will actually poo (which you can do on a toilet in privacy if you wish). However, it also can just be that you experience the sensation to open your bowels when it is actually just the baby’s head compressing the nerves in the rectum making you feel like you need to go.
The reason all the above is exciting is that it is a sign your baby is close to arriving. Women who are labouring without regional anaesthesia such as an epidural will have full sensation of this urge, and there is only so much you can resist it. Eventually the body will just take over and the urge to push is somewhat involuntary. This is a phenomenon known as the ‘fetal ejection reflex‘ and is most often seen when birth is undisturbed, and the woman feels safe and supported. It is normal at this point to make noise and often women will report a sudden and intense expression of fear; this is adrenalin acting. Midwives and birth workers refer to this period as ‘transition’ and it often means we will be seeing a baby very soon!
So basically, if you are pooing it is most likely a good thing. Your baby is in the right place (low down) and your body is making way for them to arrive! Trust your body and go with it. Poo is normal.