Bloody Discharge after Childbirth

The blood stained vaginal discharge continuing after delivery is mistaken by some women as menstruation. This discharge is known as “lochia” and consists of blood mixed with mucus and endometrial tissue lining the uterus. The lochia will gradually diminish in amount in a week or two but may continue for up to 6 weeks after delivery.

Changes in Periods after Childbirth and Breastfeeding

Periods may become unpredictable after birth of your baby. You cannot know for sure when you will get your first period after childbirth – it may be within 6 to 8 weeks of delivery or as late as after 6 months or more. It is normal to find the menstrual cycle becoming irregular and the bleeding heavier than before. The cycles may be of shorter or longer duration and you may even skip a period. The length of the period can be longer or shorter too.

Menstruation may become painful (dysmenorrhea) even though you may not have had such complaints previously, or they may be accompanied by symptoms of premenstrual syndrome (PMS) such as swelling of the body, nausea, dizziness or emotional changes a few days before periods. Always differentiate between abdominal pain and menstrual pain when pregnant or after giving birth – refer to Abdominal Pain and Menstrual Cramps.

The single most important factor determining how soon after childbirth a woman will get her periods is whether she is breastfeeding or not. Usually, a woman who is breastfeeding her baby exclusively without any supplementary feeding will not get her periods as long as she is breastfeeding. This rule is not absolute and you can get your periods even while breastfeeding. However, it is most likely that you will get your periods within 6 months after stopping breastfeeding.

If you are breastfeeding your baby intermittently with bottle-feeding, you may get your periods 3 to 4 months after childbirth, which may initially start as spotting. As you can see, there is no hard and fast rule.

Causes of Changed Periods

Hormonal changes in the body following childbirth and breastfeeding are mainly responsible for the changes in the  period occurring around this time. During breastfeeding, the pituitary gland secretes the hormone prolactin which helps in the secretion of breast milk and also suppresses ovulation, which is the reason why lactation is a natural means of contraception (though by no means a fool-proof one). Prolactin also suppresses estrogen, resulting in lactational amenorrhea (cessation of periods during breastfeeding), or it may cause irregular periods.

It should not be assumed that a woman cannot get pregnant if she has not had a period after childbirth. It is possible for a woman to ovulate even without menstruation. As a rule, it is safer to use some form of contraception once you start your periods after childbirth.

Alternatively you can discuss your concerns with your gynecologist and obstetrician who will direct you to appropriate reading material and videos on the labor process.

Signs of Labor

The question that most women want to ask is “How will I know when labor is starting?” That is indeed a very important question but it is often very difficult to differentiate between ‘true’ and ‘false’ labor pain.

The basic point you need to remember is that if the pain is coming regularly, increasing in intensity with each contraction, and the gap between pains is gradually becoming less, then chances are that you are going into labor.

On the other hand, ‘false’ labor pain causes contractions that come irregularly, do not increase in intensity, and are often relieved upon walking or lying down.

The other signs of labor, in addition to true labor pains are :

1. Membrane rupture – which may come as a gush of fluid from the vagina or as a slow trickle.
2. Low back pain.
3. A red-tinged mucus discharge from the vagina – known as “show”.

Stages of Labor

The labor process is divided into 3 parts.

First Stage of Labor

This is the time from onset of regular contractions (onset of labor) till the cervix is fully dilated (10cm). At this point the cervix is said to be fully effaced – there is no rim of cervix felt around the head.

This is usually the longest stage of labor and can take from 8 to 12 hours if this is your first pregnancy, or 6 to 8 hours in subsequent pregnancies. Although it may be difficult to pinpoint exactly when labor started, as a rule, contractions occurring every 2 to 3 minutes and lasting for 30 to 45 seconds signify that the labor process has started and delivery is imminent.

Second Stage of Labor

This is the time from full dilatation of the cervix to birth of the baby. This can take from a few minutes to 2 hours, and will usually take between 45 minutes to 2 hours if this is your first childbirth, or may take only 15 to 45 minutes in subsequent deliveries.

With each contraction you get an urge to push (you should push during contractions and rest in between) until the baby is finally out. The umbilical cord is clamped and cut after delivery of the baby.

Third Stage of Labor

This is the time taken from birth of the baby till delivery of the placenta. After delivery of the baby, the uterus contracts so that the placenta separates out from it and can be removed. You might have chills and trembling at this stage.

Sometimes, the hour following delivery of the placenta is referred to as the “fourth stage of labor” and is important because this is the time when there is maximum chance of severe bleeding (postpartum hemorrhage). Women with certain risk factor

You may choose to have a natural birth without any drugs or you may want to go for something to help you relieve the pain during childbirth. Your doctor will be the best person to advise you regarding your medication options. Normally IV (intravenous) or epidural medications are given for pain relief.

During delivery, the position of your baby is very important. Normally the baby comes out head first but at other times the buttocks or feet may be the first to come out (breech delivery) or the face or shoulder may be the presenting part.

You may need an episiotomy (a surgical incision given in the area between the vagina and anus to help easy delivery of the baby) or a forceps delivery. A Cesarean section may need to be done in certain situations, where the baby cannot come out through the vagina, or in case of some life-threatening condition to save you or the baby.

Acne Before Pregnancy

Acne, if pre-existing prior to pregnancy, may settle or even totally resolve during pregnancy. However many pregnant women with pre-existing acne experience an aggravation. The oil gland (sebaceous gland) increases production of oil (sebum) and when this combines with dead skin cells, dirt or cosmetic applications, it will form a plug that will block the pore from which the oil exits onto the skin surface. This will form a papule (pimple) and if it gets infected by bacteria, it will become a large, cyst like pimple.

Myths relating to acne during pregnancy are usually unfounded. Whether you are pregnant with a male baby or eat unusual foods during pregnancy as a result of cravings has no bearing on developing acne during pregnancy.

Acne and the Oral Contraceptive Pill

One of the treatment options for acne is the oral contraceptive pill, which mimics pregnancy so that the body will not release an egg cell (ovum). One would think that pregnancy would therefore settle every case of acne, however this is not always the case. In fact, the converse is true. The female sex hormones exist at high levels during the course of pregnancy and this can affect the oil production on the skin as well. Women who had acne prior to falling pregnant are more prone to this aggravation.

Acne After Childbirth, Breastfeeding

After childbirth, acne that started up during pregnancy may not resolve. If breastfeeding, the hormonal change may persist for a period of time and this continues to contribute to the acne. However, breastfeeding women should not consider stopping feeding in order to settle their skin condition. This is irresponsible since breastfeeding can have a significant health impact on the baby, whereas acne is a cosmetic skin condition.

Treating Acne in Pregnancy

Any oral medication for the treatment of acne during pregnancy is not recommended, even antibiotics. Acne in pregnancy should be conservatively managed with a combination of good skin care and antibacterial skin applications. Vitamin A cream should be avoided altogether as there is always the risk of high amounts absorbing into the blood stream and affecting the fetus. It is important to not that acne during pregnancy is difficult to treat due to the extensive changes in hormone levels as a result of the physiological state.
Avoid using OTC (over the counter) skin care products until you first consult with your doctor. Not all these products are safe during pregnancy and even some natural or herbal acne products may have the potential to affect your pregnancy. Never continue with your oral contraceptive as a means of controlling the extent of the pimples and acne drugs like isotretinoin should never be considered. Attempting to cover up the pimples and acne scars with cosmetics like foundation or powder will often aggravate your acne further and lead to infections prompting the need for antibiotics. The best approach to acne during pregnancy or when breastfeeding is patience and a “wait and see” approach.

Prolapse will occur when structures which are designed to keep certain organs in place weaken; it is a very common condition in women and there can be many reasons why this happens with common ones being childbirth and gravity. Once the damage has been done then it is hard to undo but a prolapse and symptoms can range in severity from mild to very serious so it is important to be aware of the symptoms and act upon them.

What are the symptoms of prolapse?

Whatever the causes of the prolapse symptoms are almost identical and while some women can experience very few symptoms others can have very debilitating ones. Some of the more common symptoms of prolapse are:

• Intense pain in the lower back region.
• A dragging feeling in the region.
• Stress incontinence, this is usually when you sneeze or cough you might leak a little.
• Pain when having sex.
• Constipation.

Common types of prolapse

Prolapse of the womb

The pelvic floor muscles and supporting ligaments hold the womb in place, if these muscles start to weaken as they can do after pregnancy then the womb can drop down into the vagina. Prolapse of the womb is very common after women have gone through menopause when the support of muscles can become weakened due to the drop in oestrogen levels.

Vaginal prolapse

The biggest risk of vaginal prolapse is after having an hysterectomy, this is usually due to the vagina becoming weakened during vagina surgery.

Prolapse of the bladder

With the bladder sitting directly on top of the vagina if there is weakness at the top of the vagina then sometimes the bladder can drop and bulge into the vagina.

Prolapse of the urethra

This type of prolapse is very similar to the prolapse of the bladder, the only difference being it is only the urethra tube that leads from the bladder that drops down.

Prolapse of the rectum

This usually occurs if the lower part of the vagina becomes weak; when this happens the rectum can then bulge into the vagina.

What treatment is there for prolapse?

As there are so many different types of prolapse treatment will of course vary, however many of the treatments do rely on strengthening the ligaments and tendons in the pelvic area. Many treatments of prolapse also rely on toning the uterus and other organs in that area.