Hi! My name is Lyanne Nicholl and I am a charity consultant, author and writer.
In 2022 I had my first book published. I began writing ‘Your Postnatal Body’ deep in the 2020 Lockdown, when I was a few months postpartum with my second child.
I have experienced both vaginal and caesarean birth and I know how hard the initial postnatal period can be, thus I am releasing the first introductory part of my book so that you can get a feel as to whether it might help you - or someone else - whilst in the eye of the storm.
The book covers the first year postpartum (& beyond) and aims to be inclusive, informative, warm and hopeful. I interview health professionals and experts and I include case studies from mothers who have overcome significant postpartum challenges.
I do hope you enjoy this snippet:
Your Postnatal Body (a top to toe guide to caring for yourself after pregnancy and birth)
You matter. Your body matters. I am glad you picked up this book as this is the first step to regaining confidence in your body – and I absolutely don’t mean that in a ‘get fit quick’ way. I mean it in the sense that you regain trust in your body and feel the best you possibly can about yourself.
While pregnant, you receive a glut of information on pregnancy symptoms – what to expect when you’re expecting, if you will. But what about afterwards? What are the symptoms of ‘postpartum’? Which are normal, which are worrying? This book aims to explain what is happening to your body now that your little bundle(s) have arrived, and how you can help yourself recover and thrive.
Ever since I had my first son in 2015, I have been flabbergasted by the lack of care and attention given to women’s postnatal bodies. Aside from the unhealthy fixation on getting back in to ‘pre-pregnancy’ jeans, no one seems to give a rat’s arse about what you have just been through. Pregnancy and birth may be everyday occurrences, but they are not easy, and the after-effects can be wide-ranging and sometimes difficult to live with. To (mis)quote Kiera Knightley, ‘Birth happens every day. What’s the big deal? So does death, but you don’t have to pretend that’s easy.’ Women are often well prepared for pregnancy and the side-effects and symptoms that come with it, but can be blind[1]sided by a host of new symptoms that appear postnatally. This can be particularly hard after a difficult birth, if you don’t have much support, or if you are struggling mentally and emotionally.
I still remember the postnatal period with my first son very clearly, despite surviving on about three hours’ sleep a night – or maybe because of that. It was not easy. I was sore, leaky and overwhelmed and it was left solely up to me to research what was normal and what wasn’t and create my own care pathway. That experience led me to start the Postnatal Health Community (@postnatalhealthcommunity) on social media and begin campaigning for better postnatal care. There are signs that things are improving (or there were pre-pandemic!) but we are still a long way from satisfactory care for women, and birthing people, after birth.
I hope to be able to empower you by increasing your knowledge about what the hell just happened and how to really look after yourself. You may feel that all of your attention needs to be on your baby or babies, and this notion may be perpetuated by friends, family, and even health professionals, but I am here to say: you matter. Taking care of your physical and mental health is paramount, not only because a healthy, happy mum is more likely to be able to cope with the demands of parenthood and enable her children to thrive, but because you are still the whole human being you were before, and you deserve to recover properly.
We should not take the current ‘put up and shut up’ culture sitting down – especially if you are currently sat on one of those inflatable doughnut rings. For too long there has been a casual disregard of women’s bodies after birth, as if we have served our purpose as a vessel and are no longer of much value. There is a pervasive culture of ‘well, this is just what happens after childbirth’, particularly when it comes to things like urinary incontinence. Weeing your pants when you laugh, sneeze or run postpartum may be common, but it is not normal, and we have been sold a lie that it is. And the word ‘sell’ here is particularly pertinent. The adult continence industry is booming, faster than children’s nappies. Well, ‘oops moments’ (sigh) are not part and parcel of becoming a mother. It’s not our fault that we just put up with this – we haven’t been told any different. There has been a wall of silence about the reality of postpartum bodies. The mothers who went before us just ‘got on with it’ because women are stoic, resilient and, unfortunately, accustomed to their health issues being minimised. But that changes now. With proper care postnatally, we can strengthen and support our bodies to recover – and maintain optimal physical health for life.
This book does not seek to diminish the importance of mental health postpartum. The statistics show how worryingly prevalent mental health issues are for new mothers. There are a significant number of books that address postnatal depression and anxiety. Far fewer deal with physical recovery post-birth. I am very firmly of the opinion that the two are interlinked in any case. The mind-body connection has long been proven and, from a personal perspective, I know my mood would have been significantly better had someone taken proper care of my physical self after my birth experience. As it was, my world had been turned upside down by the arrival of this heart-wrenchingly cute and vulnerable little baby. I was exhausted, battered and swollen but very much expected to ‘just get on with it’ and accept unquestioningly any changes to my body, no matter how painful they might be. Many mothers ride a wave of emotions in those early days and months, as I did, but how much more reassuring would it be if there was a plan in place to piece you back together? At the moment, that service does not really exist within our over-stretched maternity services and so I hope this book will be your helping hand.
One thing I really feel the need to stress from the off is that after five pregnancies and two births (one vaginal, one caesarean) – I have never felt happier with my body. This book contains an overwhelming list of things that might happen to your body and, if you are currently pregnant or hoping to become so, you’d be forgiven for thinking ‘fuck that’! BUT, and this is a big but, not only may many of these things not happen to your body, but it is also critical to remember that your body has done a wonderful thing and needs love and appreciation. Equally you need to know when to push for more help, where to go and how to help your body heal optimally. I hope I succeed in showing you how to do this.
I think my positive/neutral attitude toward my body is partly because I thought that it might look and feel a lot worse after all I’d been through, but also because I was armed with the right information to take care of myself and I believe I am reaping the rewards of that. I don’t look perfect (whatever that is), but the way I feel about my body is way more important than that ‘perfect 10’ image, and I feel pretty good about my 40-odd-year-old mum-bod – jiggly bits and all.
A QUICK TOP-TO-TOE
Here is a brief rundown of the side-effects you could experience directly after birth or in the weeks, months and even years afterwards. I say ‘could’ because not all women experience the same side-effects. Some of you will be lucky and experience just a few, and hopefully not too drastically (I do look at those pictures of the Princess of Wales on the steps of the Lindo Wing and think ‘you poor woman’ as no one escapes all the glorious after-effects!). Some of you will experience many of them, but do not panic – there are ways and means of dealing with them all. The important thing is to recognise what is normal and what is not.
Hair postpartum hair loss, changes to hair
Head postpartum headaches and migraines, jaw pain, dizziness
Brain neurological changes
Hormones mood changes, fatigue, night sweats
Eyes changes to eyesight, dry eyes, floaters
Nose changes to sense of smell, rhinitis, size
Mouth changes to your teeth and gums, oral thrush from antibiotics, taste changes
Spine (neck, back) pain, postural issues, recovering from spinal block/epidural
Heart hypertension (high blood pressure), low blood pressure
Blood lochia, how you feel after blood loss and/or blood transfusion, taking blood thinners
Breasts swollen, sore breasts, leaking, mastitis, cracked nipples, nipple thrush, changing shape and size
Ribs expanded ribcage
Stomach and core how your belly feels after birth (including phantom kicks), diastasis recti, gut reaction to taking antibiotics, general weakness, stretch marks
Hips and Pelvis pain, postural issues, prolapse, pubic bone injuries, pelvic floor issues (including incontinence)
Uterus cramps, infection, shrinking back, endometriosis after c-section, painful or heavy periods
Vagina tears, haematoma, episiotomies, pain, dyspareunia, infection
Bum constipation, coccydynia, haemorrhoids, fissures, wind, incontinence, prolapse, pain
Legs varicose veins, spider veins, deep vein thrombosis
RECOVERY AFTER BIRTH– THE FIRST 24 HOURS
The first 24 hours after birth can be a bit of a blur. Your birth experience can, obviously, profoundly affect how you feel in the first few days and beyond. Whether you had a long labour, trauma, blood loss, or a planned caesarean section/abdominal birth – suffice to say birthing a baby and the subsequent recovery is not a walk in the park.
Firstly, I hope it went well! If there were any complications at all, with you and/or with your baby, I recommend a thorough debrief with the obstetrics and midwifery teams before you are discharged. Your health is your wealth, please don’t be fobbed off.
So what might you experience in those first 24 hours? Well, you’ll likely experience some pain, mostly around your vagina or your stomach – depending on what the mode of birth was. You may also experience nipple pain if you are beginning to breastfeed. You can request pain relief! I don’t remember having much after my first (vaginal) birth, even though I was very sore, but I did alternate paracetamol and oramorph (a kind of morphine that is only available in hospitals) after my caesarean birth.
My own experience, both times, was that I felt like I had been hit by a train after giving birth. I know it is not the case for everyone. I have heard of women who feel euphoric after birth, but I felt exhausted, achy and swollen. If you lose a lot of blood, you may feel particularly tired. If you needed an epidural or spinal block, whether as part of a vaginal birth or abdominal birth, you will need to regain the feeling in your legs before you can get up and move about. You may be wearing surgical stockings to help prevent blood clots. These are neither snazzy nor comfortable. If you have had any kind of surgery, you may struggle to walk in those first 24 hours – rest assured, this is normal. It will feel very debilitating and frustrating not being able to walk, particularly if you don’t have a birth partner with you. If this is the case, please flag it to your midwifery team as you will need help both tending to yourself (such as going the loo/showering) and your baby. Trapped wind is a common complaint in those early hours, so your stomach might feel swollen and sore, and remember the pain from trapped wind can manifest in odd areas of your body, such as your shoulder! You will bleed from your vagina after any type of birth and this blood and discharge is called lochia.
Red flags, which you should raise with your healthcare provider, include excessive blood loss, fever (chills), hives, oozing from incision sites, foul-smelling discharge, cloudy urine which is difficult to pass, severe pain, shortness of breath, feeling disorientated or a sense of doom, severe headaches and/or dizziness, and a throbbing or red/hot calf (this can indicate a deep vein thrombosis, which is a blood clot).
Don’t let the above alarm you. Some women will feel good and ‘well’ after birth.
POSTNATAL SYMPTOMS – OR BLOOD, SWEAT AND TEARS
Below is a pretty long list, though not exhaustive, of symptoms we may experience in the initial postpartum period. Should we call them ‘symptoms’ if we are not ‘sick’? Well, despite pregnancy being a natural state and not an illness, it often does create ‘symptoms’ (nausea, anyone?) in your body. Likewise, even if you do not have any conditions to contend with, the immediate postnatal period will result in some symptoms in your body.
Hormonal changes
The hormonal Molotov cocktail that happens straight after birth is perhaps the biggest hormonal shift to happen in a short period of time that any human will ever experience. How do you like them apples? This is a big deal. Both your progesterone (the ‘pregnancy’ hormone which helps establish and nourish an embryo) and oestrogen (a hormone which aids with womb lining and developing organs in the foetus), which have been so critical in helping you build your baby, plummet and very soon are back to baseline pre-pregnancy levels. At the same time, your body should be flooded with oxytocin (the ‘bonding’ hormone) and prolactin (originally named because of its function in enabling lactation). The way I am envisaging this is as a rollercoaster. During labour/pre-surgery you’re at the very top and then once you deliver your baby you go plunging downwards at breakneck speed – only to swoop back up for the next loop. No wonder you don’t know which way is up for that first couple of weeks. These dramatic hormonal changes, as well as emotional and environmental factors, can make you feel tired and weepy and can increase feelings of anxiety. Hormonal shifts can also affect your skin, joints and bones.
Oxytocin should help you feel ‘loved up’ and able to bond with your baby. Oxytocin and prolactin can, however, be affected by trauma and blood loss. This is why women having caesareans are often told (or were in the past) that their hormone levels after surgery may adversely affect bonding and breastfeeding. To balance this view, I lost more blood with my vaginal birth than I did with my (planned) caesarean, and I found breastfeeding and the availability of milk easier after my caesarean. As with most things, it is multi-factorial and there are many things – both environmental and physiological – which can affect the production of milk and your mood.
Oxytocin levels are at their highest level for one hour after the birth, which is one reason why it is called ‘the golden hour’. Your elevated oxytocin helps the uterus contract, which expels the placenta and cuts off the blood supply to it, helping to prevent a postpartum haemorrhage. It also enables the release of milk (colostrum initially) from your nipple; the infant’s suckling action boots the oxytocin into action to ‘eject milk’. Clever stuff. You can ‘up’ your oxytocin release with eye contact and comfortable stroking of the skin. This wonderful hormone also acts as an anti-inflammatory, increases your pain threshold, induces calm, and will warm up the skin on your chest for your newborn to snuggle in to. Oxytocin will likely remain raised, although gradually decrease, for about eight weeks postpartum. Studies have not yet concluded whether oxytocin remains higher or lower in lactating mothers, but there is a theory that oxytocin release by way of breastfeeding may paint part of the picture as to why breastfeeding mothers experience lower incidence of diabetes and cardiovascular issues.
Lochia
Lochia is pronounced lock-ee-ya. Yes, more blood for us women to contend with. But we’re used to it by now, right? Lochia is the discharge that comes out of your vagina after you have given birth. It is a mixture of blood, mucous and uterine tissue. Every woman that gives birth will experience this whether it was a c-section or vaginal birth. The amounts of blood and colour, consistency and so on will vary – as will the amount of time you bleed for – but, on average, it lasts for two to six weeks postpartum. With my first child I had heavy lochia for six weeks and with my second I had a very small amount for four weeks. You may notice heavier bleeding if you are breastfeeding as the uterus contracts as you feed. This bleeding should not be painful or smelly, you should not develop a temperature with it and very large clots should be flagged to your healthcare provider. A significant bleed, which soaks through more than one pad, and has much larger clots, should be investigated as there is a small chance it could be postpartum haemorrhage and not just lochia. Too much physical exertion can also increase lochia, so be mindful of that.