What to expect when you're expecting (217 page)

What are the signs and symptoms?
The symptoms of postpartum hemorrhage include:

Bleeding that soaks through more than one pad an hour for several hours in a row

Heavy, bright-red bleeding for more than just a few days

Passing very large clots (lemon size or larger)

Pain or swelling in the lower abdominal area beyond the first few days after delivery

The loss of large amounts of blood can make a woman feel faint, breathless, dizzy, or cause her heart to speed up.

What can you and your practitioner do?
After the placenta is delivered, your practitioner will examine it to make certain that it’s complete—that no part of it is remaining in your uterus. He or she will probably give you Pitocin (oxytocin) and may also massage your uterus to encourage it to contract, in order to minimize bleeding. Breastfeeding (if you will be nursing) as soon as possible will also help your uterus to contract.

You should expect bleeding following delivery, but alert your practitioner immediately if you notice abnormally heavy bleeding or any of the other symptoms listed above during the first postpartum week. If the bleeding is severe enough to be categorized as hemorrhage, you may need intravenous fluids or possibly even a blood transfusion.

Can it be prevented?
Avoiding any supplement or medication that may interfere with blood clotting (such as the ones listed on the previous page), especially in the last trimester and the immediate postpartum period, will reduce the possibility of abnormal postpartum bleeding.

What is it?
The vast majority of women recover from delivery without any problems at all, but childbirth can occasionally leave you open to infection. That’s because it can leave you with a variety of open wounds—in your uterus (where the placenta was attached), in your cervix, vagina, or perineum (especially if you tore or had an episiotomy, even if it was repaired), or at the site of a C-section incision. Postpartum infections can also occur in your bladder or kidney if you were catheterized. A fragment of the placenta inadvertently left behind in the uterus can lead to infection, too. But the most common postpartum infection is endometritis, an infection of the lining of the uterus (the endometrium).

While some infections can be dangerous, especially if they go undetected or untreated, most often infections simply make your postpartum recovery slower and more difficult, and they take time and energy away from your most important priority: getting to know your baby. For that reason alone, it’s important to get help for any suspected infection as quickly as possible.

How common is it?
As many as 8 percent of deliveries result in an infection. Women who had a cesarean delivery or those who had premature rupture of the membranes are at greater risk of infection.

What are the signs and symptoms?
Symptoms of postpartum infection vary, depending on where the infection is, but there’s almost always:

Fever

Pain or tenderness in the infected area

Foul-smelling discharge (from the vagina in the case of a uterine infection, or from a wound)

Chills

What can you and your practitioner do?
Call your practitioner if you’re running a postpartum fever of around 100°F for more than a day; call sooner if the fever is higher or if you notice any of the other symptoms above. If you have an infection, you’ll probably receive a prescription for antibiotics, which you should take as prescribed for the entire course, even if you begin to feel better quickly. You should also get plenty of rest (a near impossibility with a newborn in the house, but do the best you can) and drink lots of fluids. If you’re breastfeeding, check with your physician and your pharmacist to be sure that any medication you’re given is breastfeeding-friendly (most antibiotics are).

Can it be prevented?
Meticulous wound care and cleanliness after delivery (wash your hands before touching the perineal area, wipe from front to back after going to the bathroom, and only use maxi pads—not tampons—for postpartum bleeding) can definitely help prevent infections.

If You’re Put on Bed Rest

The thought of lying in bed with a stack of magazines and the TV remote may sound pretty appealing—until it’s prescribed in the form of bed rest. Bed rest, unfortunately, is no pajama party. Once reality sets in and you realize that you can’t even run out for milk or meet some friends for a latte, the appeal of lounging around all day is quickly lost. That’s why it’s important not to lose sight of the big picture (healthy pregnancy, healthy baby) and to remind yourself that your practitioner probably has good reason for keeping you off your feet.

If you’ve been put on bed rest, you’re in good company. A million pregnancies a year (that’s one quarter of pregnancies) are classified as “high-risk” or “at-risk.” And 70 percent of these moms will be put on bed rest at some point during their 40 weeks. Even though there is much controversy surrounding the benefits of bed rest, it continues to be prescribed because many practitioners believe, based on their experience with their patients, that it works in preventing preterm labor or slowing the progress of preeclampsia and keeps an otherwise high-risk pregnancy from becoming more complicated. Among the rationales suggested for a prescription of bed rest: Staying off your feet takes pressure off the cervix; it reduces the strain on your heart and improves blood flow to your kidneys, which helps eliminate excess fluids; it increases circulation to your uterus, providing additional oxygen and nutrients to your baby; and it minimizes the level of stress hormones in your bloodstream that can trigger contractions.