The Challenge

All women experience vaginal blood loss (lochia) after giving birth. It comes from your uterus (womb) and the area where your placenta (after birth) was attached. Immediately after giving birth, it can seem like a heavy period, but the amount of blood lost should gradually decrease over the following hours and days.

Sometimes bleeding after birth is heavier than normal, this is called a postpartum haemorrhage (PPH). Primary PPH is when you lose about a pint or more of blood within the first 24 hours after the birth of your baby. Secondary PPH occurs when you have abnormal or heavy vaginal bleeding between 24 hours and 12 weeks after the birth. 

Definition

Lochia is the name given to the blood loss after childbirth. It comes from the area in your uterus (womb) where your placenta (aftebirth) was attached. 

Our Key Message

It is normal to have vaginal bleeding after you have a baby. Initially, vaginal bleeding can be like the start of a heavy period, but the amount gradually lessens over the first few hours, days and weeks. Over the first two weeks and up to six weeks, the amount of blood loss should decrease to a light vaginal discharge, the colour will also change, from bright red to light pink or brown. Be aware of the pattern of change of your blood loss, it should decrease over time and you should never have a sudden increase in blood loss or pass large clots. 

In the first few days after birth, some women may notice that their blood loss happens, mainly, during and after breastfeeding. Some women get cramps in their tummy (after pains), like period pains, because the hormone that makes your milk flow, also makes the muscles in your uterus contract (tighten). These should lessen over the first few days and week and should not persist. 

Self Assessment & Management

Be aware of the pattern of change of your blood loss. Keep yourself feeling fresh and clean, by regular washing, baths or showers. Don't use tampons, use sanitary pads and change them regularly throughout the day. 

Identify the point where professional help is needed

Seek professional help if:

• Your blood loss become heavy, suddenly or even over a few hours, when it had been decreasing in amount.
• You pass any large clots, (the size of a tennis ball or bigger) especially if you have not passed any clots before, or if you notice that your blood loss has become a lot heavier than it had been.
• You think there is a bad or unpleasant odour of your blood loss.

Keep the sanitary pad(s) or clot(s) so that your midwife, doctor or healthcare professional can examine them – this will help them assess the amount of blood lost and decide on the type of treatment you may need.

Always get immediate help if your vaginal blood loss becomes heavy. 

How to seek help

Always seek immediate professional help if you have sudden or persistent heavy bleeding, the blood loss is soaking through your sanitary pads and you have to change your sanitary pads very frequently, every hour to two hours.

Always ask for advice if you are unsure of what is and is not normal.

Links to and other resources

Checklist

Tell your healthcare professional:

• All of your symptoms
• When the pain or symptoms began

Other Resources

The Challenge

The arrival of your newborn baby is a huge event. It can bring a lot of excitement and happiness but there are also challenges and uncertainty that can cause you to feel stressed, scared and anxious. Women can experience a range of mental health issues during this time, so it’s important to:

• Know the signs and symptoms of mental health issues,
• Know that help is available, without judgement or criticism,
• Know how to seek help. 

Definition

Anxiety: Anxiety is a normal adaptive response to stressful situations. In pregnancy and motherhood, it can be considered normal to have some worries or fears, however these worries or fears can become a problem when they are persistent and disruptive and negatively impact your ability to enjoy pregnancy and motherhood, to care for yourself or your baby and function in everyday life.

Depression: Postnatal depression is the term used for depression that some women experience in the first year after having a baby. Postnatal depression can include a broad range of symptoms such as feelings of sadness and low mood, a loss of appetite and fatigue, feeling irritable or restless and feelings of failure or inadequacy.

Our Key Message

Mental health problems can affect anyone, help is available, and mental health issues can be overcome and managed. Seeking help and receiving treatment for your mental health is a positive act of self-care so that you can enjoy life and motherhood on your terms.

Self-assessment and management

Are you feeling stressed, worried or tense most of the time? Do you feel low, sad or cry without really knowing why?

Are these feelings persistent? Have they lasted for two weeks or longer?

Are they disruptive to your life? Are they preventing you from enjoying time with your baby, enjoying things you used to like or affecting your relationships?

• Talk to someone you trust about how you are feeling. Getting the conversation started can help you to identify some practical areas in your life where you can make changes to improve your mental health.
• Make time for yourself: asking for and accepting help from loved ones can give you space to better cope with your thoughts and feelings, and assess when you need to seek professional help.
• Make an appointment: speaking with a counsellor or psychologist is not just for people with mental health concerns. Everyone can benefit from having a calm space to talk about their worries without judgement. 

Identify the point where professional help is needed

You should seek help from a healthcare professional when

• Feelings of anxiety or depression are persistent, or they are lasting for longer than two weeks.
• They are interfering with your ability to function in everyday life, to do things you normally would be able to do, or to care for yourself or your baby and are affecting your ability to enjoy life and time with your new baby.

Seeking help from a healthcare professional will help you make a plan, and focus on what you can do to address these issues so that you can return to positive mental health.

How to seek help

Make an appointment with a healthcare professional. This can be your local doctor or midwife, nurse, or another healthcare professional like a counsellor. 

Several mental health charities and organisations around the world have helplines. If you are unsure of which healthcare professional you should talk to in your area, your local mental health organisation can give you this information. 

Links to and other resources

Checklist

Tell your healthcare professional:

• About how you have been feeling.
• How long you have been feeling this way.
• How these issues have affected your life; have they have affected your ability to do everyday things? Have they have negatively affected your relationships with your partner, family or friends? Do they limit your ability to care for yourself or your baby
• Ask about treatment options, such as counselling. 

The Challenge

Data from the MAMMI study shows that more than one in two women experience urinary incontinence, or leaking urine, three months after their first baby’s birth, and one in five women still leak urine one year after the birth. Women who leak urine can feel alone and embarrassed, and afraid to talk about it. Often, women may feel that; ‘there’s nothing that can be done about it’ or that ‘it’s normal during pregnancy and after childbirth’.

Urinary incontinence is NOT normal, and can be treated, and in the majority of cases, cured. 

Definition

Urinary incontinence is defined as the involuntary loss of urine, leaking any amount of urine when you don’t mean to.

There are a few types of incontinence, and the main ones are:

• Stress (urinary) incontinence: leaking urine due to physical exertion (e.g., sporting activities), or when sneezing or coughing. The term ‘activity related incontinence’ might be preferred in some languages to avoid confusion with psychological stress.
• Urgency (urinary) incontinence: involuntary loss of urine associated with urgency.
• Mixed (urinary) incontinence: involuntary loss of urine associated with urgency and with effort or physical exertion or when sneezing or coughing.
• Coital incontinence: leaking urine during sexual intercourse.

Our Key Message

Urinary incontinence is NOT normal, and can be treated or cured. Pelvic floor muscle exercises (PFMEs) are the first line of treatment. Our women’s health physiotherapist has developed a lovely coached PFMEs task to help you get started and become confident in doing the exercises.

Self-assessment and management

Are you leaking any urine at all? Does it happen during exercise, or when you cough, laugh, sneeze, or even when you lift your baby or child? Does it happen when you are on your way to the toilet, or have to wait to get to the toilet?

If you answer yes to any of these questions, then the first line of treatment and management is to do pelvic floor muscle exercises (PFMEs).

Key questions to ask yourself about doing PFMEs are:

Can you do these exercises? Are you confident you are doing them correctly? Do you know when and how to do them so that the muscles get stronger and more coordinated?

Identify the point where professional help is needed

If you are confident that you are doing the exercises correctly, and STILL leak urine, even if it is only when you laugh, cough or sneeze, or when you do some exercises, then you should talk to and discuss your symptoms with a healthcare professional, ideally a woman’s health physiotherapist. 

How to seek help

The first thing to understand is that leaking any amount to urine is not normal and can be treated. Conservative, non-invasive approaches such as PFMEs are usually the first line of treatment.  The first step to regaining control of leakage is to ask for help. Don’t be afraid to speak with your healthcare professional, and seek a referral to a women’s health physiotherapist. They can help identify the best plan of action for you.

Links to and other resources

Checklist

Tell your healthcare professional:

• When you started leaking urine.
• What causes you to leak, how much and how often.
• What you have done to manage the problem.
• How leaking urine has affected your daily life. 

The Challenge

Some women can experience pain when they resume sexual intercourse after giving birth to their baby. Some may also experience a decreased, or lack of, interest in sexual activity after birth and in the following months.

Definition

Dyspareunia: this is pain experienced during sexual intercourse. It may happen when the penis enters the vagina, during penetration, during orgasm or at all of these times. Lack of interest in sexual activity: this is an absence of interest in sex or sexual activity and is a little bit different to a lack of sexual desire or lack of sexual arousal.

Our Key Message

Many women experience sexual health issues in the first few months after birth. For most women this resolves by 12 months after birth. While 54% of women experienced pain during sexual intercourse during the first 3 months after birth, just 20% reported pain at 12 months after birth.

Twelve months after birth, 40% of women said they experienced a lack of interest in sexual activity, yet nearly 70% of women remained satisfied with their overall sexual life. Therefore, having a lack of interest in sexual activity does not mean that women were dissatisfied with their overall sex life.If pain during sexual intercourse persists or if your lack of interest in sexual activity is causing you concern you should speak with your healthcare professional, such as your doctor, public health nurse, midwife or women’s health physiotherapist.

Self-assessment and management

Simple solutions such as using a good quality water-based lubricant, taking longer to build up to sexual intercourse, and trying different sexual positions where penetration can be controlled, may help resolve pain during sexual intercourse.

Good communication between the couple has been shown to be one of the effective ways of staying emotionally connected to a partner. Talking about adapting to parenthood, feeling isolated as a new mother, concerns about the baby’s well-being, changed interest in sexual activity and feelings of guilt associated with lack of interest in sexual activity enables couples to understand each other’s experiences.

Identify the point where professional help is needed

If pain during sexual intercourse persists after trying the above solutions, and if it is interfering in your ability to feel sexual pleasure, you should seek advice from your healthcare professional. 

How to seek help

You can contact your local doctor or a women’s health physiotherapist for advice with sexual health problems. Following a thorough assessment, you may benefit from a referral to psychotherapy, counselling or gynaecologist.

Use simple everyday language with your healthcare professional, avoiding euphemisms. For example, ‘it is very painful when he enters me’ or ‘it is really sore during penetration’ or ‘I cannot feel his penis in me at all during sex’. Identify solutions that you have already tried and emphasis the negative consequences that the problem has had in your life and relationship.

Links to and other resources

Postpartum sexual health is covered in more detail in Week 4.

Checklist

Tell your healthcare professional:

• How long has the issue persisted.
• How it makes you feel, and the impact it has on your relationship.
• What you have done to manage the problem.
• Are there private care options (e.g. physiotherapy, psychotherapy) available?

The Challenge

Breastfeeding can sometimes be challenging, particularly if there are complications, such as a breast inflammation or infection (mastitis). Mastitis can create negative feelings around breastfeeding, and can often lead to women stopping breastfeeding, which may lead to disappointment and feelings of distress, or even a sense of failure.

Definition

Mastitis is inflammation of the breast that sometimes involves an infection. It is usually caused by milk being trapped in the breast or if bacteria has entered the breast through little cracks in the skin of the nipple or through a milk duct opening. It usually occurs in the first few months after giving birth. Some symptoms include:

• Generally feeling ill, run down or achy. You may experience nausea or vomiting
• Breast pain
• Your breast may feel warm or hot to the touch
• A tender lump or area of hardness on your breast
• A burning sensation when breastfeeding.
• A fever of 101℉ (38.3℃) or higher may be present or you may also have no fever.

Our Key Message

Mastitis is common and affects between 7% and 20% of women who are breastfeeding. However, it is not normal and it can be treated effectively. If you think you have mastitis, it is important to talk to your midwife, public health nurse or doctor, as soon as possible. If left untreated, it may lead to complications such as a breast abscess, which is much more difficult to treat and may need to be drained surgically.

Self-assessment and management

If you have any of the symptoms of mastitis, contact your midwife, public health nurse or doctor as soon as possible to avoid any complications.

To manage symptoms you can:

• Wash your hands before touching your breasts.
• Avoid putting pressure on your breasts - wear a supportive bra and light, loose clothing.
• It is safe to continue breastfeeding even with mastitis. Breastfeeding regularly helps clear the infection.
• Before feeding, place a warm, damp cloth on your breast or take a shower. This helps to get the milk flowing.
• Use a cold pack on the affected breast to help reduce swelling after feeds.
• Try changing feeding positions, to help empty your breasts. Aim to breastfeed every two hours, or whenever your baby is hungry. Try to start feeding with the affected breast. Massage your breast gently behind where it is sore, using a circular motion towards the nipple. If you are in pain, you might not be able to feed from your breast. If this happens, try breastfeeding on the unaffected breast and try switching back once the supply starts to flow. If breastfeeding is too painful, you could try use hand-expression or a breast pump.
• Over-the-counter pain medicine such as paracetamol or ibuprofen can help relieve pain.
• It is important to rest if you feel you have mastitis. Ask your partner, family or friends to help out around the house.
• Remember to empty the breast and get lots of rest.

Identify the point where professional help is needed

Again, if you think you have mastitis, contact your midwife, public health nurse or doctor as soon as possible to avoid any complications.

Contact your doctor right away if :

• You don’t feel better in 8-24 hours after following the steps above or you begin to feel worse
• You still have a fever or suddenly develop a high fever (38.4° C [101° F] or higher)
• You have a lump that does not get significantly smaller within a week.

How to seek help

Contact your family/local doctor, or healthcare professional

You may also want to seek support for breastfeeding from your local support group. Full details of support groups in Ireland are available here.

Links to and other resources

Mastitis/ Common Concerns/ Mastitis/ Mastitis Breastfeeding

Checklist

Tell your healthcare professional:

• All of your symptoms
• When the pain or symptoms began.

The Challenge

The anal sphincter can tear during childbirth, or the nerve supply to the sphincter can become damaged (neuropathy). This means that women will lose sensation and be unable to control passing faeces or wind.

Data from the MAMMI Study showed that one in 100 women leaked faeces (stools), even BEFORE their first pregnancy, and one in ten women leaked faeces three months after giving birth. Another study found that 7.1% of women, that’s one in 14 women, leaked faeces four years after their first baby’s birth. 

Definition

Anal incontinence is the involuntary leakage of faeces (stools) or flatus (wind). Faecal incontinence is the involuntary leakage of faeces, solid or liquid.

Faecal incontinence could happen for several reasons.

It could be due to:

• Damage to the anal sphincter, the muscle at the back passage;
• Not being able to contract (tighten) the anal sphincter because of nerve damage;
• A combination of sphincter damage and nerve damage;
• Overflow incontinence, seepage of stools due to faecal impaction (severe constipation)

Our Key Message

You should not have to tolerate, or put up with, not being able to control when you pass wind or faeces. It is not normal and can be treated. You can learn to control it, and get help for it. 

Self-assessment and management

If you leak faeces and it is not caused by a short-term illness such as a tummy bug or infection, you should seek professional help straight away. 

• Good bowel habits are important. It is often easier to empty them first thing in the morning so having a healthy breakfast can stimulate your bowels to move.
• Use correct toileting posture; sit on the toilet with your feet up on a little stool so that your knees are higher than your hips. Lean forward and rest your elbows on your knees. Take a low deep breath in and let your tummy expand. Bulge and brace your tummy out as you push to empty the bowels. Open your mouth and make a sound like ‘urgh’ as you push. Once you have finished emptying your bowels, do a few pelvic floor squeezes, starting at the back passage to make sure you have emptied fully.
• When you get the feeling of urgency, stand or sit still. Take a few deep breaths and do your pelvic floor squeezes, concentrating around the back passage. Wait until the urgency begins to pass, and then walk directly to the toilet. This will help give you more control rather than rushing to the toilet immediately as the act of walking can make the urgency worse.

Identify the point where professional help is needed

Faecal incontinence is never normal, but help is available. If you experience ongoing faecal incontinence that is not due to a tummy bug or infection, you should seek professional help straight away. 

How to seek help

It can be very hard to tell someone, even a healthcare professional, that you cannot control passing faeces. However, it is important to get professional help because faecal incontinence can be treated or cured so that you regain control. Speak with your healthcare professional, this may be your doctor, practice nurse or public health nurse. 

Links to and other resources

Pregnancy

Fecal Incontinence Female

Checklist

Tell your healthcare professional:

• When you started leaking faeces.
• What causes you to leak, how much and how often.
• What you have done to manage the problem.
• How leaking faeces has affected your daily life.

The Challenge

If you gave birth vaginally, you may have experienced a tear or had a cut (episiotomy) in your perineum (the area between the vagina and back passage) which needed sutures (stitches).

If you had a caesarean section, you will have an abdominal (tummy) wound.

Most of the sutures used dissolve themselves and don’t need to be removed. Your health professional should tell you what type of sutures you have, but be sure to ask if these need to be removed or will dissolve themselves.

Wound healing follows a particular pattern. To keep yourself well and healthy, know the signs of normal healing and signs of wound infection.  

Definition

A wound is an injury (cut or tear) to living tissues. Women may have wounds following birth from episiotomy cuts, tears to the perineum or from a caesarean section. 

Our Key Message

Normal wound healing, regardless of where the wound is, follows a particular pattern.

Over the first few days after giving birth, you will probably need to take pain relief to help you deal with your wound pain, but you should notice that the pain decreases gradually and you need to take less or even no pain relief. Once the pain starts to ease, it should never get worse again. Track your healing process and be aware of any changes.

A wound that is healing well is clean and dry, and it doesn’t smell. It causes you less pain over time. It doesn’t bleed or ooze fluid, either blood-coloured or clear fluid. The two sides (surfaces) of the wound stay close together and there are no gaps or hot red spots in it, and they gradually change in colour, back to the colour of your own flesh.

Self-assessment and management

While you are having care after the birth, your healthcare professional will look at your wound and check to make sure it’s healing, but have a look at your wound in a mirror and see what it looks like for yourself. This will help you see how it heals over time, but you will feel it healing.

The most important point is that once the pain starts to ease, it should never get worse again. Your wound should be clean and dry. Take regular baths or showers in plain water, you don’t need to add anything to the water. After you have washed, dry your wound well with a clean towel – ‘pat’ it dry, as rubbing it will hurt you.

Identify the point where professional help is needed

Seek advice or help if:

• Your wound was clean and dry but starts to bleed or ooze
• You notice that the sides start to separate or come apart, even in just one part of it
• The pain was easing but is getting worse again
• You have pain in one part of it and it is not going away
• You have a sharp burning pain in any part of it
• You notice that your wound has a smell

How to seek help

Contact your local doctor or healthcare professional if you have any concerns about wound healing. Attend an 

Links to and other resources

Recovering Home after C-Section

Recovering after an Episiotomy

Your Body after Baby the first 6 weeks

Checklist

Tell your healthcare professional:

• All of your symptoms
• When the pain or symptoms began 

The Challenge

One in five women may experience pelvic girdle pain (PGP) at any stage in their pregnancy. The pain can vary from being mild to very severe and can limit your activities, ability to work or mind your children. Certain tasks or movements may make the pain worse. Another common difficulty is getting comfortable at night or turning over in bed. The pain may be constant or come and go. Many women find that it improves when you reduce your activities and take frequent rests.

Definition

Pelvic Girdle Pain (PGP): PGP is pain in the joints that make up your pelvic girdle. Pain can be in the pubic joint at the front, or in one or either of the two sacroiliac joints at the back. Pain can occur in the hips, buttocks or perineum (the area between the vagina and back passage). Symphysis Pubis Dysfunction: refers specifically to pain in the front of your joint where the 2 pelvic bones meet.

Our Key Message

Pelvic Girdle Pain is common in pregnancy but can be managed by self-help strategies and pacing your activities. The sooner you seek help, the easier it will be to manage your pain.

The key message is do more of what helps your pain and less of what hurts you. It may be that you have to stop doing some exercises or reduce your activities to let the pain settle. Don't be afraid to seek help from family or friends.

Pelvic Girdle Pain rarely persists after pregnancy; if you are still experiencing or develop pelvic girdle pain after giving birth speak with your healthcare professional.

Self-assessment and management

Having a good posture in pregnancy is important, and finding how to stand or sit well as your pregnancy progresses will help reduce your back and pelvic girdle pain.

Use pillows to help support your tummy and legs in line with your hips when you are resting in bed, and keep your hips and knees in line when rolling over to avoid twisting your back. Use your arms and elbows to go down on your side to get in and out of bed.

Heat packs are useful on sore muscles of the buttocks and lower back. Ice packs over your underwear can help reduce pubic joint pain. A spiky ball or tennis ball can be rolled over sore muscles to ease painful areas.

Identify the point where professional help is needed

If you are finding that pelvic pain is limiting your daily activities, ability to work or disturbing your sleep, you will benefit from being assessed by your women’s health physiotherapist.

How to seek help

You should seek help from your healthcare professional who may be able to refer you to your women’s health physiotherapist. You may be assessed for a sacral belt, a belly support such as tubigrip or you may need crutches.

Links to and other resources

Pelvic Girdle Pain in Pregnancy

Pregnancy

Checklist

Tell your healthcare professional:

• When you experience pain.
• What you have done to manage the problem.
• How the pain has affected your daily life.