First week after delivery: How to cope with my wound?

​T​​he wonderful sensation of being a new mum has just begun to sink in, but now your body has to recover fully after the delivery. It is important to know the basics of proper wound care, be it an episiotomy or cesarean section wound. 

If you had a natural childbirth, it is possible that your obstetrician may have performed an episiotomy (read the article Pushing and delivery: Is an episiotomy needed?) for you. Some women also tear naturally during delivery. It is important to know how to take care of the wound so that it heals well with the least discomfort. To ease the pain and promote good healing of your episiotomy wound, the following can be applied: 

• ​​Icing — Immediately after the delivery it is useful to apply some ice packs (usually less than 10 mins) to the sore area as this will relieve the pain and help to “numb” the area. It will also help to reduce the swelling. This is usually done in consultation with the physiotherapist to prevent skin damage from excessive icing. 
• Perineal ice pad (e.g. Epi-Kool) - alternatively, you can try perineal ice pad which combines coldness and padding. This i​ncreases patient’s comfort and the coldness is activated by twisting the pad. 
• Good hygiene and wound care 
• ​Keep the area clean after you pass urine or move your bowels by rinsing the area gently with tap water. You can also use soft cotton balls soaked in Chlorhexidine liquid (a gentle non-stinging antiseptic) to gently clean the area three times a day for the first week. There is no need to use strong soaps. Clean gently from front to back to prevent germs from the rectum coming in contact with your wound. 
• Keeping the area dry reduces the pain and promotes healing. After washing yourself, you can try putting a hairdryer at the low heat setting to dry the area. Also keep the area dry by changing your sanitary pads regularly especially in the first week when the lochia is the heaviest. If you can, expose your wound to air as much as possible. 
• Avoid sitting for prolonged periods while the wound is still healing. The use of an inflated swimming ring or “doughnut” maybe useful as it relieves direct pressure on the sore area. 
• Pain control — Your obstetrician would have prescribed you some oral painkillers, e.g. non-steroidal anti-inflammatory drugs which may be stronger and more effective than paracetamol. There are also various anesthetic sprays or gels available which you might find useful. 
• Avoid constipation ​— Ensure you have regular bowel movements by drinking plenty of fluids, and take stool softeners, e.g. lactulose or Fybogel for the first two weeks. This ensures you do not become constipated. If you have had a third or fourth degree tear (one which involves the anal sphincter), ensure you keep bowel movements soft with stool softeners. Avoid the use of suppositories or enemas. 
• Sitz bath — The use of a sitz bath for the first week may relieve pain. A sitz bath is a small basin of warm water with a handful of salt thrown in. You can sit in it, immersing your hips and buttocks and this relieves the pain. 
• Pelvic floor exercises — Begin doing Kegel exercises as this will promote healing, improve blood flow to the area and improve pelvic floor tone (read the article on Pelvic Floor Exercises). ​

Care of a Cesarean Section Wound 

If you have had a cesarean section​, you will need to cope with your tummy wound. E​ach person’s recovery will be different, depending on the medical and obstetrical circumstances and general health of the patient. It is important to remember that it is a major abdominal surgery and you need to take things slowly.

• ​​Pain control — To prevent pain from the incision, painkillers will be prescribed. It is likely you will need regular painkillers up to two weeks after delivery. You may also experience uterine contractions, especially when breastfeeding. 
• Early ambulation — You should get out of bed early and start walking around. This will speed up recovery and prevent the development of blood clots in the veins. 
• Catheter care — In general, the catheter will be removed the next day after the operation. 
• Suture — The most commonly used types are the dissolvable ones. At times, you may be asked to return after a week to remove the non-dissolvable stitches or metallic staples. 
• Dressing — The dressing over the wound may be changed to a waterproof type before you are discharged from hospital. You can bathe but it is important to keep the dressing dry in the first few days. This can be removed after a week. The use of an abdominal binder helps to support the abdominal wall muscles when walking and this reduces pain. The incision wound will feel less painful as the days go by. 
• Breastfeeding​ — Breastfeeding can be started any time after delivery. ​
  

Social and Emotional Support ​

Social and emotional support from family members and friends is important. By the end of the sixth week, you should be fully recovered and be able to resume most of your activities. You should ask your obstetrician about beginning an​ exercise programme to regain abdominal muscle tone as well as Kegel exercises for your pelvic floor and when to return for a postnatal check-up. ​

FREQUENTLY ASKED QUESTIONS

1. When will my menstruation return after delivery if I am not breastfeeding? 

Most women have their first menstruation by ten weeks if they are not breastfeeding. 

2. When will my menstruation return after delivery if I am breastfeeding? 

Breastfeeding can delay menstruation ​for 20 weeks (five months) or more. However, it is not uncommon to find your period returning sooner or much longer than 20 weeks. 

Your Postnatal Visit 

At the time of a postnatal review, the doctor will ensure the following: 

• ​You are well and have no problems with fever, urination and defecation or abnormal vaginal discharge. 
  
• You have no breast related problems like engorgement or infections if you are still breastfeeding. 
• Your cesarean section or episiotomy wound has healed well. 
  
• Your pap smear​ is performed. 
  
• Discussing the various options of contraception​ available and helping you decide which is the most suitable. 
  
• If necessary, your blood pressure will be checked (especially if you had a problem with pregnancy related hypertension​) and your Oral glucose tolerance test performed at six weeks postnatal (if you suffered from Gestational Diabetes Mellitus​ during the pregnancy). 
  

​Your doct​or will decide on the appropriate follow up visits for you after the initial postnatal review. 

Did You Know?

It takes up to six weeks for all your pregnancy related changes in your body to revert back to its pre-pregnancy state.

Water retention (edema): You will experience increased urination (diuresis) immediately after your delivery but it may take up to four to six weeks for the swelling to resolve.

Womb (uterus): Six weeks to return to its pre-pregnancy size and position.

Per vaginal bleeding (lochia): Takes 4-6 weeks to completely stop. During the first week, the bleeding can be quite heavy but will gradually decrease. It usually changes from bright red to pink or brown, and may become yellow before it disappears.

Episiotomy: Takes a week for the pain to diminish and up to two weeks to heal.

Cesarean section wound: Six to eight weeks for the wound to heal. 

Acknowledgement

Source: Dr TAN Thiam Chye, Dr TAN Kim Teng, Dr TAN Heng Hao, Dr TEE Chee Seng John, The New Art and Science of Pregnancy and Childbirth, World Scientific 2008.

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