Postnatal

Vaginal Looseness Postnatally

My vagina is still very stretched out. Will it ever return to its original size?perineum

After a vaginal delivery a woman will often notice that her vagina looks and feels more loose and open.

This is particularly apparent with sexual intercourse. It can have an impact on the enjoyment of sexual intercourse. There can be the embarrassment of "air trapping" and "vaginal flatus"with sex. She can also notice the looseness with tampon usage and occasionally stretching is such that tampons can no longer be used because they fall out.

As well women mention to me they don't like their vaginal opening appearance after they have had a baby vaginally and want it to look it did before they had a baby.

Vaginal looseness is a common phenomenon after a vaginal delivery, especially if you have had a big baby. It is caused by stretching of the vagina, especially vaginal entrance and of the pelvic floor musculature with the vaginal birth. Hence it is not a problem after a Caesarean section.

What can be

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Posted by Dr Gary Sykes on -

Skin and abdominal wall changes after childbirth

When will my skin and tummy muscles get back to normal?

Immediately after having a baby the abdominal wall feels loose and the skin feels dry. Pigmentation changes persist and occasionally are even worse for a while. Some women will experience stretch marks.

What can be done?

Abdominal wall skin dryness
  • While it will gradually get less, dryness of your abdomen skin can persist while  you are breast feeding The liberal use of a good quality moisturiser and drinking adequate amounts of water can also help.
Pigmentation 
  • Pigmentation changes can persist particularly while breastfeeding, though they should subsequently settle over time.
Stretch marks
  • Stretch marks are due to tearing in the deeper layers of the skin. They can happen at any stage of pregnancy but are more likely in advanced pregnancy. Sometimes they are only apparent right at the end of or even just after the pregnancy. They will happen or not happen irrespective of whether or not you have used
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Sexual Intercourse after Delivery

When can we start having sex again?iStock_000006807414XSmall_thumb

Sexual intercourse can be resumed once the lochia discharge ceases

Will it hurt?

Unfortunately it can be somewhat uncomfortable initially particularly after a vaginal delivery.

After a vaginal delivery there has often been damage to the lower vaginal and perineal tissues. Whether a vaginal delivery or Caesarean section sex can initially be more uncomfortable because of hormonal changes with the onset of lactation which means that the vagina is more dry and lacks lubrication. Also a woman's libido is usually not strong because she is more focused on the baby and developing her mothercraft skills.

What can be done?

Advise me of the problem and I will check to make sure that the vaginal and perineal areas have healed well. Occasionally there is a small amount of granulation tissue or excessive scar tissue which can be easily dealt with and so the problem can be corrected.

A vaginal lubricant

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Rectal bleeding postnatally

I have bleeding from my rectum. Is that ok?anal fissure

This is not infrequent question at the 6 week postnatal visit
It is usually due to an anal fissure. An anal fissure results from tearing the anal mucosa with passage of hard large stools.

What can be done about it?

  • You will need an examination to clarify diagnosis
  • Try to avoid hard large stools and constipation
  • Change your diet so you have more fruit and vegetables and less red meat (which can constipate you). Have bran, sultanas, prunes and liquorice. Keep away from processed food and junk food which is more constipating (as well as not being healthy for you).
  • Increase your water intake to 1 - 2 liters per day
  • Exercise with lots of walking . Lack of activity tends to constipate,
  • Metamucil or similar anti constipation medication can help
  • A topical anti haemorrhoid preparation can make you more comfortable

Usually it will heal after a short time.

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Postnatal Depression

I think I have postnatal depression!

Baby blues

After having a baby, up to 80 per cent of women may develop the 'baby blues'. This most common when milk is coming in which is on about day three after birth. You will typically may by tearful, crying with minimal or any provocation, feel overwhelmed and feeling you are not able to cope as a new mum. This feeling passes in a day or two and is different to postnatal depression.

Postnatal depression

Postnatal depression (PND) is a depression that comes on within 12 months of having a baby, usually during the first few weeks or months. It can range in severity from very mild and transient, to severe and lingering. For most mothers, it passes quickly; for others, professional help is needed.

Some women may experience depression during the pregnancy (this is called antenatal depression).

About one in eight mothers develop postnatal depression. Postnatal depression is most common after the first pregnancy.

What are the symptoms of postnatal depression? Read More...

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Numbness of my Caesarean Scar

Why is my tummy numb above my Caesarean scar?

This occasionally happens and is unpredictable. It  is due to the disruption of the nerve supply in the abdominal wall because of the Caesarean section incision.

What can be done about it?

Nothing. Over time normal skin sensation usually returns. Occasionally it doesn't and so some women will have ongoing numbness in that region.

Caesarean section wound_thumb Read More...

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Keloid

How can I avoid keloid in my Caesarean section scar?

Keloid forms if there is over healing of the skin wound and in this keloid_scarcase the Caesarean section scar. Often it has a familial tendency. It is more prevalent in highly pigmented people, especially women of African background. The keloid skin is raised, thickened and unattractive. As well it can be itchy and even painful.

What can be done?

The risk can be minimised with careful closure of the abdominal wall and particularly the skin. I use a closure technique and a particular dressing which helps minimise the chance of keloid occurring.

With a repeat Caesarean section I will always excise the old scar. This will include any keloid that has occurred in association with the old scar. With fresh edges and the excision of keloid and careful closure it is less likely that keloid will recur. If there is a marked predisposition then steroid injection with closure can help. Also I will sometimes give patients who are predisposed to keloid, topical steroid to apply

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Contraception after Pregnancy

When do In need contraception after I  have had my baby?

Breastfeeding will give some protection, especially while you are fully breastfeeding. Breastfeeding should not be relied on exclusively, as unplanned pregnancies do occur while breastfeeding and even before your first period.

What are the options?

microlut

If a combined oral contraceptive pill was used pre-pregnancy this is not recommended postnatally if breast feeding as is can result in suppression of milk supply. Rather a progestogen-only pill can be used, as it is less likely to reduce milk supply. Occasionally a progestogen-only pill can cause nuisance bleeding.  Also it must be taken within the same 3 hours time period each day to be effective. When you stop breast feeding you should switch to a combined oral contraceptive pill as this is more effective.

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Breastfeeding Problems

Below is information on the most common breastfeeding challenges.ObstetricExcellence2408 (100)

Engorged breasts

The signs of engorged breats are:

  • Larger, heavier and tender breasts.
  • Breasts hard and painful and warm to touch.
  • Swelling of breasts.
  • Firm nipples and areola.

What can be done about it?

  • Feed your baby frequently at least eight to 12 times per day.
  • Wear a support bra 24 hours per day while breasts heavy.
  • Apply a warm washer over each breast three to five minutes before feed.
  • Warm showers and express milk in shower.
  • Breast pump can help
  • Apply a cold compress for 20 minutes after feeding.

Sore nipples & cracked nipples

The impact of sore nipples and cracked nipples is painful feeding resulting in you deciding to

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Posted by Dr Gary Sykes on -

Breastfeeding

I want to breastfeed my baby

Darius and hospital may 2010 1681_thumb_thumb

Breastfeeding is feeding your newborn with milk directly from your breasts and not from a baby bottle or other container. Babies have a sucking reflex that enables them to suck and swallow milk. Most mothers can nourish their newborn infant (or infants in the case of twins) by breastfeeding for the first six months or more, without the supplement of infant formula milk or solid food.

Breastfeeding is encouraged where possible. Human breast milk is usually the best source of nourishment for infants. It helps prevent disease, is inexpensive, is convenient and helps with mother-baby bonding.

What can be done?

Put your baby to your breast adjacent to your breast as soon as possible after birth. Your baby will soon be finding your nipple and then you can help your baby attach. The midwife will help you do this. This will not though be possible while in the operating theatre if you

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