Urinary incontinence

Urinary incontinence is common and distressing pregnancy Urinary Incontinence And Pregnancyand postpartum problem. It is usually urinary stress incontinence. Stress incontinence happens when the bladder sphincter muscle does not function well enough to hold in urine in the bladder.

Recently I was called for a delivery. I arrived to find there was blood in the urinary catheter. The catheter had been inserted as the patient had an epidural block. I checked and found the blown-up balloon of the catheter was in her urethra. I deflated the balloon, removed the catheter and she went on to have spontaneous vaginal delivery. I inserted a new catheter into her bladder after delivery, which remained in situ until after the epidural had worn off. A catheter is essential with an epidural as otherwise it is likely bladder will become overdistended with urine and that will cause bladder function damage. She had a quick labour of one and hours duration with minimal pushing needed in second stage.

When I saw her the next day she said she was incontinent. She said every time she stood up urine ran down her leg. I advised her that the balloon coming through her bladder neck would have stretched the bladder neck and this temporarily would have made

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Why postnatal care is important

Before answering this question, what is the postnatal period needs to be considered. Why Postnatal Care Is ImportantPostnatal care considerations will vary for each postnatal time period.

The postnatal period starts after the third stage of labour (delivery of placenta) has been completed. It can be considered in three time periods:

  • Immediately after childbirth while the new mother is still in the birth unit.
  • In-patient postnatal period when mother and baby are still in hospital on the postnatal ward.
  • After discharge from hospital, which includes the six-week postnatal visit.

Many of the postnatal care considerations while in hospital are attended to by midwifery staff who report any concerns to the obstetrician (or junior medical staff if public patient).

While still in the birth unit

The main considerations in postnatal care are:

  • The immediate medical considerations are the basic clinical observations of blood pressure, pulse and temperature and addressing any abnormalities.
  • Checking baby’s wellbeing and that there are no obvious congenital anomalies.
  • Checking placenta is complete.
  • Making sure blood loss is
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Vaginal Looseness Postnatally

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

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 done?

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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 breastfeeding The liberal use of a good quality moisturiser and drinking adequate amounts of water can also help.


  • 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 moisturisers or more expensive skin products in your pregnancy (none work). There have to do with the elasticity of your skin (you don't control this) and often there is a
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Sexual Intercourse After Delivery

When can we start having sex again?sexual intercourse after delivery

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

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Rectal Bleeding Postnatally

I have bleeding from my rectum. Is that ok?Rectal Bleeding Postnatally

This is not an 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 litres 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. Occasionally you will need to see a colo-rectal surgeon if doesn't heal. If on

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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


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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.

Numbness of my Caesarean Scar

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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 to the wound after removal of the dressing. This also can be of

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Contraception after Pregnancy

When do I 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?

Contraception After Pregnancy - Microlut

If a combined oral contraceptive pill was used pre-pregnancy this is not recommended postnatally if breastfeeding 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 breastfeeding you should switch to a combined oral contraceptive pill as this is more effective.


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