You've just had a new addition to your family, a precious entity in Singapore today. Taking care of yourself can help you to be strong when you face the challenges ahead.

By Nikki Macfarlane

Childbirth is an enormously stressful event - both physically and emotionally. After your baby is born you need to give yourself time for the adjustment of the new responsibilities of parenthood.

Physically, your body has many changes to make in the weeks following birth. Your tummy will take some time to return to its pre-pregnancy shape and still may never quite look as it did before you were pregnant. Your breasts may be different and you may have stretchmarks on your abdomen, breasts, thighs and bottom. Most women are exhausted, especially in the first few weeks, and can feel they are on an emotional roller coaster. It is important that you take care of yourself while also caring for your baby.

Changes To Expect
All women bleed after childbirth, regardless of whether their babies are born vaginally or by caesarean. This bleeding is called lochia and is the way your body sheds the lining of your uterus after your baby is born. The blood will initially be very red, slowly changing to a brownish discharge over the next few weeks. If the smell is offensive you should seek the advice of a doctor since this can indicate an infection.

Your body will look very different after you have had your baby. Your tummy may feel flabby and loose and will take a few weeks to start to return to its normal shape. Breastfeeding will help your uterus return more quickly to its pre-pregnancy size, which will help your tummy shape.

You may be concerned about stretchmarks. There is no cream or lotion that you can apply to stretchmarks to help them since it is the underlying layers that have been damaged. Over time they will fade to a silvery colour and will not be as obvious. Although you will lose the weight of your baby, the placenta and amniotic fluid after the birth, you may still find that you have a thickened waist, larger thighs and fuller breasts. Gentle exercise and a healthy diet will help you lose this weight. You may find yourself sweating a lot in the first few weeks as your body eliminates the excess fluid in your body.

Even if you are not planning to breastfeed, your breasts will initially produce milk and this is likely to make them slightly larger than normal. If your baby does not suckle at the breast the milk will eventually dry up.

Your breasts contain colostrum when your baby is born - highly nutritious first milk full of antibodies to help your baby. You may notice that on about day 3-5 you begin to feel your breasts becoming fuller or discomfort near your armpits as your milk "comes in". If you are breastfeeding you should offer your baby the breast often to help your supply establish itself and reduce the engorgement you may be feeling. Not all women experience engorgement - this does not mean that you do not have an adequate supply for your baby.

The Real Work Begins
Caring for a new baby is hard work. Your baby may be waking regularly throughout the night preventing you from never sleeping for more than a couple of hours. It is important that you rest whenever you can. If you sleep when your baby sleeps - rather than trying to catch up on household chores - may help. Having someone to help with the housework frees you up to spend the time enjoying your baby.

Many new mothers find they don't have enough time to eat properly in these early weeks. You need to eat proper meals and a healthy balanced diet during this time. Eating whenever you feed the baby is a good guideline and will ensure that you are eating enough. Perhaps your partner could prepare some of the meals while you rest.

Emotionally, the weeks following birth can be a difficult time. Many women experience the baby blues at around day 3 when they find themselves feeling sad and depressed - often for no obvious reason.

Give yourself time to adjust to your new responsibilities and ensure you are resting enough to help you through. If you had a difficult birth you may need to talk this over with someone to come to terms with your feelings. If this sadness does not seem to resolve itself, you may be experiencing postpartum depression - a condition that one in ten mothers experiences.

If this happens you need to seek help. Some women find talking to a counsellor beneficial while others may need anti-depressant drugs. The sooner you seek advice the quicker you will return to normal. Postpartum depression is a serious condition that requires some form of treatment - it is unlikely to go away on its own.

Your Sexual Life Resumes
You can begin to have sexual intercourse whenever you feel you would like to after the birth of your baby. But some women find they are not very interested for the first few weeks or even months, especially if they have had stitches. Also, women who breastfeed sometimes find that they do not feel very passionate since so much of their energy is directed towards their baby and their hormonal balance may be very different than before the birth.

Give yourself time to get used to the new feelings you are experiencing. You will need to consider contraceptive choices, even in the early weeks. You can ovulate as soon as two weeks after the birth and although breastfeeding exclusively reduces the likelihood of this happening it is not a full-proof form of contraception.

At around one week postpartum you will go to see your doctor for a postnatal check-up. A final check-up is then made at six weeks postpartum. Dr T.C. Chang, an obstetrician in private practice, says that he checks if a new mother is recovering well, whether or not she is having any problems with breastfeeding and that the uterus is contracting well at these appointments. At the six-week check-up he would do a Pap smear if the mother wants one and would also discuss contraceptive choices.

Here is a short summary of what to expect with the birth-control choices you may make:

Combined Pill
Can be taken immediately following birth

Do not take if you:
ú are breastfeeding
ú have diabetes or high blood pressure

Seek your doctor's advice if:
ú you have varicose veins
ú are over 35
ú are a smoker

Mini-Pill
Can be taken once milk supply is established if breastfeeding (6-10 weeks)

Diaphragm
Not suitable until six weeks after birth since it must be refitted after pregnancy and cannot be done accurately until this time

Intra-Uterine Device
Suitable from six weeks after birth

Condoms
Can be used immediately after birth but may need to also use lubricant since the vagina may be less well lubricated than normal.

Above all, congratulations on being a new mum! It's hard work. It's also great work to raise another human being. As the hand that rocks the cradle, your every move now echoes through eternity in the new life you are holding in your hands.

Date reviewed: 29 May 2000