Sony Karki, 31, had been married for three years when she gave birth to her first child – a beautiful baby girl. An interior designer by profession, she had recently started her own business when she conceived. She worked for 12 hours a day until weeks before she gave birth and resumed work a month after Suruchi was born.[break]
“Between taking care of the baby and work responsibilities, I hardly had time to take care of my own health,” says Sony for whom post-delivery care was limited to making sure she had her meals on time. She admits that many advised her against going back to work so soon and were quick to make snide remarks when she left her month-old infant under her mother’s care as she went about meeting clients and working on proposals.
Photo:Bikash Karki
“I didn’t know what else to do. I also had my career to think of as well as a baby who needed me,” she says, adding that in hindsight she wishes she had taken some more time off. “Now I think I should’ve given myself a few months off and taken care of myself,” laments Sony who had to face problems like postpartum hemorrhage and uterine infection for weeks after delivery, and to top it off, she recently had a miscarriage three months into her second pregnancy.
According to her gynecologist, she had severe anemia as a result of negligence and lack of proper care after giving birth to Suruchi, and that posed complications the second time she conceived which eventually led to miscarriage.
In the postpartum period, which begins immediately after delivery, the body starts healing from childbirth, rebuilds its strength as the internal organs start regaining its pre-pregnancy state. During this crucial stage, it is imperative that women rest and give their bodies ample time to recover, and not doing so may have grave repercussions. From post-pregnancy health complications to future pregnancy difficulties, the downsides of not taking care of yourself post-delivery are aplenty.
Many women, in today’s age and context, can probably relate to Sony. You know well that you have not fully recovered from the very stressful event – also known as pregnancy –when work pressures compel you to jump on your feet. The need to juggle your career and motherhood poses a challenge that many are forced to take up without a second thought.
The notion of the “working mom” has always been a debatable issue, and the current discourse is no different, as it is rife with varying opinions and judgment. On one hand, going back to work post-baby is a matter of health for many. Various studies have shown that working mothers reported fewer symptoms of depression and were more likely to be in better health as compared with non-employed mothers. While on the other hand, going to work too soon may deprive your baby of the care it needs as well as prove to be harmful to a woman’s own health in the long run.
A lot of women also experience a horde of physical problems as a result of labor and birth, or because of having to go back to work they are unable to give their bodies the much required rest. Problems such as recurring infections, back pain, a leaky bladder and painful intercourse are some of the most common problems women face post pregnancy.
Nevertheless, many women are now opting to resume work as soon as they can. Doctors are of the opinion that though when a woman chooses to go back to work is a personal matter, she needs to make sure she takes care of her health and not put herself under unnecessary stress. As with all changes, there are also emotional and psychological adjustments to make when you return to work after maternity leave.
Kabita T. Rongong, employee at Ekta Books Pvt. Ltd, resumed work three months after delivering Namthak, her now four-month-old son. Though she had had a vaginal delivery, the post-delivery period was quite a challenge. Besides taking care of her newborn, she had to nurse recurrent infections for weeks afterwards.
“I was still not completely fine when I joined work but I had no other option,” says Kabita, explaining that due to the added responsibility of the baby, she had to work. However, Kabita admits that her health hasn’t been up to the mark post-delivery and that she continues to suffer from health issues every now and then.
“Having a baby changes your body in ways you never thought possible. It’s a wounded body as there are so many things wrong with you internally,” says Elizabeth Tiwari, MD at Pilgrims Book House whose four-month-old son, Siddhartha, is quite a handful.
Photo:Keshav Thoker
Siddhartha was just six days old when a fire at a lounge near their bookstore in Thamel reduced the place to ashes, forcing Elizabeth to return to work merely a month after she had undergone a Caesarean section. She did not get a chance to recover fully as the time she should have ideally spent taking care of her “wounded body” had to be given to managing accounts and dealing with customers.
Sony and Kabita also admit to feeling guilty about leaving their babies under their parents’ care while Elizabeth is disheartened by the fact that she has to lug her baby along to work. No matter how long and hard you have thought about your decision to return to work and how sure you are that it is the right choice, women confess to having mixed emotions every single day.
“You may feel guilty about leaving your baby in someone else’s care or not being able to give enough attention to them,” says Sushma Mukhiya, a psychologist, adding that postpartum depression is also one of the major issues women have to battle post-pregnancy.
“When women deprive themselves of the essential care that’s needed post-delivery, they also deprive their babies of proper nurturing. I’ve seen many cases where women are too depressed to attend to their babies’ needs,” says Mukhiya, adding that post-delivery care is essential not only to ensure the mother is healthy physically but mentally as well.
Whether or not to pursue a career, or give all your time to your baby, is a very personal and entirely individual decision that depends on many factors. But no matter what you choose, the one thing that should not change is paying attention to your own needs – physical, mental and emotional. The babies will turn out to be all right, perhaps even better, when Mom puts herself, if not first, then pretty close to the top of the priority list.
Normal delivery vs. Caesarean section
More women today appear to be opting for a Caesarean section (C-section) instead of giving birth naturally. Maternal request for delivery by C-section is reportedly on the rise and has been blamed, in part, for the continuing rise in the C-section rate.
The reason for women opting for C-sections might vary but one of the most common reasons is fear of episiotomy – a surgically planned incision on the perineum and the posterior vaginal wall during the second stage of labor.
The idea of someone taking a knife or scissors to an area as sensitive as the vagina is a terrifying prospect – one that compels women to opt for surgery instead.
“I opted for a C-section because I have a very low tolerance for pain,” says Swasti Regmi, 35, mother of two daughters, both of whom were delivered through C-sections. For Regmi, enduring hours of labor pain was out of question as she was someone who would faint even after a single tetanus shot.
A caesarean is quick in comparison to labor which can go on for hours. Also, it is perceived to be pain-free. Many women also believe that the risk of the baby dying during its birth is comparatively lower in a C-section as there is no chance of the infant suffocating or choking to death in the birth canal.
However, doctors recommend normal deliveries and only tend to opt for C-sections when there is a strong clinical indication.
“Only when and if the mother’s or the child’s health is endangered, do we opt for surgery,” says Dr Shanti Shrestha, obstetrician-gynecologist, explaining that surgical intervention becomes only necessary when the baby gets stuck in the birth canal or the mother is unable to push.
But many women still tend to prefer C-section to vaginal delivery since it is quick and relatively painless as childbirth is carried out under anesthesia. However, the post-pregnancy period can be quite difficult in case of C-sections and the recovery time is prolonged than in the case of vaginal deliveries which don’t make it a perfect solution as many think it to be.
“The recovery time is prolonged in the case of C-section as with all kinds of surgeries,” says Dr Shrestha, adding that while a woman who has given birth vaginally can resume a normal lifestyle within a few days, the case isn’t the same when someone has given birth surgically.
According to her, even though caesarians are substantially less painful than vaginal birth, the difference in pain three days postpartum is not huge.
As far as the health of the child goes, it is believed that babies born vaginally have a lower risk of respiratory problems as the contractions of labor help prepare the baby’s lungs. Babies born through C-sections have a higher risk of respiratory distress syndrome than babies born vaginally at the same gestational age. However, there is a slightly raised risk of injury to the vagina and early postpartum hemorrhage for women who have vaginal deliveries.
“Pregnancy is a highly unpredictable event in women’s lives and comes with a fair share of risks,” says Dr Shrestha, adding that there is no way to predict how a woman will give birth to her baby and neither method is completely risk-free.
“Both have their own share of pros and cons,” she concludes, explaining that it is, however, better to opt for a normal delivery during your first pregnancy and let nature take its course.
The importance of post-delivery care
Many women can be seen opting to resume work as soon as they can after having a baby. Between job responsibilities and taking care of their newborn, oftentimes their own health and well being goes for a toss.
Cilla Khatry caught up with Dr Shanti Shrestha, Consultant at Alka Hospital, Pulchowk, and Duty Registrar at Prasuti Griha, Thapathali, to talk about why post-delivery care is a crucial aspect of pregnancy.
Why is post-pregnancy care of paramount importance?
The uterus is about the size and shape of an inverted pear and it enlarges after conception as the pregnancy progresses. After childbirth, the uterus involution, a process by which the uterus returns to its former size, starts at the rate of one to two centimeters per day and it takes 45 days for the uterus to return to its original size. During this period, it’s extremely important that the mother take care of herself, otherwise it can lead to a lot of complications and hence prolong the recovery time. Post-delivery care is also essential to make sure a woman can conceive and carry a baby again without any problems should she decide to do so in the future.
Talking about complications, what are some of the most common health issues women can face post-delivery?
Every pregnancy, irrespective of how it progresses, is a high-risk event in a woman’s life, mainly because all her body organs undergo changes during those nine months. From hypertension to anemia, the risks are many. Also because a mother’s immune system is not very strong post-delivery, it leaves her highly susceptible to infections. If they don’t pay attention to their diet, it can lead to nutrient deficiencies too. Again, I would like to stress the importance of postpartum rest and care here because these two things will minimize risks to a mother’s health and ensure that she recovers perfectly.
What are some of the things a woman who has just delivered needs to keep in mind?
A mother’s attention tends to be focused on the baby so much that she ends up neglecting herself at times. I always advise my patients to take care of themselves so that they are able to take care of their babies too. Post-delivery, women need to pay special attention to their diet so that their bodies are nourished. Besides that, I also advise going for body massages which help strengthen their muscles. They should take care not to lift heavy objects or put too much pressure on their bodies. Follow-up appointments with their doctor are also crucial. Besides these, adequate rest is vital as the body has been under a lot of stress and needs time to heal.
A lot is being said about breastfeeding and its importance. What’s your stance on the issue?
Breastfeeding is important not only for mother-child bonding and for the child’s nourishment but it also helps women recover faster post-delivery. When a mother breastfeeds her child, it actually helps in shrinking the uterus to its normal size. Breastfeeding causes the release of prolactin and oxytocin. Oxytocin is a hormone that causes uterine contractions and the release of oxytocin, while breastfeeding, speeds uterine involution. The cramps they tend to complain about while feeding their child is associated with uterus involution and is quite normal and nothing to worry about.
When is it safe to conceive again?
As every organ undergoes changes during pregnancy, it takes a while for them to recover after childbirth. Though the uterus takes 45 days to go back to its normal size, it isn’t prepared for another baby and that is why doctors usually recommend two to five years’ gap between two pregnancies. Though it’s safe to have sex after 45 days of delivery, it’s best to let at least two years pass before conceiving again. That way, you can avoid miscarriage risks and ensure a safe pregnancy. Also, if you’ve miscarried, it’s advisable to wait for six months before conceiving again.
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