Bleeding and Perineal Care
As with miscarriage and live birth, the lining of the uterus that had built up during your pregnancy must be shed. It’s not unusual for women to pass clots—some of them quite large—after a stillbirth. Keep in mind that clots should not be larger than a small plum. Anything larger could be a sign of a complication, like a small part of the placenta being retained in your uterus. During this time, you should use sanitary pads, not tampons, to minimize the risk of infection. You should also avoid taking baths for the same reason. After a vaginal delivery with a full- or near-term stillbirth, you may have swelling and soreness of your vulva and perineum. You also may have small tears or stitches in the area. Using a small squirt bottle filled with warm water after urinating will soothe the delicate tissue and prevent any further irritation from rough toilet paper. For the first 24 hours after delivery, ice packs also can help with swelling and pain.
Taking Pain Medication
Ice packs and good hygiene practices will help with the soreness and swelling, but you will most likely need some kind of pain medication as well. Medications also can help with the inevitable cramping. Motrin (ibuprofen) is the most effective over-the-counter medication to help alleviate cramping, although Tylenol (acetaminophen) can also help. In some cases, cramping or perineal pain can be severe enough to require something stronger, which your doctor will prescribe for you.
Lactation Following Stillbirth
Any pregnancy that lasts beyond 12 weeks can cause a small amount of milk to come in after delivery. In the case of a stillbirth, you may even experience engorgement. To avoid increasing milk production, you should avoid expressing any milk from your breasts. Wear a supportive bra—you may even find it more comfortable to wear while sleeping for the first few days. Also avoid letting hot water run over your breasts during your shower, as warm water can cause the milk to “let down.” Without stimulation, milk production should taper off naturally after a few days.
C-Section Considerations
If you had a cesarean section (c-section), you will still experience some vaginal bleeding—though generally less—and if you labored or pushed at all prior to your c-section, you may have some tenderness of your labia as well. After surgery, you will have to consider incision care as well. Your doctor and anesthesiologist will prescribe pain medication through your IV until you are able to tolerate pills. You also may want to try ice packs on the area, provided you can keep the incision dry. Women who have had c-sections should try to walk on the same day as their surgery unless other complications or conditions specifically prevent it. Getting moving again, even when it’s uncomfortable at first, will reduce your pain in the long run. It’s also good for your lungs, circulation, muscle strength, and mental well-being to get on your feet again as soon as you can.
Signs of Infection
Although you will be given special instructions about infection after a c-section, all women should be aware of the signs of infection after any vaginal delivery as well. They include fever (generally greater than 100.4F), increasing pain, and increased heavy bleeding. Another possible sign of infection includes a foul smell to your vaginal discharge. However, an earthy odor is not unusual just as with menstrual fluid. If you experience any of the signs or symptoms of infection, you should call your obstetrician or midwife as soon as possible.
Sex and Contraception
Sexual intercourse should be avoided until your bleeding has stopped and your cervix is fully closed again. Your physician or midwife will probably want to see you for a postpartum visit four to six weeks after your delivery and give you the OK to resume sexual activity if you’re ready. Still, it’s best to be prepared. After a miscarriage or stillbirth, it’s OK to resume using contraception immediately. If your preference is for the birth control pill, remember that you’re not “protected” from pregnancy for the first week on a new prescription. Also, barrier methods like the cervical cap or diaphragm would not be recommended until your cervix is fully closed. Talk to your physician or midwife about your options and the best choice for you.
Return of Your Period
After your vaginal bleeding tapers off, your normal period should return in four to six weeks. Your cycle may be abnormal for several months. It’s important to remember that just because you’re not having normal periods doesn’t mean you can’t get pregnant.
Dealing With Fatigue
It’s no surprise that you’ll feel tired after such a dramatic physical change, but the emotional toll of a stillbirth can also add to your feelings of fatigue. Your healthcare provider will excuse you from work until you have had some time to recover. Rest whenever you feel tired, and don’t feel obligated to socialize with friends and family who want to show their support. What you’re going through is difficult and you need to rest, especially if it’s interfering with your physical recovery. Other signs of depression can include changes in your eating or sleeping habits, loss of interest in your normal activities, uncontrollable crying, confusion, and anxiety. Consult your healthcare provider if you think you might be depressed.
