Healing and Physical Recovery After a Stillbirth

Bleeding, pain and lactation are all concerns

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Healing and physical recovery following a stillbirth can be more difficult and complicated than healing after an early miscarriage. This is because a woman's body continues to change and adapt throughout pregnancy. The farther along you are when your pregnancy ends, the more changes from which your body has to recover.

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. A guideline to keep in mind is 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 the uterus.

Bleeding will start heavily and decrease slowly over time. The heaviest bleeding occurs on the first two to three days after delivery and should gradually lighten. It may change from a dark red to a pink color and even to a yellowish tint before tapering completely.

During this time, you should use sanitary pads, not tampons, to minimize risk of infection. You should also avoid taking baths for this same reason.

After a vaginal delivery with a full- or near-term stillbirth, you may have swelling and soreness on your vulva and perineum. You may also 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 can also help with swelling and pain.

Pain

Ice packs and good hygiene practices will help with the soreness and swelling of your delicate tissues, but you will most likely need some kind of pain medication as well. Medications can also help with the inevitable cramping.

Cramps occur as the uterus contracts to reduce bleeding and as it attempts to return to its pre-pregnant size. Cramping feels similar to menstrual cramps and can range from mild to severe. Ibuprofen is the most effective against cramping, although Tylenol 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

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, a woman 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 it while sleeping for the first few days.

Try to avoid letting hot water run over the breasts during your shower, as warm water can cause the milk to "let down." Without stimulation, the milk production should taper off naturally after a few days. Watch for any painful or hardened areas in the breast as well as for redness, fever or chills.

These can be signs of an infection of one of your milk ducts and may require antibiotics.

Special Considerations After C-Section

If you had a 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. However, your biggest concern will most likely be your incision.

Your doctor and anesthesiologist will prescribe pain medication through your IV until you are able to tolerate pills. You may also want to try ice packs, 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 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.

There is a risk of infection with any surgery, so you should keep your incision clean and dry according to your doctor's instructions. Watch for redness, foul-smelling discharge from the incision and bleeding.

Signs of Infection

Although women who had C-sections will be given special instructions about infection, all women should be aware of the signs of infection after any vaginal delivery as well. They include fever (generally greater than 100.4 F), increasing pain, increased heavy bleeding and a foul or rotten smell to the vaginal discharge (some earthy odor is not unusual, just as with menstrual fluid). Any woman experiencing these symptoms should call her obstetrician or midwife as soon as possible.

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, however.

Sex and Contraception

Sexual intercourse should be avoided until your bleeding is gone 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 okay to resume sexual activity if you're ready. There is no rush, however, and you should wait until you feel emotionally ready.

Sometimes, though, things happen, and it's best to be prepared. After a miscarriage or stillbirth, it's okay to resume using contraception immediately. If you are a birth control pill user, remember that you are not "protected" from pregnancy for the first week. Barrier methods like the cervical cap or diaphragm would not be recommended until the cervix is fully closed. Talk to your physician or midwife about your options and the best choice for you.

Fatigue

It's no surprise 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 provider will excuse you from work for a few days or longer, until you have had some time to recover. Rest whenever you feel tired, and don't feel obligated to socialize with all the friends and family who want to show their support at this difficult time, especially if it's interfering with your physical recovery.

It's important to remember that the normal tiredness following a vaginal delivery or C-section could also be a sign of depression if they continue for several weeks or interfere with your life. 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.

Sources:

American Pregnancy Association, " After a Miscarriage: Physical Recovery." American Pregnancy Association. Oct 2003.

Miscarriage Support Aukland. "Your Health After Miscarriage." Accessed 8 Sept 2011. 

Varney, H., Kriebs, J., et al. Varney's Midwifery, Fourth Edition. 2003.

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