The big moment is finally here! You have waited nine months (by the way, it’s actually 10 months) for this big event! Your baby is about to enter the world. You have prepared diligently and meticulously for this exact moment. And, then it happens. The baby is here!

You’re ready to slay this thing called motherhood. Once your home, you start cramping. “Wait. Is that normal?” you think. Your significant other asks you if you want ketchup for your fries and you burst into tears. Is this normal?

“Is this normal?” is probably one of the most frequently asked questions by both new moms and seasoned moms alike. Women spend countless hours preparing to bring home the baby, but what about preparing for YOU? It is just as important to prepare for YOUR arrival home. In this 3-part series, we are going to focus on Postpartum Care for mom. That’s right! This is your ultimate guide to Bringing YOU Home. In today’s discussion, we are going to talk about what’s normal. But first, let’s talk about what the postpartum period is.

What is the Postpartum Period?

The postpartum period is defined as the time from delivery of the infant to the first six to eight weeks afterwards. Just as your body experienced all these miraculous changes during your pregnancy, your body will continue to go through changes after delivery in order to get back to its normal state; or more likely its “new” normal state. Remember, your body is recovering from 10 months of growing and nurturing another human being; not to mention the stress of that Iron Man triathlon you just completed, otherwise known as delivering a baby. So, this is an important time that you should be ready for.

So, what is normal?

This topic here could take up one of those ginormous 1000-page college textbooks you use to have. But let’s try to briefly summarize this.

• Cramping – Your uterus is a muscle. When the baby is full term, your uterus is about the size of a watermelon. After the baby is delivered, your uterus shrinks by approximately 50%. Even after its initial downsizing, it still has a long way to go before it is back to its normal size – around the size of a pear. Part of that shrinking process involves cramping. This can be normal for the first couple of weeks.

Typically, acetaminophen (Tylenol) and/or ibuprofen (Motrin), which are both available over-the -counter, can help. Be sure to check your discharge instructions from the hospital to see what your doctor recommends. A heating pad can also be soothing.

What to consider having at home: Acetaminophen, ibuprofen, a heating pad.

• Bleeding – The blood and discharge expelled from the uterus after delivery is called lochia. In the first 24 hours after delivery, the lochia may be heavier than a period. After that, the bleeding will gradually decrease to a flow similar to a period, then to spotting, and finally it will stop. This process can take anywhere from two to six weeks. Be sure to have both pads and panty liners at home to use. Avoid using tampons during this time.

What to have at home: Maxi pads and panty liners

• Emotional Changes – A wide range of emotions can occur after having a baby. Of course, there can be plenty of bliss and joy, but there are many other emotions women experience such as anxiety, exhaustion, and frustration. Feeling overwhelmed in general or irritated by unsolicited advice from EVERYONE can also be normal emotions for moms. Typically, these changes in emotions can start around two to three days after delivery but last no longer than two weeks.

Why does this happen? After delivery, there is a sudden withdraw of the increased levels of hormones that were circulating in your body to support the pregnancy. With this withdraw, many women experience changes in emotions. All these things can be a part of what is called the “Baby Blues”. According to the March of Dimes, up to 80% of women can experience the “Baby Blues” after delivery.

If your symptoms are not getting better after two weeks OR your symptoms are getting worse, PLEASE speak with your provider. Sometimes there can be something more, such as Postpartum Depression. More on this in Part 3 of this series.

What to have at home:A support network, be it friends or family, that can lend a helping hand when needed. It is even better if they are also willing to give you a little space when needed but are honest enough to speak up if there is a concern. If there are certain ways you want things done, let them know that in advance BEFORE you and baby come home.

• Breast changes – Whether you breastfeed, bottle feed, or a little bit of both, your breasts will go through changes.
• If you are breastfeeding, you may get discomfort as your milk comes in and when your breasts get engorged. A nice warm shower can help to ease this discomfort. If you are engorged, breastfeeding your baby or pumping your breasts can help.

Nipple discomfort is also something women can face. Things that you can do for nipple discomfort are applying lanolin cream and cool compresses to the nipple. They sell creams and nipple cooling pads at your local store, or they are available online. You can also use a soaked tea bag that you put in the refrigerator. Another helpful tip that is quick and easy is expressing some of the milk after nursing, rubbing the milk into the nipple, and allowing the nipple to air dry.  Finally, avoid using soap on the nipple as this can be drying. If it is not getting better after a week, you may want to speak with a lactation consultant to help you with the baby latching on.

What to have at home: Lanolin cream, nipple cooling pads, nursing bra

• If you are bottle feeding, you can still get some breast discomfort. If your mom or grandmother tells you to bind your breasts, DON’T DO IT. Back in the day, that was a recommendation, but times have changed. Instead, experts recommend that you simply wear a good supporting bra. Cool compresses can also be comforting. Heat is not recommended as this stimulates the milk and that defeats the purpose if you don’t want to breastfeed.

What to have at home: Good supporting bra, ice pack

Other normal changes:

• Swelling of the hands and feet – Your body is starting to mobilize and get rid of the fluid it retained during pregnancy. Elevating your feet can help with this. If more support is needed, you can purchase compression stockings at your local pharmacy or online.

• Pain in the vaginal area – Even if you don’t have any tears, you can still get pain in the vaginal area. Ice packs to that area or cold maxi pads can help to relieve some of the discomfort. They do sell ice pack pads as well. Perineal bottles, which are often given to you at the hospital, can help flush water over the perineum – the area between the vagina and rectum – during and after urination, as urinating can be irritating. There are also numbing sprays with benzocaine in them, such as Dermoplast, that are available over-the-counter.

• Hemorrhoids  – Having hemorrhoid cream and witch hazel wipes, such as Tucks wipes, is always good to have on hand.

• Hair loss – It is normal to have thicker hair DURING pregnancy, but it is also normal to lose more hair than normal after you give birth. But don’t panic. It all evens out after a few months.

To sum it up, your “Bringing You Home” care package should include:

• Pads
• Maxi pads

You might also consider these items as well:

• Acetaminophen
• Ibuprofen
• Heating Pad
• Ice packs
• Lanolin cream
• Nipple cooling pads
• Nursing bra
• Good supporting bra
• Compression stockings
• Hemorrhoid cream
• Witch hazel wipes
• Benzocaine spray

These are some of the normal things that you may experience in the postpartum period. Of course, there are other things that you may notice that are completely normal as well. If ever in doubt, reach out to your doctor.

Next time, we will talk about some of the abnormal changes you want to watch out for.

Until then, be well and be sure to show yourself grace and love.

Dr. Kristin Williams

Medical Director of Women’s Health Specialists of North Texas

About the author: Dr. Kristin Williams is a board-certified Ob/Gyn. She graduated from Wayne State University School of Medicine in Detroit, Michigan. After completing one year of training at Tulane University in New Orleans, Louisiana, Dr. Williams moved to Dallas, Texas to complete her residency at Parkland Hospital. She worked in private practice with Women’s Health Specialists of North Texas for 16 years and now works with the office as the office Medical Director.

This blog provides general information and discussions about health and related topics. The information and other content provided in this blog, or in any linked materials, are not intended and should not be construed as medical advice. This information is not a substitute for professional medical expertise or treatment.

If you or any other person has a medical concern, please consult with your healthcare provider, or seek other professional medical treatment. Never disregard professional medical advice or delay seeking care based on the information you have read on this blog or in any linked materials. If you think you may have a medical emergency, call or go to the Emergency Room or dial 9-1-1.

Can you guess one of the most frequently asked questions I received when I was in private practice? No matter their age, nationality, or education level, women wanted to know – Do I need a pap smear?

Who can blame them? Recommendations have changed throughout the years, and once you think you’ve got it all figured out, it changes again. So, what’s the answer?  In this blog, you will finally know the answer to a question that has bewildered women for ages. But first, let’s talk about what a pap smear is.

What is a pap smear?

A Papanicolaou test, affectionately known as the pap smear, is a test that looks for abnormal cells on the cervix that can lead to cervical cancer. But did you know that now experts say that looking for abnormal cells of the cervix is not the only way to screen for cervical cancer? Let’s take a closer look at this.

What are the tests for cervical cancer screening?

There are three basic types of tests for cervical cancer screening – Cytology, HPV testing, and Cytology with HPV testing. While all these tests are performed the same way in the doctor’s office, they are tested differently in the lab.

• Cytology only (also known as the Pap smear) – Looks for abnormal cells on the cervix but does not screen for HPV. This type of cervical cancer screening is recommended for women 21-29 y/o.
• HPV testing only – Looks for high-risk strains of the Human Papilloma Virus (HPV). There are well over 100 different strains of HPV. But not all strains of HPV cause abnormalities that could potentially lead to cervical cancer. Therefore, screening only for high-risk strains of HPV, not for abnormal cells of the cervix itself, is one option for cervical cancer screening. This test can be performed on women 30–64 years old.
• Cytology with HPV testing (also known as the Pap smear with co-testing) – Combines the two methods described above. This test can be performed on women 30–64 years old as well. It basically combines the two methods mentioned above.

Therefore, in this blog, we will not use the term pap smear but instead cervical cancer screening. Now, let’s debunk five of the most common myths about cervical cancer screening.

Does age matter?

Myth #1:  You should have cervical cancer screening when you turn 18 years old.

Fact:  Women should start having cervical cancer screening at 21 years old. Even if someone becomes sexually active before then, screening for cervical cancer is not necessary until age 21.

How often do I really need to be screened for cervical cancer?

Myth #2:  Even if your cervical cancer screening is normal, you should still have to repeat your screening every single year.

Fact:  Women who have normal screenings of their cervix do not need to have yearly cervical cancer screening. I know some of you are saying, “Are you sure about that? Is that safe?” Yes, I am and yes it is!

Women who have normal screenings of their cervix may space out their screenings between 3 -5 years, depending on your age and what type of screening you had. I continue to stress normal because these guidelines do not necessarily apply to women who have had an abnormal result on their cervical cancer screening.

Let’s break this down further

• Cytology only (the pap smear) – This type of cervical cancer screening is recommended for women 21-29 y/o and is performed every 3 years if normal.
• HPV testing only – This type of cervical cancer screening only looks for high-risk strains of HPV, not abnormal cells from the cervix. It can be performed on women 30–64-year-old and is performed every 3 years if normal.
• Cytology with HPV testing (the pap smear with co-testing) – This test screens for both abnormal cells of the cervix and high-risk strains of HPV. It can be performed on women 30–64-year-old and can be performed every 5 years, instead of every 3 years.

The good thing is that you do not have to remember all of this. Your doctor will keep track of when you are due for your cervical cancer screening. The takeaway from this myth is that not every person needs a cervical cancer screening every year. This takes us into Myth #3.

How often should I see my Gynecologist?

Myth #3:  My doctor says that I do not need to have cervical cancer screening every year. Therefore, I do not need to see my gynecologist every year.

Fact:  You need to see your gynecologist every year. YOU NEED TO SEE YOUR GYNECOLOGIST EVERY YEAR. One more time for the people in the back – YOU NEED TO SEE YOUR GYNECOLOGIST EVERY YEAR. Ok. I think I have made my point.

You need to see your gynecologist every year for your annual exam even if cervical cancer screening is not needed. At an annual exam, other important things occur such as:

• Blood pressure check
• Weight check (Yeah, I hate it too.)
• Breast exam
• Pelvic Exam
• Birth control options
• Risk factor screening for medical illnesses and cancers
• Menopause discussion
• Blood work
• Ordering mammograms
• Options for colon cancer screening (colonoscopy, Cologard)
• And more!

Yearly visits help to maintain the doctor-patient relationship. This is important for many reasons. But one huge perk of being seen each year is that if you develop health concerns between your yearly visits, you won’t be considered a new patient and won’t have to wait as long to be seen. Just remember, it is important to see your doctor every year even if you don’t have cervical cancer screening performed.

I’m on my period. Now what?

Myth #4:  If you are on your period, you should cancel your yearly exam.

Fact:  If you are having CERVICAL CANCER SCREENING, it is best to reschedule your appointment. The blood obtained on the specimen can make it difficult for the pathologist to interpret the results. This means that we would need to repeat your cervical cancer screening when you are not on your period.

If you are having your ANNUAL EXAM without cervical cancer screening, you can still keep your appointment. I know it may feel embarrassing being examined while you are on your period. But let me assure you, it is ok. However, if you feel uncomfortable, you can always call to reschedule your appointment.

It is understandable that it can be confusing trying to keep up with when you are due for your cervical cancer screening. If you aren’t sure and need to know before your appointment, just call. We can let you know if your cervical cancer screening is “to be, or not to be” (thank you, Shakespeare). But whatever you do, don’t just not show up for your appointment with your doctor. Always call if you need to cancel, reschedule, or have questions about your appointment.

Can cervical cancer screening look for cancers other than cervical cancer?

Myth #5:  Cervical cancer screening lets you know if you have cervical cancer, uterine cancer, and ovarian cancer.

Fact:  Cervical cancer screening only screens for cancer of the cervix. It does not screen for any other cancers. Here are how other cancers are screened for.

• Ovarian cancer – Yearly pelvic exams can help your doctor determine if there are concerns for ovarian cancer. A pelvic exam can look for any physical signs concerning for ovarian cancer. But it is also important for you to listen to your body and report any persistent swelling/bloating and or abdominal/pelvic pain. Your family history is also an important consideration.
• Uterine cancer – If you have not gone through menopause, look for significant, persistent changes in your period such as them being heavier, longer, or more frequent. If you have already gone through menopause and have not had a period for at least one year, you should report any vaginal spotting or bleeding.
• Vulvar cancer – Once again, yearly pelvic exams with your doctor are key. Also, you should report any itching on the outside of the vaginal area that is persistent.

So, back to the original question –Do I need a pap smear?  Well let’s change that question to – Do I need cervical cancer screening? The answer is… maybe. There are a few factors that go into the correct answer for each individual woman. The takeaway message is not everyone needs to have cervical cancer screening every year, but you should still see your gynecologist every year. But do not worry if you can’t remember all the ins and outs of cervical cancer screening. That’s what we are here for!

I hope that the information shared in this blog helped to shed some light on what may be right for you. Now, you can walk with your head held up high, knowing what to do, and confidently tell your girlfriends and family what they need to do as well.

Keep in mind that recommendations could very well change again in the future. But for now, you’ve got it! Plus, you’ll be going to see your gynecologist every year anyways, right?

Dr. Kristin Williams

Medical Director of Women’s Health Specialists of North Texas

About the author: Dr. Kristin Williams is a board-certified Ob/Gyn. She graduated from Wayne State University School of Medicine in Detroit, Michigan. After completing one year of training at Tulane University in New Orleans, Louisiana, Dr. Williams moved to Dallas, Texas to complete her residency at Parkland Hospital. She worked in private practice with Women’s Health Specialists of North Texas for 16 years and now works with the office as the office Medical Director.

This blog provides general information and discussions about health and related topics. The information and other content provided in this blog, or in any linked materials, are not intended and should not be construed as medical advice. This information is not a substitute for professional medical expertise or treatment.

If you or any other person has a medical concern, please consult with your healthcare provider, or seek other professional medical treatment. Never disregard professional medical advice or delay seeking care based on the information you have read on this blog or in any linked materials. If you think you may have a medical emergency, call or go to the Emergency Room or dial 9-1-1.