On this edition of "Things they don't tell you about birth and postpartum".... let's talk about postpartum pee...
After giving birth, more than likely you will quickly start to get a lot of questions and encouragement from nurses to use the toilet. Along with wearing diapers, it can start to feel like you are are being potty trained all over again! In some sense.. there can be some bladder re-training that needs to happen, but mostly, we just want to make sure everything is working properly and that it continues to work properly.
What are we worried about?
Urinary leaking, incontinence or urgency seem to be most frequently discussed urinary issues associated with pregnancy and birth. The problem we most likely see and are looking to avoid during the first few hours and days after birth is urinary retention. Urinary retention is when urine builds up in the bladder from not being able to empty your bladder fully or at all. When urine backs up it can lead to infection, stretching of the bladder and permanent bladder damage.
Specifically in terms of postpartum health:
When your bladder gets full, it puts pressure on your uterus, preventing it from contracting properly. This can intensify your bleeding and cramps.
Quick anatomy lesson about the uterus and a lesson for another day, your uterus doesn't stop contracting after birth, it continues to contract back to it's pre-pregnancy size. In the first few hours to days, there is a drastic reduction in size and the contractions serve kind of like putting pressure on the wound where your placenta was. These contractions also help to keep expelling the lochia (postpartum bleeding) so that it does not build up and form clots.
What to expect for postpartum urination?
Vaginal Birth: After a vaginal birth, your Labor & Delivery nurse may try to get you up 1-2 hours after birth to pee. If you had an epidural, it may or may not be worn off all the way, and they should have a way to safely transport you to the toilet, if it hasn't. We typically want to make sure you pee by 6 hours after birth.
C-Section: If you had a c-section, you will probably have a catheter in place for a while, depending on your OB's instructions. Once it is removed, you will be pretty much on the same regimen: we want you to pee and keep peeing as soon as possible, but at the latest within 6 hours. If you labored before your c-section, you may have some of the swelling, tearing or pelvic floor damage seen with a vaginal birth.
No matter how you deliver, your pelvic floor, bladder and hormones have all undergone changes during pregnancy and delivery that can lead to urinary difficulties.
You may have swelling, pelvic floor, urethral or other damage that make urinating uncomfortable
Use the peri bottle to squirt warm water over your vulva and urethral area while you urinate to help ease any stinging or burning
Use ice packs and anti-inflammatory medications in the first 24 hours to reduce swelling and pain
Pain relieving medications can help you feel more comfortable.
Pelvic floor muscles have been stretched and strained through pregnancy and birth and will take time to strengthen and repair.
You may have decreased sensation that you need to urinate
Go to the toilet often, every 2-3 hours, even if you don't feel like you need to.
Stay hydrated with lots of WATER! Avoid bladder irritants like coffee, tea and dark sodas.
Don't strain and try to force it, go easy and relax.
If you feel an increase in your cramps, try to use the bathroom. (If it is sudden and extreme or accompanied by a sudden and large increase in bleeding, don't get out of bed and call your nurse!)
Tips to empty your bladder
If you are are having trouble feeling the sensation to urinate, unable to start or empty your bladder, here are some ways to help:
RELAX!
Continuously hydrate. Don't just chug a bottle of water, you don't want quickly over-fill your bladder and add to the strain. Avoid bladder irritants like coffee, tea and dark sodas.
Sit fully and comfortably on the seat with feet flat on the ground, or slightly raised on a surface like a squatty potty if that is more comfortable for you. Learn slightly forward.
Give yourself time, don't rush or strain.
Stand in a warm shower or use the peri bottle to run warm water over your urethra
Listen to warm water, and for more effectiveness, put your hand under cold running water.
Rock your pelvis while seated or stand and walk around a little bit.
Sit in a warm sitz bath.
If you aren't able to urinate or feel like you haven't emptied fully, tell your nurse, doctor or midwife so they can help. If it continues to be a problem, you may need to have intermittent or longer term catheterization.
In the longer term after birth
Keep hydrating and using the toilet regularly until your sensation and ability to urinate is back to normal. After birth, some urinary incontinence or frequency *MAY* be considered normal, but if it feels extreme or continues 4-12 weeks or more after birth, your OB, midwife or a pelvic floor therapist should be consulted.