Alleviating afterpains

I am pregnant with my fourth child. Shortly after each previous birth I had painful cramps. Unfortunately, they become more painful after each birth. My doctor said that this is the uterus contracting. Please share any tips you have that may help reduce the pain.

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Peg Plumbo CNM

Peg Plumbo has been a certified nurse-midwife (CNM) since 1976. She has assisted at over 1,000 births and currently teaches in the... Read more

Afterpains, or postpartum uterine cramping, can be debilitating for some women -- especially for women who have experienced more than one birth. Such pain is caused by the rhythmic contraction and relaxation of the uterus as it shrinks down.

Breastfeeding accentuates these cramps because it facilitates uterine contraction through the release of maternal oxytocin. Tylenol is effective when taken prior to breastfeeding. For severe cramping, Tylenol with codeine can be provided for the first two to three days postpartum.

With each pregnancy, the tone of the uterine muscle becomes more and more lax, which causes greater periods of relaxation with a corresponding need for the uterus to contract more forcefully. In the first time mother, the tone is usually better so the muscle stays in a state of better contraction.

One very effective preventive measure is keeping your bladder empty by using the bathroom every hour. A full bladder displaces the uterus and makes it prone to relaxation and inefficient contraction.

Another tip is to lie on your abdomen with a pillow against your lower abdomen. This creates a pressure that keeps the uterus contracted. Initially, the pain might be more severe, but after five minutes the pain will usually be relieved.

There have been anecdotal reports of exercise and calcium in the prevention and treatment of afterpains. It may be helpful to take a calcium supplement (one 500 mg. tablet twice per day) during the last trimester and into the postpartum period as well.

You might also try mini head lifts; lie down with your knees bent, take a deep breath and as you exhale, lift your chin so it rests on your chest. Head lifts performed 5 to 10 times an episode, several times per day, will encourage uterine contraction.

Massage your own uterus externally through the abdomen frequently during the first three days postpartum. This will discourage uterine relaxation, and thus the necessity for it to contract so forcefully.

I believe this complaint is understudied and underemphasized in the literature and in classroom education. There are a few references about various analgesics, but not a great deal about anticipatory guidance and prevention.

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