You will hurt. You don't push something as big as a newborn baby out of a passage as narrow as your vagina without incurring some damage. You may have experienced a natural tear or had an episiotomy, and the stitches in your perineum may pull and itch. You may have gotten through with nary a stitch, but have bruised labia. And you may have aches and pains where you never expected them, from your thigh muscles if you labored standing, to your chest muscles if you had a hard time pushing. You may have hemorrhoids.

Are My Insides Falling Out?

The sensation of feeling your insides sag is a surprising one. While you never really noticed before the birth, looking back you may recall that your insides always felt snug. Now they don't. If you've had a cesarean you may worry that your insides could literally fall out, but remember that they are held in place, inside and out, by several layers of stitches and staples.

Hemorrhoids

Hemorrhoids are swollen veins around the rectum that are typically caused by pressure — like carrying and pushing out a baby. Many new moms have hemorrhoids; the good news is that, in most cases, they go away. The bad news is that, while present, they can make having a bowel movement, or even sitting down, extremely uncomfortable. To find relief:

• Avoid constipation. Drink lots of water, walk around, eat fresh fruits and vegetables, and take a stool softener.

• Soak in a warm bath (bathtub or sitz bath).

• Sit on a donut. These blow-up cushions relieve pressure until the hemorrhoids heal; carry the donut with you — it beats standing all the time.

• Use over-the-counter remedies, which include Tucks pads, refrigerated bottled witch hazel, and hydrocortisone cream.

Tailbone

You may feel pain in your tailbone, which can take a pounding during a vaginal birth. It may be bruised, in which case the pains will go away after a month or so, or it may be dislocated. Stretching can also help make your tailbone feel better. Talk to your health care provider if you continue to have pain a few weeks after delivery.

Afterpains

Afterpains are cramps caused by your uterus contracting. They're not usually so bad with your first child, but the strength of them can surprise second-time moms. This is the time to reach for a pain killer, typically acetaminophen (Tylenol), ibuprofen (Motrin or Advil), or a prescription narcotic such as Tylenol with codeine, hydrocodone (Vicodin), or oxycodone (Percodan). Acetaminophen and ibuprofen have few side effects and are generally considered benign. All the narcotics can cause dizziness, nausea, and vomiting. Codeine and Percodan can also increase constipation. If you are breastfeeding, talk with your doctor about your pain-relief options.

Sweating, Itching

You may sweat more than normal as your body sheds the extra fluids it stored during pregnancy. You also may have some unexplainable symptoms — moms have reported itchy rashes that can appear anywhere on the body. (The reason for this is not clear, but it is not uncommon, and the rashes go away on their own.) None of these are anything to worry about.

The Shakes

You may start to shake immediately after delivery, regardless of whether you delivered vaginally or had a C-section. This is your body's reaction to the loss of blood and other physical and psychological stresses. You can't control it, but it will usually pass within an hour. Ask the nurse for a warm blanket. Although the shaking is not related to the room temperature, you may find this blanket comforting.

Breathe Easier

You may feel short of breath after delivering, especially if your baby is large and you've had to push for a long time. This may cause your chest muscles to spasm. If your hospital offers a postpartum massage, take advantage of the opportunity. A massage may also ease the cramps in your thighs and other aches and pains. If your hospital doesn't offer this service, you might consider hiring your own masseuse or ask your partner to give you a massage. Hot showers also help relax your muscles.

Exercise

After nine months of pregnancy, you probably don't want to hear this, but it is time to start Kegeling again — you can do it before you've even left the delivery bed. At first, you won't feel anything; it won't even feel like you have any muscles there, but keep trying every few hours, and eventually you'll get a response.

Kegeling increases the blood flow to the vaginal area, which will help healing and tone up the muscles that keep you from peeing when you laugh. (These muscles will also come into play when you eventually think about having sex again — see Chapter 19.)

As soon as you can, get up and walk around. This stimulates your digestive and circulatory systems (which are probably sluggish after the birth), prevents blood clots, and starts the general recovery of your muscles. Be sure to have someone accompany you for that first walk, as you may feel shaky and like your legs are going to buckle.

Post-C-Section Pain

Moms recovering from a C-section often don't have perineal pain, although some may if they tried to push. The primary pain is at the incision site, and this can be exacerbated by the internal pressure of trapped gas created when the digestive system is slowed by anesthesia and other drugs.

You can reduce gas pains by getting up and moving as soon as possible (shuffling slowly down the hall counts, so don't try to do too much). Pressing a pillow against your incision as you climb out of bed can reduce the pain of getting up and moving.