Appointment
Your postpartum appointment is very important. If you delivered your baby vaginally, we would like to see you in the office in four weeks. If you had a cesarean section, please plan to see us three weeks after your delivery.
It is best that you make your postpartum appointment with the physician who delivered your baby so any questions or concerns you may have about your labor or delivery can be addressed.
Normal Changes
During the first 4 to 6 weeks after the birth of your baby, your body will gradually be returning to normal. You will notice “afterbirth pains”. The muscles in your uterus are contracting, shrinking it down to the pre-pregnant size. The contractions also help to reduce blood loss following delivery.
Vaginal bleeding may continue 6 to 8 weeks following delivery while the uterus is returning to the pre-pregnancy state. You may have spotting, or a menstrual type flow. The discharge, or lochia, is red at first, and then later will turn brown. Usually by the tenth day it is paler and generally yellow. Do not be alarmed if red bleeding reappears from time to time throughout the first 6 to 8 weeks postpartum. Increased activity can cause a heavier flow, or can change the brown lochia back to red. If your bleeding and cramping increases to greater than a normal menstrual period, get off your feet for several hours. Generally this happens when you have been too active. If the bleeding does not slow down while you are off your feet, please call the office.
If you are not breastfeeding, your first menstrual period may come 4 to 8 weeks after the birth of your baby. Do not be alarmed, though, if it is as long as 12 weeks before your period returns. Some nursing mothers have periods while they are breastfeeding, but many do not. Either way is perfectly normal. The first period for a breastfeeding mother may come after she has weaned the baby, or after the baby has begun to nurse less.
It is not unusual for the first period to be different. You may notice an increased menstrual flow with clotting. You may bleed longer than usual, or you may start, stop, and then start bleeding again. If you are changing a pad every hour – get off your feet until the bleeding slows down. If you find heavy bleeding continues, please call the office.
Activity
During the first few weeks after the birth of your baby it is important to rest when the baby is resting. Your energy should be directed toward taking care of the baby and yourself. Ask friends, neighbors and family for help when you need it.
Refrain from taking tub baths (other than sitz baths), douching, using tampons, swimming or having intercourse until your postpartum check.
Avoid lifting anything heavier than 10 pounds (a gallon of milk) until after your postpartum visit. Please refrain from doing sit-ups, jumping jacks, or aerobic type exercises until after your postpartum checkup. We encourage you to do a few simple exercises (see Exercise section) and walk as desired.
If you delivered vaginally and have stitches, you may begin driving a car after 2 weeks. With tender stitches you will not have the normal reflexes you may need in an emergency situation.
If you delivered by cesarean section, please do not drive a car until after your postpartum visit. You will need to limit the number of trips you take up and down the stairs. Take the stairs slowly, one step at a time. Do all your activities upstairs before you go down so you will not have to take the steps again for several hours.
Constipation
Some women experience constipation following childbirth. Hormones, medications, dehydration, episiotomy pain and decreased activity all play a part in slowing down normal bowel function. The first bowel movement is usually within the first 2 to 3 days.
To help alleviate or prevent constipation, you should consume 8 to 10 glasses of water a day. Eat high fiber foods, such as bran muffins, whole grain crackers and bread, fresh fruits and vegetables, raisins, prunes and high fiber cereals. If you need a medication for constipation, you may use a powdered fiber drink, such as Metamucil or Citrucel, and/or a stool softener such as Colace, Dialose, or Milk of Magnesia. If your episiotomy went through your rectum (“4th degree”), do not use suppositories or an enema until the stitches have healed.
Episiotomy Care
While your stitches are tender, you will need to use the sitz bath 3 or 4 times a day for 15 to 20 minutes. If you do not have a sitz bath, sit in a few inches of warm water in the bathtub. Keep the stitches clean and dry. Each time you go to the bathroom, pour water over the entire area, and then pat dry. Once you are comfortable using toilet tissue, remember to wipe from front to back. While you have vaginal drainage, change your sanitary pad frequently to keep the area dry and to avoid infection.
Incision Care for Cesarean Section
Your staples will be removed while you are in the hospital, or by a home health nurse, unless your doctor specifically requests that you return to the office for staple removal at a later date.
After the removal of the staples, the incision will be held closed with pieces of tape called “steri-strips”. Please keep the strips on the incision for at least 3 days. The steri-strips can be removed after seven days if the edges begin to loosen and curl. The easiest time to remove the tape is after a shower while the strips are damp. Remove each end of the tape to the incision, and then lift the tape off the incision.
Be sure to keep the incision clean and dry. Use hydrogen peroxide on a cotton ball to wash the incision and pat dry. Do not use soap.
Leave the incision open to the air to facilitate healing unless your clothing is irritating it. If so, you may cover the incision with a bandage.
If you notice a red, warm area along the incision, and run a fever higher than 100.6, please call the office.
Breast Care While Bottle Feeding
Even though you are not breastfeeding, your body will begin to make milk. It takes about a week for your body to get the message to stop producing milk. For the first few weeks following delivery you will need to wear a well-fitting, sturdy bra day and night. Keep all stimulation away from your breasts. Stand with your back to the hot water in the shower.
Your breasts may get engorged (hard, lumpy, tender) as milk is produced and not released. Do not express your milk for relief; this will just encourage the milk production. You may apply ice packs to your breast 3 or 4 times a day for twenty minutes at a time. You may bind your breasts with an ace wrap for added support. You may take 2 acetaminophen tablets every 4 to 6 hours as needed for pain. Your engorged breasts should be comfortable again within 3 to 5 days.
Breastfeeding
Continue with a well balanced diet. You will need 500 calories more a day than a normal diet. As long as you breastfeed take your prenatal vitamins and drink plenty of fluids, at least 8 glasses a day. It is helpful to have a glass of milk, water or fruit juice each time you nurse your baby.
When showering, wash your breasts with water only. Your body makes a special lubricant containing a substance to kill germs. This is secreted on the areola (the brown area around the nipple.). Washing this away can cause the nipple to get dry and crack.
If you notice a red, warm and tender area on a breast, have a fever and flu-like symptoms, please call the office. You may have a breast infection and may need an antibiotic for treatment.
There are some medications, such as acetaminophen, that are safe to take while breastfeeding. Generally, any over-the-counter medication that was safe to use during pregnancy can be used while breastfeeding. Please call the office and ask to speak with a nurse for all medication questions.
Hemorrhoids
Hemorrhoids are varicose veins in the rectum. Pregnancy can cause hemorrhoids to develop when the growing uterus interferes with the blood flow in the region of the rectum. When you are constipated, or strain with a bowel movement, these veins become enlarged and painful. You may notice some itching or slight bleeding. Pushing to deliver the baby can aggravate or cause hemorrhoids. They are generally the most uncomfortable the first week following delivery, but most will resolve over the next six to eight weeks.
For comfort, you are encouraged to use the sitz bath three or four times a day. You may also apply an ice pack (you can make one at home by putting ice into a ziplock bag, then wrap in a clean towel) to the area for 20 minutes every 4 hours. Drink plenty of fluids (at least 8 glasses) along with eating a high fiber diet. Do not strain with bowel movements. You may take a stool softener as needed (see Constipation section). Anusol and Preparation H may be bought over the counter and used according to directions.
Postpartum Depression vs. “Baby Blues”
The intensity of feelings following childbirth is a unique experience. During the first few days following the birth of your child, you may feel sad, anxious, angry or afraid. This is perfectly normal and is commonly called the “baby blues”. These feelings should disappear within a few days.
While 70% to 80% of all women experience the “baby blues”, only about 10% will have postpartum depression. With postpartum depression, the feelings of sadness, anxiety or despair are more intense and interfere with the ability to function. Postpartum depression can develop days or even months after the birth of your child. If you feel you are suffering from postpartum depression, you are not alone. Please call the office for advice.
Postpartum Warning Signs
Call the office if any of the following occur:
- A temperature higher than 100.6 orally
- Frequency or burning with urination
- Heavy vaginal bleeding (changing pad every hour) or bleeding longer than 6-8 weeks)
- Red, tender areas of the breast
- Tenderness, swelling or redness of the lower leg.
Postpartum Exercises
The following exercises can safely be done the first four weeks following the birth of your baby. Pay attention to your body. If any of these exercises cause unusual pain – stop. Begin with five repetitions of the exercise. Slowly add more as you are able, adding only one more each day until you are doing ten.
- Lie on your back with your knees bent and your feet on the ground. Place a pillow under your head. Slowly raise your head and shoulders off the ground and try to touch your chin to your chest. Slowly lower your head to the pillow.
- Lie flat on your back with your head on a pillow. Raise one leg at a time about six inches off the floor, then slowly lower the leg. Repeat with the other leg.
- Lie on your back with your knees bent, feet resting on the floor and arms down at your sides. Push down with your feet to raise your hips off the ground. Hold this position for a slow count of five, and then lower your hips to the starting position.