Postpartum Care for Mothers

Uterine Contractions and Bleeding

Shortly after you have delivered the placenta, your health team will begin working on your recovery. You’ll have uterine massage to encourage your uterus to begin contracting. These contractions start the uterus on its retreat to its pre-pregnancy size, and prevent excess bleeding. You may also be given oxytocin to encourage contractions. The uterus usually returns to its pre-pregnancy size by six weeks after delivery.

Some women experience these uterine contractions as sharp abdominal pains, which are called afterpains. Afterpains are most common during breastfeeding. Breastfeeding stimulates the release of oxytocin, which causes the uterus to contract. Afterpains typically subside by the third day. If this is your first baby, you are less likely to have afterpains than if you have given birth before. For severe pain, your doctor can prescribe pain medication.

Don’t be alarmed by bleeding after birth, this is normal. A bloody discharge called lochia occurs for three to four days after delivery. Lochia changes to a pinkish-brown within a week of delivery, and then to white or yellow. You should notice less blood after two weeks, but lochia can continue for six to eight weeks postpartum. Use sanitary pads and change the pads at least every four hours. This level of bleeding and discharge is normal, but excess bleeding is a concern. Call your doctor if you have any of the following:

• Bloody discharge that lasts longer than four to five weeks; the color of the discharge should change by this time
• Bleeding that saturates one extra-large sanitary pad per hour for four to five hours
• Blood clots that are larger than a golf ball over several hours; occasional, smaller blood clots are not a concern

Healing of an Episiotomy or Perineal Tear

Once delivery is complete, your doctor or nurse-midwife will examine the perineal area. If you had an ]]>episiotomy]]> or your perineum tore during delivery, you’ll have stitches (with local anesthesia) to close these tears. While tenderness in this area is common after any vaginal birth, the incision or tear adds extra soreness. You may notice discomfort with walking, sitting, and going to the bathroom. Try soothing this area with an ice pack, anesthetic spray, or by sitting in a tub of warm, shallow water (a sitz bath). Your doctor can also prescribe pain medication.

An episiotomy or tear should be healed within three weeks. Call your doctor if you have any of the following:

• Moderate to severe pain
• Fever
• Increased redness or swelling
• The wound begins to separate
• Increased pain with urinating or having a bowel movement
• Little improvement after three weeks

Urination and Bowel Movements

In the first few days postpartum, you may notice that you are urinating much more than normal. This is your body’s way of getting rid of extra fluid from pregnancy. Some women have increased sweating for the same reason.

During pregnancy, the change in anatomy due to the growing baby and uterus can cause leaking of urine. In addition, injury to muscles and nerves during labor and delivery can also result in a woman’s being less able to control urine or sometimes even gas or stool. Wear a sanitary pad to catch leaks and talk to your doctor about your symptoms. Kegel exercises may help strengthen weakened muscles. For most women, these problems will go away within six weeks. If they last for more than six weeks, you should talk to your doctor.

You may not have a bowel movement until three or four days after delivery. Your first bowel movement can be quite painful, especially if you had a perineal tear or episiotomy. Drink a lot of water and juice, and take a stool softener to ease this pain. Do not avoid bowel movements, as this can lead to constipation and hemorrhoids. A warm sitz bath can ease pain from hemorrhoids. To keep this area clean and prevent infection, clean it with warm water (a squeeze bottle or wash cloth) and pat dry with gauze or a sanitary wipe. Always wipe from front to back.

Recovering From a Cesarean Section

A cesarean section (c-section) is major surgery so you may take longer to heal. Pain is greatest the day after surgery and should decrease from then on. Take care to protect your incision. Watch for swelling or redness, and alert your doctor immediately if you see any. Your doctor will also give you specific instructions for bathing, lifting, and gentle exercise during recovery.

When breastfeeding, avoid placing your baby directly on your stomach. Place a pillow on your stomach or use the football or lying down positions.

Breast Engorgement

As your breasts increase milk production, you will notice them filling up quite quickly. This fullness can be uncomfortable. It is most noticeable by the third or fourth day postpartum as your mature milk is coming in. Breastfeeding your baby often and using both breasts at each feeding is one way to help reduce this discomfort. Between feedings, take a hot shower or use warm compresses or ice packs. If you do not plan to breastfeed, wearing tight binding clothing can help reduce symptoms.

General Soreness and Body Changes

After the hard work and straining of delivery, you may notice soreness in your upper body and head as well as your lower body. Some women have bloodshot eyes or facial bruising from their efforts. All of these aches and pains should resolve within a few days.

After delivery, your hormone levels go through major changes. You may have hot flashes or chills. You may also notice changes in your mood.

Emotional Changes

While a new baby brings a lot of joy, that same baby also brings sleepless nights, demanding feeding schedules, and unexplained crying. In those first few weeks with their new baby, about 80% of moms report sadness, crying, anxiety, or irritability. The causes of these common “baby blues” are many. They may be unexpected delivery experiences, hormonal changes, lack of sleep, the baby’s needs, loss of time to yourself, or any other combination of factors.

Recognize that these feelings are normal as you take on a new phase of life. Here are some tips for helping to manage those challenging early days:

• Accept or ask for help from friends and family. Receiving help with meals, shopping, cleaning, and other errands can take pressure off of you. Consider hiring a cleaning service or teenager to take over cleaning duties for a while.
• If visitors stress you out, limit them. It’s okay to request that visitors only stay for a certain amount of time (or not at all) while you are establishing your baby’s schedule.
• Sneak in sleep whenever you can.
  • Sleep when your baby naps.
  • Once you’ve established a feeding routine, pump your breast milk or prepare a bottle for your partner or babysitter to feed the baby so you can sleep for a longer stretch of time.
• Nourish yourself. Eat well and drink plenty of fluids. Most women can return to a normal diet as soon as they desire after delivery. If you are breastfeeding, you need 500 extra calories per day. Strive for 64 ounces of fluids per day.
• Exercise. Begin slowly and increase the time and exertion level slowly. Exercise is a great way to increase your energy and sense of well-being, while reducing weight. It can also reduce the risk of constipation. Non-impact activities such as walking, swimming, and yoga are good options.
• Make time for relaxation each day. Even if it’s only 10 minutes, set aside time for reading, listening to music, watching TV, meditating, showering, or any relaxing activity.
• Find time every day for you and your partner to be alone and talk.
• Spend time enjoying your baby every day. Don’t get too focused on just feeding and changing diapers.
• Ask questions. If you are unsure of anything, call your pediatrician. Consider joining a support group or other mother’s group, such as infant massage or mother-infant yoga.

Postpartum Depression

Some women have feelings that are more severe and last longer than those associated with the baby blues. Postpartum depression (PPD) affects one in eight women during the first few months after childbirth. It can also occur in women who have a miscarriage or abortion, or who adopt a baby. Common symptoms include extreme fatigue, loss of pleasure in daily life, lack of interest in your baby, insomnia, sadness, anxiety, hopelessness, feelings of worthlessness and guilt, irritability, changes in appetite, and poor concentration.

The hormonal changes after delivery are believed to lead to PPD. Women with a personal or family history of depression are at greater risk of PPD. Risk also increases if a woman has a weak support system or other significant stress. PPD can be treated with counseling, antidepressant medications, or a combination of both. With treatment, symptoms can improve quickly. Women who do not get treatment can have symptoms for seven months or more. Talk to your doctor or someone you trust if you have any symptoms of PPD.

If you feel that you might hurt yourself of your baby, get help immediately. Call your doctor, 911, the national suicide hotline (1-800-784-2433), or the national child abuse hotline (1-800-422-4453). These are people who want to help you.

Birth Control and Sexual Relations

Before resuming sexual intercourse, wait for your perineal area to heal and bleeding to stop—about four to six weeks. This will make sex more comfortable and reduce the risk of infection. To allow your body time to recover from pregnancy and the demands of caring for a newborn, wait at least three months before trying to become pregnant again. Do not depend on breastfeeding for effective birth control. Most methods of birth control are safe and effective for breastfeeding women.

When to Contact Your Doctor

You’ll see your doctor for a routine checkup between two and six weeks after delivery. However, if any of the following occur, call your doctor immediately:

• An unexplained fever ≥100.4 degrees in the first two weeks
• Your bleeding soaks more than one sanitary napkin an hour
• An incision from a c-section or episiotomy becomes more red or swollen, or drains yellow or foul-smelling liquid
• New pain, swelling, or tenderness in your legs
• Significantly reddened, sore breasts, breasts that are hot to the touch, or any cracking or bleeding from the nipple or areola
• Vaginal discharge has become foul smelling
• Painful urination, sudden urge to urinate, or inability to control urination
• Increasing pain in the vaginal area
• Cough, chest pain, nausea, or vomiting
• Depression, hallucinations, suicidal thoughts, or any thoughts of harming your baby

It can be easy to ignore your own needs as you focus on caring for your new baby. But it’s important for both you and your baby that you take good care of yourself. It’s essential that you fully recover from delivery so you are physically and mentally prepared to take on the challenges of the coming weeks, months, and years.