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After-delivery care

​​​​​​​​​​​​​​​​​​​​​​​​​​The time following the birth of your child is called postpartum. During this time, your body recovers from the changes of pregnancy and childbirth. Within 6 weeks of delivery, almost all body functions have returned to normal.

It is important to use your hospital stay wisely. Visitors, other than immediate family, should be discouraged to allow you the most time for rest and learning opportunities.

Some of the most common concerns of your recovery are discussed. If you have questions or concerns that are not addressed, ask your health care provider.

Episiotomy Care

The episiotomy is an incision made in the perineum from the vagina back toward the rectal area. This may be done to facilitate the birth of the child. Ice packs to the area after delivery help lessen discomfort. Later, sitz baths (sitting in warm water) make you more comfortable. Pain medication and anesthetic sprays are also used as needed. 

Sitting on a pillow or a rubber ring for a few days may decrease discomfort. You will be taught how to clean the perineal area to help prevent infection and encourage healing. Stitches are naturally absorbed. It is not necessary to have them removed. If the episiotomy becomes infected, the area may become red, swollen, tender and there may also be a discharge. Contact your health care provider if this occurs.

Lochia

Vaginal discharge (bleeding) that occurs after delivery is called lochia. For the first few days, the discharge is bright red, then becomes dark red, pink or brownish color, and later pale yellow. The drainage usually lasts several weeks, gradually decreasing in amount. Bleeding with heavy clots, foul smell or fever should be reported to your health care provider.

After Pains

After pains are caused by the uterus continuing to contract and relax after delivery. These contractions are mild with first babies and stronger with subsequent babies. They will lessen each day following delivery. Breastfeeding mothers may notice increased after-pains during or right after nursing. Changing your position, keeping your bladder empty and taking pain medication makes you more comfortable.

Breast engorgement

You may experience a fullness and discomfort in your breasts 2 to 4 days after delivery as milk production begins. If you are breastfeeding, the baby's demands will regulate your milk supply and the congestion will disappear. Measures to relieve discomfort of breast engorgement if you are not breastfeeding include:

  • Wearing a supportive bra at all times.
  • Cold packs to reduce "swelling" feeling.
  • Avoid stimulating the breast.

The discomfort will go away in 24 to 36 hours. If any breast area becomes red, tender, hot to the touch, or is associated with fever, report it to your health care provider.

Hemorrhoids

Hemorrhoids may become swollen and painful following delivery. The same measures used to relieve episiotomy discomfort are helpful (ice, sitz baths, analgesic ointment, pain medication). Witch hazel compresses (ex. Tucks) and Anusol suppositories or cream are also soothing. The hemorrhoids will gradually decrease in size and possibly disappear.

Constipation

Relaxed abdominal muscles, slowed movement through the intestines and discomfort contribute to the tendency toward constipation. A balanced diet with fiber, fruit and juices will usually prevent the problem. Occasionally, a mild laxative such as Milk of Magnesia may be useful.

Hygiene

A daily shower or sponge bath is preferred. Cleanse the perineal area from front to back using a clean cloth. Change Sanitary pads frequently. Do not use tampons or douche until after your 6-week check-up.

Nutrition

A balanced diet of the basic food groups will aid your recovery and maintain your energy level. Calorie restriction before your 6-week check up may make you feel more tired, and in nursing mothers, may affect milk production.

Rest and Activity

Fatigue is one of the most common problems following delivery. Rest is important for both your physical and emotional well-being. Try to nap when the baby does. Household activities will seem more manageable if you are not overly tired. Consider preparing and freezing some meals ahead of time. Stock up on supplies - food staples, diapers, sanitary napkins, well fitting bras and breast pads.

Gradually return to your usual activity level. Gauge how much you can do by how well you feel. Avoid heavy work and lifting and limit stair climbing for the first few weeks. Accept help from family and friends during the first week or two. Assistance with housekeeping chores allows you time for a faster recovery and time to focus on your infant. If you don't have help, let housekeeping chores go for a while; don't overdo and cause added fatigue. Special note to farm wives - do not return to farm chores for at least 2 weeks.

Postpartum Exercises

You can help restore muscle tone, assist pelvic organs to return to normal and promote relaxation by following an exercise program. Start exercising slowly and gradually increase according to how you feel. You will be given postpartum exercise information in the hospital.

Emotional Changes

You will have many new and different feelings in the weeks following delivery. Many mothers notice they are more emotional and have frequent mood swings. Changes in hormonal balance, fatigue and feeling overwhelmed with new responsibilities can cause you to feel down. (This is what is called "postpartum blues" or "baby blues".) Other common feelings during this time include:

  • Excitement with new baby.
  • Laughing or crying for no apparent reason.
  • Sadness at no longer being pregnant.
  • Anxiety and nervousness about assuming responsibility for care of child.
  • Frustration with managing household as well as family.
  • Jealousy toward baby getting attention.

It is important for you to understand these feelings are normal and experienced by many new mothers. Try to stay relaxed and rested. Talking about your feelings with others will help. Set time aside each day for yourself and for your partner. Don't become totally centered on the baby.

Sharing your life and being a new mother are big responsibilities. New adjustments are necessary. Remember that being a mother is not a natural instinct. Take one day at a time and don't feel that you need to be perfect in order to be a good mother. Gradually, you will become more confident and comfortable.

Postpartum Depression

A serious condition called postpartum depression affects about 10% of new mothers. Instead of the relatively mild sadness and anxiety, you may experience more intense feelings of depression, irritability and despair that may disrupt your ability to function. If not recognized and treated, postpartum depression may become worse or last longer than necessary, and affect the rest of your family.

Feelings of depression may even start before the birth of your child. If you feel that you are experiencing any of these symptoms before or after delivery, talk to your health care provider. Resources for counseling and treatment are available and can help you feel better.

Return of Menstrual Periods

Your menstrual periods will usually return in 6 to 8 weeks after delivery, although this does vary. Breastfeeding mothers may not experience return to menstruation for several months or until their infant stops nursing. Your first few periods may be irregular and shorter or longer than usual, but will gradually return to what is normal for you. It is important to be aware that your ovaries may begin to function soon after delivery. This means you can become pregnant even though you may not have had a period yet. Also remember breastfeeding does not prevent pregnancy.

Resuming Sexual Intercourse

Sexual intercourse can usually be resumed when your episiotomy is healed, vaginal drainage has stopped and you feel comfortable. This usually occurs in about 4 to 6 weeks.

Family Planning

It is necessary to choose some form of birth control before you resume intercourse if you do not want to risk becoming pregnant. You and your partner should discuss this ahead of time.

There are many methods of birth control available:

  • Oral contraceptives (birth control pills)
  • Intrauterine devices (IUD)
  • Barrier methods (diaphragm, condom, vaginal sponge, spermicidal cream, jelly or foam)
  • Natural family planning (periodic abstinence)
  • Sterilization (tubal ligation, vasectomy)
  • Implantation device

When selecting a method that best meets your needs, consider:

  • Effectiveness of method
  • How comfortable you feel using it
  • Health of both partners
  • Risks
  • Costs

Since there are advantages and disadvantages with each method, discuss them with your partner and your health care provider. Specific information on each method is available to you upon request. Whatever method you choose, it will work best when used correctly and consistently.

Care Following Cesarean Section

You may shower 24 hours after the C-section. You will notice steri-strips over your incision; as they start to loosen, you may gently remove them. The stitches in the incision will gradually dissolve and will not need to be removed. Cesarean section should not interfere with your ability to breastfeed. You should be able to return to your normal activity in 4 to 6 weeks.

Postpartum Check-up

Your first Clinic visit after leaving the hospital is about 6 weeks from birth. At this visit, a brief examination is done to check healing. It is a good idea to bring a list of questions you may have to this visit.