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Congratulations on the birth of your baby!
Remember to call the office to make an appointment for your four week postpartum checkup.
Although pregnancy, birth and recovery is a healthy natural process, a new infant brings many physical and emotional adjustments. Remember to be yourself, pay attention to your body’s signals and trust your judgment. The rate of recovery is individual to each new mother. Some women are back to full activity within one or two weeks, and others need six weeks. We hope these general guidelines will help.
A new mother should resume her routine when it feels right. The only limitations are:
- No heavy lifting for two weeks to two months
- No douches, tampons until the post-partum exam or 4-6 weeks after delivery
- No intercourse until the post-partum exam or 4-6 weeks after delivery
There are important signs and symptoms to watch for during the postpartum period. If any of the following occur, call the office right away:
- Temperature greater than 100.5°F.
- Pelvic pain greater than after-birth pains or menstrual cramps.
- Any bleeding greater than a heavy period. Initially you may pass clots or bleed somewhat heavily for a few days, but it should not continue. It is rare, but postpartum hemorrhage can occur even weeks after delivery. If at any time you experience a reoccurrence of heavy bleeding, call the office immediately.
Perineal Care
Caring for the perineum, the area between the vaginal opening and the anus where you may have stitches is critical to prevent infection and promote healing. Keep the area clean and dry. The nurses in the hospital will show you how to achieve this.
Here are some guidelines:
- Your vaginal discharge will be like a heavy period for several days, gradually decreasing to a thin pinkish-brown mucus discharge for 2-6 weeks after delivery. Wear pads starting with full size pads and decreasing the size as needed. Do not use tampons.
- You can bathe immediately after delivery. One of the best treatments for a sore bottom is a sitz bath. Sit in 3-4 inches of very warm water for 20 minutes 3-4 times a day. Be sure to thoroughly rinse any soap from around the labia and vagina to avoid a chemical irritation.
- After a bath or shower pat dry and if needed, you may apply a topical anesthetic spray such as Dermoplast or Epifoam. You may want to blow dry the area by using a hair dryer on the low setting.
- To avoid contamination of the stitches, vagina, and urethral opening, always wipe from front to back after a bowel movement or use a peri bottle with warm water.
Hydration
Fluid intake is more important than ever for three reasons:
- You are more susceptible to bladder infections now, so wash out your urinary tract by drinking lots of water.
- Breast-feeding requires plenty of fluids for adequate milk volume.
- Regular bowel function requires good hydration.
Bowel Function
As you have seen, bowel function is sluggish in pregnancy. Over the next 2-6 weeks it will return to normal. It will continue to respond to good hydration, daily walking and exercise, and adequate bulk in diet. Leafy green vegetables, bran cereals, whole grain breads, and fruits and fruit juices are important each day. If you have not had a bowel movement within a couple of days after leaving the hospital, you may want to use a mild laxative. If you are breast feeding, stool softeners, milk of magnesia, or a bulk agent like Metamucil are fine as they are not absorbed by your body and will not pass to your baby. Do not use any other type of laxative unless you are bottle feeding, in which case the laxative of your choice is fine. Try not to fall into a regular pattern of laxative use, because your system may become dependent on it. If you are concerned, or if constipation persists, please call the office.
Hemorrhoids are very common after delivery. They usually resolve in 6-8 weeks. Regular soft stools that do not require straining will help. Colace or Surfak, available over the counter are good stool softeners. They are not absorbed so can be used while breast-feeding. Sitz baths, as described under perineal care above, can be helpful to relieve the discomfort from hemorrhiods.
Diet
Eating right is as important now as before, whether or not you breast feed. You still need plenty of protein, fiber, and the appropriate number of servings from each of the basic four food groups. Continue your prenatal vitamins for 6-8 weeks. If desired, you may begin a weight reduction diet. Read labels and shop wisely. Avoid over-processed foods and foods with added ingredients like preservatives, dyes, sugar, sodium, etc. A healthy diet contains less red meat and more fish, poultry, and other lean meats.
If you are breast-feeding all of the above apply with some additions. You need extra protein and dairy products, and prenatal vitamins with iron until you wean your baby. Avoid or limit caffeine, alcohol, and excess carbohydrates, fats and sugars. Some breast feeding mothers notice that the baby will have a reaction to certain foods she eats. If this happens, and you are not certain which food it is, eliminate the suspects from your diet and reintroduce them one at a time several days later to pinpoint the culprit.
Remember, good dietary habits are important now while your baby is small, but also as your child grows older, when your eating habits will set an example.
Exercise
It’s as important to exercise now as any time in your life. Special care should be taken with your abdominal and lower back muscles, as these were the most stressed with pregnancy. For the first 2 weeks, walking and stretching exercises are sufficient. Gradually stretch out the back with toe touches and stretch the waist by twisting side to side and leaning down to each side. After 2 weeks you can begin a gradual progressive process towards a full exercise program of at least 10-15 sit-ups, toe touches and leg lifts each day. Vigorous walking is excellent exercise if it’s done on a regular basis. Resume Kegal exercises immediately postpartum to help regain pelvic tone.
If you had a cesarean section, we encourage you to be active, but you must avoid heavy lifting and strenuous activity for 4-6 weeks. Stretching exercises and walking are fine, but not sit-ups, lifting weights, etc.
Breast Feeding
We strongly encourage you to breast-feed. It is one of nature’s simplest functions, yet it takes some adjusting both for the mother and baby. You may sail through without a problem, but if you encounter difficulty in the first weeks please do not give up. Call our office for assistance. A good support bra is essential while breast-feeding. Since drugs can pass to the baby through your milk, call us before taking any drugs including over the counter drugs. If an area develops on your breast that is tender, firm and reddened, especially if your temperature is over 100.5°F, call the office immediately.
If you decide not to breast feed or you are weaning your baby, the best way to manage the engorgement is to 1) wear a tight support bra or a pressure wrapping around the breast 24 hours a day and 2) use ice packs. Do not pump, express, or stimulate the breast as this only encourages continued milk production. Relief usually comes within 24-48 hours.
Postpartum Depression
Postpartum depression is often called the “baby blues.” Some women never experience it, but most do to some degree. Some reasons for it are anxiety and confusion over parenting, tiredness, engorged breasts, sore nipples, hormonal fluctuations, and lack of sleep. Symptoms may be bouts of depression and crying jags. These feelings are most common 3-10 days after delivery.
If you experience postpartum depression, accept it for what it is. Try putting up a “no visitors” sign, turn off the phone and delegate household duties to whoever is available to help you. Leave the baby with someone you trust. Then spend some time on your own or with a supportive and understanding friend. Take a walk or go to the movies. A two-hour respite can work wonders for renewing emotional energy.
The best advice on baby care is to trust your judgment. There are volumes written on the subject, and you may be bombarded with friendly advice from friends, relatives and even strangers. Try not to take everything you read or hear as the gospel truth. Absorb and digest the information, then process it. Use what you feel applies to you and your baby. Babies can sense your mood, so let that mood be relaxed and happy and hopefully your baby will be too.
If the feelings of depression don’t go away in 1-2 weeks and become severe or seem to dominate your life, call us or make an appointment to talk to your doctor.
Contraception
Most women do not resume ovulation for 6-8 weeks, but this is not true for all. It’s possible to conceive again, even before you begin to menstruate again. That’s why contraception is important following delivery. Breast-feeding alone is not an adequate form of contraception. Foam and condoms should be used until other methods can be initiated. If you are not breast-feeding and want to use birth control pills, they can be started 3-4 weeks after delivery. Diaphragms can be fitted 4-8 weeks after delivery when your normal vaginal tone has returned. Do not use your pre-pregnancy diaphragm until the size has been checked.
If you are breast-feeding and wish to use birth control pills, we suggest a progestin only pill. Birth control pills are usually a combination of an estrogen and a progestin that is more effective at preventing pregnancy, but estrogen can cause a decrease in milk supply. Therefore we recommend a progestin only pill until you have weaned the baby. Then you will need to call us and change to a pill containing both estrogen and progestin.
Knowing what to expect and maintaining a relaxed and positive attitude can ease your postpartum adjustments.
Enjoy your new infant,
Women Partners in OB/GYN
