Postpartum

From delivery to 6 weeks after

Most people spend their pregnancy worrying about delivery with little thought to the postpartum period.  This time period deserves some thought ahead of time.  Much like the birth preferences, it is nice to think about how you might need help and who you could call for reinforcements and support.  See our planning sheet in the link below to start the thinking process.

 Postpartum Planning Worksheet

Bleeding

  • Postpartum bleeding is called lochia.  Lochia often follows a progression of bright red bleeding for the first week or so, followed by watery pink or brown for several more weeks and, lastly, a yellowish-white that may last for several more weeks.
  • Lochia may only last for 2-3 weeks but may last as long as 8 weeks.  It often starts and stops with no apparent reason.
  • Sometimes women pass dark clots. This is old blood that was sitting in the uterus. As the uterus contracts, it will expel the old clots.  Let us know if the clot is greater than a tennis ball in size

After birth pains

Cramping after birth is normal and, actually, good for you!  These cramps are the uterus contracting and returning to normal size.  When you breastfeed, you release oxytocin which increases these contractions.  Often you will only notice these pains for a few days after delivery but some women may notice for a few weeks.  Ways to increase your comfort include emptying your bladder more frequently, using hot compresses and taking ibuprofen.  Pain often worsens with each subsequent pregnancy.

Swollen breasts

Most women will have engorgement when their milk comes in.  You may notice a low-grade fever, aching and painful, swollen breasts.  If you are breastfeeding, continue to feed as often as your baby needs.  If you are not breastfeeding, place ice packs in a tight-fitting bra (sports bras are great!) 24 hours/day until engorgement has resolved. Also, avoid any extra stimulation of the breast by pumping, massaging or allowing warm water to run on them in the shower.  Those activities will slow the resolution.

Swelling

Swelling in the hands, feet, and legs is common after delivery.  It will gradually go away as your body gets rid of excess fluid.  As this happens, you may be urinating and sweating more than usual. Please call our office is the swelling is in the face, associated with persistent headaches unrelieved by Tylenol or ibuprofen or if the swelling in the legs is associated with pain particularly behind the knee.

Constipation

One of the great miseries of life is constipation.  You don’t appreciate the simple pleasure of a good bowel movement until you can’t have one. Many people fear the first bowel movement.  If, however, you try not to poop you will find you get constipated and that will be uncomfortable whether you have stitches or not!  We recommend using stool softeners until regular bowel movements are reestablished.  You can use colace or Miralax.  Once your bowel movements are normal, wean yourself off.  If you have constipation that requires more than a stool softener, try milk of magnesia. If you have not had a bowel movement within two days of going home, call us for guidance.

Vaginal tears or episiotomy

Many women tear naturally when delivering, and occasionally, we have to make a small incision to help the baby delivery.  These are repaired with dissolvable stitches.  They will dissolve over 3-6 weeks time. To care for these:

  • Try using cold packs immediately then dry heat, sitz baths or a spray bottle
  • Sitz bath-a clear comfortably hot bath over your waist. This can be done 2-3 times a day for 15 minutes at a time.  Afterward, dry completely by blotting with a towel or blow drying.
  • Periwash- a spray bottle used to rinse after using the restroom for the first week.  Pat or blow dry after

Hemorrhoids

They are no fun but are common. Try Preparation H, Tucks pads, dry heat and sitz baths for comfort.

Hair Loss

Thinning hair is normal postpartum often occurring months after delivery. It usually takes a year for hair growth patterns to correct themselves.

Intimacy

We encourage you to wait to have intercourse until we have seen you back in the office.  Most women are physically healed enough for sex after 6 weeks.  Many women who breastfeed struggle with vaginal dryness so we recommend having a lubricant available.

Changes in bladder function

Many women will have trouble controlling their urine after delivery.  This is from pressure to the bladder and the nerves to the bladder during labor.  Doing Kegel exercises (link) and emptying your bladder before it becomes overfull help.

Postpartum blues

  • Sadness, tearfulness, irritability, and anxiety
  • Insomnia
  • Decreased concentration
  • Brief beginning 2-3 days after delivery and resolved within 2 weeks

Postpartum depression

  • Can occur anytime within 12 months of delivery
  • Irritability, anger, feeling inadequate, overwhelmed, or unable to care for your baby
  • Lack of energy (unable to get out of bed, to care for baby or self)
  • Insomnia
  • Decreased appetite, weight loss and inability to enjoy the taste of food
  • Feeling shame, guilt or having failed as a mother
  • Thoughts about hurting yourself, your baby or your other children

Please call us if you have symptoms of postpartum depression. We can help.