During pregnancy your uterus stretched to 11 times its normal size to accommodate your baby. About six weeks postpartum, your uterus will shrink from the size of a grapefruit, weighing about two pounds, to a mere 2 ounces.
- As the uterus shrinks you may experience "afterbirth pains" that feel like mild contractions.
- Afterbirth pains are most noticeable the first three to four days after delivery.
- Pains may be more pronounced during breastfeeding or if this is not your first child.
If you are in pain:
- Change position
- Lie on your abdomen
- Keep bladder empty
- Take Tylenol or Advil
Episiotomies take four or more weeks to fully heal.
- During this time it is ok to take a shower or tub bath.
- Change your sanitary napkin or pad frequently to avoid infection.
- Rinse and clean the episiotomy with lukewarm water two to three times daily and after each urination or bowel movement using the peribottle (given to you by the hospital).
- Use a sitz bath or a handheld shower attachment to cleanse the episiotimy.
- Use antiseptic spray or cream for relief
- No vaginal douching until after your first postpartum visit.
When returning home from the hospital after a cesarean delivery, you should expect to need assistance with caring for yourself and your newborn.
- At first your incision will be raised and somewhat swollen and pinker than the rest of your body.
- Any pain should feel better after about two to three days, but your incision may be tender for three weeks or longer.
- Your scar will become thinner, flatter and less-noticeable over time.
Care for Your Incision
- If you go home with a dressing, change the dressing over your incision once a day, or sooner if it gets dirty or wet.
- Your doctor will tell you when to stop keeping your wound covered.
- Keep the wound area clean by washing it with mild soap and water. You don't need to scrub it. Often, just letting the water run over your wound in the shower is enough.
- You may remove your bandages to take showers.
- Do not soak in a bathtub or hot tub, or go swimming, until your doctor tells you it is okay, usually not until 3 weeks after surgery.
If your incision becomes red, swollen, tender, warm, or if it is draining, call your doctor.
Getting up and moving around will help you to feel better, heal faster and may prevent blood clots. The healing process should take about four to eight weeks. While you are recovering:
- Do not lift anything heavier than your baby for the first six to eight weeks.
- Stick to short walks, light housework at first. Slowly increase your level of activity as you see fit.
- Avoid heavy activity until you are fully healed and your physician gives you permission.
- Do not drive if you are on narcotic pain medicine.
Becoming a parent is a big step. To do so, you went through both emotional and physical stresses to carry and deliver your child. This is alot for you to process on top of the responsibilites of parenthood. No amount of study and practice can truly prepare anyone for parenthood.
Your priorities and demands on time will immediately change as you acclimate to a new schedule and routine. It is normal to feel overwhelmed. It takes two to three months to fully acclimate to these changes. Do not be afraid to ask for help during this period.
Baby Blues and Postpartum Depression
As a new mother you will feel joy, fear, confusion, exhaustion and love. During the first few days after giving birth, you may experience the "Baby Blues" which includes impatience, irritability and crying. About 70% of women experience the Baby Blues after childbirth. These feelings are normal and generally last anywhere from a few hours to a week or so and go away without treatment.
Postpartum depression is generally more severe and may start as early as the second or third day after delivery or take several weeks or months to develop. Symptoms of Postpartum Depression include:
- Loss of appetite
- Crying spells
- Feelings of hopelessness or loss of control
- Over concern or no concern at all about the baby
- Fear of touching the baby
- Little or no concern about your appearance
- Inability to sleep or excessive sleep
- It is important to realize that these symptoms are not signs of weakness or inadequacy. At the onset of these changes, you need to contact your healthcare provider immediately.
- You may eliminate large amounts of urine in the first few days after delivery to get rid of excess fliud.
- Swelling or bruising of the tissue surrounding the bladder or urethra may cause difficulty when urinating.
- The fear of the sting of urination may also cause difficulty.
- Pouring water accross your vuvla while on the toilet may help to relieve pain and aid in urination.
Contact your healthcare provider if you have any symptoms of a urinary tract infection:
- Pain when urinating
- Not empying your bladder when urinating
- Experiencing an unusually frequent urge to urinate.
Because of the stress pregnancy puts on your bladder muscles, you may leak urine when you laugh, cough or strain. Wear sanitary pads and practice kegel exercises to help alleviate this issue.
There are many reasons that you may be constipated after delivery, including: hormones, medication, dehydration, perineal pain, decreased physical activity.
- The first bowel movement usually occurs in the first two to three days.
- Temporary constipation is not harmful aothough it may be leave you with an uncomfortable "full" or "gassy" feeling.
- A laxitive or stool softner may provide relief from constipation or any hemorrhoids that may develop during and after labor.
- If you are breast feeding: Consult your healthcare provider before taking any medications.
Light exercise, dietary fiber and water can also help to prevent constipation.
- Walking is a great exercise. Increase your distance and pace based on how you feel - don't push it.
- Drink six to eight glasses of water each day.
- Eat foods high in fiber like fruits and vegetables.
Talk to your healthcare provider if constipation causes pain or lasts a long period.
Hemorrhoids are stretched or swollen veins in the anus or lower rectum. If you have hemorrhoids, you may notice pain during bowel movements or swelling around the anus.
- Soaking in a warm tub may help to alleviate discomfort.
- Talk to your healthcare provider about the use of a topical ointment.
- Take care to avoid constipation while you have hemorrhoids. Refer to above section.
Your menstrual cycle usually occurs within seven to nine weeks after your delivery.
- If you are breastfeeding, your periods may not return for several months or even six to 12 weeks after weaning. During this time you may still ovulate and become pregnant. Use birth control during this time if you do not want to become pregnant.
- Once your menstrual cycle returns, it may be heavy for the first few cycles. It will gradually return to what is normal for you.
Because of the exertion that you demonstrated during labor, the first few days you may experience the following aches and pains.
- Muscle aches and fatigue - especially in your shoulders, neck and arms.
- Joint stiffness as a result of the redistribution of fluids as a result of leg swelling and intravenous fluids given to you during labor.
The FDA recommends an extra 300 caloies per day to maintain a healthy pregnancy. When breastfeeding, you will need an extra 500 calories per day to stay healthy and produce nutritious milk. Keep this in mind as you begin to change your diet to lose your pregnancy weight.
- Maintain a balanced and nutritious diet.
- Eat lots of fruits and vegetables, low-fat dairy, lean meats and fish, and whole grains.
- Know appropriate portion sizes.
- Exercise regularly.
- Refer to www.ChooseMyPlate.gov for additional tips on proper nutrition.
Avoid tobacco, alcohol and non-essential medications while breastfeeding.
You may be surprised at how tired you become after minor activity. The birth of a baby can take an immense physical and emotional toll on you and your body. Try to rest when you are able, especially when the baby is sleeping. If you are overly tired, consider asking your support person for help with the baby while you rest.
Some suggestions to assist you at home:
- Keep your routine flexible while you develop a new routine with the baby (ie. meal times, bed time, etc.)
- Consider limiting visitors for the first week or so while you rest.
- Ask for help with shopping and cooking.
- Postpone the undertaking of any major projects or household chores.
- Avoid any substances containing caffeine.
- Try relaxation methods such as meditation or nature sounds to help you rest.
- Ask for help!
Many skin changes that you may experience during and after pregnancy are a result of an increase of hormones.
- The blotchy appearance of your face and dark line on your lower abdomen should disappear gradually during the months following childbirth.
- Varicose veins can be helped with recommended leg elevation and the use of support stockings when walking or standing for the first 6 weeks following childbirth.
For the first few days after delivery you will experience vaginal discharge. This drainage from the birth canal is called lochia.
- Drainage from the vagina will be like a menstrual flow for 3-4 days then it will become more watery and pale.
- By the second week lochia will be thicker and yellow-will be minimal by 4 weeks.
- The odor is fleshy, musty or earthy. It should not be foul smelling.
- Occasional cramping or passing of small clots are normal.
- It is normal for heavier flow when getting up after laying or sitting.
- To reduce the risk of infection, use sanitary napkins or pads rather than tampons.
Call the doctor if :
- Bleeding is heavy or persistent;
- You are passing clots bigger than the size of a fifty cent piece;
- The discharge begins to have a foul odor;
- You have a fever of 100.4 F or higher.
Vaginal Strength and Dryness:
- The pelvic floor may take 6-7 weeks to return to normal.
- Epesiotomies usually require about four weeks to heal.
- Kegel exercises can help to strengthen the pelvic floor and speed healing.
- Vaginal dryness may occur for breastfeeding moms - this is caused by diminished estrogen production.
After giving birth, much of the weight that remains is from excess fluid. The baby, placenta and amniotic fluid weigh approximately 12 pounds. It is normal to weigh the same or more after delivery as you did before you delivered - this is because of all of the fluids given to you during labor.
- You may lose up to 20 pounds within 10 days after delivery.
- It is best to lose about a 1/2 pound per week after the first 10 days.
- Healthy exercise and nutritious eating will help you to return to pre-pregnancy weight.
- Do not diet if breastfeeding - a sensible diet and exercise will help you to stay strong and lose weight.
Please contact your physician if you experience any of the following:
- Bleeding that soaks a pad every hour for 2 hours or more
- Foul odor from your vagina
- Fever of 100.4 degrees Fahrenheit or higher
- Unrelieved incision or abdominal pain
- Swelling, redness, discharge or bleeding from your cesarean incision or episiotomy site
- Your incision begins to separate
- Problems urinating
- No bowel movement within four days of delivery
- Visual disturbance or severe headache
- Flu-like symptoms
- Pain or redness in one or both breasts
- Pain, warmth, tenderness, or swelling in legs (especially calf)
- Frequent nausea and vomiting
- Signs of postpartum depression
If you experience chest pain or problems breathing - call 911 immediately!