Post Partum Care

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Activity
Restricted activity includes nothing in the vagina for 6 weeks (no intercourse, no douching, no tampons). You should not drive while requiring pain medications and until you feel like pain will not decrease your reaction time or keep you from comfortably wearing a seatbelt. This is usually a few days after a vaginal delivery and about 2 weeks after a c-section. Lifting should be limited to nothing greater than 10 to 15 pounds for the first 2 weeks if you have had a Cesarean delivery. Exercise may be restarted as tolerated after a vaginal delivery and 2 weeks after a C-section but please avoid getting too tired. You may do what you feel like doing, but stop to rest often. Take care of yourself and the baby and allow others to help with cleaning and cooking for the first couple of weeks. If you have no one to help, you may do light household duties after the first week and as you feel able, but stop to rest often. Try to lie down and rest when the baby naps during the day. You may climb stairs but you may need to stop and rest along the way.

Bleeding
Your bleeding should gradually decrease in amount and change from bright red to brown and then to yellow. You should use pads for 6 weeks and then you may use tampons. Call our office if your bleeding greatly increases after you get home. Post partum bleeding may continue for 8 weeks postpartum but has usually stopped by 6 weeks. If you are not breastfeeding, your menstrual cycle will probably resume in 6 to 8 weeks. If breastfeeding you may not have a period until you stop breastfeeding. Call if you have questions or problems.

Pain
Perineal stitch pain can be helped with warm baths 2-3 times daily (see Bathing). The stitches are absorbed by the body and do not have to be removed. Using pillows and selecting soft places to sit may be helpful. Tylenol, Ibuprofen, or Aleve may be taken if needed. Most stitches will be completely healed within 2-3 weeks.

Pain at your incision site after a c-section will also respond to Tylenol, Ibuprofen, or Aleve but you will likely need a narcotic during the first 2 weeks. This will be prescribed by your doctor. If it contains acetaminophen (which is the same as Tylenol) make sure that you do not take this with regular Tylenol as you can exceed the recommended dose this way. You can use a heating pad at your incision and you can try to give support when you cough or sneeze by holding a pillow to your incision. You may wish to take a stool softener, such as Colace, while requiring a narcotic as this medicine can slow your GI tract. You cannot drive while requiring a narcotic for pain control.

“Afterbirth” pains are caused by contraction of the uterus as it attempts to return to its original size. If you are breastfeeding, you may experience more cramping while you are feeding. Tylenol and Ibuprofen may help. Increasing and/or constant abdominal pain may be abnormal and you should notify our office should this occur.

Bowel Movements and Hemorrhoids
Your bowels may be sluggish after delivery. We recommend that you increase the fiber in your diet. You could do this by eating bran cereal daily or by increasing fruits and vegetables and whole grain breads. Remember to drink 6-8 glasses of water daily. Bowel movements may be painful at first due to the stitches, contracting uterus, or hemorrhoids. Sitz baths, Tucks pads, ice packs, and soft pillows may be helpful. Stool softeners may be taken daily if needed. There are certain vaginal lacerations in which suppositories and creams for hemorrhoids are not acceptable so please make sure your doctor has ordered these prior to using them.

Urinary tract
It will probably feel very different or even painful at first when you empty your bladder. This is due to the stretching and swelling that occurs with the delivery or may occur after catheterization of the bladder. Call the doctor if you have any concerning symptoms such as, fever, chills, pain with urination, inability to empty your bladder completely, or pain in the lower abdomen or back.

Bathing
If you have had a Cesarean delivery, you should not soak your incision. Therefore, either a very shallow bath or showers should be used during the first 2 weeks.

Douching
As Obstetricians and Gynecologists, we suggest that you do not douche during the post partum or ever unless prescribed. However, if you do, please do not douche for 6 weeks.

Breast care if you are not breastfeeding
What Can I Expect?

  • At the time of birth, changes occur in a woman’s body associated with lactation regardless of the mother’s intention to breastfeed.
  • Before your milk comes in, your breasts should feel soft. Colostrum is the “early milk” present in your breasts for the first few days after childbirth.
  • When your milk comes in (a few days after childbirth), your breasts may be swollen, firm, tender and warm.
  • Engorgement is when your breasts become too full with milk. Engorgement is temporary and goes away on its own along with breast tenderness in 1-3 days

What Can I Do?
If you choose not to or cannot breastfeed your baby, follow these guidelines:

  • Wear a well-fitting, supportive, but non-constricting bra for at least three or four days following delivery.
  • Refrain from stimulating the breasts or nipples too often.
  • Milk stasis can create infection, therefore small amounts of milk need to come out to avoid engorgement and infection.
  • Choose to either hand express small amounts of milk of pump just to leave the breasts comfortably full.
  • Apply cold compresses in the form of a frozen wet towel, cold packs, or ice packs on the breasts for 15 minutes for a time every hour as needed. (To prevent tissue injury, do not apply cold directly to bare skin. Place a light towel between the cold compress and your breast.)
  • Apply cold raw green cabbage leaves to the breasts under the bra and change when wilted or after 30 minutes.
  • Take acetaminophen or ibuprofen as directed to help relieve the pain and discomfort.
  • Do not massage or apply heat to the breast.
  • Rest and good nutrition will help you heal after childbirth. Drink plenty of fluids unless directed otherwise by your health-care provider. Cut down on salt intake. Salt causes your body to retain fluids. Sage tea contains a natural form of estrogen and can decrease your supply and help dry up your milk.

NOTE: Some women find that they would like to donate their breastmilk to a milk bank or another mother. If you are interested in this option, please schedule with our Lactation Consultant who can guide you through this process.

When to Call Your Health Care Provider
If you are experiencing pain that is not relieved by some of the methods described above, or if you have symptoms of a breast infection known as mastitis. Symptoms include:

  • Fever higher than 100.4 degrees (by mouth).
  • Increased fatigue.
  • Red, hot or hard breast(s).
    Muscle aches and flu-like symptoms.
  • Painful lump(s) in the breast.
  • Red streaks extending from a lump toward the underarm area.

Breast care if you are breastfeeding

A few days after your baby’s birth, your breasts will swell with milk. They are likely to feel tender and heavy. This is normal. To help prevent breast soreness and control irritation, follow these tips:

Coping with swelling

  • Use cold compresses or an ice pack directly to the breasts for 15 minutes to help reduce the ache or pain. To prevent tissue injury, do not apply cold directly to bare skin. Place a light towel between the cold compress and your breast. Make sure to take the ice pack off for 15 minutes before reapplying.
  • Breastfeed often to keep milk from clogging your breast ducts. Keep your milk moving.
  • If your nipples are flat from breast swelling, hand express some milk. Squeeze out a few drops of milk by massaging and compressing your breasts. You can visit this website for more information: http://www.breastfeedinginc.ca/content.php?pagename=doc-EngRPS
  • If you have swelling with pain or fever, call your health care provider.

Preventing sore nipples

  • Make sure baby latches on to your breast correctly. The baby’s tongue should always be under your nipple, and your entire areola should be in the baby’s mouth.
  • You can let milk dry on your nipples. This dried milk can protect the skin on your nipple/breasts.
  • Do not use alcohol, or scented cleansers on your breasts. These can cause the nipples to dry and crack. Avoid lanolin which can cause irritation.
  • Do not wear nursing pads that are lined with plastic. They hold in moisture and can cause chapping.
  • If you experience cracked or bleeding nipples, consult your doctor or ourLactation Consultant. She will ensure that your baby’s latch is correct and may suggest topical treatment.

See our Lactation Consultant
Kimberly Rush is a Registered Nurse and International Board Certified Lactation Consultant. Kimberly offers support for breastfeeding questions or concerns. She is available to meet with patients who are pregnant to discuss ways to get breastfeeding off to a good start and identify anything in your health history that may affect a good milk supply for you. She can also meet mothers after baby has arrived. Reasons to see her might include pain with breastfeeding, infant weight loss or slow weight gain, help with latch and positioning, concerns about tongue or lip tie, returning to work, if your baby was born prematurely, if you are concerned about low milk supply, if you need to rent a medical grade breast pump, if feedings seem to take “forever,” if you are hearing conflicting advice, if your baby is fussy during feedings or sleepy during feedings, if you have twins or multiples, is your baby is jaundiced, if you think or have been told your baby has thrush, if you have flat or inverted nipples, if your breasts are engorged, if you are experiencing breast pain or plugged ducts or signs of mastitis, if you have had breast surgery or trauma, if you have questions about medication safety while breastfeeding, if you have questions about how to use your breast pump or other breast feeding equipment, if your baby has a cleft lip or palate, if your baby struggles to bottle feed, if you think you have too much milk supply, or any other feeding question or concerns.

Choosing a good bra
Wearing the right sized bra is especially important now. If a bra is too tight, it may cause a duct in your breast to clog and become irritated. If possible, have a salesperson help fit you for a new bra. Look for one that’s 100% cotton and comfortable. Also, choose a bra with wide straps that won’t dig into your back and shoulders. If you’re breastfeeding, find a nursing bra that allows you to uncover one breast at a time.

Diet
You should continue a nutritious diet as in pregnancy. If you have had a Cesarean delivery, you may need to gradually advance your diet from soft bland foods to a regular diet. You should call our office if you have nausea and vomiting. You should continue your prenatal vitamins. If you are breastfeeding, you will need about 500 more calories than you did before you were pregnant (about 2500 calories total per day). Try to get 1000mg calcium per day and drink 8 glasses of water.

Birth control
You should not have intercourse until 6 weeks after delivery. It will likely be uncomfortable to have intercourse at first. Be gentle and patient with each other. Talk about your feelings and concerns. Use extra lubricants (such as K-Y jelly or a lubricated condom). Please use some form of birth control if you do not want to get pregnant. Breastfeeding can sometimes delay your ability to become pregnant but this IS NOT a reliable means of birth control. Please talk to your physician about the method of birth control that you wish to use.

Follow-up
Please call our office at (828) 253-5381 for an appointment as soon as possible after the birth of your child. The timing of this appointment will be based on the discharge instructions given at the time of your discharge.

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