Postpartum Guide Taking care of mother after baby is born 1 Congratulations Important on the birth of your baby! warning signs The time just after a baby is born, the , is a special one. It brings many physical and emotional changes. This guide will help answer Call your health care provider questions about the changes in your immediately if you develop any body and about your postpartum care. of these warning signs:

It is not meant as a substitute for • Pain that gets worse and is professional medical care. If you have unrelieved by medication questions or concerns, be sure to talk with your health care provider. • Painful, very red and swollen incision or leaking of any fluids

• Bright red or heavy vaginal bleeding with or without clots that saturates a pad in less than one hour

• Foul-smelling vaginal flow

• Fever or chills with a Table of contents Postpartum period defined temperature over 100.4 F The time immediately after you deliver your baby until your • Ongoing urinary or Warning signs...... 3 reproductive organs return to their prepregnancy state is perineal discomfort Postpartum care...... 4 called the postpartum period. It begins as soon Blues and ...... 4 as your baby is born and usually lasts about six weeks. • Burning, frequent or Cesarean section care...... 5 During this time, you’ll likely be on “night shift” with the bloody urination baby for several days or even weeks. Many babies are more care...... 6 • Cracked nipples or red, wakeful at night and want to feed frequently in the first Discharge/...... 6 few weeks. tender areas in a breast Showers and baths...... 6 that don’t respond to home It is important for you to sleep when the baby sleeps; focus treatment Perineal care...... 7 only on caring for yourself and your baby. If possible, have Bladder care...... 8 family or friends help with housecleaning, laundry and • Symptoms of postpartum Swelling...... 8 cooking for the first couple of weeks. depression Bowels/hemorrhoids...... 9 • Crying spells or mood swings Breast care...... 9 that feel out of control Diet and nutrition...... 11 Activity and exercise...... 12 Exercises...... 13 Returning to work...... 14 Resuming sex...... 14

2 3 Some mothers may experience Some women may not feel depressed postpartum depression. Symptoms but may feel very anxious. This is known may include: as postpartum . • Frequent sadness or crying Symptoms may include: • Changes in appetite • Intense anxiety and/or fear • Trouble sleeping • Rapid heart rate • Intense fatigue with low mood • Sense of despair • Emotional numbness • Hot or cold flashes • Feelings of helplessness • Chest pain • Irritability, surges of anger • Shaking • Feelings of inadequacy, guilt or shame • Dizziness • Difficulty concentrating, indecisiveness • Insomnia • Repetitive fears, thoughts or images These symptoms are often caused • Lack of interest in sex by a hormone imbalance, which may • Lack of feelings for your baby require treatment by medication and/or • Exaggerated high or low moods counseling. Call your health care provider if you experience any of these symptoms.

Care for a cesarean section • Keep the incision (wound) clean and • It is okay to lift your baby, but don’t dry. Usually you may shower beginning lift anything heavier than 15 pounds Postpartum medical care the first day after surgery, but you for the first six weeks. should have no tub baths for one to Within a few days of going home from resentment and self-doubt can accompany • Avoid sitting for long periods with two weeks or until your health care the hospital, make an appointment your adjustment to motherhood. your knees bent or crossed. This provider allows them. with your health care provider for can cause blood clots to form. Many mothers feel overwhelmed a postpartum medical checkup. The • Your incision may be covered with • Avoid driving for the first two weeks and very, very tired. Such feelings are timing of this visit will vary according to Steri-Strips (little strips of tape that or until your health care provider normal. They usually do not last more your health care provider’s preferences help the incision heal). You can get the allows you to do so. than a few weeks. However, if your and your delivery experience, but it Steri-Strips wet in the shower and you feelings are more than you can cope • Kegels are the only exercise you should will be sometime between two and six can remove the strips after seven days with, do not hesitate to call your health do until your six-week checkup, unless weeks after your baby is born. if they have not already fallen off. care provider for help. advised by your health care provider. After leaving the hospital, you are • Look at your incision daily with a hand Walking for short periods is fine Normal “baby blues” symptoms always welcome to call your health mirror. Report any redness, swelling, with rests in between. (Check with may include: care provider. separation, drainage or foul odor from your health care provider if you need • No energy or around your incision to your health information on Kegels.) • Anxiety or worry care provider. Postpartum blues • Sadness and depression • Confusion or nervousness Note: You may find that an abdominal binder, prescribed by your health • Concern over physical changes care provider, gives you additional support during your recovery. Having a baby brings many dramatic • Increased crying changes – changes in your lifestyle, • Oversensitivity Most of all, listen to your body. You will know you are overdoing it if your sleep, hormones, and views of yourself • Irritability bleeding increases or if your incision, abdomen or back begins to hurt when and your family. It is not surprising that • Excitability you’re doing an activity. mood swings and feelings of sadness,

4 5 Uterus Immediately after your baby is born, your uterus becomes firm and about the size of a large grapefruit. If your abdomen still looks pregnant after delivery, this is normal and will gradually decrease in size. Six weeks later the uterus should have returned to its normal size, similar to a small pear. While you are in the hospital, your nurses will check your uterus regularly for location and firmness. Some mothers, especially second-time mothers, feel painful after-birth contractions when breastfeeding. These contractions, caused by hormones released when you breastfeed, usually disappear in five to seven days. In the meantime, if you experience such contractions, try the following steps to ease pain. • Apply heat to your abdomen. • Take mild, non-aspirin pain relievers (such as ibuprofen) before breastfeeding. • Gently massage your abdomen. • Keep your bladder empty. • Do deep-breathing and relaxation exercises.

Lochia (vaginal discharge) and menstruation Some vaginal discharge ,or “lochia,” will usually be present for at least two to three weeks after you give birth. Initially, it will be red with small clots. Notify your health care provider if you pass clots larger than a golf ball or if you notice a foul odor to your vaginal discharge. Within eight days of your baby’s birth, the discharge may be pink or brown-tinged. It is normal for the flow to increase whenever you increase your level of activity, even if it is simply getting out of bed. If the flow turns bright red and becomes heavy after you leave the hospital, you should rest and count the pads you use. If rest does not slow the flow and you Perineal care after vaginal delivery saturate a pad in less than one hour, call your health care provider. The perineum is the area between your Vaginal and stitches will After giving birth, women start menstruating again on varying schedules. It may and rectum. For comfort and to dissolve during the healing process. take a few months for your cycles to become regular again. mothers often prevent infection after giving birth, use They do not need to be removed. Limit find it takes 18 weeks or longer to resume menstruation after giving birth. a peri-wash squirt bottle to clean the intense activity, particularly lifting, for perineal area in a front-to-back direction at least two to three weeks. You may Note: You can become pregnant before your menstrual periods resume and you after you go to the bathroom or when be more comfortable if you lie down can become pregnant even if you are breastfeeding. Be sure to discuss family your vaginal discharge is heavy. Continue rather than sit for prolonged periods of planning with your care provider. to use the peri-wash bottle until bloody time. Elevate your feet while sitting and, vaginal flow has decreased. You may when you sit, use cushions. Placing a gently wash the area with soap and a medicated pad against the stitches may Showers and baths soft washcloth as you shower or bathe. reduce irritation. Call your health care You may take showers or (after vaginal deliveries) baths. On the first day, you may apply ice packs provider promptly if you notice any of No special vaginal care is necessary. However, don’t to the perineum to reduce swelling these signs: put anything in your vagina for four to six weeks and pain. After that, you may find that • Increasing pain after birth: no , douching or intercourse. soaking in a clean bathtub for 10 to 20 • Redness minutes several times a day helps relieve • A foul odor in the perineal area pain and discomfort. Your health care • Fever provider may prescribe medicated pads and/or anesthetic spray for comfort.

6 7 Bowels and hemorrhoids Physical inactivity, narcotic pain Note: If you have rectal stitches, do NOT medications and perineal soreness may use an enema without consulting your cause constipation and gas. Try these health care provider first. simple tips to prevent or relieve Hemorrhoids (painful, swollen veins constipation. in the anus) commonly occur during • Drink plenty of fluids – six to eight and may become tender and glasses of water a day. inflamed after a vaginal birth. To relieve • Eat fruits, including prunes and figs, hemorrhoidal discomfort on the first leafy green vegetables, and whole- day after giving birth, use ice packs to grain bread and cereals. reduce swelling. After that, it may help • Take stool softeners and/or laxatives to apply warm, moist heat to the area or as recommended by your health to soak in warm water in a clean bathtub. care provider. You may also try hemorrhoidal cream, • Establish a regular time to go to medicated pads and/or anesthetic spray. the bathroom. Avoid sitting or standing for long • Begin taking walks. periods of time. Try to alternate periods of rest and activity. It is important to prevent constipation and straining with bowel movements, so increase your fluids and the fiber in your diet.

Breast care It is normal for your breasts to get bigger and tender two to five days after you give birth. You may be more comfortable if Breastfeeding you wear a well-fitted, supportive bra (with no underwire) day classes Bladder care after delivery and night as your body adjusts to these changes. Your breasts It may take a few days for your bladder to return to normal and for you to regain may leak milk for several weeks, so wear breast pads (cotton is One of the most important your normal bladder control. Your may have been bruised or the bladder best) until the leaking stops. choices a new mother makes is how best to nourish her overstretched during delivery. If you were catheterized after delivery, you may Breastfeeding be more susceptible than usual to urinary tract infections. Drink plenty of liquids baby. Consider taking one For a few days after your baby is born, your breasts will secrete and empty your bladder at least every three to four hours. of our breastfeeding classes a thin, yellowish fluid called colostrum. Composed of water, to help your baby get off to It is normal to feel some tingling or slight discomfort when you urinate. If you fat and protein, colostrum contains substances that help your a healthy start. feel burning or worsening pain, call your health care provider. newborn’s immune system. Although your milk does not “come in” for several days, your baby will get plenty to eat. Colostrum contains all the nutrients a newborn needs. Nursing your baby Swelling on demand up to 12 feedings per day acts as a good stimulus for milk production. Both of your legs and feet may swell after you give birth. This is common. Although uncomfortable, it is not dangerous, nor is it a sign of infection or Wash your hands thoroughly before each feeding. Keep your circulatory problems. You may take warm baths and elevate your feet to make breasts and nipples clean, but avoid harsh soap and drying lotions. yourself more comfortable. Within a week, the swelling should be gone. There is no need to wash your breasts and nipples with soap. Clean water is best. (continued)

8 9 Breast care (continued)

Nipple care Mastitis After several feedings, your nipples may Mastitis, an infection within the breast, become tender with the first few sucks may occur at any time while you are as the baby latches on. This discomfort nursing. Symptoms of mastitis include: should improve within the first few • Fever higher than 100.4 F (38 C) weeks of nursing. • Increased fatigue If your nipples become very sore, • Flu-like symptoms cracked or blistered, the baby is • A red, tender area in the breast probably not latching on correctly. • Red streaks extending toward your For breastfeeding help and guidance, armpit call your health care provider. If you experience any of these Here are some comfort measures for symptoms, call your health care provider sore nipples. immediately as medications may be • Avoid using soap on nipples. necessary. Be sure to continue nursing or Wash with warm water only. pumping your breasts. • Expose your breasts to air and keep them as dry as possible. Engorgement • Apply purified lanolin nipple Engorgement is a process in which cream after breastfeeding. breast tissue swells and hardens. It lasts • Manually express a small amount about 48 hours and causes varying of colostrum or breast milk; degrees of discomfort. Some women apply to sore nipples. feel only mild swelling and tenderness. Others have more pronounced soreness • Cover sore nipples with a special as their breasts become firm and the skin hydrogel dressing (trade names: Vigilon, stretches and becomes tight and shiny. Second Skin, Water-Jel). These products are available over the counter at most If your breasts continue to be pharmacies. Limit use to 24 hours or as uncomfortable, try the following: directed by your lactation specialist or • Avoid using heat or hot water, as this health care provider. may increase swelling. Diet and nutrition • Do not use lanolin if you use a hydrogel • Lie on your back. After giving birth, mothers are usually busy and tired. You may find it difficult dressing. Be careful when removing a • Apply ice packs made of crushed ice to eat regular meals and drink plenty of fluids, but these are important to dressing; it can dry out and stick to the in plastic bags that will mold to your postpartum recovery. You will need energy and strength to care for yourself and nipple, further damaging the nipple. breasts. Be sure to have one layer of your infant. You should eat three good meals daily and have healthy snacks and cloth (such as a towel) between your plenty of water throughout the day. Do not be overly concerned about losing skin and the ice pack. Apply one ice the weight you gained during pregnancy. If you have prenatal vitamins left pack to each breast for 20 minutes. when your baby is born, continue taking them as prescribed. Alternate them 20 minutes on and 20 minutes off until you are comfortable. If you are breastfeeding, your diet should include extra calories for milk production. You can do this easily by adding an extra serving of protein and • Try placing cold, green cabbage leaves calcium to your diet. You may also continue taking your prenatal vitamins while on the breasts, lining your bra. Some breastfeeding. Drink when you are thirsty, but avoid alcoholic beverages. women have found this reduces Limit caffeinated drinks to one or two servings per day. discomfort. Change the leaves as they become warm and wilted.

10 11 Exercises Add one new exercise each day. Begin by repeating the exercise five times and gradually increase to 10 times.

4th day: Lying with your knees and hips flexed, tilt your pelvis inward and tightly contract your buttocks as you lift your head.

1st day: Breathe deeply, expanding your abdomen. Hiss as you slowly exhale, then forcibly draw in your abdominal muscles.

Activity and exercise 5th day: Lying with your legs straight, raise your head and left knee slightly, then reach for (but do Most women find that full recovery from • Tighten and release the perineal not touch) your left knee with your right hand. takes from six to eight weeks. muscles (Kegel exercises) to tone Repeat, using your right knee and left hand. You may notice that you tire easily and muscles that were stretched during the that you welcome household help for a birth process. Repeat 10 times at least few weeks. Try to nap and rest as much as twice daily. you can. This is a time to pamper yourself. • Lie on your back with your arms at Because sitting slows the circulation to your sides. Raise your head so that your legs, do not sit for too long. When your chin touches your chest. Slowly you do sit, put your feet up. If you notice lower your head. (Raising your head 2nd day: Lying on your back with your legs a red, hard and tender area on your leg strengthens abdominal muscles.) slightly apart, place your arms at right angles to your body and slowly raise them, keeping just under the surface of the skin, or if one Repeat 10 times, four times daily. your elbows stiff. When your hands touch, of your legs becomes swollen and painful, lower your arms gradually. You can begin other exercises, such as those especially when you stand or walk, notify 6th day: Lying on your back, slowly flex one illustrated on the following page, in 10 to knee and one thigh toward the abdomen; your health care provider immediately. 14 days if you feel strong enough. Feel free lower your foot toward your buttock, then straighten and lower your leg. As your recovery progresses, you can to make minor changes in the movements. increase the amount of activity and Yoga or stretching exercises are fine if they exercise in your daily routine. Exercise are not too strenuous. Walking is usually a helps restore muscle tone, which is good exercise for new mothers. Ask your needed to protect your bones and joints. health care provider about specific activities It will also help you lose the weight you you want to undertake. Most health care gained during pregnancy. You can start providers recommend waiting six weeks these simple strengthening exercises as before gradually resuming strenuous soon as you feel comfortable: exercise. Remember to listen to your body; 7th day: Leaning on your elbows and knees, you will know if you are overdoing it. 3rd day: Lying with your arms at your sides, keep forearms and lower legs together. Hump • Lie on your tummy with a pillow draw your knees up slightly, and arch your your back upwards, strongly contracting your under your hips to relieve back strain. back. buttocks and drawing in your abdomen. Then Relax your abdominals. Don’t let your relax and breathe deeply. back sag. 12 13 with Providence

At Providence, we understand how important your family is to you. As you enter this new stage of life, you’ll learn the joys of motherhood and the significance of your role in your child’s life. Providence offers numerous classes and resources to support new parents. Explore our website further to find more information about our services.

Returning to work Many women who work outside the home return to their jobs when their babies are 6 to 12 weeks old. Consult your health care provider before driving, returning to work or going on out-of-town trips. Many women successfully pump their breasts to continue the benefits of breastfeeding. Legislation protects your ability to pump your breasts while at work. If you need advice or supplies for pumping your breasts, you may contact a breastfeeding expert.

Resuming sex Note: Pregnancy can occur before your menstrual periods resume. You will have an opportunity to discuss with your health care provider at your postpartum visit. Most health care providers suggest refraining from intercourse until stitches stop hurting and the birth canal has healed. This usually takes four to six weeks after the baby is born. When you resume , it may be beneficial to use additional lubrication and go slowly.

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