What is postpartum and when do I come to the office for my postpartum checkup?

The postpartum period begins immediately after the birth of your child and extends for the next six weeks. During this time your body, including your hormone levels and uterine size, returns to pre-pregnancy conditions.

Your obstetrician will tell you when you need to return for a check-up. For a normal delivery, it is usually six weeks. If you had a C-section, your provider will want to see you two weeks after the birth of your baby and again at six weeks after the birth. A follow-up appointment may be scheduled sooner if there were any problems during your pregnancy. At these visits, the progress of your postpartum recovery will be checked and options for contraception may be reviewed.

How much rest will I need and when can I resume my normal activities at home?

When you go home after delivery, try to get extra rest and avoid fatigue. However, with caring for and feeding a new baby, there is not much time to rest. Get help from friends and family with household chores so you will have extra time to care for the baby and yourself. Because you must feed the baby day and night, you may need to change your sleeping schedule to get enough rest.

Try to sleep while the baby sleeps. Morning and afternoon naps can be very helpful.

If you had a normal delivery without any problems, you can resume most of your normal activities right away. You should still take it easy and avoid heavy lifting, vacuuming and a lot of stair climbing for the first couple of weeks. If you have had a Cesarean section, you will need to avoid heavy lifting for six weeks and you should not drive a car until you are confident you can hit the brake firmly and without hesitation (usually about two weeks) and are no longer taking narcotic medication.

How long will I bleed after my delivery and when will my period return?

Lochia, or menstrual bleeding after birth, normally will last between two and six weeks with it gradually tapering to a dark pink staining. Bleeding is rarely heavier than a heavy period. If you notice any large clots or heavier bleeding, you may be doing too much and need to slow down. If the bleeding continues to be heavy, please call us as the uterus may not have the tone it should, may have an infection or may contain a piece of placenta that did not expel itself.

You may also notice a distinct smell; don’t be concerned unless you have other symptoms like elevated temperature or abdominal pain. You should use pads for the first six weeks, not tampons, so that you do not increase your risk of infection.

If you’re bottle-feeding your baby, you may start having menstrual periods three to ten weeks after delivery. If you are breastfeeding, there is no specific time when your periods will start again. It may not happen until after the first six months of breastfeeding, but it could happen earlier. Some women do not get their period again until they stop breastfeeding.

What can I use for pain relief?

If you delivered the baby normally through the birth canal, pain in the area between your rectum and vagina is common. To relieve the pain and prevent infection, you can sit in a warm bath, put cold packs on the area, or put warm water on the area with a squirt bottle or sponge. It is also important to wipe yourself from the front to back after a bowel movement to prevent infection.

If sitting is uncomfortable, you may want to buy a doughnut-shaped pillow at your local drugstore to help ease the pressure when sitting. For pain relief after a vaginal delivery or cesarean section, you may take ibuprofen along with any prescription pain medication you were given upon discharge.

What problems after delivery should I report to my provider?

In addition to heavy bleeding, call us if you are experiencing burning with urination, increasing pain, temperature over 100.4°F, depression for more than 2 to 3 days, breast concerns or incisional redness or tenderness.

What can you tell me about postpartum breast care?

Breast milk usually comes in two to four days after delivery. This may make your breasts very large, hard and sore. This will get better once you start a breastfeeding routine. If you are not breastfeeding, your breasts may become large and painful while you are waiting for your milk to dry out and you may benefit from wearing a well-fitting support bra 24 hours per day, putting ice packs on your breasts and avoiding any nipple stimulation.

Breastfeeding is recommended and both our affiliated hospitals have lactation consultants available to assist with questions. Breast pumps may be useful, especially for the working mother or premature infant.

Sore nipples

may be relieved with ice packs and regular feeding from both breasts alternating feeding positions. Avoid prolonged feeding sessions and ensure a good latch. Keep your nipples as dry as possible between feedings. Apply cool steeped tea bags or ointment (such as Bagbalm or A&D) to any cracks.

Blocked ducts are usually felt as a hard, firm mass without a fever. Gentle massage, hot packs and frequent feeding from both breasts are the best relief.

Mastitis, or breast infection, causes a red, warm and painful mass associated with a temperature over 100.5°F. Should this develop, contact our office immediately. The usual treatment is antibiotics and hot packs. Continue to breastfeed to decrease the chance of an abscess developing.

Weaning

can be accomplished at any time. Planning ahead is helpful, beginning with a gradual decrease in the length and number of feedings. Avoid hot showers or any stimulation to the breast area that would encourage milk production. Continue to wear a good support bra, apply ice and bind the breasts tightly. Medication is not recommended to stop breast milk. You may use ibuprofen to decrease discomfort.

What is postpartum depression and “baby blues”?

Many physical and emotional changes occur during and after pregnancy. These changes can leave you feeling sad, anxious, afraid or confused. These feelings are called the “baby blues” and usually start right after the baby is born and go away within a week. However, for some women, these feelings do not go away and they may get worse. This is called postpartum depression and occurs in about 10% of all postpartum women. It can start right after the baby is born or begin weeks later. Women who are most at-risk of postpartum depression include first time moms, women with prior history of depression and those women with less support. Postpartum depression can be a serious problem and requires treatment involving counseling, anticipatory guidance, support from others and possibly antidepressant therapy. If you are feeling depressed, let your obstetrician know.

When can I start exercising and when will I return to my usual weight?

During birth, you lose approximately 12 to 14 pounds. However, this may still leave some extra weight depending on the amount gained during pregnancy. Losing this weight takes time. It takes most moms 8 to 12 months to return to their normal weight. The key to slow and natural weight loss is healthy eating and regular exercise.

After the first few months of eating right and exercising, you can begin a healthy weight-loss program if necessary. If you are breastfeeding, you should make sure you are still eating at least 1800 calories a day. Because breastfeeding uses a lot of calories, it usually helps women lose their pregnancy weight. Exercise is one of the best ways to lose weight, get more energy, relieve stress and get back into shape.

You can usually start exercising after six weeks. Walking and gentle stretching and strengthening exercises are the best exercises to start with.

When can I have sex after my delivery and what about contraception?

You should not resume intercourse until six weeks after delivery, as this is the time it takes for your uterus to return to normal size. It is normal to feel uncomfortable at first when you start having sex again after childbirth.

Talk to your obstetrician about methods of birth control you can use after the birth of your baby. The method that may be best for you depends on the type of delivery you had, how you are recovering and if you are breastfeeding.

Learn about your postpartum contraceptive options during your pregnancy. These options include but are not limited to birth control pills, patches, condoms, IUDs (Mirena and ParaGard), Nexplanon, vaginal contraceptive ring (NuvaRing), and permanent sterilization (Bilateral Tubal Ligation, Essure, or Vasectomy). Most of these are safe even if breastfeeding.