Bleeding  |  Breasts  |  Perineum  |  Episiotomy  |  Hemorrhoids  |  Bladder  |  Bowel  |  Menstruation  |  Changes in your uterus - after birth pain  |  Fatigue  |  Additional physical changes

Bleeding

Vaginal discharge after birth is called lochia. It is a combination of the old uterine lining and blood. The lochia usually changes from bright red, to pink, to whitish over the course of several weeks.

It is very common for the bleeding to start and stop and to have clots. Decrease your activity if you notice an increase in the amount of bleeding, as it is a sign for you to slow down and rest more.

Use sanitary pads instead of tampons until you have your first menstrual period after birth or until your health care provider advises otherwise. Vaginal bleeding after a cesarean will usually be less than after a vaginal birth.
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Breasts

When your milk supply increases, about 48 to 72 hours after delivery, your breasts may become firm and a little tender. Fullness in your breasts occurs naturally from an increase in blood flow. This prepares your breasts for increased milk production. If you are breastfeeding, nursing often will help keep your breasts soft and prevent engorgement. (See section on breastfeeding.)

If you are bottle-feeding
If you are not breastfeeding, a snug-fitting bra or towels wrapped tightly around both breasts will help minimize breast engorgement. If your breasts become painful, avoid nipple stimulation and milk expression. Apply ice packs to decrease the swelling and consider taking a mild pain reliever. When showering, avoid warm water directly on your breasts as this may increase milk production. If engorgement is really painful, bend over a pan of warm water and put your breasts into the water. After a minute or so, milk will flow without stimulating your breasts.
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Perineum

Perineum (tissue at the outlet of the vagina) cleanliness promotes healing and comfort. Take special care in cleansing the perineum as long as postpartum bleeding (lochia) continues. If you are comfortable, you will be able to care for your baby better during the first days after birth.

Your perineum may be sore and slightly swollen after birth. If you have had an episiotomy, your stitches will be tender (see below). The puffiness decreases in a few days. Any increased pain or increased swelling should be reported to your health care provider.

For your comfort:

• Wash hands before and after changing pads, before using a peribottle, etc.
• Always wipe from front to back (toward your rectum) after bowel movements and urination.
• Wash your perineum daily with soap and water during your shower or bath.
• Change peri pads when necessary and after going to the restroom.

Use of the peribottle

• Fill the bottle with plain warm water.
• Sit on the toilet.
• Remove soiled peri pad.
• Squeeze bottle to rinse perineum.
• Pat dry with soft tissue, from the front to the back (toward your rectum).
• Put on a clean peri pad each time you use the bathroom.

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Episiotomy

If you had an episiotomy, the stitches used to repair your incision will dissolve in about two weeks and do not need to be removed. The skin heals in about 2 to 3 weeks. You may see small pieces of the stitches in your underwear as your episiotomy heals. This is normal and no cause for concern.

Care of your episiotomy or tear
Immediately after birth and whenever swelling is present, use an ice pack for comfort. You may also use a portable Sitz bath or sit in a shallow amount of warm bath water. Repeat 3 to 4 times per day for about 10 minutes, until the swelling has gone. Alternating heat and cold may be helpful.

Episiotomy pain usually improves daily. Take a mild pain reliever (such as acetaminophen or ibuprofen) if needed. Many women find that sitting on a hard surface is usually more comfortable if they squeeze their buttocks together and hold the contraction while sitting down. Keep the perineum dry and wear cotton underwear. Begin Kegel exercises as soon as possible. (See section on postpartum exercises.)

Caring for your perineum becomes even more important if you had a more extensive perineal tear (into the anus or rectum). Most women find frequent Sitz baths (4 to 5 times per day) comforting and healing. Keeping your stool soft and following instructions for hemorrhoids (below) will also help.

If you notice a bad odor or have trouble controlling your stool, call your health care provider immediately.
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Hemorrhoids

Many women develop hemorrhoids during pregnancy and after giving birth. Hemorrhoids are varicose veins of the rectum caused by the weight and pressure of the baby and the force of pushing. Hemorrhoid pain may be relieved with ice packs, ice cold pads containing Witch Hazel, or your health care provider may suggest other creams or suppositories.

Reduce the risk of constipation by eating fruits, vegetables and whole grains and drinking lots of fluids. Prunes and bran are helpful remedies if you have a tendency toward constipation. You may also be prescribed a stool softener. Contact your health care provider for recommendations. Hemorrhoids will eventually shrink and become less uncomfortable.
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Bladder

It may be slightly uncomfortable to urinate for a few days after your baby’s birth. Pain or burning when you urinate, or the urge to urinate frequently, may indicate a bladder infection and should be reported to your health care provider.

Helpful hints to avoid a bladder infection:

• Drink plenty of water.
• If you are having trouble urinating, try turning on the faucet when you are on the toilet. The sound of running water may help you urinate.
• Pour a peribottle filled with warm water over your perineum as you sit on the toilet.
• Urinating often to empty your bladder may decrease your chance of bladder infection. It also helps decrease cramping.
• Urinate while using a warm Sitz bath or in the shower

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Bowel

Your bowel movements may be delayed until three or four days after childbirth because of the lack of food during labor and discomfort from hemorrhoids or an episiotomy. Do not hold back a bowel movement, even if it is uncomfortable. Ask your health care provider about over-the-counter stool softeners if you have problems.

Helpful hints to avoid constipation:,

• Eat a high-fiber diet (fresh fruits and vegetables, whole grains, etc.).
• Drink plenty of fluids.
• Walk as much as is comfortable.

Exercise as your health care provider recommends.
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Menstruation

Your menstrual period may not resume while you are breastfeeding. If it does, it should not interfere with breastfeeding but may slightly decrease the amount of breast milk available. Drink lots of fluids often, and your milk supply will stabilize.

If bottle feeding, your period may return within four to eight weeks. Your first period may be heavier than normal. There may be clots, and the bleeding may start and stop.
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Changes in your uterus - after birth pain

The uterus begins to return to its pre-pregnancy size right after delivery. It shrinks from about the size of a basketball during pregnancy, to the size of a grapefruit right after delivery and, finally, to the size of a small pear by six weeks after delivery. Your uterus will shrink to your navel at first and gradually descend back into your pelvis. If your uterus does not feel hard right after birth, massage it until it is firm. Pitocin, a medication that causes the uterus to contract, is often given right after birth to ensure that the uterus remains firm and to prevent too much vaginal bleeding. After-birth pains triggered by these medications may also be triggered by breastfeeding and orgasm. If you have given birth to other children, your contractions may be more painful due to the stronger force needed to make up for previous stretching of the uterus.
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Fatigue

Even mothers in top physical condition prior to the delivery may feel a great deal of fatigue in the early recovery period. Feeling continually tired may last weeks or even months. Recognize that your body has been through a major physical process and that you need to allow yourself enough recovery time.

Tips for coping with fatigue

• Remain in your bathrobe or lounge wear for the first week at home and rest whenever possible. New babies tend to be more awake at night than during the day for the first three weeks, so be prepared to rest when your baby sleeps.
• Let others help with household chores, such as, laundry, cooking, shopping, cleaning, etc. When friends offer to help, let them!
• If possible, arrange to have your partner take one to two weeks off after the baby arrives.
• If possible, hire outside help for a few hours during the first weeks, even if your partner will be off work and helping. You will both need some time to adjust and be with the baby.
• If you have an answering machine or voice mail, you may wish to leave a message stating that you are resting and will call when you have the time to talk. Consider renting or borrowing an answering machine if you do not have one.
• Make life as simple as possible by using paper plates, take-out food and delivery services. Take it easy!
• Review your diet to be sure you have enough protein and iron in your diet. For more information on iron, ask your health care provider about iron supplements

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Additional physical changes

Once you give birth, there is a large change in the amount of certain hormones in your body. These changes can effect the amount of fluid in your body and can cause some common physical changes including:

• Retention of fluid/swelling
• Initial hair loss (your hair will come in again later)
• Hot flashes
• Night sweats
• Dry skin
• Mood swings
• Increased urination
• Vaginal dryness

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