Postpartum Care

Stitches

Keep an ice pack in place for the first 24 hours after delivery, then take a sitz bath 2-3 times each day. When you go home, your tub can be used for a sitz bath. After urination or a bowel movement, clean the area with warm water . The nurse will give you a small plastic peri-bottle for this purpose. Change your pad frequently. Begin Kegel exercises immediately after the birth to increase the circulation of the perineum and to provide for rapid healing of any tears. The stitches are absorbed by about two weeks. You can begin to have intercourse about 3 weeks postpartum if you feel ready physically and emotionally. Sometimes it takes much longer than that. Comfort, both physical and psychological, should be your guidelines in resuming love making. Remember that you can conceive again soon, so birth control must be used consistently. We recommend condoms and spermicide until your six week checkup. Nursing mothers often experience vaginal dryness due to low estrogen levels. Spermicidal gel or KY jelly or astroglide helps. Replens may be used 3 times a week. Sometimes nursing women need an estrogen cream or estrogen ring. Please let us know if this is a problem.

Afterpains

These are cramps or contractions of the uterus. These are usually minimal with the first baby, but may be stronger with subsequent deliveries. Nursing mothers will be more aware of afterpains while nursing. This is the way the uterus gets back to its non-pregnant size and position in the pelvis. Motrin or tylenol can be taken for the discomfort. These pains last about one week.

Breast care

Nursing mothers should put on a well-fitting nursing bra as soon as you get to your postpartum room. Cleaning your breasts with plain water in the shower is perfectly adequate. Wash your hands carefully prior to nursing. Colostrum is the fluid coming from the nipples prior to delivery as well as during the first 2-3 days after birth. It is full of good antibodies, and provides for the baby's needs while you are learning how to nurse. Purified lanolin may be applied to the nipples after nursing if you are sore or have dry skin. If soreness or nipple tenderness develops, use a heat lamp, or sit 10 inches away from a 60 watt light bulb for 10-15 minutes, three to four times a day. When at home, if you develop a fever or a red sore lump on your breast that doesn't go away after nursing, call the midwife.

Non-nursing mothers should put on a tight bra as soon as you get to your postpartum room. Leave it on throughout your hospital stay, including sleeping. Avoid stimulation of the breasts or nipples. When showering, avoid letting the hot water hit your breasts. Ice packs and pain medication will help any engorgement.

Bleeding

You will bleed like a heavy period on the first day. Some clots are normal. The bleeding may stop after 1 or 2 weeks, or it may last 5-6 weeks, but the amount should lessen. The bleeding may stay red or pink, or it may change to a yellowish-pink color.

After you go home from the hospital, the bleeding may get heavier. This is usually from doing too much, too soon. If you start soaking through pads in less than an hour, or pass large clots, get off your feet, nurse the baby, massage your uterus, and if the bleeding doesn't promptly stop, call us. We may tell you to take a drug called methergine. You will be given a prescription for this before you leave the hospital.

Urination

Empty your bladder frequently, and drink plenty of fluids. Keeping your bladder empty helps your uterus to stay firm and well contracted. Tell us if you have difficulty urinating, or have pain or burning with urination.

Bowels

Plenty of fluids and the use of a stool softener such as Colace is all you should need. If you are constipated, Milk of Magnesia and metamucil may be used even if you are nursing.

Activity

When you go home, resume activity gradually. Stair climbing should be limited to a few times a day in the beginning. Frequent rest periods are important. Don't drive a car until the baby is one week old. Full resumption of your exercise program should wait until after your six week check.

Iron and Vitamins

Take one iron and one vitamin daily until your 6 week checkup. If you are nursing, continue a daily multivitamin for as long as you nurse.

Bathing

You may shampoo, shower or take a tub bath at any time.

Post Partum Blues/Postpartum Depression

It is not uncommon to experience a mild depression when you return home. The reality of being home with a newborn can seem over-whelming. Call our office if you need to talk. Sometimes a visit to our office at 2 weeks is helpful and reassuring.

About 10% of women suffer more than just "the baby blues", and have a true depression in the days, weeks and even months following childbirth. If you are crying for no reason, have difficulty eating or sleeeping, feel worthless, feel anxious or scared, or have any thoughts about harming yourself or harming the baby, you may have postpartum depression. Please call us! There are things we can do to help you.

Here is an excellent web site with a lot of information, and discussion of treatment of PPD in nursing moms.

Yale University School of Medicine/Department of Psychiatry and the Connecticut Mental Health Center have a Maternal Behavioral Health Program/. If you have been concerned aout how you have been feeling during the postpartum period, and would like to get more information about treatment options, please contact the Yale Maternal Behavioral Health Program for a free evaluation and consultation at 203-764-9934. The Clinic offers a free weekly support group as well as free treatment through a research study. Treatment includes weekly supportive therapy and potential treatment with an antidepressant.

Menstruation

You can expect your period in 4 to 8 weeks if you are bottle feeding. It is hard to predict when you will get your period if you are nursing. If you are supplementing with formula, your period can return anytime. Without supplementing, you may not have a period for 6-12 months. Be sure to use contraception during this period, since the first ovulation occurs 2 weeks prior to the first period, and it is possible to get pregnant before you have your first period.

Obstetrics-Gynecology-Infertility Group, PC
203-562-5181