American Academy of Family PhysicianspresentsKidsHealth on

By Glenn Lawrence,2014-05-08 20:27
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American Academy of Family PhysicianspresentsKidsHealth on

    Postpartum Care

    Recovering From Delivery

    Your baby's finally here, and you're thrilled - but you're also exhausted, uncomfortable, on an

    emotional roller coaster, and wondering whether you'll ever fit into your jeans again. Childbirth classes

    helped prepare you for giving birth, but not for this.

    What to Expect in the First Few Weeks

    After your baby arrives, you'll notice you've changed somewhat - both physically and emotionally.

    Physically, you might experience the following:

    ; sore breasts - Your breasts may be painfully engorged when your milk comes in, and your

    nipples may be sore.

    ; constipation - The first postpartum bowel movement is typically delayed to the third or fourth

    day after delivery, and sensitive hemorrhoids and sore muscles may make bowel movements


    ; episiotomy - If your perineum (the area of skin between the vagina and the anus) was cut by

    your doctor or if it was torn during the birth, the stitches may make it painful to sit or walk for a

    little while during healing.

    ; hemorrhoids - Although common, hemorrhoids (swollen anal tissues) are frequently

    unexpected and initially unnoticed.

    ; hot and cold flashes - Your body's adjustment to new hormone and blood flow levels can

    wreak havoc on your internal thermostat.

    ; urinary or fecal incontinence - The stretching of your muscles during delivery can cause you

    to inadvertently pass urine when you cough, laugh, or strain or may make it difficult to control

    your bowel movements, especially if a lengthy labor preceded a vaginal delivery.

    ; "after pains" - The shrinking of your uterus can cause contractions that worsen when your

    baby nurses or when you take medication to reduce bleeding.

    ; vaginal discharge (lochia) - Heavier than your period and often containing clots (sometimes

    golf-ball sized), vaginal discharge gradually fades to white or yellow and stops within 2 months.

    ; weight - Your postpartum weight will probably be about 10 pounds (the weight of the baby,

    placenta, and amniotic fluid) below your full-term weight, before additional water weight drops

    off within the first week as your body regains its sodium balance.

    Emotionally, you may be feeling:

    ; "baby blues" - About 80% of new moms experience irritability, sadness, crying, or anxiety,

    beginning within days or weeks postpartum. Like the more severe associated syndromes of

    postpartum depression and postpartum psychosis, these baby blues result from hormonal

    changes, exhaustion, unexpected birth experiences, adjustments to changing roles, and a sense

    of lack of control over your altered life as you adjust to your new baby.

    ; postpartum depression (PPD) - More serious than the baby blues, this condition is evident in

    10% to 20% of new moms and may cause mood swings, anxiety, guilt, and persistent sadness.

    Your baby may be several months old before PPD strikes, and it's more common in women

    with a family history of depression.

    ; postpartum psychosis - Postpartum psychosis is a severe and fairly rare condition that makes it

    difficult to think clearly or function and may become life-threatening to you or your baby. It's

    common for women with postpartum psychosis to have thoughts about harming themselves or

    their babies. If you experience any such feelings, call your doctor immediately.

    In addition, when it comes to sexual relations, you and your partner may be on completely different pages. He may be ready to pick up where you left off before baby's arrival, whereas you may not feel comfortable enough - physically or emotionally - and may be craving nothing more than a good night's


    The Healing Process

    It took your body months to prepare to give birth, and it takes time to recover. If you've had a cesarean

    section, it can take even longer because this major surgery requires a longer healing time. If unexpected, it may have also raised emotional issues. Pain is greatest the day after the surgery and should gradually subside. Take sponge baths for several days, and don't scratch the incision. If the

    incision becomes red and swollen, have your doctor check for an infection. Begin gentle exercises as soon as possible (abdominal tightening, bending and straightening your knees, walking - with

    assistance at first) to speed recovery and help avoid constipation. Drink eight to ten glasses of water

    daily. Expect vaginal discharge. Avoid stairs and lifting until you've healed, and don't drive until you can make sudden movements and wear a safety belt properly without discomfort.

    Some other things to consider during the healing process include:

    ; birth control - You can become pregnant again before your first postpartum period. If you are

    exclusively breast-feeding (day and night, no solids, at least every 6 hours), have not had a

    period, and your baby is younger than 6 months old, you have about 98% protection. If you're

    not breast-feeding exclusively or want additional protection, discuss your options with your

    doctor. Many recommend starting low-dose oral contraceptives or injections about 6 weeks

    postpartum. These methods shouldn't affect milk production or your baby. Barrier methods

    (condoms, diaphragms, spermicidal jellies, and foams) affect breast-feeding less, but are also

    less effective than pills or shots.

    ; breast-feeding - You need adequate sleep, fluids, and nutrition. Drink a glass of water

    whenever your baby nurses. Until your milk supply is well established, avoid caffeine, which

    causes loss of fluid through urine and sometimes makes babies wakeful and fussy. Your clinic

    or hospital lactation specialist can advise you on how to deal with any breast-feeding problems.

    Relieve painful, clogged milk ducts with breast massage, frequent nursing, and warm moist

    packs applied throughout the day. If you develop a fever and your breast becomes tender and

    red, you may have an infection (mastitis) and need antibiotics. Continue nursing from both

    breasts. Drink plenty of fluids.

    ; engorged breasts - They resolve as your breast-feeding pattern becomes established or, if you

    can't or don't choose to breast-feed, when your body stops producing milk - usually within 3


    ; episiotomy care - Continue sitz baths (sitting in just a few inches of warm water and covering

    the buttocks, up to the hips, in the bathtub). Squeeze the cheeks of your bottom together when

    you sit to avoid pulling painfully on the stitches. Use a squirt bottle to wash the area with water

    when your urinate; pat dry. After a bowel movement, wipe from front to back to avoid

    infection. Reduce swelling with ice packs.

    ; exercise - Resume as soon as possible to help restore your strength and prepregnancy body,

    increase your energy and sense of well-being, and reduce constipation. Begin slowly and

    increase gradually. Walking and swimming are excellent choices.

    ; hemorrhoids and constipation - Alternating warm sitz baths and cold packs help. Ask your

    doctor about a stool softener. Don't use laxatives, suppositories, or enemas without your

    doctor's approval. Increase your intake of fluids and fiber-rich fruits and vegetables.

    ; sexual relations - Your body needs time to heal. Doctors usually recommend waiting 4 to 6

    weeks to reduce the risk of infection or increased bleeding. Fewer than 20% of couples resume

    sexual activity in the first month, but 90% do so by 4 months. Begin slowly, with kissing,

    cuddling, and other intimate activities. You'll probably notice reduced vaginal lubrication (this

    is due to hormones and usually temporary), so a water-based lubricant might be useful. Try to

    find positions that put less pressure on sore areas and are most comfortable for you. Tell your

    partner if you're sore or frightened about pain during sexual activity - talking it over can help

    both of you to feel less anxious and more secure about resuming your sex life.

    ; urinary or fecal incontinence - This usually resolves gradually as your body returns to its

    normal prepregnancy state. Encourage the process with Kegel exercises, which help strengthen

    the pelvic floor muscles. To find the correct muscles, pretend you're trying to stop urinating.

    Squeeze those muscles for a few seconds, then relax (your doctor can check to be sure you're

    doing them correctly). Wear a sanitary pad for protection. If the problem doesn't resolve in

    several months, tell your doctor.

    What Else You Can Do to Help Yourself

    You'll enjoy your new role - and it will be much easier - if you care for both yourself and your new

    baby. For example:

    ; When your baby sleeps, take a nap. Get some extra rest for yourself!

    ; Set aside time each day to relax with a book or listen to music.

    ; Shower daily.

    ; Get plenty of exercise and fresh air - either with or without your baby, if you have someone

    who can babysit.

    ; Schedule regular time - even just 15 minutes a day - for you and your partner to be alone and


    ; Make time each day to enjoy your baby, and encourage your partner to do so, too.

    ; Lower your housekeeping and gourmet meal standards - there's time for that later. If visitors

    stress you, restrict them temporarily.

    ; Talk with other new moms (perhaps from your birthing class) and create your own informal

    support group.

    Getting Help From Others

    Remember, Wonder Woman is fiction. Ask your partner, friends, and family for help. Jot down small,

    helpful things people can do as they occur to you. When people offer to help, check the list. For example:

    ; Ask friends or relatives to stop by and hold your baby while you take a walk or a bath.

    ; Hire a neighborhood teen - or a cleaning service - to clean once a week, if possible.

    ; Investigate hiring a doula, a supportive companion professionally trained to provide postpartum


    When to Call Your Doctor

    There are times when you should call your doctor about your postpartum health. Be sure to call if you:

    ; experience an unexplained fever of 100.4 degrees Fahrenheit (38 degrees Celsius) or above in

    the first 2 weeks

    ; soak more than one sanitary napkin an hour or if the bleeding level increases

    ; had a C-section or episiotomy and the incision becomes more red or swollen or drains pus

    ; have new pain, swelling, or tenderness in your legs

    ; have hot-to-the-touch, significantly reddened, sore breasts or any cracking or bleeding from the

    nipple or areola (the dark-colored area of the breast)

    ; find your vaginal discharge has become foul-smelling

    ; have painful urination or a sudden urge to urinate or inability to control urination

    ; have increasing pain in the vaginal area

    ; develop a cough or chest pain, nausea, or vomiting

    ; become depressed or experience hallucinations, suicidal thoughts, or any thoughts of harming

    your baby

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