Congratulations on the birth of your new baby!
This is both an exciting and challenging time for new mothers. Following delivery, you may find that you are experiencing new physical and emotional symptoms. It is very common to have questions and concerns during this time. The following information will be helpful in understanding what you can expect.
If you don’t find the answers you are looking for, please feel free to contact us.
6 Week Postpartum Appointment
Please call our office after delivery to schedule an appointment for your 6 wk postpartum check-up. At this visit, we will screen for postpartum depression, discuss birth control options, make sure your pap smear is up to date and confirm the normal healing process. If you have concerns before 6 wks postpartum, please call our office for assistance or to schedule a visit sooner than the routine check-up.
Commonly, vaginal bleeding will continue for 3-6 weeks following delivery. It will gradually lessen and change to a thick yellow discharge before stopping altogether. This discharge is normal and it is called lochia. Even after slowing to minimal lochia, it is normal to experience intermittent bright bleeding and small clots (especially during breastfeeding). You should call our office if you feel the bleeding or discharge seems excessive, requires pad changes more than one an hour or if you notice repeated passage of large blood clots. During the 6 wk post Partum period, you should refrain from intercourse, using tampons and douching.
It is common to feel soreness in the area around the vagina after delivery, especially if you required stitches to repair a perineal tear or episiotomy. Any stitches placed will dissolve spontaneously. No suture removal is necessary. It is important to keep the area clean. You may use sitz baths 2-3 times/day for the first few days to promote healing. To do a sitz bath, sit in a tub with a few inches of warm water for 10-15 minutes. Pat the area dry afterward. You may also use cold packs or chilled witch-hazel pads to the area. A numbing spray is typically given in the hospital and you may continue to use this at home for several additional days. Sitting on a pillow or “doughnut” cushion may be helpful for the first week or so. Perineal symptoms typically resolve by your 6 wk postpartum check-up.
Constipation & Hemorrhoids
Both constipation and hemorrhoids are common during pregnancy and in the postpartum period. Increasing intake of fluid (water), fresh fruits, vegetables and minimizing the use of narcotics will help avoid constipation. Use of stool softeners (Colace) and fiber supplements (Metamucil, Benefiber, etc.) may be used according to package directions. Miralax is an osmotic laxative that is also effective for occasional constipation. Hemorrhoids can be effectively treated with over the counter hemorrhoid cream or witch hazel pads. If hemorrhoid symptoms are persistent or severe, please call our office for an appointment or for a referral to a proctologist/colon-rectal specialist.
Upon discharge from the hospital, you will be prescribed pain medicines similar to the oral medicines used to treat your pain while you were hospitalized. After a vaginal delivery, narcotic use is limited to just a few days postpartum while ibuprofen may be used intermittently for several weeks. Postpartum patients after a C/section may require narcotic pain medications for approximately 1 week and ibuprofen intermittently for several weeks.
Our patients who have a C-Section (scheduled or unscheduled) typically have a hospital recovery time of 2-3 days after delivery. Typically, sutures/staples that are used to close the skin are located under the skin and are designed to spontaneously dissolve. Occasionally it is necessary to use metal staples to close the skin. If this is the case, you will need an appointment within 1 week of delivery for staple removal. You may shower and clean the area around your incision with soap and water. Otherwise, keep your incision dry. You may remove any remaining surgical tapes one week after discharge. Please call the office if you notice fever, increasing incisional pain, redness or drainage of fluid.
We recommend that you do not drive for 2 weeks and avoid heavy lifting or strenuous exercise for 4 weeks after surgery. You may traverse stairs when you get home but limit the frequency until you feel stronger. Have someone else transport the baby up and down the stairs until you are well recovered.
It is normal to experience fatigue or even exhaustion in the weeks that follow your baby’s arrival. Sleep when you are able. Rest can be a challenging goal, especially if you are breastfeeding. Remember that this stage is fleeting. It will get better! Enjoy the unique closeness that nurturing a newborn affords.
You may walk or stroll with the baby upon arriving home. Additionally, you may resume light exercise within 4 weeks of delivery. Avoid abdominal exercises until we see you at your 6-week postpartum check-up.
Try not to skip meals and take care to stay well hydrated (8-10 glasses of water daily). You need about 450 – 500 extra calories/day when you are breast feeding (approximately 2,500 total calories/day). Continue taking your prenatal vitamin until your 6-week postpartum visit or until you have completed breastfeeding, whichever comes last.
Please see the following link regarding ACOG recommendations for exercise following pregnancy.
If you are breastfeeding your baby, wear a supportive bra and use ice packs or warm showers to reduce swelling when needed. Appropriate positioning on the breast (latching) will help prevent nipple soreness. You also may use nipple ointment (lanolin) after each feeding to protect from drying and cracking. Watch for localized breast tenderness, redness, generalized aches and fever. These are signs of mastitis (breast infection). Please call our office for an appointment if you experience these symptoms.
If you are interested in a personal consultation, please contact our very own lactation consultant:
Robyn Bermudez, LPN, IBCLC
(919) 571-1040 ext 223.
New moms who do not plan to breastfeed should wear a firm, tight-fitting sports bra and use ice packs and ibuprofen to treat engorgement symptoms. Because expression of milk stimulates more milk production, avoidance of expression is recommended. There are no suppressive medications available which are reliable and safe to prescribe. Your symptoms will improve in a few days to weeks after delivery.
For commonly asked postpartum breast care questions the following ACOG link is helpful.
Postpartum Blues and Postpartum Depression
Life with a newborn can be overwhelming. Feelings of frustration, anxiety, sadness, loneliness or disappointment are sometimes experienced by new mothers. Sleep deprivation contributes to these feelings and patients can find themselves experiencing “baby blues” or even postpartum depression. The following link explains the difference between these two conditions and other important facts.
Please realize that these feelings are common (you are not alone!) and that there are simple, short term treatments available. There is no need to suffer, especially if the symptoms are affecting your relationships, sleep, nutrition or the bonding process with your newborn. Occasionally, postpartum depression is life-threatening and requires hospitalization. Talk with trusted family or friends, let them know how you are feeling and please call our office with any concerns. Do not wait for your 6-week postpartum check-up to call. A support group meets at Rex Hospital for women experiencing anxiety or depression related to childbirth and motherhood. You may contact RexHealth.com/maternity at (919) 784-3100 during normal business hours for support group information.
Short inter-pregnancy interval (12-18 months from delivery to the next pregnancy) has been associated with increased risk for some adverse pregnancy outcomes. Therefore, we recommend the use of birth control following delivery. You might consider using condoms, birth control pills, an IUD, a sub-dermal implant, IM injection or permanent sterilization. If you are breastfeeding a progesterone only method is recommended. We usually advise against sexual intercourse until you are evaluated at your 6-week check-up. At that time, we will help you decide on the birth control method that is best for you. The following links are helpful in exploring commonly asked questions about postpartum birth control.