The Postpartum Period
The postpartum period is the first six weeks following the birth of your baby. During this time, your body will go through many changes as it returns to the non-pregnant state.
The size of your uterus will undergo the most change. Immediately following birth, the fundus (top of the uterus), can be felt at or just below the navel (belly button) will rise just above the navel (belly button) within a few hours. In about two days, the uterus begins to decrease in size, and after 10-12 days, the uterus will not be felt.
As the uterus returns to the non-pregnant size, you may have cramping sensations similar to menstrual cramps. This is called “after-birth pains” and may be more noticeable in some people than others. After-birth pains tend to be stronger the more babies you have. If you are breastfeeding, you may notice cramping during feeding, since breastfeeding stimulates the uterus to contract.
After-birth pains may last several days, but usually become less intense after 48 hours. Your physician/nurse midwife may prescribe a medication to help lessen this discomfort.
Even though your abdominal muscles will partially recover from stretching, your abdomen will remain soft and flabby for some time. These muscles need at least six weeks to return to their pre-pregnant state. Proper rest, nutrition, exercise and good posture will help to restore muscle tone and tighten the abdominal muscles. Although striae, or “stretch marks”, usually remain on the abdomen, they become less noticeable as they grow lighter and may finally have a silvery-white appearance.
About 10 to 12 pounds of weight may be lost when the baby is born. This loss includes the weight of the baby, the placenta or “after birth” and fluid that was around the baby in the uterus. There is usually a loss of another five pounds within two to five days after delivery due to increased urine output and sweating. In the first few days after the baby is born, the body rids itself of extra fluid through the kidneys and skin. Increased sweating and episodes of profuse sweating are not unusual. You may gradually lose more weight. Weight loss will vary with each individual. Diet and activity play an important role.
You will experience a vaginal discharge after delivery that starts like a heavy menstrual flow and then gradually decreases. This discharge is not a menstrual period, but is a shedding of the lining of the uterus. It is called “lochia.” At first it is red, then it turns pink, then brown and finally white or colorless. The changes in the color of your lochia are signs of healing. If the lochia turns red again after it was pink or brown, it may be that you have been overactive and that your body needs more time to heal. Should this occur, decrease the amount of your activity and take regular rest periods. You may have a vaginal discharge for up to six weeks. During this period of your recovery, use sanitary napkins rather than tampons to absorb the flow. It takes about four weeks for the cervix (opening to the uterus) to close completely and during that time tampons could introduce unwanted germs
into the uterus.
The first real postpartum menstrual period usually occurs within five to eight weeks after delivery in mothers who bottle-feed. Breastfeeding mothers may not have a period until they wean the baby.
An episiotomy is a small incision in the perineum (the area between the vaginal opening and the rectum). The episiotomy enlarges the vaginal opening, allowing more room for the baby to be delivered. The incision is repaired with stitches which dissolve and do not need to be removed.
After delivery you may experience pain in the perineum, the muscular area between the vagina and the rectum that is stretched during the pushing stage of labor. The perineum may have been cut during delivery (episiotomy), or it may have torn naturally (laceration).
If you had an episiotomy or laceration, ice may be applied to the area. Ice numbs the area and helps prevent or reduce swelling for the first 24 hours. After 24 hours, a portable sitz bath or a tub bath may also be used as it produces comfort and is helpful for healing.
As soon as you are able to be up to the bathroom after delivery, you will be given a small plastic bottle to use for perineal care. Each time you use the bathroom, fill the peri bottle with warm water and squirt it over your perineum. After rinsing with the warm water, pat this area dry with toilet paper, patting from your vaginal area to your rectum. Pat from front to back and drop the tissue in the toilet. It is important for you to continue this peri care for up to two weeks after your delivery.
You may also have an anesthetic spray for your perineal area if you have stitches. Do not overuse the spray but use enough to provide relief. You may also have witch hazel pads (a moist pad) which can be placed on your stitches.
Your first bowel movement can be a problem due to the relaxed state of the abdominal muscles and the fear of discomfort. Constipation may result unless certain measures are taken to prevent it. These include:
1. Drinking at least eight glasses of liquid a day
2. A diet that includes fresh fruits and vegetables, and whole-grain breads and cereals
3. Early walking after delivery
Your physician/nurse midwife may prescribe a mild laxative or stool softener. Only take the medications recommended by your physician/nurse midwife as certain laxatives are excreted in breast milk and could affect your baby if you are nursing.
Hemorrhoids (enlarged veins in the lower rectum and anus) are common due to the pressure on this area during pregnancy and delivery. They may be swollen, tender and protrude through the rectal opening. You may feel persistent pain, itching and/or pressure.
Hemorrhoids are most uncomfortable during the first two to three days after delivery. They usually decrease in size and may gradually disappear. Avoid constipation to help prevent hemorrhoids.
Discomfort caused by hemorrhoids may be relieved by:
• anesthetic sprays
• sitz baths
• medications or ointment, as prescribed by your physician/nurse midwife
• cool astringent compresses (witch hazel pads)
• wearing the perineal pad loosely to prevent irritation
• warm, moist compresses
At home, take a shower or tub bath daily. Wash your breasts first. Then finish the rest of your bath. Wash your perineum with soap and warm water. If you have stitches, wash your perineum gently. You may wash your hair as often as you wish.
After bathing, gently dry your breasts, and finish drying the rest of your body. You may spray your stitches with the anesthetic spray and put on a
Nutrition for Breastfeeding Mothers
If you are breastfeeding, it is especially important for you to eat and drink appropriately in order to produce an adequate amount of breast milk. You should eat approximately 500 more calories each day than you normally would. This increase is necessary to produce the breast milk. You should drink about four quarts of fluids daily. Four to five cups of that liquid should be in the form of milk unless you are advised differently by your physician/nurse midwife. You may, if you wish, drink low-fat milk instead of whole milk. Other liquids can be water, decaffeinated tea, juices, decaffeinated coffee, or decaffeinated soft drinks.
The foods you eat may affect your baby. Some foods have a tendency to make the breast milk taste strong or bitter. Usually your physician will not restrict specific foods, but will recommend that you limit the foods that seem to bother the baby. If your baby seems to be unusually gassy or seems irritable, think about what you ate during the day.
You should not try to diet while you are breastfeeding. If you diet, you will not be consuming the appropriate amount or types of foods necessary to produce the quality and quantity of breast milk your baby needs. Wait until you have weaned the baby to diet.