Your Guide to Postpartum Health

The Postpartum Time Period
You experience the excitement, hardships, and ups and downs of pregnancy. You prepare for 9 months for that unknown moment that your body will bring your baby to you, when you’ll labor and deliver and have your sweet baby finally in your arms. It’s a strongly anticipated and prepared for moment. Now what?

So many moms tell me that they spent so much thought and time preparing for labor, but were totally unaware of how things would be immediately after delivery. The first few days, even the first few weeks, after your baby arrives is a very important time for both of you. During these happy days, there is a lot going on with your body and health. Let’s talk about it!

Changes in Your Uterus
After delivery, your uterus will still need to move back down to its “normal” size. This doesn’t happen immediately, and there are some things that your doctor and nurse may do to ensure that it changes how it is supposed to.

You will receive “fundal massages” frequently after delivering your baby. The word fundus means the top of your uterus. The word massage sure makes it sound nice, but it won't exactly feel pleasant. Your nurse will place their hand on your stomach and push fairly hard to feel where the top of your uterus (fundus) is, and push on it.

This will make you feel crampy, because pushing on the top of your uterus will stimulate it to contract. This is very important to help it shrink back down in size, and also helps to slow down your bleeding. You may also feel this cramping while breastfeeding. Breastfeeding releases the hormone oxytocin in your body, and oxytocin stimulates uterine contractions.

Your nurse will keep track of where the top of your uterus is in relation to your belly button to be sure that over time it is moving down. Your nurse will also check that your uterus feels firm. A firm uterus is a good thing because that means it has been contracting. 

After delivery, you will have vaginal bleeding, called lochia. For the first few days after labor, this bleeding will be bright red and gradually slow down. You will wear a pad during this time, no tampons. The hospital will have pads for you to wear with stretchy “mesh underwear”. 

If you are soaking through a pad in an hour and it isn’t slowing down, then you are bleeding too much. Let your nurse know, or seek medical attention if this happens at home. You may have some clots, but they shouldn’t be larger than a quarter. If you are passing large clots, again let your nurse know or seek medical attention. If you begin bleeding too much, you will likely be given medicine that will stimulate uterine contractions to slow down bleeding.

After a few days, your bleeding will continue to slow down and change to a brownish or pinkish color for about a week. After that, you will continue to have white discharge for weeks following delivery. Remember, no tampons or anything else in the vagina for 6-8 weeks after delivery.

Episiotomies, Tears, Swelling
You may have had to have a cut (episiotomy) at the bottom of your vagina to deliver your baby, or that area may have torn during delivery. If needed, you will be given stitches for this immediately after delivery. The hospital will give you items to care for this injury.

You will most likely be given small, round pads medicated with witch hazel to wear in your pad. These provide a cooling and healing effect. You may also be given a spray or cream with a medicine such as benzocaine, that will provide a numbing effect to that area.

Even if you don’t tear or get an episiotomy, your perineum will be very swollen and probably tender after childbirth, and these care items could still be useful. You should routinely have ice on the area to help with pain and swelling. You will be given a small squirt bottle to use for cleansing after using the toilet, and instructed to only pat dry while this area heals.

Breasts and Feeding Your Baby
If you would like to breastfeed your baby, it is best to feed as soon as possible after they are born. You should be able to try breastfeeding right away, as long as there are no medical problems for you or your baby that would require postponing. 

Taking breastfeeding classes before delivery can be very useful, and you can get help and support from a lactation consultant or your nurse. They will teach you different ways to hold your baby and how to watch for cues that your baby is ready to eat. A supportive nursing bra and nursing pillow can really help you be comfortable while breastfeeding.

After your baby is born, your breasts will produce a substance called “colostrum”. Colostrum is a pre-milk substance made for newborns. It contains the antibodies and nutrients that your baby needs. You may only produce a little at first, but your baby’s stomach is so tiny that it really doesn’t need much in the first days.

Three to five days after delivery, your body will produce breast milk. Your breasts will swell when this happens, which may cause some discomfort. This discomfort can be eased with breastfeeding, pumping, or putting some ice on your breasts to reduce swelling. When your milk comes in you may also experience leaky breasts. Disposable or washable breast pads can be very useful to prevent leaking through your clothes.

Your body will make breast milk in a supply-and-demand manner, so the more your baby eats, the more your body will make. It may take some time, but your body should eventually regulate to make exactly what your child needs.

Breastfeeding will be uncomfortable, but it shouldn’t be extremely painful. If it is, seek help from a lactation consultant to see how you can improve your child’s latch. You may experience painful and possibly even cracked nipples while they adjust to the change of breastfeeding. You can buy nipple cream with lanolin to put on your nipples between feeds.

Emotions and Mental Health
Childbirth and the postpartum period bring a lot of hormones. With hormones, losing sleep, and the incredible changes that come with parenthood, it is normal to feel a lot of emotions and some overwhelm. It’s very important, however, for you and your support system to be aware of the signs of postpartum depression and other mental health issues that can affect new moms.

If you have feelings of sadness, hopelessness, or feeling “down” that seem extreme, or if they last for more than a couple of weeks, you may be experiencing postpartum depression. Other signs of postpartum depression include tearfulness and crying for no reason, excessive sleeping or inability to sleep (when the baby is sleeping), feeling extreme anger or rage, difficulty concentrating and making decisions, withdrawal from social interactions, loss of interest in activities that are usually enjoyable, and feeling unable to bond with your baby.

If you think you may be experiencing postpartum depression, don’t hesitate to talk to your provider. There are available treatments that can help, including therapy and medication.

While rare, delusions (beliefs out of line with reality), hallucinations (seeing or hearing things that aren’t there), and thoughts of harming yourself or your baby are signs of postpartum psychosis and need immediate medical attention. If you have any thoughts of harming yourself or your baby, seek help immediately.

An Important Time
The postpartum period is a very special and important time for you to bond with your baby and experience the new joys of motherhood. Knowing what to expect in regards to your health can give you the power to take care of yourself during recovery. Your job is this - to take care of your baby and take care of yourself. Don’t hesitate to seek support from those around you and from your healthcare providers. Remember to enjoy this important time with your baby and soak it all in.

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