Postpartum care of the mother

The period of adjustment after pregnancy and delivery is known as postpartum or puerperium, which lasts six to eight weeks. During this time, your mind and body go through physical and emotional changes as you adjust to not being pregnant.


Changes in the uterus
During the postpartum period, your reproductive organs will return to their normal state. Just after delivery, for example, your uterus contracts to less than half the size it was before labor. It remains this size for two days, and then steadily becomes smaller for about the next six weeks. Soon, your uterus will be only slightly larger than the uterus of a woman who has never delivered a baby.

Contractions
You may experience contractions or "afterpains" after delivery, especially if you've delivered other children. These contractions help prevent excessive bleeding by compressing the blood vessels in your uterus. These contractions are also thought to help your uterus return to its normal size. The contractions may be regular and strong the first day after delivery, and then taper off, often becoming mild by the third day. If you choose to breastfeed, you may experience afterpains while your baby is nursing. If the afterpains are extremely uncomfortable, your doctor may recommend a mild pain medication, such as acetaminophen.

Vaginal discharge
You'll have a vaginal discharge called lochia for up to six weeks after delivery. This discharge contains blood, mucus and tissue from the uterus. During the first three to four days after delivery, lochia is bright red and may contain small clots. It may be as heavy or even heavier than a menstrual period. It can pool in the vagina when you are lying down, and you may notice a small gush when you get up. This bright red lochia is followed by a pink or brownish, watery discharge. By about two weeks after delivery, the discharge is scantier and becomes white or yellowish-white in color.
Strenuous exercise, such as heavy lifting or climbing stairs, may increase the flow of lochia. The flow will decrease when you decrease your activity. If you're breastfeeding, you may notice an increase in lochia when your baby nurses and your uterus contracts. While you have a discharge, use sanitary napkins instead of tampons.

If you choose not to breastfeed, menstruation may resume within six to eight weeks after delivery. Your first period after childbirth may be heavier than normal, but more typical periods usually follow. If you're nursing your baby, menstruation may be delayed. The exact timing differs for everyone.

Since ovulation can occur before your first menstrual period after childbirth, it's possible to become pregnant before you've had a period. Remember the importance of effective birth control if you want to avoid pregnancy. (Breastfeeding should not be considered adequate contraception.) Discuss your birth control options with your doctor.


Changes in the perineum
After delivery, your vagina and perineum (the area between the vagina and rectum) will be swollen and uncomfortable. This discomfort may be compounded by stitches used to repair an episiotomy (an incision between the vagina and anus to create more room for a baby to be delivered and help prevent the vaginal tissues from tearing) or any tears in the perineum. The episiotomy or tear will usually heal within two weeks, and much of the swelling will gradually subside within three weeks. For most women, pain in this area subsides within a month after delivery. Some women may continue to have discomfort for up to three months, however.
While you're healing, it's important to keep the perineal area clean to prevent infection. After you urinate or have a bowel movement, wipe from front to back. Then, clean the perineal area with warm water from a squirt bottle and dry gently with clean gauze pads or wipes. Remember to wash your hands with soap and water before cleaning this area and after using the toilet.

Here are some other hygiene and comfort measures:

Change your sanitary pad at least every four to six hours.
Apply an ice pack or sterile gauze pad with refrigerated witch hazel to the perineum.
After the first 24 hours, you may also apply warm compresses to the perineum or sit in warm tub water.
Avoid long periods of standing or sitting. When you do sit, use a pillow. Better yet, lie down whenever you can.
Your doctor may recommend a spray that will temporarily numb the perineum.

Changes in urination
After delivery, you may find it difficult to urinate. This may be related to swelling in or around your urethra (the tube through which urine drains to the outside of the body), medications you were given during or after labor, or pain in the perineal area. However, it's important to urinate within four hours after delivery to avoid infection and keep the bladder from becoming too full. Drinking plenty of fluids and walking around may help, as well as running water in the sink while you try to urinate. If you can't urinate on your own, a catheter (a flexible tube) may be inserted to empty your bladder.
After the first day, you'll begin to urinate more as your body sheds some of the extra fluid from pregnancy. This may last two to three days. You may also notice an increase in perspiration, which is another way your body gets rid of extra fluid.

After delivery, some women notice a loss of urine during activities that put pressure on the bladder, such as lifting, sneezing or laughing. This is known as stress incontinence. Complete urinary control usually returns within three months as the muscles of the perineum regain their tone. Your doctor may recommend Kegel exercises (the rhythmic tightening and relaxing of the muscles around the rectum and vagina) to help strengthen these muscles.


Changes in bowel function
Constipation is another common occurrence after delivery. In part, this may happen because your intestines relax during pregnancy and your abdominal muscles stretch and become less efficient. It may also be related to medication you were given during or after labor, as well as the pain or fear of pain in the perineal area. The first few bowel movements may be uncomfortable, but remember the discomfort will subside as your body heals.
To alleviate constipation, eat plenty of high-fiber foods, including dried beans and peas, fresh and dried fruits, raw or slightly cooked vegetables, wheat bran and whole-grain breads and cereals. Drink plenty of fluids, such as water, fruit juice or vegetable juice. Prune juice may be especially helpful. Your doctor may also recommend a stool softener or laxative.

Activity can also help prevent constipation. After delivery, begin exercising in moderation as directed by your doctor. For example, you may be able to walk short distances soon after delivery. Your doctor may also recommend Kegel exercises to help strengthen the perineal muscles, including the rectum.

Many pregnant women develop hemorrhoids (stretched and swollen veins in the anus or lower rectum), a bothersome condition that may also appear after childbirth. To help ease the pain of hemorrhoids, consider the following suggestions:

Avoid constipation with the suggestions described above, and try not to strain when you have a bowel movement. It may be helpful to rest your feet on a low stool while sitting on the toilet.

Don't put added pressure on your rectal veins. Avoid prolonged sitting, standing or sleeping on your back. Take frequent breaks from standing and sitting, and sleep on your side at night. When you can, it's also helpful to lie on your side several times during the day.

Soak your perineal area in warm water for 10 to 20 minutes, several times a day. A tub bath may be used if recommended by your doctor.

Ice packs or cool compresses with witch hazel may also offer relief.

Try a topical hemorrhoid medication if recommended by your doctor.

Changes in your breasts
After the baby is born, your breasts will enlarge as they produce and fill with milk. Two to six days after delivery, your breasts may feel full, heavy and a little tender. For some women, the breasts become painfully engorged during the first week after delivery, swelling to as much as twice their normal size. Regular nursing can help ease discomfort and prevent painful engorgement.
If you choose not to breastfeed, these symptoms will subside after two to three days. Medication is no longer routinely given to stop milk production because of potentially serious side effects. To ease discomfort during this time, wear a supportive bra or wrap elastic bandages tightly around your breasts and avoid stimulating your breasts, such as standing under warm water in the shower or expressing milk. Applying ice packs to your breasts and taking a mild pain reliever, such as acetaminophen, may also help.


Other postpartum concerns
Bathing
You'll probably be able to shower soon after delivery if you're feeling up to it. You may prefer to have help the first time. Some women become very light-headed and may even faint. To decrease the risk of infection, your doctor may recommend waiting a few weeks to take a tub bath.

Diet
You can return to your normal diet soon after delivery unless your doctor tells you otherwise. Remember the importance of a well-balanced diet, including fresh fruits and vegetables, whole-grain breads and cereals, protein-rich foods and dairy products. If you're breastfeeding, add 200 to 500 calories to your daily diet, including three or more servings of dairy products. Your doctor will probably encourage you to take your prenatal vitamins while you're breastfeeding.

Rest
As tough as it may be, it's important to get plenty of rest as you recover from the delivery and adjust to your new responsibilities. If possible, have your friends or family help with daily activities at home. It's often a good idea to nap while your baby sleeps, and set aside time for extra rest whenever you can.

Exercise
Exercise will help your muscles return to prepregnancy form. You may even be able to do some simple exercises as quickly as 24 hours after delivery. Discuss appropriate exercises with your doctor.

Sex
Before having sex, make sure your perineum is healed and comfortable. Some doctors recommend waiting four to six weeks after delivery. Even once it's safe to resume sexual activity, many women find they have little desire to do so. Although the rewards of giving birth are numerous, caring for your new baby takes time. You'll likely be tired and stressed. You may fear that sex will be painful. In addition, hormonal changes after delivery can affect your sexual desire. If you're not ready to have sex, discuss your feelings with your partner. You may enjoy other ways of expressing affection and experiencing sexual pleasure until you feel ready for intercourse. When you do resume sexual activity, it may be helpful to use a vaginal lubricant (such as Astroglide or Replens) if your vagina feels dry.

Remember the importance of effective birth control if you want to avoid pregnancy. Do not consider breastfeeding an adequate form of contraception. If you're concerned about birth control, discuss the options with your doctor.