Postpartum Instructions for Our Patients

Enjoy the excitement of being at home. The emphasis today should be on resting. Tonight may be more stressful than in the hospital because you will be tired and yet fully responsible for the care of your new baby. With time and practice, things will get easier.
 

• Fever with or without chills (temperature of 100.4 ̊ or higher)
• Any difficulty with urination (burning, frequency)
• Vaginal bleeding that is excessive (soaking more than one pad per hour)
• Sudden extreme weakness or loss of consciousness
• Swelling, redness or tenderness in one area of the breast or leg
• Anything that troubles you

Your course after leaving the hospital should be one of progressive activity and exercise. Your incision will not reach its maximum strength for approximately four to five weeks, so try not to overdo it.

Usual activities such as walking, climbing the stairs and light housework are permissible but no heavy lifting for approximately six weeks.

You may drive within 10 days after leaving the hospital. Do not drive if you are taking narcotic pain medication (Percocet, Vicodin).

Your incision should be kept clean and dry and should be left either uncovered or loosely covered. Tub baths or showers are permissible, but be sure to let the wound dry thoroughly in the air following completion of your bath. If there are small bandage strips on the wound, these may be gently removed five to seven days after you return home.

As with vaginal delivery, we recommend waiting 4-6 weeks before having intercourse. When intercourse is resumed remember your contraceptive needs.

With time, your incision will become less sensitive. It is common to feel a thick ridge beneath the incision, which will gradually disappear. Some numbness and/or itching around the incision are common and do not indicate a problem. Should you develop redness around the incision, increased pain and tenderness, or temperature elevation, please let us know right away.

Gradually increase your daily activity so that in about two weeks you are leading a fairly normal life. We recommend daily rest periods during this time. You may shower, bathe or wash your hair at any time after the birth of your baby. During your first six weeks, avoid hard work. It may be desirable that the number of visitors is kept to a minimum during the first two weeks; it may cause undue fatigue for you and may be detrimental to your baby’s health. You may take short trips if you desire. If long automobile rides are necessary, you should stop and get out of the car at frequent intervals. The Family and Medical Leave Act (FMLA) provides certain employees with up to 12 weeks of unpaid, job-protected leave per year.
 

Your postpartum visit will be six weeks after delivery. In some circumstances, your physician/midwife may recommend a visit two weeks after delivery. Please call and make this appointment soon after you are discharged from the hospital. Your postpartum visit will consist of a pelvic exam, a pap smear may be performed and contraception will be discussed as well as any issues or concerns.

After a bowel movement, wipe from front to back. If you have hemorrhoids, they usually improve in the first days or weeks following delivery. Sitz baths will occasionally give considerable relief. You should relieve constipation by ample intake of fluids each day or, if necessary, take a laxative like Milk of Magnesia. A stool softener, such as psyllium powder (Metamucil) or Colace, may also be used.

Your perineal area may cause you discomfort depending on the type of delivery you had. If it is uncomfortable after you return home, the following should be done:

• Sit in a tub containing several inches of plain warm water for 15 minutes two to three times a day (Sitz baths)
• Apply Tucks pads afterward (place in the freezer and they may be more soothing)
• Continue to use your peri-bottle after each void while having vaginal flow
• Keep your stools soft as discussed above

Specific recommendations will be based on your personal history as well as breastfeeding. Please consider these options before your postpartum visit. Options include:

• Progesterone only birth control pills (mini pill)
• Combined estrogen/progesterone birth control pills (regular pill), birth control patch, birth control ring (Nuva Ring)
• Foam and condoms
• Diaphragms
• Depo Provera
• IUDs
• Contraceptive implant (Nexplanon)

If you are interested in something permanent:

• Tubal Ligation
• Vasectomy

ACOG says there is no set “waiting period” before a woman can have sex again after giving birth. Some health care professionals recommend waiting 4–6 weeks. The chances of a problem occurring, like bleeding or infection, are small after about 2 weeks following birth. If you have had an episiotomy or tear during birth, intercourse may not be recommended until the site has completely healed.

The original bloody vaginal discharge called “lochia” will gradually decrease and change to pink, then brown and finally to yellow. You may bleed for as long as six weeks. This should not deter you from keeping your six-week appointment. You may occasionally bleed heavier for short periods of time. The first menstrual period may occur before your check-up, especially if you are not breastfeeding. You should call if you are having bright red vaginal discharge bleeding that causes you to change your pad more than once per hour.

During pregnancy, your breasts prepare for lactation (milk production) and after birth, hormonal changes and infant sucking trigger a surge in milk supply. Nursing on demand every one to three hours for 15 to 20 minutes on each breast should empty the breasts and provide proper nutrition and fluids for your infant. Sore nipples and engorgement are common in the early stages of breastfeeding and the most frequent causes for new mothers deciding to stop breastfeeding. Proper positioning and latching with frequent nursing can help alleviate these temporary and uncomfortable symptoms. Call the lactation consultants at Women’s Care at (541) 868-9700 for advice if you are having problems. During growth spurts, your infant may nurse more frequently for one to two days while the milk supply catches up with his/her needs. It is recommended that infants be exclusively breastfed for the first six months to provide optimal nutrition and protection against infections. Other benefits from breastfeeding include decreasing the risk of subsequent pregnancy and assisting with weight loss. When you are breastfeeding it is important to continue eating a well-balanced diet. You actually need more calories while breastfeeding than you did during your pregnancy! It is a good idea to continue your prenatal vitamins while breastfeeding as well as drinking a lot of fluids (64 ounces a day).

You should expect a period of engorgement, treatable with form-fitting bras, ice treatments, and avoiding stimulation to the breast (pumping or hot showers). Tylenol or ibuprofen may be taken every three to four hours for relief of symptoms. Symptoms should resolve within 24 to 48 hours although leaking of milk may continue for days or weeks.

Your first menstrual period after giving birth often occurs within the first two months; however, you may not have periods while nursing. The first period may be unusually heavy or prolonged. If you are concerned about this, please call the office.

It is common to have postpartum blues. This is a normal response to many of the hormonal changes, stress, and lack of sleep that go with raising a newborn and physically recovering from the birth. Activities that can be helpful include:

• Getting more sleep
• Try to find time for your own needs, including recreation and social activities with friends, family, and your partner. A short period away from infants who are requiring your constant care and attention can be very helpful.

Postpartum depression is not uncommon and you should call your physician/midwife if you find yourself in a downhill spiral marked by:

• Prolonged crying spells
• Thoughts of harming yourself, the baby, or others
• Severe anxiety
• Inability to function or care for your newborn or yourself
• Depressive symptoms lasting longer than two weeks

You may begin exercising two to three weeks after the baby is born. Start gradually and be consistent. Light walking for 20 to 30 minutes is a good activity. It is normal to have some swelling of your feet and legs. If moderate to extreme, elevate your legs higher than your heart several times a day. You may begin Kegel exercises two to three weeks after delivery. Kegel exercises help increase the strength of your pelvic muscles. If you desire, you may begin swimming two to three weeks after delivery.

The “after pains” may be bothersome for first-time mothers and more intense with subsequent babies, especially during breastfeeding. Tylenol or ibuprofen every three to four hours will alleviate the discomfort. Expect cramping to continue for the first several days after birth.