Postpartum Recovery

Congratulations on your new baby! Parenting, whether this is your first or your fourth baby, brings new challenges. Hopefully this quick reference will be a helpful guide to your recovery in the first weeks postpartum. Please contact your physician's office if you have any additional concerns. Call the office immediately if you experience any of the following: Fever > 100.4 degrees Pain not relieved by pain medications Heavy vaginal bleeding (saturating > 1 pad/hour or large clots) Depression symptoms Redness and pain of the breast (see "Mastitis" in the Breastfeeding section below) Unrelenting headache even after taking Tylenol, or right-sided upper abdominal pain After Vaginal Delivery:

Most women, especially if they had a cut/laceration/tear, will be sore for several days and some can be sore for a few weeks. You should feel better each day. Call with any persistent fever > 100.4 degrees or foul odor. Stitches dissolve on their own Rinse with a water bottle each time to you use the bathroom for the first 1-2 weeks, until you feel comfortable wiping. Bath soaks or Sitz baths (for 5-10 minutes) twice a day can be very helpful, followed by completely drying after getting out of the water. Prevent constipation and straining as described below. Avoid lifting > 10 pounds for the first 2 weeks. Start exercise with short, slow walks and gradually increase. No vigorous exercise prior to 6 week check-up. After Cesarean Delivery:

Do not scrub or apply anything to your incision; just let soapy water trickle over the incision when you shower, and then pat it dry. When you're not bathing, it is important to keep the incision dry. No swimming or tub baths. Remove Steri-strips from your incision at 2 weeks after delivery if they have not fallen off yet. Silicone strips such as Scar Away can then be used to reduce scar formation. Call my office if you notice redness around the incision or drainage from the incision. You may notice a slight pulling sensation within your wound for weeks to months, and some numbness or tingling around the incision for a while as well. Walking is very helpful in recovery from surgery, and I encourage it. You may climb stairs but try to take it slow and minimize trips up/down. More strenuous activity and a normal exercise routine may be gradually resumed after the 6 week check-up visit. Do not lift anything heavier than the baby (or ten pounds) for 6 weeks. No driving for at least 2 weeks, and if you are still using your strong pain medication, you should not drive. After ALL Deliveries:

Vaginal Bleeding/Lochia:

You may have heavy bleeding (like a heavy period) for 1-2 weeks after delivery, and some bleeding up to 8 weeks postpartum. Nothing in the vagina (tampons, douching, intercourse) until after your 6 week check-up. Call your physician's office if you soak more than one pad per hour for more than 2 consecutive hours Pain:

Continue your NSAID: ibuprofen 600 mg every 6 hours (over-the-counter). Do not take more than 2400 mg per day. These medications reduce swelling, inflammation, and pain, and have few side effects. Continue Tylenol as written on the bottle, with a maximum of 3000 mg per day. Pain should get better each day. If your pain is severe or worsening, please call the office. Some patients need stronger pain medications after cesarean deliveries or with larger vaginal tears. For moderate to severe pain in these patients, we prescribe a narcotic medication. These are to be taken in addition to your ibuprofen and Tylenol; take them as needed as written on the prescription. These medications can cause drowsiness, and you cannot drive while taking them. They can also cause constipation. Nutrition:

Maintaining a well-balanced diet is important for healing and breastfeeding. Be sure to get good protein and unsaturated fats in your diet. Exclusive breastfeeding requires about 500 calories/day in addition to your normal requirements. Continue your prenatal vitamin and 4-5 servings of dairy/day (equivalent to 1000-1200 mg of calcium). I will tell you if you need additional iron supplements. Stay well-hydrated while you breastfeed! Swelling/Edema:

Usually increases for several days following delivery, peaking at about 1 week after delivery and then gradually improving Call your physician's office if you notice swelling that is predominantly in one leg and associated with pain Breastfeeding:

Be patient and remember that you and your baby are both learning something new! Rest, hydration, nutrition, repeat. Eat a healthy snack and drink a bottle of water during feedings. Milk supply usually comes in between 3-5 days post-delivery. If you have painful engorgement, continue your ibuprofen, hydrate, rest, and use a warm compress before feedings to soften the breast. Cramping during breastfeeding is normal and usually increases with each pregnancy. Nipple soreness: use expressed breast milk on the area around the nipple, Lansinoh (lanolin) ointment or pads, and avoid irritants like soap. Consider talking with a lactation consultant to evaluate your latch and breastfeeding techniques to get more comfortable. Blocked milk ducts: Usually feels like a firm area on the breast. Use a warm compress prior to feeding (warm water in a clean diaper works well), massage the area while you feed/pump, and be sure to completely empty the breast during feeding/pumping. Mastitis: Signs are usually a warm, painful, red area on the breast, “flu-like” symptoms such as muscle aches and chills, and fever >100.4. Call your physician's office if you have these symptoms! Continue breastfeeding, hydrate well, and start a pain/fever reliever like ibuprofen or acetaminophen. Lactation support is available from the hospital and our office; please do not hesitate to ask! Bladder/Bowels:

Keep your bladder empty to avoid abdominal discomfort, emptying at least every 3 hours. Some leaking urine can be normal after delivery. It will improve, especially with Kegel exercises beginning after your follow-up visit: try for three sets of 10 “squeezes” daily. Bowel function can take up to 5 days to return after delivery. In addition to hydration and a balanced diet including fruits and vegetables, you may take a stool softener like Colace (or generic) 100 mg twice daily by mouth for the first week or so postpartum, unless your stools are loose. You can also add a fiber supplement if you’re having difficulty. Do not use a suppository or enema. If you developed hemorrhoids, you may use topical remedies: Tucks pads, Preparation H, or Anusol HC. Sitz baths are also helpful. Mood:

Baby blues”: depressed mood, tearfulness, or feeling “down” should usually last less than 2 weeks and then improve. Look out for symptoms that last longer than two weeks or more extreme symptoms like not sleeping, not wanting to take care of the baby, wanting to run away, or thoughts about harming yourself or the baby. Call your physician's office immediately if you experience these symptoms. Postpartum depression can develop at any time in the first year after delivery and is VERY common. If you have any of the following, contact your physician's office so you can get help: Being sad/depressed Lack of pleasure from usually joyful activities Decreased energy/motivation Feeling hopeless Trouble sleeping Loss of appetite Feeling restless or anxious a lot of the time Lack of concentration Lack of self-esteem Get as much rest as you can, delegate tasks to family and friends Intercourse:

Not until after your 6 week check-up. You may expect some discomfort due to healing and hormonal changes associated with postpartum and breastfeeding. Have lubricant ready! Birth control is important to consider prior to becoming sexually active, because some women will still have cycles while they breastfeed and could become pregnant. There are many options! Follow-Up Visits:

6 weeks post-delivery If you had hypertension during your pregnancy or hospitalization, you need to come in for a blood pressure check within 1-2 weeks of discharge from the hospital. Additional visits may be needed and discussed before you leave the hospital.