CALL YOUR PEDIATRICIAN WITH INFANT CARE QUESTIONS!
You need to be seen in our office for your postpartum visit 4 – 6 weeks after delivery.
Call our office if you have any of the following symptoms:
1. Temperature greater than 100.4º
2. Red area on breast associated with pain, firmness. It is normal to have fullness and pressure with slight warmth for a couple days when your milk comes in.
3. Heavy vaginal bleeding requiring changing pads every hour or clots the size of a lemon
4. Foul smelling vaginal discharge
5. Severe abdominal pain unrelieved by pain medication
6. Urinary tract infection symptoms: increased frequency with painful urination
7. Redness, swelling, yellow or green discharge from any stitches you have
8. Pain in the calves of your legs
9. Depression or crying spells that last more than 3 days.
Expect to have bleeding like a heavy menstrual period for 3 to 5 days, whether you deliver vaginally or by cesarean section. This flow will taper off and become dark brown and then pink to clear in color. This discharge may continue for six weeks with intermittent spotting. Use only pads, no tampons. If your bleeding increases you need to rest more. Your first menstrual cycle after delivery is often heavier than usual. When you breastfeed you may not have a period for several months, however, do not consider this as your birth control method. If you do not breastfeed, you should have a period within 6 to 10 weeks after delivery.
Use only pads for two weeks after delivery, the cervix needs time to heal – no tampons, douching, swimming or tub baths. No vaginal intercourse until you come for your postpartum visit, sexual pleasure is fine as long as nothing enters the vagina. After urination, continue to use squirt bottle from hospital to cleanse the perineum. Clean the rectal area after a bowel movement, always wiping from the front to the back.
If you have stitches in the perineum, they will dissolve within a couple of weeks. For comfort, you can try an ice pack on the area, use a spray anesthetic or tucks pads.
Cesarean section requires a little extra attention. Keep your incision dry and notify our office if you have symptoms of infections: fever, tenderness, redness and discharge from the incision. Be very careful not to lift anything heavier than the baby.
Expect to have uterine cramping for several days after delivery. If you experience severe cramping that is unrelieved by the medication prescribed by your doctor, please call the office.
Breast-feeding is encouraged and supported in our office. It is the best nutrition for your baby and has other benefits as well. It is not always as natural as you might expect and requires commitment and support from family members. If you experience difficulty in the first couple of weeks, please get help from a lactation consultant or call our office. If your breasts become engorged you can use warm packs for comfort and Tylenol prior to nursing. If you have reddened areas of the breast that are hot to touch and sore with a temperature greater than 100.4 you may have mastitis or breast infection. Call the office to discuss these symptoms and possible treatment. You will continue to nurse the baby with mastitis. If your nipples crack or are very tender it may be a problem with the baby latching on correctly or thrush. You may wash with water only or use lanolin or gel shields designed to heal this sensitive area. It is advisable to continue taking your prenatal vitamins while breast feeding. It is very important to be sure over the counter and prescription medications are safe, check with your pediatrician. To maintain an adequate milk supply you need to get plenty of rest, drink 10 glasses of fluids and increase your calorie intake about 300 calories daily. Do not smoke while breastfeeding.
Bottle feeding may be the best option for some women. If you choose to bottle feed, remember this is a very important time for bonding with your baby and give them your full attention. DO NOT prop a bottle for an infant until they can sit up and hold it on their own. Wear a tight fitting bra. Use an ice pack for comfort if you experience tenderness or engorgement, this will pass in a few days. There is no safe medication to “dry up your milk.” Do not express the breast milk, this will increase your discomfort and stimulate more production. You may use Tylenol or other pain relievers.
Activity needs to be modified when you go home from the hospital and you should have additional help and support from your partner, family or friends. You may drive yourself in 1-2 weeks, depending on narcotic pain use. You may shower anytime and bathe in one week. Walking for exercise is ok immediately and will be encouraged in the hospital. If you have a vaginal delivery you may begin other exercise after 3 weeks, start slowly and work up. If you have a cesarean section, you should wait 6 weeks or after your postpartum visit. You may be able to travel in 2 weeks with approval from your pediatrician. Strenuous activity and heavy lifting may delay your recovery, do not lift anything heavier than 10 pounds. Avoid standing or sitting in one position for prolonged periods. You may notice swelling in your feet, hands and legs the first few days you are home; this is a result of IV fluids and changes in your body. Call the office if you have headache and visual changes associated with swelling. Take naps during the day and learn to say YES to offers of help.
Intimacy, intercourse and birth control are important topics to discuss with your partner. Some women feel desire sooner than others and the average time frame is 6-8 weeks after delivery. If you are breast feeding, you may experience vaginal dryness that can be relieved by using a water based lubricant. Be patient with each other. It is important to choose your method of birth control before you need it. Breast feeding is not a good method of birth control. If you breast or bottle feed you have many choices to choose from. Birth control pills, IUD, diaphragm, condoms, and Depo Provera injections are available for breast feeding moms. If you are bottle feeding, you have these same choices as well as the patch or the ring. If you are certain you do not desire to have any more children, you may choose permanent sterilization-either vasectomy or bilateral tubal ligation. Discuss these issues with your healthcare provider.
Constipation and hemorrhoids are a frequent problem after delivery due to pressure on the rectum during pregnancy, pushing and delivery. Drink plenty of liquids and avoid caffeine. Eat fresh fruits and raw vegetables as well as high fiber foods. You may use a stool softener for 2-3 weeks. Sitz baths, Tucks pads and Anusol are used to provide comfort for hemorrhoids and stitches.
Postpartum Blues and Depression are two separate issues. Having a baby and starting or expanding your family is a special and very emotional time for you. You may not experience either of these situations, but it is important to recognize the symptoms and what can be done to alleviate them. The baby blues is relatively common within the first few days after you deliver. Feeling a little sad or depressed is temporary and is due to sudden demands of motherhood and hormone changes. You may feel fine and then be crying for no apparent reason. Sometimes it is helpful to have a good cry and let it out. It is okay. Then find some time for yourself-a massage or lunch with a friend. Remember to keep your relationship with your partner as a top priority and go out on a date without the baby. Seek advice from family and friends who have had children, they can tell you what it is really like becoming a mom. Share your feelings!!
Postpartum depression tends to occur after the first couple of weeks and is more prevalent than you realize. It may be difficult for women to discuss their feelings due to embarrassment, shame and uncertainty of how their partner will respond. You are not alone. It is a real illness that affects 20-30% of all postpartum women. The important thing to remember is that it is treatable and your doctor wants to be of assistance. Know that you can feel good again, do not let denial, misinformation, finances or anything get in the way of your getting the help you need.
Some symptoms include:
1. Irritability and sudden mood changes, snapping at your family, crying easily
2. Trouble sleeping, feeling exhausted all the time
3. Worrying over things that did not bother you in the past
4. Wondering if you will ever have time for yourself again
5. Thoughts that your children would be better off without you
6. Have decreased appetite or difficulty concentrating
7. Loss of interest, no longer enjoy things you used to enjoy
8. Feelings of guilt or that you are not a good mother
9. Isolating yourself from friends and family
10. Fear of leaving the house or being alone
11. Have unexplained anger or anxiety attacks
12. Think something is wrong with you and will never get better
(If you answered yes to 3 or more, you should seek advice from your physician. Talk to your partner and take the first step to getting help and feeling better.)