Recovering From Delivery

From KidsHealth.org

Your baby's finally here, and you're thrilled — but you're also exhausted, uncomfortable, on an emotional roller coaster, and wondering whether you'll ever fit into your jeans again. Childbirth classes helped prepare you for giving birth, but not for this.

What to Expect in the First Few Weeks

After your baby arrives, you'll notice some changes — both physical and emotional.

Physically, you might experience:

• Sore breasts. Your breasts may be painfully engorged when your milk comes in and your nipples may be sore.
• Constipation. The first postpartum bowel movement is typically delayed to the third or fourth day after delivery, and sensitive hemorrhoids and sore muscles may make bowel movements painful.
• Episiotomy. If your perineum (the area of skin between the vagina and the anus) was cut by your doctor or if it was torn during the birth, the stitches may make it painful to sit or walk for a little while during healing.
• Hemorrhoids. Although common, hemorrhoids (swollen anal tissues) are frequently unexpected and initially unnoticed.
• Hot and cold flashes. Your body's adjustment to new hormone and blood flow levels can wreak havoc on your internal thermostat.
• Urinary or fecal incontinence. The stretching of your muscles during delivery can cause you to inadvertently pass urine when you cough, laugh, or strain or may make it difficult to control your bowel movements, especially if a lengthy labor preceded a vaginal delivery.
• "After pains." The shrinking of your uterus can cause contractions that worsen when your baby nurses or when you take medication to reduce bleeding.
• Vaginal discharge (lochia). Heavier than your period and often containing clots (sometimes golf-ball sized), vaginal discharge gradually fades to white or yellow and stops within 2 months.
• Weight. Your postpartum weight will probably be about 10 pounds (the weight of the baby, placenta, and amniotic fluid) below your full-term weight, before additional water weight drops off within the first week as your body regains its sodium balance.

Emotionally, you may be feeling:

• "Baby blues." About 80% of new moms experience irritability, sadness, crying, or anxiety, beginning within days or weeks postpartum. Like the more severe associated syndromes of postpartum depression, these baby blues are very common and may be related to physical changes (including hormonal changes, exhaustion, and unexpected birth experiences) and the emotional transition as you adjust to changing roles and your new baby.
• Postpartum depression (PPD). More serious than the baby blues, this condition is evident in 10%–20% of new moms and may cause mood swings, anxiety, guilt, and persistent sadness. Your baby may be several months old before PPD strikes, and it's more common in women with a family history of depression.

In addition, when it comes to sexual relations, you and your partner may be on completely different pages. He may be ready to pick up where you left off before baby's arrival, whereas you may not feel comfortable enough — physically or emotionally — and may be craving nothing more than a good night's sleep.

The Healing Process

It took your body months to prepare to give birth, and it takes time to recover. If you've had a cesarean section (C-section), it can take even longer because this major surgery requires a longer healing time. If unexpected, it may have also raised emotional issues.

Pain is greatest the day after the surgery and should gradually subside. Your doctor will likely advise you on precautions to take after surgery, and give you directions for bathing and how to begin gentle exercises to speed recovery and help avoid constipation.

Things to know:

• Drink 8–10 glasses of water daily.
• Expect vaginal discharge.
• Avoid stairs and lifting until you've healed.
• Don't drive until you can make sudden movements and wear a safety belt properly without discomfort.
• If the incision becomes red and swollen, call your doctor.

Some other things to consider during the healing process include:

• Birth control. You can become pregnant again before your first postpartum period. If you are exclusively breastfeeding (day and night, no solids, at least every 6 hours), have not had a period, and your baby is younger than 6 months old, you have about 98% protection. If you're not breastfeeding exclusively or want additional protection, discuss your options with your doctor. Barrier methods (condoms, diaphragms, spermicidal jellies, and foams) are less effective than pills or shots.
• Breastfeeding. You need adequate sleep, fluids, and nutrition. Drink a glass of water whenever your baby nurses. Until your milk supply is well established, avoid caffeine, which causes loss of fluid through urine and sometimes makes babies wakeful and fussy. Your clinic or hospital lactation specialist can advise you on how to deal with any breastfeeding problems. Relieve painful, clogged milk ducts with breast massage, frequent nursing, and warm moist packs applied throughout the day. If you develop a fever and your breast becomes tender and red, you may have an infection (mastitis) and need antibiotics. Continue nursing from both breasts. Drink plenty of fluids.
• Engorged breasts. They resolve as your breastfeeding pattern becomes established or, if you can't or don't choose to breastfeed, when your body stops producing milk — usually within 3 days.
• Episiotomy care. Continue sitz baths (sitting in just a few inches of warm water and covering the buttocks, up to the hips, in the bathtub). Squeeze the cheeks of your bottom together when you sit to avoid pulling painfully on the stitches. Use a squirt bottle to wash the area with water when your urinate; pat dry. After a bowel movement, wipe from front to back to avoid infection. Reduce swelling with ice packs.
• Exercise. Resume as soon as possible to help restore your strength and pre-pregnancy body, increase your energy and sense of well-being, and reduce constipation. Begin slowly and increase gradually. Walking and swimming are excellent choices.
• Hemorrhoids and constipation. Alternating warm sitz baths and cold packs help. Ask your doctor about a stool softener. Don't use laxatives, suppositories, or enemas without your doctor's approval. Increase your intake of fluids and fiber-rich fruits and vegetables.
• Sexual relations. Your body needs time to heal. Doctors usually recommend waiting 4–6 weeks to have sex to reduce the risk of infection or increased bleeding. Fewer than 20% of couples resume sexual activity in the first month, but 90% do so by 4 months. Begin slowly, with kissing, cuddling, and other intimate activities. You'll probably notice reduced vaginal lubrication (this is due to hormones and usually is temporary), so a water-based lubricant might be useful. Try to find positions that put less pressure on sore areas and are most comfortable for you. Tell your partner if you're sore or frightened about pain during sexual activity — talking it over can help both of you to feel less anxious and more secure about resuming your sex life.
• Urinary or fecal incontinence. This usually resolves gradually as your body returns to its normal prepregnancy state. Encourage the process with Kegel exercises, which help strengthen the pelvic floor muscles. To find the correct muscles, pretend you're trying to stop urinating. Squeeze those muscles for a few seconds, then relax (your doctor can check to be sure you're doing them correctly). Wear a sanitary pad for protection. If the problem doesn't resolve in several months, tell your doctor.

What Else You Can Do to Help Yourself

You'll get greater enjoyment in your new role as mom — and it will be much easier — if you care for both yourself and your new baby. For example:

• When your baby sleeps, take a nap. Get some extra rest for yourself!
• Set aside time each day to relax with a book or listen to music.
• Shower daily.
• Get plenty of exercise and fresh air — either with or without your baby, if you have someone who can babysit.
• Schedule regular time — even just 15 minutes a day — for you and your partner to be alone and talk.
• Make time each day to enjoy your baby, and encourage your partner to do so, too.
• Lower your housekeeping and gourmet meal standards — there's time for that later. If visitors stress you, restrict them temporarily.
• Talk with other new moms (perhaps from your birthing class) and create your own informal support group.

Getting Help From Others

Remember, Wonder Woman is fiction. Ask your partner, friends, and family for help. Jot down small, helpful things people can do as they occur to you. When people offer to help, check the list. For example:

• Ask friends or relatives to stop by and hold your baby while you take a walk or a bath.
• Hire a neighborhood teen — or a cleaning service — to clean once a week, if possible.
• Investigate hiring a doula, a supportive companion professionally trained to provide postpartum care.

When to Call Your Doctor

You should call your doctor about your postpartum health if you:

• experience an unexplained fever of 100.4? Fahrenheit (38? Celsius) or above in the first 2 weeks
• soak more than one sanitary napkin an hour or if the bleeding level increases
• had a C-section or episiotomy and the incision becomes more red or swollen or drains pus
• have new pain, swelling, or tenderness in your legs
• have hot-to-the-touch, significantly reddened, sore breasts or any cracking or bleeding from the nipple or areola (the dark-colored area of the breast)
• find your vaginal discharge has become foul-smelling
• have painful urination or a sudden urge to urinate or inability to control urination
• have increasing pain in the vaginal area
• develop a cough or chest pain, nausea, or vomiting
• become depressed or experience hallucinations, suicidal thoughts, or any thoughts of harming your baby

Reviewed by: Serdar H. Ural, MD
Date reviewed: May 2005