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The time from birth to six weeks after birth is called the postpartum period. During this period the mother goes through many physical and emotional changes.

Hospital

Immediate Recovery Period
For about one hour following birth, you will be closely monitored. Nurses will be checking your uterus, perineum, lochia, and vital signs to ensure that you are making a normal recovery.

You are encouraged to keep your baby with you during recovery so that you can explore, touch, and nurse your baby if you desire. In addition to your coach, your children may also be with you. Many new parents phone relatives and friends to share their happy news while in recovery.

You may be very hungry and thirsty after birth. Be sure to request food as needed.

Chills are common following delivery and are often accompanied by shaking and trembling. Definite causes are uncertain. Do not be alarmed; ask for another blanket, a warm drink, and utilize your relaxation skills.

Hospital Stay
You will be transferred to your room, where you will spend the remainder of your hospital stay. A minimum hospital stay of 24 hours is usually requested by both your physician or nurse midwife and the pediatrician taking care of your baby.

During your hospital stay, your baby may either stay with you in your room or be in the nursery. Do not feel that your baby must be with you all the time. It is very important for new mothers to get plenty of rest.

Uterus
Following birth, your uterus will be tender, yet it will be necessary to check and massage it frequently. Massage stimulates the uterus to stay firm and contracted, helping to prevent bleeding from the blood vessels at the placental site. The nurses may ask you to help by showing you the location of your uterus and having you massage it yourself.

You may experience afterpains, which are the body’s way of contracting the uterus back to its normal size and position, and controlling excess bleeding. Afterpains are more pronounced with each pregnancy. They may continue for several days and may be more noticeable while you breastfeed. Your physician or nurse midwife will have ordered a pain medication for afterpains and general discomfort. Please ask the nurses for medication as needed.

Lochia
Lochia is the uterine discharge of blood, mucus, and tissue after birth. Your discharge may last from three to six weeks. The color and amount of lochia will change progressively as uterine healing occurs. Initially, the lochia will be bright red, sometimes with small clots. It is not uncommon to pass an egg-sized clot during the week following delivery. The lochia will then gradually decrease, becoming pinkish-brown and, later, a pale, creamy color. There is no odor present with the discharge.

An increase in lochia may occur with sudden, increased activity. This is usually not indicative of a problem, but it should remind you not to overdo it.

Initially, we request that you wear a sanitary pad, but after two weeks, and when you are comfortable, you may use tampons. Tampons should be worn during the day only and changed every four hours.

Perineum
During birth, the pelvic floor muscles have stretched greatly, and they may have been cut by an episiotomy. To prevent infection and to promote healing of the perineum (and episiotomy, if you had one), we recommend the following care:

• Ice packs to the area for six hours following birth to decrease swelling
• Sitz baths three times a day for 15–20 minutes; moist heat is not only soothing, but it also promotes healing by increasing circulation to the area
• Sitz baths at home, two to three times a day in the bathtub—clean the tub and fill it with comfortably hot water
• Warm water washes using a peri- bottle after each bathroom use
• Do Kegel exercises the day of birth and in the days following; gradually increase the number you do as your comfort permits

After about 10 days, your perineum should feel comfortable again. If you have had an episiotomy, most of your stitches will have dissolved by this time.

Breasts (Bottle-Feeding)
While you are in the hospital, plan on wearing a tighter bra. This will decrease stimulation of the breast and production of breast milk. Wear the bra for several days and even through the night. When showering, keep warm water from touching your breasts, since the warmth may also encourage milk production. Ice packs, breast binding, and ibuprofen will help if breast milk is produced.

Breasts (Breastfeeding)
For detailed information, please see the “Feeding Your Baby” chapter.

Bladder
Early in your recovery, it is important for you to empty your bladder. Initially, because of swelling around the bladder and urethra, and because of numbing from the local anesthesia, this might be difficult. A sitz bath may be very helpful since sitting in warm water often stimulates urination. If it becomes apparent that you are unable to empty your bladder, a small catheter may be used to drain it for you.

Bowels
Many women experience difficulty in having a bowel movement during the early postpartum period. This difficulty results from the relaxation of the abdominal muscles, soreness of the perineum, the episiotomy if you had one, and possibly the presence of hemorrhoids.
Some helpful suggestions for re-establishing normal bowel function include

• early ambulation,
• adequate diet rich in fresh fruits and vegetables and whole grains, and
• adequate fluid intake of 8–10 glasses per day.

In addition, a stool softener is prescribed for you throughout your hospital stay.
If you have hemorrhoids, sitz baths will also help to reduce pain and swelling.

Rest
Labor and birth require great physical exertion, and we cannot overemphasize your need for rest following birth. Without adequate rest and sleep, your recovery will be slowed, and you may become irritable, frustrated, and generally unable to cope with life and your new responsibilities.

Activity
Early in your recovery period, when you are able, you will be encouraged to get out of bed and walk. Early ambulation will help you hasten your recovery and regain your strength.

You may begin postpartum exercises within 24 hours after birth as long as you are comfortable. Please see the “Postpartum Exercises” chapter.

Emotions
Immediately after birth, many mothers feel very excited and elated. Sleep and relaxation may be difficult, but it is wise to remember that although you are emotionally “high,” you are physically tired.

It is also common for you to experience many mood fluctuations following birth. Rest is your best ally in handling your emotions.

Care Provider Visits
Twice a day, your physician and/or nurse midwife will visit you in the hospital. We request that you be in your room at 7:30 for the morning visit. Please write down any questions you have and discuss them at that time.

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Home

Going Home
Since the mother’s hospital stay is so short, complete rest and recuperation are impossible at the hospital. The trip home may be tiring, no matter how short. Dress the baby in comfortable clothing so that she/he may be placed in the crib as soon as you reach your home.

You, too, may want to rest as soon as you arrive home. If you have help at home, encourage the helper to take over the care of your other children, housework, and cooking so that you will be free to care for yourself and your baby.

The baby’s brothers and sisters will be anxious to see their new sibling, of course, but they will be particularly anxious to see you. Have your husband carry the baby into the house so that you will have open arms to greet your children. Sit down and allow any smaller children to crawl into your lap. Do not lift anything heavier than your baby!

Limit company for a week or two, and feel free to encourage friends to visit when you’re more rested. Because excessive handling and disruption of sleep tend to be upsetting to new babies, they will feel the strain, too, if there is too much activity in your home.

Rest
It may take several weeks to regain all your strength and resume all activities. For the first two weeks, take advantage of the time when the baby is sleeping to nap or at least rest by getting comfortable and reading a book. A new mother regains her strength slowly, so get as much rest as possible for the first few weeks.

Willingly accept help that is offered. If you do not have someone to help you during this time, confine your household chores to a minimum of light tasks.

Now is the time to put your relaxation to work again just as you did before delivery. Make yourself comfortable, take a deep breath, close your eyes, and completely relax.

Activity
Being sensitive to how your body feels is valuable in gauging how much physical activity is good for you.

It is important to establish priorities and avoid setting high expectations for yourself in the early postpartum period.

You may begin mild exercises as soon as it’s comfortable, usually 24 hours after birth. Never push yourself to the point of exhaustion or muscle strain. Consistent exercise each day is the key to regaining your figure. For recommended postpartum exercises, please see the “Postpartum Exercises” chapter.

Baby Blues
Early in the postpartum period (frequently during the first week), a phenomenon called “baby blues” may occur. This may be caused by a combination of the following:

• Drastic hormonal changes following birth
• Fatigue
• Physical discomfort from breast engorgement, a sore perineum, or other physical concernsv
• Reality of the baby’s presence

This depression is brief, usually no more than 48 hours. Understanding and accepting this temporary depression, combined with lots of rest, will successfully get you through the baby blues.

Diet
Do not go on a crash diet to lose extra pounds. Instead, plan to eat nutritious meals that are low in calories. If you are breastfeeding, do not attempt any sudden, significant weight loss. You should eat as well and as carefully as you did when you were pregnant.

Vitamins
Continue to take your vitamins and iron until your supply is gone. If you are breastfeeding, continue vitamins and iron until the baby is weaned.

Medications
Ibuprofen may be taken every four to six hours as necessary for discomfort. For constipation, Pericolace may be taken.

If you are breastfeeding, do not take any other medication without consulting with your physician or nurse midwife first.

Temperature
We encourage you to take your temperature twice a day for 10 days. If your temperature is over 100 degrees Fahrenheit, call the office since a fever can be the first sign of many postpartum infections.

Re-establishment of Menstruation
Some women have periods as early as one month after birth, whereas others may not have a period for several months, especially if they are breastfeeding. Your first period may be irregular in amount and length.

Sexual Intercourse
Sexual intercourse may be resumed when your discharge has nearly stopped and your perineum and/or episiotomy has sufficiently healed so that you will be comfortable. This usually takes three to four weeks after birth.

It is important to note that a woman may ovulate before regular periods resume after birth. Therefore, if contraception is not utilized, conception can occur. Use a contraceptive foam or cream and have your partner use condoms until your six-weeks checkup. Remember, breastfeeding is not a reliable form of contraception.

Due to a lack of lubrication in the vagina after birth, a water-soluble gel such as Maxi-Lube or K-Y Jelly may be helpful during intercourse.

Because fatigue may cause your sexual arousal to be less than normal, rest for both partners is essential.

If you are breastfeeding, stimulating the breasts during intercourse may result in the “let-down” reflex, soaking you and the bedclothes. However, this usually stops once breastfeeding is well established.

Do not give up if intercourse is not what it used to be. Resumption of intercourse may be quite easy, or it may take a little persistence. Plan ahead so you can be fairly certain that the baby will not awaken. Also, do not have the baby in your room. You can hear the baby cry from another room.

Emotionally, it is important for both you and your partner to nurture the relationship you had as a couple before the baby was born. All your needs cannot be met by the baby. Spend some time together without the baby. Please feel free to discuss any problems you are having with your physician or nurse midwife.

Family Planning
If you are interested in using any of the methods of contraception, we will discuss these with you at your six-weeks checkup. If you should become sexually active before your six-weeks checkup, use condoms and a contraceptive foam. Please refer to the “Methods of Contraception” chapter.

Douching
Douching should not be done.

Appointments
You will make an appointment for a six-weeks postpartum checkup unless your physician or nurse midwife indicates otherwise. The purpose of this checkup is to ensure that your recovery from birth is physically and emotionally complete. A pelvic exam is done to confirm that the uterus and other reproductive organs have returned to their normal pre-pregnant size, position, and function.