Postpartum Care: What to Expect After a Vaginal Delivery
Pregnancy changes your body in more ways than you might have guessed, and it doesn't stop when the baby is born. After a vaginal delivery, taking good care of yourself is an essential part of postpartum care. Here's what to expect.
If you had an episiotomy or vaginal tear during delivery, the wound might hurt for a few weeks. Extensive tears might take longer to heal. In the meantime, you can help promote healing:
Soothe the wound. Cool the wound with an ice pack, or place a chilled witch hazel pad - available in most pharmacies - between a sanitary napkin and the wound.
Take the sting out of urination. Pour warm water over your vulva as you're urinating. Press a clean pad firmly against the wound when you bear down for a bowel movement.
Keep the wound clean. Use a squirt bottle filled with water to rinse the tissue between the vaginal opening and anus (perineum) after using the toilet.
Sit down carefully. If sitting is uncomfortable, sit on a pillow or padded ring.
While you're healing, expect the discomfort to progressively improve. Contact your health care provider if the pain intensifies, the wound becomes hot, swollen and painful, or you notice a pus-like discharge.
You'll have a vaginal discharge (lochia) for a number of weeks after delivery. Expect a bright red, heavy flow of blood for the first few days. If you've been sitting or lying down, you might notice a small gush when you stand up. The discharge will gradually taper off, changing from pink or brown to yellow or white. To reduce the risk of infection, use sanitary napkins rather than tampons.
Don't be alarmed if you occasionally pass small blood clots. Contact your health care provider if:
- You soak a sanitary pad within an hour while lying down
- The discharge has a foul odor
- You pass clots larger than a golf ball
- You have a fever of 100.4 F (38 C) or higher
You might feel contractions, sometimes called afterpains, during the first few days after delivery. These contractions - which often resemble menstrual cramps - help prevent excessive bleeding by compressing the blood vessels in the uterus. For reasons that aren't entirely clear, these contractions tend to be stronger with successive deliveries. Your health care provider might recommend an over-the-counter pain reliever if necessary.
Contact your health care provider if you have a fever or if your abdomen is tender to the touch. These signs and symptoms could indicate a uterine infection.
Swelling or bruising of the tissues surrounding the bladder and urethra can lead to difficulty urinating. Fearing the sting of urine on the tender perineal area can have the same effect. Difficulty urinating usually resolves on its own. In the meantime, it might help to pour water across your vulva while you're sitting on the toilet.
Contact your health care provider if you have any symptoms of a urinary tract infection. For example:
Pregnancy and birth stretch the connective tissue at the base of the bladder and can cause nerve and muscle damage to the bladder or urethra. You might leak urine when you cough, strain or laugh. Fortunately, this problem usually improves within three months. In the meantime, wear sanitary pads and do Kegel exercises to help tone your pelvic floor muscles.
To do Kegels, tighten your pelvic muscles as if you're stopping your stream of urine. Try it for five seconds at a time, four or five times in a row. Work up to keeping the muscles contracted for 10 seconds at a time, relaxing for 10 seconds between contractions. Aim for at least three sets of 10 repetitions a day.
- It hurts to urinate
- You don't think you're emptying your bladder fully
- You have an unusually frequent urge to urinate
Hemorrhoids and bowel movements
If you notice pain during bowel movements and feel swelling near your anus, you might have hemorrhoids - stretched and swollen veins in the anus or lower rectum. To ease any discomfort while the hemorrhoids heal, soak in a warm tub and apply chilled witch hazel pads to the affected area. Your health care provider might recommend a topical hemorrhoid medication as well.
If you find yourself avoiding bowel movements out of fear of hurting your perineum or aggravating the pain of hemorrhoids or your episiotomy wound, take steps to keep your stools soft and regular. Eat foods high in fiber - including fruits, vegetables and whole grains - and drink plenty of water. It's also helpful to remain as physically active as possible. Ask your health care provider about a stool softener or fiber laxative, if needed.
Another potential problem for new moms is the inability to control bowel movements (fecal incontinence) - especially if you had an unusually long labor. Frequent Kegel exercises can help. If you have persistent trouble controlling bowel movements, consult your health care provider.
Sore breasts and leaking milk
Several days after delivery, your breasts might become heavy, swollen and tender. This is known as engorgement. To ease the discomfort, nurse your baby or use a breast pump to express milk. You might also want to apply cold washcloths or ice packs to your breasts. Over-the-counter pain relievers might help, too. To help prevent nipple pain, make sure that your baby latches on to your breast correctly. If you're unsure or every feeding is painful, ask a lactation consultation for help.
If your breasts leak between feedings, wear nursing pads inside your bra to help keep your shirt dry. Change pads after each feeding and whenever they get wet.
If you're not breast-feeding your baby, wear a firm, supportive bra. Compressing your breasts will help stop milk production. In the meantime, don't pump your breasts or express the milk. This only tells your breasts to produce more milk.
Hair loss and skin changes
During pregnancy, elevated hormone levels put normal hair loss on hold. The result is often an extra-lush head of hair - but now it's payback time. After delivery, your body sheds the excess hair all at once. Within six months, your hair will most likely be back to normal. In the meantime, shampoo only when necessary, and find a hairstyle that's easy to maintain. Avoid curling irons and harsh chemicals.
Stretch marks won't disappear after delivery, but eventually they'll fade from reddish purple to silver or white. Expect any skin that darkened during pregnancy - such as the line down your abdomen (linea nigra) - to slowly fade as well.
Childbirth triggers a jumble of powerful emotions. Mood swings, irritability, sadness and anxiety are common. Many new moms experience a mild depression, sometimes called the baby blues. The baby blues typically subside within a week or two. In the meantime, take good care of yourself. Share your feelings, and ask your partner, loved ones or friends for help. If your depression deepens or you feel hopeless and sad most of the time, contact your health care provider. Prompt treatment is important.
After you give birth, you'll probably feel flabby and out of shape. You might even look like you're still pregnant. Don't worry. This is perfectly normal. Most women lose more than 10 pounds during birth, including the weight of the baby, placenta and amniotic fluid. In the days after delivery, you'll lose additional weight from leftover fluids. After that, a healthy diet and regular exercise can help you gradually return to your pre-pregnancy weight.
The postpartum checkup
About six weeks after delivery, your health care provider will check your vagina, cervix and uterus to make sure you're healing well. He or she might do a breast exam and check your weight and blood pressure, too. This is a great time to talk about birth control, breast-feeding and how you're adjusting to life with a new baby. You might also ask about Kegel exercises to help tone your pelvic floor muscles.
Above all, share any concerns you might have about your physical or emotional health. Chances are, what you're feeling is entirely normal. Look to your health care provider for assurance as you enter this new phase of life.
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Postpartum Care: What to Expect After a Vaginal Delivery