A brief review for the first few weeks postpartum.
The first few weeks after the delivery of a baby is often a roller coaster ride; the physical changes that occur with a women’s body can be equally confusing. We wanted to discuss some of the physical changes occurring during the first few weeks postpartum and when to notify the office.
Breast changes:
Whether you choose to feed your baby breastmilk or formula you will have breast changes after delivery. Most often by the 3rd to 4th day after delivery a woman’s milk will “come in” and cause engorgement. A woman may feel like her breasts have grown 3 sizes overnight, and she may notice a free flow of milk. If you are breastmilk feeding (pumping or nursing) you will simply continue to feed your baby on demand (8 times in 24 hours on average). If there are any hard areas of the breast, you can try using a warm washcloth, perform gentle massage, and continue to nurse the baby off both breasts starting with the more painful one – these steps can help to make you more comfortable and “work out” the hard area. If you chose to formula feed, you should wear a tight-fitting bra throughout the day and night as much as possible. You can apply ice to the breasts and use cold cabbages leaves (DO NOT USE IF YOU HAVE A SULFA ALLERGY) to help to “dry up” the milk as well. Breast stimulation, touching or even with your breasts facing the shower head, should be avoided until you are no longer producing milk. NSAIDS (Advil, Motrin, or ibuprofen) are helpful in keeping women comfortable whether breast or formula feeding.
If you develop fever, chills, flu-like symptoms, body aches, breast redness, or you notice a warm or hot area when you touch the breast, please call the office. You may need to be evaluated for Mastitis.
Bleeding/Discharge:
All women will have bleeding in the first few weeks after delivery. After a cesarean section, the lochia (bleeding after delivery) may be a lighter flow than women who have had a vaginal delivery. Bleeding begins as a red color and after the first 5 to 7 days will become a lighter pink color. Around 14 -21 days the bleeding will become a tan to white color. Women may notice an increased amount of bleeding when they first begin to do more physical activity after delivery or have gushes when they are breastfeeding. Some rest should improve this bleeding.
If the bleeding goes back to red after lightening and persists for more than 2 hours, or if you have a large amount of bleeding like a menstrual period or repetitive golf ball size or large clots you should call the office. Severe pelvic pain, foul discharge, and fever are not expected and if noted you should call the office and speak to a triage nurse.
Episiotomy / Tear / Hemorrhoid Care:
Some women do require an episiotomy, or naturally tear, during a vaginal delivery. The stiches which are used for the repair will dissolve on their own in the first 1-2 weeks after delivery, however this can take up to 6 weeks. If the stitch remains after this time you can call the office for recommendations. It is not uncommon to have some soreness of the perineum after delivery. Applying witch hazel pads to the stiches, using a numbing spray, or using an ice pack may be helpful. To make an ice pack, you can simply use a sandwich baggie of peas or carrots or get some inexpensive pads or baby diapers and fill them with water and freeze. They work just as well as the hospital pads. There are also recipes online – search “Padsickles”.
If you notice any severe perineal pain, foul discharge, or fever you should call the office and speak to a triage nurse.
Hemorrhoids are very common after pregnancy. You should consider taking a stool softener daily until you have returned to your normal bowel schedule. Witch hazel pads, Preparation H and cushions can be helpful in keeping you more comfortable.
Weight and swelling:
Some women are lucky enough to leave the hospital in their pre-pregnancy clothing, however, this is UNUSUAL. Many women experience a great deal of swelling after giving birth, even once they are home. Compression stockings, elevation, and hydration are helpful in eliminating the extra fluid collection women can get in their legs after delivery.
If you have calf pain, redness, trouble walking, or one leg is more swollen then the other, this is a reason to call in and speak to a triage nurse.
The baby weight may take some time to lose. Around 2 weeks you can begin to gradually resume your physical activity. Any water activities should be avoided until 3 weeks after a vaginal delivery and 6 weeks after a cesarean section. Lifting your other children may be okay but you should have them climb up to you as much as possible in the first two weeks. It is fine to take stairs immediately after delivery, but you should limit the times you take the stairs daily in the first two weeks and take them slowly.
Intimacy:
Intimacy commonly changes after delivery. It is normal for romantic relationships to be challenged; however, it is important for both partners to communicate openly about their needs and expectations. Women who have had a vaginal delivery should wait until at least 6 weeks post-partum to become sexually active again. Please remember that contraception (condoms) should be used, even while breastfeeding, if you choose to have intercourse before your postpartum appointment.
Emotional changes:
The emotional changes in a woman after delivery are known to many. It is very common for women to experience some sadness, anxiety, or depressed mood after delivery. These feelings should improve as you adjust to life with your little one. It is important to remember to take care of yourself and ask for help if you need it. If a friend or family member wishes to visit, consider having them make a meal for you or take the dishes out of the dishwasher before they cuddle the baby. Also try to nap when the baby is napping during the day. If the emotional or mood changes continue beyond the 2nd week after delivery you may want to consider reaching out to the office for a meeting with one of the physicians.
However, if you ever have feelings of hurting yourself, someone else, or your child this could be a sign of something more. Please know YOU ARE NOT ALONE. Please contact 9-1-1, Crisis at UPMC-Pinnacle @ 717-232-7511, or Crisis at Geisinger Holy Spirit @ 717-763-2222.
Other adjustments:
Skin and hair changes are often seen in the first few months after delivery. Women may lose hair or having increased skin dryness. This can all be normal as your hormones readjust.
Many women experience some urinary leakage after delivery. It may take the full 6 weeks after delivery for you to notice an improvement. If you are still having urinary leakage at your postpartum appointment you should discuss this with your provider.
We hope that this information helps to make the postpartum transition less intimidating.
