Postpartum Care for the Mother
FIRST 24 HOURS: A support person needs to walk with mom to the bathroom and stay close by. Place baby in a safe area so that mom and support person’s arms are free incase mom faints. It is not uncommon for moms do faint. If mom does faint, please help her to the floor safely and apply a cold wash cloth to her forehead. And contact the midwife.
Bleeding (Lochia)
Bleeding after having a baby is much like a normal period except with heavier flow in the beginning. At first there may be small clots. These shouldn’t be bigger than a golf ball. Over the course of several days to two weeks, the lochia will turn brown, then yellowish-white or clear, and finally, end by six weeks. Anytime you bleed as much as to saturate two large pads within a one-hour period you should immediately call your midwife.
Uterus
The uterus should feel firm and should feel about the size of a grapefruit for the first few days. The fundus (top portion of the uterus) should be felt at the level of your belly button or lower. You can attempt to feel your fundus by gently pressing on your abdomen. The uterus shrinks at about the rate of one cm. per day. By day 10 it can no longer be felt above the pubic bone. If the uterus is not firm you can massage it. Some women will experience “after-pains” (contractions after the birth). These can be quite painful but can often be alleviated by applying a hot compress. After-pains usually occur after nursing, especially in mothers who have given birth previously. They usually end by the third day. If your fundus is found above your navel, you probably need to pass urine. Call your midwife if your uterus feels soft or is not descending.
Infection
Eating nutritious foods, taking adequate fluids (8-10 glasses of water daily), and getting adequate rest are all important measures to avoid a postpartum infection. Call your midwife if you develop flu-like symptoms, have a temperature of 38 C /100.4 F or higher, or if you are experiencing night sweating. Please note: it is common for women to have a low-grade temperature when their milk comes in but should resolve spontaneously within 12 hours.
Vagina & Perineum
During the first 24 hours after birth, you may appreciate applying some ice or cold pads to help reduce swelling and discomfort from any birth trauma. On the second day, taking a sitz-bath (soaking your bottom end in warm water) twice a day can relieve discomfort, and promote healing. Afterward, air drying is recommended. Tylenol and Ibuprofen can be taken as needed. Call your midwife if you are experiencing an unreasonable amount of pain.
Urination
Use a peri bottle to spray warm water while you void can help dilute the urine if you are experiencing any stinging sensations. Drinking plenty of water will also help dilute your urine. Call your midwife if you are unable to empty your bladder.
Bowel Movements
It may take 2-3 days to resume normal bowel activity. Eating foods that will promote a soft stool is recommended. This includes raw fruits and vegetables, bran, and plenty of fluids. Taking Calcium/Magnesium to the point of just loose stools can also help. Call your midwife if you have not passed a bowel movement by the fourth day.
Hemorrhoids
Hemorrhoids are protrusion of veins around the vagina and anus. They can be treated with applications of the herb witch hazel, tucks, Annusol, or Preparation H, and by promoting soft bowel movements as discussed above. Apply cold compresses, and avoiding straining on the toilet.
Breasts
Ensure your baby is latching effectively to your breast at each nursing. This will prevent sore nipples and the baby will receive more milk. You can rub the baby’s lips or cheek with your nipple to encourage a wide-open mouth before allowing the baby to take the breast. The baby’s mouth should be placed behind the nipple onto the areola. The lips should be relaxed and open. After feeding you can express some of your colostrum and apply it to your nipple to keep them healthy. Do not wash your nipples before feedings, or with soap when showering.
On the 2nd to 4th day some women experience very full breasts. This is call breast engorgement. Warm compresses and expressing breast milk just before feedings may be helpful to soften the areola so the baby can latch properly. Cold cabbage leaves in your bra may help relieve this sensation. This is generally a temporary condition lasting 1-2 days. If you develop a lump, massage it during the following feedings but do not ignore it. Lumps should be dealt with immediately through a combination of warm compresses, massage, and keeping the effective side empty. Call your midwife if your nipples are bleeding, sore, or cracked; you cannot get the baby positioned correctly to the breast; you notice a red or hot spot on the breast or if a lump does not resolve with measures listed above.
After pains
The “after pains” are when the uterus is doing its job of contracting the uterus to help lessen bleeding and heal after having a baby. First-time moms may only feel afterpains while they are nursing. With each subsequent baby, afterpains can be significantly more intense especially during breastfeeding. Tylenol or ibuprofen every three to four hours will alleviate this discomfort. You can also use an herbal tincture called Cramp Bark or After-ease and Homeopathic Arnica. Expect cramping to continue for the first several days after birth.
Self Care
A healthy diet and rest are essential for a speedy recovery. Plan on taking naps during the day while the baby is sleeping. Having HEALTHY friends or family come in to help with laundry, childcare, house cleaning, and meals will help aid in your speedy recovery.
Resuming Normal Activities
You may find over the next couple weeks your days are full with taking care of your body, and caring for your baby. We highly recommend staying in bed 7-10 days after birth. This allows your internal organs to move back into place without the pressure of gravity. Listen to your body when considering resuming normal activities. Do not place anything in your vagina (tampons) for the first six weeks after birth.
It does take 6-8 weeks for your uterus to get back to pre-pregnancy size and completely under your pubic bone.
You may resume intercourse after you have stopped bleeding for 7 days. You are both ready both physically and emotionally. Some people that is close to 6-8 weeks postpartum and it not uncommon for it be up to 3 plus months before both parties are ready. It is important to consider a method of birth control as a woman ovulates before she has her period. Taking your basil temperature may help predict ovulation.
If you are interested in starting to exercise, please contact your midwife to discuss what exercise you are considering. A gentle walk is a great place to start as long it is not straining yourself.