Call our office to schedule your 6-week appointment as soon as you are discharged from the hospital.

WATCH FOR THESE DANGER SIGNALS!

Call your physician if any of the following appear:    

• Temperature over 100.4 degrees orally on 2 occasions 6 hours apart.
• Painful firm red area on one breast or cracked, bleeding nipples (It is normal to have fullness, pressure and slight warmth in both breasts for a day or so when your milk comes in.)
• Heavy vaginal bleeding or large clots (It is normal to have a slight increase in bleeding and pass small clots after breast-feeding or with increased activity.)
• Severe abdominal pain (Some cramping is normal, especially if you are breast-feeding your baby.)
• Pain or burning with urination.
• Constipation lasting 3 days or more.
• Pain in the calves of your legs.

Call your physician if the blood becomes bright red with a heavy flow saturating a menstrual pad in less than 1 hour for 2 or 3 hours consecutively.

As a rule, women who breast-feed have a decreased amount of flow from delivery on; however, sometimes breast-feeding women will experience a sudden onset of bleeding in conjunction with a feeding time. This is a hormonal response and should not be cause for alarm. If it continues, however, call our office.

If you are breast-feeding, you may not have a period for several months. If you are not breast-feeding, you can expect to menstruate within 6-10 weeks after the birth. If you haven’t started by the 11^th week, you should call your physician.

VAGINAL CARE

Put nothing in the vagina for 4 weeks after delivery—no tampons, douching or swimming. Wait 2 weeks before resuming tub baths. The cervix needs this time to close after dilatation. You should refrain from intercourse until you have seen your physician for your postpartum visit. Don’t wipe yourself with toilet paper after urination for 1 week after the birth. Instead, cleanse your perineum with soapy water from a squirt bottle and rinse. You may pat excess moisture away. Be sure to use your squirt bottle after bowel movements and try to avoid your episiotomy and perineal area. Always remember to wipe from front to back.

If you have an episiotomy or tear, the stiches will dissolve within several weeks. Meanwhile, follow these tips for soothing the discomfort:

• Take a sitz bath 1-3 times daily.
• Once the stitches have dissolved, massage the scar with Safflower, Olive or Vitamin E oil after bathing. This will soothe the shrinking of the scar that occurs naturally with healing.

THE UTERUS

After the delivery, your birth attendants will massage your uterus to stimulate contraction of the muscles. This will cause cramping, but it is a necessary and health response that prevents excessive bleeding and encourages the uterus to contract back to its normal size. You can help this process along at home by massaging your uterus a few times daily until it has descended so low you can no longer feel it. Breast-feeding also helps to facilitate this response.

BREAST CARE

If you are breast feeding, there will be creamy colostrum coming from your breast for the first 3 days—then your milk will come in. Breast milk looks watery and will at first have some colostrum mixed with the breast milk.

• Nurse soon and often after the birth of your baby to help stimulate milk production and avoid breast engorgement.
• If your breasts become engorged, apply warm towels or a heating pad to the breast and/or underarms to help the milk flow easier. A warm shower may also help. If you have fever greater than 100.4 degrees, take Tylenol as needed.
• Infection can be recognized by the appearance of a red/tender area on the breast or streaks radiating on the breast. Should this occur, call the office and CONTINUE TO NURSE, especially on the affected breast. This will help to clear the infected milk duct. Your milk will not hurt your baby; the breast milk is not contaminated.
• Consult your breast-feeding book for other helpful tips.

IF YOU BOTTLE FEED YOUR BABY, your breasts may become engorged. Your breast may also become engorged if you quit breast-feeding soon after delivery. If this occurs, follow these suggestions:

• Wear a snug bra or sport bra.
• Wrap a 4 to 6 inch wide Ace bandage (obtained from the pharmacy) around the chest.
• Use an ice pack several times daily or as needed for discomfort.
• DO NOT PUMP OR EXPRESS THE MILK—this only stimulates milk production.
• Avoid all nipple stimulation. Do not hold the baby against the bare breast. Avoid direct shower stream to the nipple area and avoid sexual stimulation of the nipples.

Following all of the above for 3-5 days will eliminate your engorgement. If any sign of infection occurs, call our office.

ACTIVITY

Strenuous activity not only slows your recovery but can also stretch the supporting ligaments of your uterus and bladder resulting in a loss of bladder control and a "dropped uterus."

• Avoid sitting in one position for more than one hour.
• Avoid prolonged standing.
• Avoid driving for 2 weeks. (You may ride in a car as you wish, but be sure to get out and stretch if you travel for more than one hour. Prolonged sitting or standing will increase your risk of developing phlebitis.)
• Rest 2 or 3 times each day as permitted by your baby’s feeding and sleeping schedule.

DIET

Eat a well-balanced diet, including lean meat/poultry/fish, fresh fruit or juice, fresh vegetable and dairy products. Breast-feeding utilizes about 300 calories per day, which will help you return to your pre-pregnancy weight faster if you watch your diet. Drink 8-10 glasses of water each day. A good habit to establish is to have a glass of water, juice, or low-fat milk each time you feed your baby.

 

INTERCOURSE AND BIRTH CONTROL

Sexual relations may generally be resumed following your 6-week postpartum checkup. Discuss with your partner what form of contraception you feel is best for you (birth control pills, IUD, diaphragm, foam and condoms, etc.). Specifics can be discussed with your physician at your 6- week postpartum visit.

A diaphragm cannot be fitted until the uterus has returned to normal size (about 6 weeks).

Additionally, if you are breast-feeding, you may notice vaginal dryness or a lack of lubrication. If this is a problem, use K-Y Jelly (or other water-soluble gel) or contraceptive gel/foam as a lubricant. DO NOT use Vaseline or other petroleum-based gels as a lubricant.

• Drink plenty of fluid!
• Eat plenty of fruits and vegetables!

Use a stool softener such as Colace, Surfak, Dialose or Modance for 2-3 weeks, or until the tenderness in the episiotomy and hemorrhoids has resolved and your bowel movements are normal. If you go 2 days without a bowel movement, use a stool softener-laxative combination such as: Dialose Plus, Senekot, Doxidan, Modane Plus, Pericolace, or use Milk of Magnesia. The drugs listed above are available without a prescription.

DO NOT use an enema without first consulting your physician. Additionally, you should consult your physician before using any stool softener or laxative not listed above.

HEMORRHOIDS

Follow the directives above to avoid constipation. Use a sitz bath as needed. Tucks or Anusol can be purchased without a prescription and may be used for hemorrhoid or episiotomy discomfort.

 

MEDICATIONS

Resume your prenatal vitamins in about one week or when your bowel movements are normal. (Iron may cause constipation.)

Some pain medications may be taken even if you are breast-feeding. You may take Tylenol or Ibuprofen for minor pain or headache; however, DO NOT take any medication other than those listed on your instruction sheet without first consulting your physician.

THE "BLUES"

It is not uncommon to have a day or two of depressed mood after your baby is born. This is transient and is due to the sudden change in hormones and the demands of motherhood. If you feel "blue," have a good cry, and then do something good for yourself without your baby. Don’t forget that important other in your life, your partner. Make time for yourself and each other without your baby. Leave your baby with a trusted friend, relative or sitter. If you are breast-feeding, you may pump your breasts and leave the milk refrigerated in a clean baby bottle.

CESAREAN SECTION

Please note the following special instructions:

• It is ok to shower and get your incision wet.
• Remove the tape across the wound in 7-10 days after discharge from the hospital.
• Notify your physician if you experience any heavy discharge from the wound.
• DO NOT lift anything heavier than your baby for 3 weeks.
• DO NOT drive for 2 weeks following discharge from the hospital.
• Return to our office in 6 weeks for your regular postpartum check-up, but call us immediately if you experience any problems.

INFANT CARE

Call your pediatrician or family physician who is caring for your baby if you have problems or questions. We recommend that you purchase and read a childcare book.