Postpartum Care

When a woman arrives home from the hospital with her newborn baby, it can be easy to focus on the baby and forget about her own postpartum care. Postpartum means what you think it does: Care after your baby is born, but this is care for the mother.

During pregnancy the body goes through significant changes and continues to adjust after giving birth. It is important for new mothers to take care of themselves during the postpartum period to insure that their body has a full recovery. There are practical considerations besides how the mother feels.

Being in good health helps a mother care more effectively for her baby. And good health includes good mental health. As many as 15 percent of new mothers experience postpartum mood disorders, including postpartum depression (PPD). When a mother is depressed, her newborn can be affected in several ways.

What to expect in the postpartum stage

A woman’s body goes through a grueling journey during pregnancy and birth. It takes time to recover after birth. The postpartum period generally lasts about six weeks. Individuals’ experiences can differ, particularly regarding mood swings and depression, which may occur as long as a year after delivery.

Postpartum changes may cause women to experience the following symptoms in the days and weeks following their baby’s birth:

• Vaginal soreness
• Vaginal discharge
• Contractions
• Urination problems
• Hemorrhoids and painful bowel movements
• Sore breasts and leaking milk
• Hair loss and skin changes
• Weight loss
• Mood swings, including serious PPD.

These physical symptoms are normal and, in most cases, relieved with over-the-counter pain relief medication, physician guidance and time. If at any point symptoms worsen or if an unusual symptom occurs, a woman should contact her doctor immediately.

Postpartum depression and mood disorders (baby blues)

Struggling with anxiety or changes in mood is common during the postpartum period due to vast hormonal changes that occur. As many as 1 in 7 new mothers experience postpartum mood disorders, ranging from unexpected crying to full blown postpartum depression (PPD). Many women are aware of the “baby blues” that often follow childbirth, but PPD is beyond blues and requires professional treatment.

The University of Colorado PROMISE clinic offers emotional support for women who have delivered within our network. PROMISE stands for Perinatal Resource Offering Mood Integrated Services & Evaluation, and offers excellent care and education for women experiencing postpartum mood disorders.

It is important to note that only a healthcare provider can diagnose a mother’s postpartum depression. The following signs of postpartum depression may be reason to seek an evaluation by an OB-GYN:

• Feeling empty or hopeless
• Anxiety
• Mood swings, irritability, anger
• Sleep troubles, not enough or too much
• Being distracted, having trouble concentrating
• Doubting one’s ability to be a mother
• Thoughts of harm to oneself or one’s child.

Managing physical changes after pregnancy

After all the changes and challenges a woman’s body goes through in pregnancy and birth, it is little wonder that physical problems may follow. Just like athletes taking time away from their sport after an injury, mothers must take some time away from certain activities after giving birth. The following activities and day-to-day regulations may seem imposing, but they will lead to a faster, more successful birth recovery.

Pelvic rest

For the first six weeks after giving birth, women should not participate in sexual intercourse, douche or use tampons. The body needs time to heal after delivering a baby and the best way for that to happen is to eliminate any interferences (yes, even if you had a c-section!).

In addition to pelvic rest, it is important for women to allow the rectal area to heal. Doctors often recommend taking an over-the-counter stool softener to make bowel movements easier to pass and less painful.

Avoid vigorous exercise and heavy lifting

After any medical procedure, doctors advise patients against strenuous exercise or heavy lifting. Delivering a baby is one of the most exhausting things a woman’s body can go through and it needs rest before taking part in physical activity. Rest is especially important in the case of a cesarean section (c-section), because heavy lifting and exercise could lead to complications with healing.

Don’t drive

Sometimes women are prescribed pain killers to reduce the pain associated with a c -section or vaginal tears that occur during delivery. Any person taking prescription pain medication should not drive or operate heavy machinery.

Caring for c-section incisions

It is important for cesarean section patients to keep the incision clean and dry. It is best to let water and soap run over the incision in the shower. Doctors do not recommend scrubbing or applying lotions of any kind directly to the incision during the early healing stages. For women who are eager to begin applying scar cream, it is important to wait until the incision is completely healed before beginning any sort of scar treatment.

Medications and treatments

Most of the physical symptoms associated with postpartum care can be managed with the following approaches:

• Pain associated with cesarean section. Pain medication is often prescribed. Motrin and Percocet (or another Tylenol/narcotic derivative) are the most commonly prescribed pain medications for post-cesarean section pain relief.

• Pain associated with vaginal birth. In most cases, over-the-counter Motrin (ibuprofen) will control pain. In some cases, the physician may prescribe narcotic pain medication for women with severe vaginal tears.

• Constipation. If constipation occurs, over-the-counter Colace, Milk of Magnesia, or Miralax may be recommended.

• Hemorrhoids. Over-the-counter Tuck pads, Preparation H and Proctofoam can be used to relieve and treat hemorrhoids that develop during childbirth.

• Cracked/sore nipple. The early stages of breastfeeding can lead to painful side effects. For cracked or sore nipples, over-the-counter lanolin cream is recommended.

• Prenatal vitamins. Our OB-GYNs recommend that women who are breastfeeding continue to take their prenatal vitamins.

Postpartum follow-up visit

For most women who delivered vaginally, the first follow-up visit will be six weeks after delivery. This appointment is referred to as a postpartum exam.

For women who underwent a cesarean section, the first follow-up visit should be two weeks after delivery. At this appointment, the incision scar will be checked and steri-strips will be removed if they have not yet fallen out on their own. Another appointment will be scheduled for the standard six-week postpartum exam.

Women should call their doctor immediately if any of the following symptoms occur prior to their scheduled follow-up appointment:

• Signs of mastitis (breast infection), including reddened, hard or tender areas of the breast accompanied by a fever
• Excessive vaginal bleeding
• Abnormally tender abdomen accompanied by a fever
• Any opening of a cesarean section incision
• Drainage coming from a cesarean section incision.