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Pregnant women have a lot to think about during the three trimesters of pregnancy. Their changing body, preparing for labor and delivery, planning for the arrival of their baby and then caring for their newborn afterward. It’s easy for women to forget about the “fourth” trimester, or the recovery period for women after childbirth. There’s so much focus on the new baby, they might forget to take care of themselves.
Many first-time moms don’t know the questions to ask about what recovery is like, because they’ve never experienced it.
Jade Elliott spoke with Hollie Wharton, DNP, CNM, WHNP, Nurse Practitioner and Certified Nurse Midwife, to discuss what new moms should expect the first few days after childbirth.
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Vaginal deliveries
For vaginal deliveries, as the adrenaline of birth or the epidural begins to wear off, they’ll begin to feel achy and sore. You’ll want to continue to use sanitary pads for bleeding and ice packs for the vaginal/rectal area to reduce swelling and alleviate discomfort. Witch hazel pads help keep the area clean and promote healing of the area and related stitches. Apply Dermoplast spray or Dibucaine gel to provide additional pain relief. All of these supplies are provided in the hospital and you’ll want to take them home with you, and continue to use for the first week or so.
The first week or two you shouldn’t be overly active. You’ll want to get out of bed or off the couch and walk around a bit, at least four times a day to help reduce chances of blood clot formation, as you are still at increased risk for this during the first six weeks postpartum.
You will have bleeding after a vaginal delivery that starts like a period and then gets lighter in color and flow. If it gets darker or brighter in color or heavier, you’re doing too much activity. So, adapt your physical activity based on your flow and listen to your body.
Ibuprofen (Advil/Motrin) and acetaminophen (Tylenol) help with swelling in the uterus and the vaginal/rectal area and can help with achy muscles in the back and shoulders due to using those muscles during labor and delivery.
Caesarean deliveries
If you deliver via Caesarean section, keep in mind, that is a major abdominal surgery. Prepare yourself to have an incision with either staples or stitches. Staples are usually removed prior to discharge, but stitching, both internal and external, will dissolve over the next four to six weeks. I recommend no heavy lifting of over 20 pounds for six weeks. Make sure to take care of your incision site and watch for signs and symptoms of infection, including foul odor at site, excess bleeding, severe abdominal pain and fever.
Bathroom habits
Constipation is typical after delivery. Take a stool softener twice daily for 1-2 weeks, or until bowel movements are soft and easy to pass without straining. During pregnancy women urinate frequently as a result of a large uterus sitting on the bladder. After childbirth, you may need to retrain your brain and bladder that you don’t have to go as often. A few days after delivery, you will notice your urinary frequency will continue to be similar to pregnancy. This helps rid your body of the additional fluid that can cause edema in your limbs.
The first few weeks: When to call your provider
If you had a vaginal delivery and are experiencing heavy bleeding, defined as soaking through more than one pad in an hour, call your provider. Other reasons to talk to your provider include pain with urination, foul vaginal odor, severe abdominal pain or fever.
If you have shooting pains up either leg, headaches, chest pain or vision changes, it could be a sign of a blood clot. A caesarean puts you at even greater risk for blood clots due to more sedentary recovery. If you experience any of these symptoms, go to the emergency room right away for evaluation.
Baby blues are common during the first two weeks after delivery. After this transitional period, those symptoms should resolve. If they do not improve, or if you ever experience thoughts of self-harm, please contact your provider immediately. Your provider can provide resources for help with mental health concerns such as panic attacks, depression, excess anxiety about your baby or significant sleep problems.
When to return to exercise and losing pre-pregnancy weight
You really need to rest for the first two weeks. Light walks are fine. Activity should increase as tolerated, while monitoring menstrual flow. Watch for physical symptoms to know your body is healing. At six weeks, you should be meeting with your health care provider for a checkup. We usually endorse regular exercise at this point as long you show appropriate signs of recovery. It takes nine months gain your pregnancy weight, so it is going to take at least nine months to lose that weight. Be patient with your healing.
Importance of self-care
New moms should continue to take their prenatal vitamins and focus on self-care and taking care of the baby. Let go of the housework and cleaning. Accept all offers of help. Let other household members help while you hold the baby.
Eating and drinking enough
If you are nursing, you’ll need an extra 500 calories per day. Drink two to three liters of water per day. This helps with fluid loss due to delivery, reduces swelling and is especially important if you are breastfeeding.
Sleep 8-10 hours per day
This can be a challenge with baby waking up at night. Take naps and sleep while baby is sleeping so you can get a collective 8 hours in a 24-hour period.
Visitors
Be cautious about visitors. It’s ok to not have visitors until you feel ready and more rested. Make sure they have not had any symptoms of COVID-19, cold, flu, diarrhea, etc. Visitors should not have had any symptoms for three days. When you do have visitors, you can have them wear masks as a precaution, especially if you are indoors or cannot social distance.
Take a break
Take time for yourself. Go for a walk. Do something that helps you unwind. Get out and feel like a normal woman without your baby. It’s good for your partner to have bonding time with the baby.
Breastfeeding
In the hospital we have experienced nurses and lactation consultants that can help you with breastfeeding. You’ll be given a brochure of lactation consultants, listed by area that you can contact after you get home if needed. Your pediatrician could also provide this information.
You should call your provider or a lactation consultant if you have symptoms such as a fever or flu like symptoms. You may have a clogged milk duct or a breast infection called mastitis. You may have pain in one or both breasts. Red, tender hot spots are possible. You may need antibiotics.
Applying a hot compress before feeding can help. Putting the baby to breast is best. Try a different nursing position, such as the football hold. A cold compress afterward can help too. Ibuprofen or Tylenol will help. Avoid unnecessary stimulation of nipple.
To listen to the Baby Your Baby Podcast on breastfeeding, click here.
Postpartum check-ups
As midwives, we provide a two week check in by phone or video. We want to know how your recovery is going, how you’re doing physically and mentally, and answer any questions you or your partner may have. We also do an in-office check-up at six-weeks.
Birth Control
Breastfeeding is not considered an effective form of birth control. You ovulate before you have a period, therefore just because you don’t have a period, does not mean you cannot get pregnant. There are many forms of birth control that might an option for you. These include, options to start right after delivery, such as progesterone-only methods, and are safe with breastfeeding. You want to avoid estrogen in the first six weeks after delivery, as this can further increase risk of blood clot formation, but progesterone-only options are safe and effective. If you prefer an IUD, we don’t recommend placement until after six to eight weeks postpartum, so that your uterus can completely heal prior to insertion. This will reduce risk of complications.
To listen to the Baby Your Baby Podcast on birth control, click here.
Return to sexual intercourse
It is recommended to wait six weeks before intercourse to protect against unintended pregnancy and infection.
Changes to pelvic floor muscles
Kegel exercises and pelvic floor physical therapy can help those muscles that may be weakened after childbirth. Stress incontinence, or leaking urine when you cough, sneeze or exercise can occur after childbirth. It’s common, but it’s not normal. Exercises and therapy can make a big difference in improving symptoms and quality of life. Ask your provider about options if you are experiencing leakage of urine.
Abdominal muscle separation
Some women have abdominal separation (Diastasis Recti) that persists after six weeks postpartum. Your provider can examine your abdomen to determine and if you might benefit from therapy or treatment.
Settle into a routine
Even though the recovery period is not always easy and there are lots of adjustments, you’ll eventually settle into a new life and routine with your baby. Don’t be afraid during this time to reach out to your provider with questions and concerns.
For more information, click here.
The Baby Your Baby program provides many resources for all pregnant women and new moms in Utah. There is also expert advice from the Utah Department of Health and Intermountain Healthcare that air each week on KUTV 2News.