Daily Adjustments for Postpartum Care

Bathing
You may take showers or tub baths. Avoid use of bubble bath or other bath soaking preparations. These can irritate and dry the perineum or Cesarean incisions. Do not use hygiene sprays or tampons until advised to do so by your health care provider.

Skin Changes
Stretch marks will fade over time, but will not completely disappear. Changes in skin pigmentation such as a dark line across the abdomen, will also fade. Immediately following childbirth, your abdominal skin will be stretchy and soft. Skin and muscles will gradually return to their former tone with time and exercise.

Bladder
It is normal for the perineal area to feel numb following childbirth. Urinating is sometimes difficult because of swelling and lack of abdominal tone.

Helpful Hints:

• Drink plenty of fluids.
• Sit comfortably on the toilet.
• Pour warm water over your perineum with the peri bottle or a cup to help start the stream of urine.
• If you are unable to urinate during your hospital stay, a catheter (small tube) may be temporarily inserted to empty your bladder. It is generally removed 8 to 12 hours after insertion.
• Once you urinate, remember to empty your bladder every three to four hours. Urinating large amounts during the first week postpartum is very normal.
• You should notify your nurse, midwife, or physician if you are unable to urinate, experience pain or burning when urinating, or experience a sense of urgency to urinate frequently. These symptoms, in addition to a fever, may indicate the presence of an infection.

Bowels
Most women have soft and even loose stools before and during labor. It is not unusual to not have a bowel movement for two or three days immediately following childbirth. This first bowel movement after childbirth may be difficult to pass due to decreased muscle tone and intestinal inactivity. Hemorrhoids or episiotomy pain may make you dread the first bowel movement after delivery. However, when you do feel the urge to go, it is important to take your time and to try.

Helpful Hints

• You are encouraged to take a stool softener, which will be provided in your SAM kit, particularly while you take pain medication.
• Eat fresh fruit, vegetables, and whole grains to provide bulk and fiber.
• Drink enough fluids to keep your urine light colored. Water is particularly helpful.
• Walking and gentle exercise each day may help.
• Gently support your stitches with toilet tissue to help relieve the fear of tearing and hurting yourself while straining.

Fatigue
Most new parents experience some fatigue for several weeks following childbirth. The combination of hard work during labor, greeting visitors, adapting to hospital routines, responsibilities for a newborn, and interrupted sleep contribute to fatigue.

Helpful Hints

• Eating well and resting at every opportunity will aid your recovery.
• Don’t feel guilty about napping. It is smart to sleep or rest when your baby sleeps. Don’t worry if you don’t actually sleep. Just resting has tremendous benefits.
• Don’t try to be Super Mom! Unplug your telephone, limit visitors, and allow friends and relatives to help.
• Newborns are often particularly fussy and hungry for several hours in the evening or at night. It’s important to know that this will not last forever. Try feeding first. If that does not work, rocking or holding your baby close may help.
• Taking a warm bath with your newborn can be calming for both Mom and baby.
• Interestingly, the sound of the clothes dryer or dishwasher calms some babies.
• Taking your baby outside can also help.

Breasts
Expect changes to your breasts in the first several days after childbirth whether you are breastfeeding or not. If you are breastfeeding you may experience nipple tenderness and breast fullness. Your nurse has special training in breastfeeding support. Our lactation consultants can help you with more challenging breastfeeding concerns.

If you are formula feeding, you may experience some mild breast swelling in the first few days following childbirth. During this time, wear a bra that fits well. Ice packs applied to the breasts several times a day for at least 20 minutes will help reduce the inflammation and increase your comfort. Ibuprofen, available in your discharge medication kit, also helps reduce pain and inflammation.

Medications to suppress lactation are no longer used because they can cause elevated blood pressure, headache, nausea, and even death. Ice and a well-fitting bra are as effective without risk.

Complete breast care information for breastfeeding mothers can be found in Chapter Three under Infant Nutrition.

Hormonal Changes
Your body’s hormone production will undergo very sudden changes following childbirth. Estrogen and progesterone levels drop abruptly and remain low until your first menstrual cycle begins. If you are breastfeeding, and not giving your baby supplements, your menstrual cycle may not return until after you begin to offer solid foods to your baby, wean your baby, or stop nursing. For some, it may begin four to ten weeks after postpartum bleeding has stopped. If you are not breastfeeding, your cycle will resume about three to eight weeks after postpartum bleeding has stopped. The first few periods are often erratic. They are frequently heavier than normal, but can also be light. Within a month or two after your first period, your menstrual cycle usually adjusts to normal.

If you do not wish to become pregnant immediately, it is necessary to use birth control prior to your first menstrual cycle. The absence or delay of your cycle does not mean you cannot conceive. You can become pregnant before your first period. However, the likelihood of becoming pregnant is low if you are breastfeeding.

Sexual Relations
Most couples wait to have intercourse until heavy vaginal bleeding has ceased, lacerations and episiotomy have healed, and each person is comfortable with resuming sexual intercourse. Please discuss this with your physician or midwife. If you have had a laceration or episiotomy, it is understandable to be concerned about physical comfort during sexual intercourse. Decreased vaginal lubrication can be common with breastfeeding. A water-soluble lubricant such as K-Y Jelly or Astroglide may help.

Family Planning
Your physician or midwife will talk to you about methods of contraception before you leave the hospital.

For Nursing Mothers: How to Determine Correct Bra Size
To determine your correct bra size, measure the chest high under the arms and above the breasts. Make sure the measuring tape is snug. This chest measurement indicates the bra size in inches, such as 34, 35, 38 and so on. If the measurement is not an even number, choose a bra in the next larger size. For example, if the chest measures 37 inches, then a size 38 is needed, not a 36.

To determine the cup size, measure around the fullest point of the bust. If the bust measures less than one and a half inches larger than the chest, an A cup is needed. Select a B cup if the bust measures one and a half to two and a half inches larger than the chest; a C cup if the bust measures two and a half to three and a half inches larger; a D cup for three and a half to four and a half inches larger. Each additional inch of bust measurement moves the required bra up one cup size. For example, if the chest measures 34" and the bust measures 36", then a 34B is needed. If the chest is 35" and the bust measures 38", select a size 36C.

Once you have determined your correct size, try on several different styles before you make your final decision. For proper support, be certain the cups give complete coverage of the breasts. Since every woman’s body is different, some bra styles may not provide the comfort, the support, or the “look” that’s exactly right for you.