We want to see you back in clinic after your delivery for a post-partum appointment. This is usually timed about 4 weeks post delivery. That is not a time table that we have to stick to exactly. The timing of this appointment can easily be later if that is what works. The purpose of this appointment is mostly to discuss birth control. You don’t need our okay to return to normal exercise or sexual activity. Rather you can start these activities when you feel up to it. Even if you haven’t come in for your 4 week appointment, you don’t need our okay to get back to normal activities. If you feel well, get to it!
If you had a c/section:
A couple of specific points. First, we offer an appointment at 2 weeks to check on the incision and make sure it is healing well. Also, we do ask that if you had a c/section that you not get back to full exercise prior to 6 weeks. You need to let that mid-section heal and we consider it fully healed at 6 weeks. This doesn’t mean you need to sit on your bum. You can do activities as tolerated, don’t put full strain on your midsection. If your post part appointment is further out than 6 weeks, you don’t need to wait for our okay for activity, if you feel up to it, get to it.
For all: Having sex prior to 6 weeks if fine if you feel well, but USE PROTECTION. You can get pregnant (unless you had a tubal, then no worries).
It is very common to have vaginal bleeding up to 6-8 weeks post partum. Initially this is often quite heavy and can include some clots. What we want you to watch for in your recovery is bleeding that is heavier than it has been previously and persistent. What does that mean? It means the kind of bleeding that fills a heavy maxipad in less than hour and this continues for a few hours in a row. During your recovery you are likely to experience some episodes of heavy bleeding like this but it won’t continue past 2-3 hours. If it does, please give your provider a call. You will often read that you should call your provider if you have a “lemon” sized clot. But truthfully, this is very common and as long as it is only one or two lemons it is normal. If you pass the whole tree please call your provider.
Breastfeeding is wonderful and euphoric and natural, right? Yeah, right. Breastfeeding is absolutely healthy for you and the baby. Is is absolutely worth the effort, pain and frustration. But like anything worth really doing, it is a lot of work. It is very unlikely that you will simply put your new darling up to your nipple and magic will happen. Don’t get me wrong, that happens for some people and if you are one of those, you are really lucky. For most people, there is significant frustration, pain and self doubt. All of this does not mean that you should stop. Please use lactation consultants as available. Lactation consultants are very dedicated to your success in breastfeeding. They have multiple tricks up their sleeves and you should take advantage of the knowledge. Do not hesitate to ask them for help.Mastitis is very common. If you develop a sustained fever at 100 degrees or higher along with generally feeling awful (like you got hit by a truck), even if you don’t have specific breast symptoms, give your provider a call. There is a decent chance you have mastitis and this can and should be treated with antibiotics.
The recommended amount of time that you should breastfeed is cause for debate. Really, any amount of time you can get is great. How long you do it is very personal and based on many factors, including how well it is going for you, going back to work and support. If you have tried to breastfeed, have used all the tricks in the book from our lactation consultants and still are struggling, please know that for some people breastfeeding is not the right thing and it is okay to move on. This does not mean your provider supports giving up easily. Medication during breastfeeding is another big question. Any medication you take has the potential to cross into breast milk. The amount that crosses is dependent on many factors that nobody knows off the top of their head unless they are a pharmacologist and even they usually need to look it up. So your provider give you Lactmed. A great reference to look up any medication so you can get what facts exist.
If you had a c/section, you’ve had a major surgery and the healing will be similar. The caveat to this is that often we see post partum moms do better than the average surgical patient, maybe because your body was already prepared for trauma. There are many old fashioned ideas out there about recovery after surgery as well as post partum. Overall, once you are a couple of days out of surgery, it is very unlikely that you will have significant complications. You may have heard rumors like you can’t climb stairs or you can’t vacuum, which aren’t true. The truth is you can do all normal activities as long as you don’t put full strain on your abdomen. We want you to start by taking it easy but slowly increasing your activity. The recovery after c/section is based on finding the balance between activity and rest. We would recommend adding a little more activity each day. If you feel fine the next day you can add a little more. If you feel more pooped, you should probably hold the activity level stable for a day or two. This also applies to how much you can lift. After abdominal surgery, we want to give all the sutures time to hold the tissue together so it can heal. At 6 weeks, we know that this has occurred. Until 6 weeks, we recommend you don’t dead lift anything heavy. What is heavy? Generally a limit of around 30 pounds is reasonable. But if you are faced with lifting something new, do it slowly and gently, if it doesn’t hurt, then that weight is fine. If it hurts, don’t do it. This applies to sex as well. Technically there is no real reason (outside of not feeling like it) that you can’t have sex right away except you are trying not to strain your abdomen and usually sex involves this. So you’ll have to answer the when to have sex question for yourself depending on when it feels comfortable. Use protection!!! You can get pregnant, even if its not likely, at any point.
It is not common to get an infection at the incision site, but of course it happens. If it is going to happen, it will likely happen by 10 days after your surgery. Seeing small skin irritations around the incision is common, likely mild reactions to the tape and bandages used. If you notice redness that is coming from the incision and spreading or if you have a fever, please give your provider a call. It is common to see some slight separation in the incision as it heals but if this is enlarged or if redness surrounds it, give your provider a call. Some drainage is normal, but if you see a large amount of drainage or it smells bad, give your provider a call.
You may find yourself running a roller coaster of feelings after having your baby. You will hear many people talk about post partum depression or blues. Most parents experience some degree of this. The important thing is to give yourself a break if you do get feelings of depression or sadness or feeling over whelmed. It is very normal to have these feelings with any large change in life. And really, what larger change is there than somebody handing you a small, helpless human, sending you home and expecting you to take care of it. It cries and you don’t know why. You’re getting either no help if you don’t have friends or family in the area or you’re getting advice about the “right” way to do things from all angles. You need to know that you aren’t not alone in feeling less than thrilled about all aspects of the baby experience. It doesn’t make you a bad parent, it makes you normal. Nobody can prepare you for what you are going to experience, it is one of those things you need to go through for yourself. The things your provider need you to watch out for that can be signs that the normal post partum roller coaster is derailing: 1)You aren’t enjoying anything. It is okay to have bad moments but there should also be some things that you can find joy in. 2)You have significant thoughts about hurting yourself or your baby. If either or both of these things are occurring, you should give your provider a call to talk about the possibility of seeing a counselor.Don't be afraid to ask for help. psychologytoday.com. is a good place to start for looking for a therapist.
One of the more unpleasant side effects of pregnancy is the swelling that you may experience. The unfair addition to this is that this swelling may actually increase post-partum, when you thought all of the uncomfortable body strains of pregnancy were going away. Swelling worsening or starting post partum is not a sign of anything bad but it is annoying. It will go down over time. That time is variable. Some people start to lose the fluid right away and some take a week to 10 days. Keep up your water intake and be patient. Eventually, you’ll start peeing like a crazy person as that fluid starts to go away. We do not prescribe anything to force the fluid out (like a diuretic) because that proves more harmful than helpful, even though the easy solution sounds nice.
Your vagina is not a delicate flower. It is a 600 pound gorilla capable of delivering a human being. The healing after that delivery though can feel like a delicate flower. The pattern of healing for every woman after a vaginal delivery is different. We’ve seen women who bounce immediately, even with a large tear and tell me they have very little pain. We’ve also had women who have a very small tear or no tear who have significant pain. The signs we want you to watch for are fever and redness around your stitches. Other than these signs, please be patient with your vagina. It will heal in its own time. If you are experiencing significant pain, we often recommend soaking in some warm water. They make really fancy items, sitz baths, that you can get to do this. But it is even easier to run some warm water in the tub and sit on a towel in the tub. After your sitz bath, simply pat the area dry or use a blow dryer. Ice is fine to use as well. Medically your activities aren’t really limited. But you will notice that you won’t necessarily want to run a marathon right away. Increase your activities on a daily basis dependent on how you feel but there is no need to sit around. Regarding sex, this is a question you can answer better than your provider. If you had a tear, you should let it heal before trying sex. If you are wondering if it is healed, take a look with a mirror. If you do take a look, don’t be surprised if things look different. There will be changes. The only warning signs are if you see redness and swelling. If you can see that your tear doesn’t look completely closed, then don’t have sex yet. If you do have sex, use protection. You don’t need to wait for your post partum visit to have sex if you feel ready sooner. Also, use lubrication, your vagina tends to be dry during breastfeeding due to hormonal changes.
Please visit bedsider.org, a wonderful website with down to earth information.