Caring for Yourself as a New Mother

Uterus

After-birth pains, or cramping, are normal. During the first twelve hours after delivery, you may still feel moderate to strong contractions as your uterus begins to return to its non-pregnant state. Your uterus will feel like a small, hard grapefruit just under your belly button and will gradually become smaller day-by-day. Cramping and “after pains” are common, whether you had a vaginal delivery or C-section. The uterus takes five to six weeks to return to its non-pregnant size.

Vaginal bleeding

You will bleed from your vagina after the birth of your baby. This can last about 10 days to six weeks. You can expect:

• dark red bleeding, called lochia, for the first three days after delivery. This is like a heavy period
• bleeding that is lighter and a brownish colour from the fourth to tenth day
• a decrease in bleeding over the next three to four weeks. The blood will change from bright red to pink to brown

If the bleeding becomes heavier or if you pass clots during the first month after delivery, inform your doctor or midwife. Notify them or go to the Emergency Department if:

• you soak one pad per hour with blood or lochia
• your vaginal bleeding or discharge has a foul smell
• you develop itching around your vagina
• you develop a fever

Your period will resume in approximately six to eight weeks but may be longer if you are breastfeeding.

Perineum

The perineum is the area between your vagina and anus. Following delivery, your perineum may be bruised and swollen. It may also be painful if you have had stitches from a tear or an episiotomy.

Below are steps to care for your perineum to prevent infection and to increase your comfort after a vaginal delivery:

• ask the nurse for an ice pack to help decrease the swelling for the first 24 hours. Leave the ice pack on your perineum for 20 minutes at a time
• ensure your perineum remains clean and free from infection. Cleanse the perineal area from front to back each time you urinate or have a bowel movement (your nurse will show you how). Always wash your hands thoroughly before and after doing perineum care and after using the toilet
• after going to the toilet, fill your plastic peri-bottle with warm water and rinse your perineum and stitches. Use toilet paper to dry your perineum from front to back. You may continue to use the peri-bottle after you've left the hospital.
• Apply a clean peri-pad or sanitary napkin every time you use the toilet. To prevent infection, do not touch the inside of the pad with your fingers
• Enjoy a warm sitz bath, sitting in a tub of warm water for 15 minutes, two to three times per day.

Your stitches will dissolve in one to three weeks. Please tell your nurse if you have any difficulty urinating or if the pain from your stitches worsens.

C-section incision

The skin from the incision will heal in several days. The full depth of the incision takes about six to eight weeks to heal completely.

Below are steps to care for your incision post C-section:

• Wear cotton underwear and loose clothing for comfort.
If you had Primapore and Opsite dressing on:
• Your nurse will remove it before you go home.
• You will be able to shower when the incision is left to air dry. Allow the water and soap to wash over the incision. Gently pat the incision dry.
• If you have the Opsite post-op visible or “honeycomb” dressing on:
  • You can take a shower with it on. Make sure to pat it dry after your shower.
  • Please remove the “honeycomb” dressing and any steri-strips underneath it seven days after your C-section. Do not leave it on longer than seven days as it may increase the risk of infection.
• If you have the PICO dressing on, your nurse will provide you with the patient information for PICO. Arrangements will be made for removal.
• If staples were used, you are to make arrangements with your family physician to have them removed.
• If stitches are used they will dissolve on their own.

Bowels

Normal bowel function will return after a few days. If you do become constipated, increase your intake of fluids such as water, milk and fruit juices. A high-fibre diet including fruit, vegetables, bread and cereals will also encourage normal bowel function.

Haemorrhoids

Haemorrhoids are swollen veins around the anus and may be very painful after delivery. To help manage haemorrhoids:

• ask your nurse for Tucks cooling pads and haemorrhoid cream
• rest on your side instead of sitting to relieve the pressure on your swollen veins. If you are breastfeeding, ask your nurse to teach you how to feed lying on your side
• eat a high-fibre diet and increase your fluid intake when you go home. You may also receive a mild laxative before you go home or take one ounce of milk of magnesia, twice per day

Sitz baths

A sitz bath is a portable plastic basin that rests on the toilet bowl. It allows you to bathe your perineum and your stitches with warm water. The bath helps to clean, heal, and soothe your sore perineum.

Breast engorgement

Engorgement is when your breasts become hard, swollen and painful. This temporary condition can be prevented by breastfeeding often. It is caused by an increase in blood and fluids to your breasts to allow for milk production.

Engorgement usually lasts for a day or two. If you are breastfeeding, please seek help. If you are not breastfeeding, apply cold cloths or crushed ice packs to your breasts for 20 minutes. This will help relieve the pain and reduce swelling. It is important that you wear a bra that fits well for support and comfort.

Pain relief

Use a mild analgesic (like Tylenol/Acetaminophen or Advil/Ibuprofen) for breast engorgement, uterine cramping, Caesarean incision or perineal discomfort.

Diet and nutrition

Continue to your prenatal vitamins until your postpartum visit with your doctor/midwife. It is important to eat a well-balanced diet and drink plenty of fluids, unless advised against it by your doctor/midwife. Follow Canada's Food Guide to maintain a healthy diet.

Menstruation

If you do not breastfeed your baby, you can expect to have a period within six to eight weeks. Your first period may be heavy and contain clots. Your second period should be more or less normal for you.

Breastfeeding mothers may find that their first period is delayed. Please remember that breastfeeding is not a reliable method of birth control. You may still become pregnant even though your menstrual period has not returned. Your midwife or physician may discuss birth control with you at your postpartum appointment.

Activity

Do not do exercise for two weeks. Check with your doctor, midwife or physiotherapist before you start exercising or for limitations on activities if you have had a C-section. Exercise after having a baby helps:

• strengthen your abdominal and pelvic muscles
• promote blood flow through your body
• increase your energy level
• prevent problems such as back strain

Guidelines for exercise:

• exercise on a firm, padded surface
• wear comfortable clothes and shoes with good support
• begin slowly. Start with one or two exercises once a day and work up to doing more as you feel stronger
• relax and stretch before and after each exercise
• stop if you feel pain. Rest and begin again only after the pain has stopped
• avoid exercises such as jogging, jumping and skipping until after your postpartum check-up

Avoid sexual activity, douching or tampons until your six weeks postpartum visit with your doctor/midwife.

Kegel exercises

Pelvic floor muscles can become weakened during pregnancy and childbirth. Kegel exercises can help. They are easy to do and can be done anywhere, without anyone knowing.

To do a kegel, it is important to identify the proper muscle group. Try to stop and start the flow of urine when you are sitting on the toilet. If you can do it, you are using the right muscles.

Once you've found the right way to contract your pelvic muscles, squeeze for three seconds and then relax for three seconds, 10 to 15 times. Try to do this at least three times a day to strengthen your pelvic floor muscles.

Emotional changes

The transition to motherhood can trigger a mixture of emotions, from excitement and joy to stress and anxiety. Up to 80% of new mothers experience the “blues” around the second to tenth day after birth.

Symptoms include:

• crying
• irritability
• mood changes
• inability to think clearly
• fatigue
• sleep disturbances
• stress
• anxiety

The source of these symptoms is unknown, but they may be related to the responsibilities of parenthood, sleep deprivation and post-pregnancy hormonal changes. These feelings are normal and should gradually improve, usually subsiding in about two weeks as mother and baby adjust to each other.

Postpartum depression and anxiety

Prolonged sadness may indicate postpartum depression. Over 20% of all postpartum women experience postpartum depression (PPD) or anxiety disorders. If ignored, these disorders can have a negative effect on the health and well-being of you and your family.

If you have some of the following symptoms for more than two weeks, you may be suffering from a postpartum mood or anxiety disorder:

• chronic exhaustion that does not go away even after a few nights uninterrupted sleep
• extreme irritability, frustration or anger
• feelings of hopelessness or no hope for the future
• trouble sleeping, even when baby is sleeping
• loss of appetite or extreme weight gain
• difficulty concentrating or remembering things
• excessive worries about your or your baby's health, even after your doctor has assessed you both
• crying for no reason
• no interest or pleasure in your baby

If you have any of these symptoms, seek medical attention. Call your doctor if you or your family are concerned about your mental health. These symptoms are not your fault, nor are you to blame. The earlier this problem is diagnosed, the speedier the recovery. With appropriate treatment, you can expect a full recovery.

Postpartum sexuality

Speak with your physician about when to resume normal sexual activity. This can usually occur six to eight weeks after delivery. Ensure you are using appropriate birth control, if desired. Contraception is advisable as soon as you resume sexual intercourse. Condoms are safe and easy to use. Birth control methods will be discussed further at your postpartum visit with your doctor/midwife.

Many couples find that adjusting to their new responsibilities and roles as parents leads to changes in their sexual relationship. These changes can last two to three months, after which sexual responses gradually return to what they were before pregnancy.

It is important that you and your partner discuss how parenting affects your lives, sexual response to each other, feelings and needs. Patience, understanding and open communication are important as you find satisfying ways of expressing your sexuality after childbirth.