Postpartum care: What to expect after a vaginal delivery
Your newborn may be your top priority — but postpartum care counts, too. From vaginal soreness to urinary problems, here’s what to expect as you recover from a vaginal delivery.
Pregnancy changes your body in more ways than you might have guessed, and it doesn’t stop when the baby is born. Here’s what to expect after a vaginal delivery.
If you had an episiotomy or vaginal tear during delivery, the wound might hurt for a few weeks. Extensive tears might take longer to heal. In the meantime, you can help promote healing:
- If sitting is uncomfortable, sit on a pillow or padded ring.
- Use a squeeze bottle to pour warm water over your vulva as you’re urinating. Press a clean pad or washcloth firmly against the wound when you bear down for a bowel movement.
- Cool the wound with an ice pack, or place a chilled witch hazel pad between a sanitary napkin and the wound.
- Take pain relievers or stool softeners as recommended by your health care provider.
While you’re healing, expect the discomfort to slowly improve.
Contact your health care provider if the pain intensifies; the wound becomes hot, swollen and painful; or you notice a pus-like discharge.
You’ll have a vaginal discharge (lochia) for a number of weeks after delivery. Expect a bright red, heavy flow of blood for the first few days. The discharge will gradually taper off, becoming watery and changing from pink or brown to yellow or white.
Contact your health care provider if:
- You have heavy vaginal bleeding
- The discharge has a foul odor
You have a fever of 100.4 F (38 C) or higher
You might feel contractions, sometimes called afterpains, during the first few days after delivery. These contractions — which often resemble menstrual cramps — help prevents excessive bleeding by compressing the blood vessels in the uterus. These contractions tend to be stronger with successive deliveries. Your health care provider might recommend an over-the-counter pain reliever.
Contact your health care provider if you have a fever or if your abdomen is tender to the touch. These signs and symptoms could indicate a uterine infection.
Hemorrhoids and bowel movements
If you notice pain during bowel movements and feel swelling near your anus, you might have hemorrhoids — stretched and swollen veins in the anus or lower rectum. To ease any discomfort while the hemorrhoids heal, soak in a warm tub and apply chilled witch hazel pads to the affected area. Your health care provider might recommend a topical hemorrhoid medication as well.
Very often, when a mom is suffering from these symptoms, it can be very isolating. Reaching out for support or talking to others isn’t always easy while feeling this way.
It can be mild or extreme…it can come before, during or after pregnancy…it can be anxiety or depression…but what it cannot be is anyone’s fault. Commonly known as Postpartum Depression, it afflicts 1 in 8 new moms.
The Blue Dot Project aims to bring it out of the shadows.
A postpartum doula is a supportive sensitive experienced helper with the day to day practicalities of parenthood until you feel better. In NYC Contact Ruth at Doula Care to set up for a doula to be your extra pair of hands helping you with the baby. Learn about the signs of postpartum depression/anxiety mood disorders
Resource Center for New York (631) 422-2255
National Resources Get Help Today
A wonderful new book that promotes an age old concept, caring for women after they give birth. A Postpartum Doula fills that role for many families.
The “doula” is a Greek word that has come to mean “one who serves or Mothers the new Mother” caring for new families and nurturing them after the birth. Postpartum Doulas are different than a baby nurse. We’re a postpartum service for families who want to take care of their newborn, but need nurturing care for their families, themselves and their household. And to learn and be supported breastfeeding and how to care for a newborn.
Doulas never interrupt the bonding of a new family.
With so much change occurring Postpartum Doulas can help ease the transition with non-judgmental supportive care, supportive by helping with the newborn and breastfeeding or by simply preparing you a cup of tea and something nourishing to eat and giving you a chance to talk about your new mothering concerns.
As experienced postpartum doulas we teach new parents how to read and understand sleeping and feeding cues.
Parents misread their baby’s sleep cues by trying to keep baby interested and engaged not recognizing baby is showing them “sleep cues”. Newborns only have brief wakeful periods after feeding (about 30 minutes)
Most newborn babies (under 8 weeks) are not wakeful for very long. Although it varies by baby, newborns stay awake naturally no longer than 45 minutes, about an hour or so closer to 8 weeks.
Instead of rocking the baby to sleep, or laying the baby down, parents start rattling toys in a baby’s face, passing the baby around to different people, and then you then have an overstimulated cranky baby hard to console!
Some easy to read sleep cue signs in a newborn :
Losing interest in people and toys
Making jerky movements (in small babies)
Becoming very still (these babies relax and fall asleep easily)
Clenching her fists into tight balls
Rubbing her eyes and ears and fussing
See more at: www.bellybelly.com.au/baby/baby-cues
By Leigh Anne O’Connor, IBCLC
You are a mammal. You expect that you will have your baby and he will just latch right on and you are all set.
But then you see all of your “friends” struggling. Why is it so darn hard?
Breastfeeding is a learned behavior for parents. Babies are very instinctive. They know how to nurse when given normal circumstances. Unfortunately, many newborns are not born into biologically normal circumstances.
Breastfeeding involves two people: the parent who gave birth and the baby.*
Many people are unaware of the impact of birth on both the mom and baby for breastfeeding. If the birth is induced, medicated or surgical this all impacts both parties. When you throw in vacuum of forceps delivery this makes an added complication for the newborn.
Medications for induction can make both mom and baby sleepy. The intravenous fluids that are necessary add fluid not only to the mom and her breasts but also to the baby. This fluid in the breasts can make it more challenging for the milk to flow in the first couple of days. As the baby sheds this excess water it may look like a dramatic weight loss, which often results in unnecessary supplementing.
We live in a culture where babies are not frequently included in social situations. Breastfeeding is hidden. It is hidden in homes, behind burkas and in bottles of pumped milk. Breastfeeding moms are often shooed away – either blatantly or subtly. This means we do not see breastfeeding on a regular basis.
Breastfeeding is very different from bottle-feeding. It is hard to quantify how much a baby is getting. In a world where most everything is measured and monitored and checked off breastfeeding is a challenge.
Breastfeeding is not routinely taught in medical school – or in any school for that matter. This means that the medical team meant to support you often have little to no training in the normal course of breastfeeding.
So, what are new and expecting parents to do?
These things can help to get breastfeeding off to a good start and continue.
Attend La Leche League Meetings http://www.lllusa.org/– these are meetings for pregnant and breastfeeding parents with trained volunteers with personal breastfeeding experience. This is a great opportunity to see real breastfeeding babies and to hear what works, what gets in the way of breastfeeding and to learn that there is a wide range of normal.
Make a birth plan. No matter what kind of birth you plan or want it is a good idea to write out your desires – even if things do not go according to your plan many of your wishes around the birth could be honored including drugs used, having skin to skin with your baby – possible even with a Caesarean if you plan ahead – rooming in, avoiding supplementing, etc.
Have a labor support doula! This person can help you craft your birth plan. Women who use a doula are more likely to have a vaginal birth and reduced interventions. This leads to easier breastfeeding.
If you need help at home after your baby is born a postpartum doula is great! She can teach you newborn care, general breastfeeding, she can care for you while you learn to care for your baby. She can take care of food for you and your family and other domestic activities you may feel compelled to do.
Have your “team,” partner, extended family, healthcare team, support you in breastfeeding. This means making sure they are informed about breastfeeding.
Make contact with an IBCLC (International Board Certified Lactation Consultant.) http://www.ilca.org/why-ibclc/falc Most will talk to you before your baby is born to discuss when and if you may need to schedule an appointment.
Avoid Dr. Google! This is important. The internet is full of opinions, marketing and general misinformation. You are not one-size-fits-all and neither is your baby. You need to look at your baby, your situation and know when to seek help and to know what is normal.
Education is key! Here are some good books:
The Womanly Art of Breastfeeding by Diane Wiessinger, Diana West and Teresa Pitman
Breastfeeding Made Simple by Nancy Mohrbacher
The Nursing Mothers Companion by Kathleen Huggins
* more if there are multiple babies
Here are a few ways your DoulaCare postpartum doula will teach you:
Sit the baby on your lap with her back resting against you and your hand holding her chest. Then rock back and forth. If you have a rocking or glider chair, all the better.
The forearm lift will often calm a fussy baby.
Bend one arm and place your baby, tummy down, along the length of your forearm, with his head resting in your open hand and his legs straddling your arm. Bring your arm close to your body for security and then stroke or gently pat his back with your other hand.
Laying him tummy-down across your knees will also often calm a fussy baby. Stroke or gently pat his back. The best hold is laying your baby across your chest so he can fall asleep listening to and feeling your heartbeat.
Use A Baby Carrier.
Babies generally like and need to be held a lot, for long periods. Part of the solution is to just accept the fact that babies take time. Integrate holding a baby with your other activities.
Many babies like to be held while you are standing up and in motion, and they can tell the difference. So you may find yourself, for hours sometimes, with your baby in your arms, walking or standing while you sway side-to-side.
You’ll Get the Shakes.
Don’t be surprised if you feel jittery after the birth.
This is normal, has nothing to do with being cold. Rather, the shakes occur from the immediate hormonal shifts that occur after delivery. They might also be a reaction to the anesthesia or an endorphin release.
Don’t worry; they’ll go away within a few minutes or, at most, a few hours.
Stitches Down There
Episiotomies aren’t a routine procedure, sometimes you might need a few stitches for vaginal tearing.
Baby Might Not Be Interested in Breastfeeding immediately.
During this time, skin to skin contact is very important to help initiate bonding for both baby and you. Take this time to look at your baby, smell, kiss, cuddle your baby.
There Will Be Blood!
Labor and delivery a messy endeavor. In the early days postpartum, it’s normal to experience large amounts of bleeding after you’ve been sitting or lying for a while, as well as a gush that can happen while breastfeeding. It’s also normal to pass some large clots in the 24 hours after delivery. All of this tapers off at a decreasing rate, similar to a period — for about four to six weeks after delivery.
After delivery, the uterus shrinks from the size of a large watermelon down to the size of a cantaloupe, Oxytocin helps this process by causing uterine contractions, and the shrinking of the uterus continues for 6 weeks.
Ice packs. Your Postpartum doula knows all the tricks for using an ice pack. Especially if you pushed for a long time you need ice packs help numb any discomfort and bring down the swelling. This can be alarming — the labia can triple in size (which is temporary).
Sweating quite a bit during the first few weeks post-baby. Tremendous night sweats are normal, that’s because your body’s estrogen drops massively — and the change in hormones upsets your body’s temperature regulation.
Your postpartum doula in your home with comfort measures
No matter how many books and websites you read or how prepared you feel, babies have their own special way of throwing you for a loop. From needing more breastfeeding support, to baby’s fussiness and indecipherable crying.
That’s where your postpartum doula can give it to you straight and help you navigate the most unexpected, unforgettable moments as a new parent
The surprise: Breastfeeding isn’t always easy. With support the doula does make it easier with her knowledgeable breastfeeding management tips, correcting latch on pain or building up your supply.
The surprise: You will bleed postpartum. Called lochia. It’s true you will have heavy bleeding the first days after the birth, it does tapper off quickly. After that, it changes to a discharge that can last up for a several weeks.
If you do too much besides caring for the baby, you can start heavy bleeding again.
Let your doula take care of things around the house.
The surprise: You won’t have time for anything else. Babies are 24/7 , even when baby sleeps it never feel as if you are “off the clock”, new parents feel like they are waiting for their newborn to wake-up again to feed. Why doulas are there, to take care of you and give you a hand.
The surprise: Most newborn clothes will go to waste. Dress baby in your favorite outfits everyday – by next week they will outgrow it. Your doula will organize the baby clothes to get the most out of what fits now, and when size 6 month old will fit.
The surprise: Newborns poops are noisy. Noisy explosive and messy. That is your breastfed babies poops! They are naturally loose, known to explode out of the diaper onto the baby’s back. Always carry an extra outfit
in your diaper bag. Your doula is a diapering expert teaching you how to diaper your baby.
The surprise: Going back to work is hard. It does feel unexpected the deeply complicated feelings about leaving your baby – just when its getting fun and your baby is responsive. Remember no one does it all and you should not try. Doing your best is a good enough parent. Hire help. You are resilient.
The surprise: You won’t always know what your crying baby wants. Your doula understands babies, and she teaches you to understand and read your babies feeding and sleeping cues, and how to comfort your crying baby.
The surprise: Baby might mix up night and day. Yes, its true, newborns sleep in short burst from 30 minutes to 4 hours. At seemly random times through out the day and night. Most infants take about 12 weeks to show day-night rhythms in the production of melatonin, the sleep hormone.
Doulas are taught to communicate with you assisting and teaching families:
Doulas never discount the importance you place on getting breastfeeding right!
Unlike the baby nurse, whose sole job is caring for the baby without consideration of the parents bonding or to ensure breastfeeding is going well, the doula is teaching you to care for your baby, as we care for you.
You start feeling confident in becoming independent as you practice and learn under the guidance of a postpartum doula.
The Postpartum Doula’s Day…
Summing it up, whatever your family needs! Once you get home your needs are Sleep, Newborn 101 and Breastfeeding focused as the days pass, the way the doula spends her time with you changes.
Each visit the postpartum doula assesses with you what needs are most important on that specific day.
Are you desperate for a nap?
Need something nourishing to eat?
Soothe fussy baby?
Bathe the baby?
How to use babywrap or carrier?
Run an errand?
Learn to pump?
Help with siblings?
YOUR DOULA DOES ALL OF THIS AND MORE!
Your priorities are the doula’s priorities. Each family is different and Doula Care support is tailor made to fit you.
Your doula is extensively trained and experienced in managing the specific needs of families with Newborns!
Everything is focused on the parents and baby… Newborn 101
Providing education is one of the doula’s main roles, and this takes many forms.