When your baby is born, they will remain skin to skin with you unless he/she needs immediate medical attention. They will remain skin to skin with you (or your support person if you are unable) for the first hours of life. A nurse will check over you and baby frequently during those first 2 hours following your delivery. We will assist you with feeding your baby for the first time. Your baby will room in with you during your stay unless he/she requires care in our Neonatal Intensive Care Unit.
After your delivery, you may have had to have stitches to fix a tear that occurred when you delivered your baby. The following descriptions may help you understand the different degrees of tears that can occur during childbirth.
First degree tear – a thin tear or graze of the perineal skin (the area between the vagina and anus). No muscles are involved. Sometimes a small number of stitches are required.
Second degree tear – includes skin and muscle tissue. Stitches are usually needed. It may take around two months to feel completely comfortable again.
Third degree tear – a tear or laceration through the perineal muscles and the muscle layer that surrounds the anal canal. This tear requires stitches. It can take at least two months before the wound is healed and the perineal area is comfortable again.
Fourth degree tear – goes through the anal sphincter all the way into the anal canal or rectum. This tear requires stitches. Fourth degree tears do not usually pose any ongoing issues, however, some women will have problems with involuntary loss of urine or feces (stool) and/or painful intercourse.
Loss of Urine - Involuntary loss of urine is called urinary incontinence. This can occur after childbirth due to your pelvic floor muscles becoming weak, a tear in the perineum and/or an imbalance between your pelvic floor and hip muscles. If you are experiencing loss of urine, talk with your doctor about a physical medicine evaluation.
Loss of Stool - Involuntary loss of stool is called fecal incontinence. Depending on the severity of your tear, the muscles of your anus may have been involved. Those muscles are responsible for helping to keep stool and gas from coming out. If you consistently cannot hold in stool and gas after your delivery, other treatment options may be necessary. If you are experiencing loss of stool, talk with your doctor about a physical medicine evaluation.
Pain with Intercourse - Once you have your doctor’s approval to resume sexual activity, it may be a little uncomfortable at first, but should get better as you heal. There is a small percentage of women who have so much pain they cannot have intercourse. This is called dyspareunia. Physical therapy can help with this in just a few visits. If you are experiencing pain with intercourse, talk with your doctor about a physical medicine evaluation.
You may experience some pain or discomfort after delivery. The following information lists feelings you may experience and options available to manage your pain.
There are several types of pain you may feel after a vaginal delivery:
The first day, ice packs will help relieve the swelling, episiotomy or repair pain. You may be given an anesthetic spray to relieve stinging pain from your stitches. Soaking in a warm bath or sitz bath can relieve general achiness and help heal an episiotomy. Witch hazel pads placed on the ice pack or peri pad can reduce peri pain. Tightening your buttocks before sitting and lying on your side can help pelvic soreness.
A cesarean delivery is major abdominal surgery. You will feel pain from both your abdominal incision and uterine cramps. If you had a general anesthetic, your memory may be fuzzy or absent. If you had an epidural or spinal anesthesia, it will take longer for the anesthesia to wear off. Once your anesthesia wears off, you may feel the following:
Since walking or moving can aggravate incision pain, you can minimize this discomfort by:
Nonsteroidal anti-inflammatory (NSAID) medicines, like Motrin®, can reduce swelling and soreness and relieve mild to moderate pain and cramps.
Narcotic medicines (for example, codeine or morphine) are often used for acute pain such as episiotomy (vaginal birth) or abdominal incision pain (cesarean birth).
If you had a spinal or epidural anesthetic, you may receive a narcotic medicine called Duramorph® through the spinal/epidural catheter. This medicine relieves pain for 8-24 hours.
Go to the Emergency Care Center or call 911 if you...
It’s always better to be safe than sorry when it comes to dealing with your health. So if you do have any of the above symptoms, go to the nearest emergency room or call 911 for help.
Normal - The length of time for bleeding is different for each woman. The first or second day your bleeding will be red in color, then turn to pinkish to brown/ tan, then clear mucous. You may spot off and on for six weeks. Your first menstrual period after delivery will start within two months after you deliver if you are not breast- feeding. If you are breastfeeding, your period may be delayed until after you stop total breast- feeding (baby is not being supplemented with any other food or liquid). Your second to third periods after delivery may be heavy and irregular, last longer and have clots.
Self-Help - Flow may increase when on your feet for too long or before, during or right after breast-feeding. If bleeding increases when up, lay down with your feet up and rest. Use sanitary napkins, no tampons or douching* until after your six week check-up with your OB provider.
Abnormal (Call OB Provider) - Saturate one or more pads in one hour, passing clots the size of small egg or a foul odor to your flow.
Normal - Cramping after delivery is nor- mal. It will gradually decrease until the uterus is back to normal size. Cramping may be stronger and last longer with breastfeeding and/or each additional baby you have.
Self-Help - Take pain meds as ordered by OB provider.
Abnormal (Call OB Provider) - Severe cramping with increased bleeding and/or clots.
Normal - Your perineum may be slightly swollen, bruised and/or tender. If you have stitches, look at the area at home with a mirror so you have something to compare it to if it is causing a problem. If you have stitches they will dissolve.
Self-Help - You will be shown how to use a peri bottle to rinse your perineum after you pass urine or stool. Can use ice packs the first 24 hours to decrease swelling and help make you more comfort- able. After 24 hours, sit in a clean bathtub with a minimum of 3-4 inches of warm water for 20 minutes (or use a sitz bath). Pat your bottom dry. You may use a blow dryer set on cool to completely dry this area. Do not add anything to your water.
Abnormal (Call OB Provider) - Increased pain, redness, more swelling, and foul odor/discharge and possibly a fever of 100.4˚F.
Normal - When the incision is healing, you may see a few drops of pink-tinged, pale yellow or clear drainage. You may have a burn- ing sensation for a few days. Tenderness, numbness and itching are common.
Self-Help - Keep incision clean daily with soap and water and pat dry. Look at incision in the mirror when you get home and if there are any problems, you can compare the site to what it looked like when you left the hospital.
Abnormal (Call OB Provider) - Bright red or greenish-yellow drainage or opening of incision. Redness, increased pain, and swelling are signs of infection.
Normal - Around the third to fifth day, you may have breast fullness and possible discomfort for 24-48 hours.
Self-Help - A well-fitting support bra, ice packs or warm compress, or acetaminophen (i.e., Tylenol®) every 4 hours can be used to decrease the pain. To help reduce the swelling, use raw green cabbage leaves on top of the breasts for 30 minutes. Break the veins in the leaves prior to use and place a cool damp cloth over them on the breasts. You may express small amounts of milk for comfort. Avoid com- pletely emptying breast.
Abnormal (Call OB Provider) - Signs of breast infection: red, sore lump on one or both breasts with fever and chills; fever that lasts longer than 24 hours or a temperature > 100.4˚F.
Normal - By the third day, you will pass larger amounts of urine each time you void. You may wake up at night and have to empty your bladder. You may feel cramping or have more bleeding when bladder is full. Bladder function should return to normal by six weeks postpartum. You may experience loss of control of your urine.
Self-Help - Wash area around vagina (front to back) to prevent stool from going near vagina or urethra (opening of bladder). Drink 6-8 glasses of fluids. Empty your bladder every 2-3 hours to prevent bladder from getting too full.
Abnormal (Call OB Provider) - Burning or pain with passing urine, difficulty starting or stopping the flow of urine. Going frequently in small amounts and feeling you are not emptying your bladder completely. Persistent inability to control bladder.
Normal - Soft, brown bowel movements. You may not have the same schedule as you had before you were pregnant. After cesarean, you will have gas for several days.
Self-Help - Eat well balanced meals. Increase fluids (example: fruit juice, water, and milk) to 6-8 glasses/day. Eat high fiber foods (example: whole wheat breads, bran cereals, fruits, and vegetables).
Abnormal (Call OB Provider) - Uncontrolled bowel movements. Hard, difficult to pass, or no stool.
Normal - Common during pregnancy or after delivery.
Self-Help - Use bath tub or sitz baths. Creams and ointments from OB provider. Eat well balanced meals with high fiber and increase in fluids to keep stools soft and avoid straining when having bowel movement.
Abnormal (Call OB Provider) - Large swollen hemor- rhoids with bleeding.
Normal - Cesarean mothers may have pain in tummy and shoulders from gas. May have pain and stiffness when getting in and out of bed, up and down from chairs, and toilet. Increased vaginal bleeding with too much activity.
Self-Help - Rest/sleep when your baby is sleeping. For cesarean mothers, take one step at a time and limit the amount of stair climbing. Don’t lift anything heavier than your baby for the first week. Don’t drive for 1-2 weeks.
Abnormal (Call OB Provider) - Continued heavy bleeding after rest.
Normal - A slight amount of swelling of your feet, legs, and hands for up to 2-4 weeks without pain. Minor muscle aches in legs, back, tummy, and shoulders from pushing.
Self-Help - Avoid sitting for long periods of time. Elevate feet when sitting. Avoid crossing or sitting on legs. Don’t wear tight knee highs or socks.
Abnormal (Call OB Provider) - Legs are tender, red, warm to touch with pain and swelling. Unable to walk without pain. Headache that does not go away with pain medication, blurred vision, seeing spots or pain in ribs.
Normal - Your appetite may increase, especially if you are nursing your baby. You may feel thirsty for a few days. You may feel nauseated if you had general anesthetic for a cesarean delivery.
Self-Help - Eat well balanced meals. Drink 6-8 glasses of fluids daily. Continue taking prenatal vitamins per OB provider’s instructions. Take a multi-vitamin with folic acid (400 mcg) throughout your childbearing years.
Abnormal (Call OB Provider) - Very weak, no energy, faint, dizzy, ringing in ears or sudden weight gain.
Normal - Most women are not interested in resuming sex during the first month after having a baby. Many women feel tired, are busy with the baby, and their stitches are still uncomfortable. You may resume normal sexual intercourse as directed by your health care provider.
Self-Help - You can resume sex when:
a) Your discharge has been white and no bleeding for several days. This helps reduce the chance of infection in the uterus. Use birth control.
b) You are emotionally ready. You may need to use some water soluble lubricant (e.g., K-Y® jelly) to lessen the dryness of the vagina the first couple of months. You can get pregnant whether you’re having periods or not.
Abnormal (Call OB Provider) - Very painful intercourse after incision has healed. Interest in sex does not return.
It’s normal for new moms to feel overwhelmed and even sad due to all of the changes in her routine and in her body, coupled with not getting enough sleep. Those feelings are often considered the "baby blues", which are different from postpartum depression. We'll go over both so you’ll be prepared to recognize the signs and symptoms if it happens to you.
It is not uncommon for women to experience the "baby blues" during the first days or weeks after delivery. These sad or blue feelings most commonly begin suddenly on the third or fourth day after delivery. Women tend to experience the symptoms of baby blues differently. However, there are some common symptoms, including:
Much more serious and lasting than the "baby blues," some women experience what is clinically referred to as postpartum depression. The following are the most common symptoms, however, each woman experiences these symptoms differently.
While the exact cause is unknown, it is likely that a number of different factors are involved, such as:
It is important to note that most women who experience the "baby blues," postpartum depression, postpartum anxiety, and/or postpartum obsessive-compulsive disorder have never experienced these types of symptoms before, especially with such intensity. And no matter what the cause or whether these symptoms are new or not, it is important for women to seek proper treatment early. This is not only to ensure that the newborn remains safe and properly cared for, but also to make sure the mother can be treated for these symptoms and experience all the joys of motherhood.
If you ever feel overwhelmed, depressed or have any signs or symptoms, don’t hesitate to call your doctor. It’s never too soon to seek help and treatment. Don’t wait until you’re so overwhelmed that it’s too difficult for you to pick up the phone to make an appointment. You and your health are important to your family and your new baby, don’t ever feel like asking for help is a sign of weakness or that you should be able to do it all on your own. It isn’t about you being weak. It’s a real medical condition that can be treated successfully, and the sooner you begin treatment, the better.
Treatment Options for Postpartum DepressionIt’s also important for spouses or family to understand and watch for signs as the new mom may not always realize that she’s struggling.
If you ever feel like harming yourself, your baby or someone else, call 911 or have someone bring you to the emergency room.
