After you've had your baby and returned home from the hospital, you are not yet finished with the physical transitions that pregnancy brings. Your body continues to change after delivery. Your breasts fill with milk and your uterus shrinks back to its regular size.
Coping with these changes while you adjust to caring for a new baby can present a challenge. To stay in good health, you need to recognize which symptoms are normal and which require medical attention.
The following are some health issues that you may encounter in the first weeks after childbirth and some suggestions on how to deal with them. Call your doctor if you experience a high fever over 100.4 degrees Fahreinheit (38 degrees Celsius), severe pain, or any other unusual symptoms.
About three to five days after delivery, when your breast milk arrives, you may notice your breasts are hard, sore, and warm. This is a normal part of early lactation and should end in about 24 hours if you are breastfeeding. If you are not, the engorgement may last up to 48 hours, until the body recognizes that it does not need to continue producing breast milk:
Apply warm compresses to the breasts to stimulate milk flow if you are breastfeeding. Apply cold compresses if not breastfeeding.
Wear a well-fitting bra for support.
If breastfeeding, make sure the baby feeds from each breast, alternately.
Although a low-grade fever is normal, see your doctor if your temperature rises above 100.4 degrees Fahreinheit (38 degrees Celsius). This could indicate mastitis, an infection in the breast tissue.
Well-meaning family and friends, aware of the many benefits of breastfeeding, sometimes pressure new mothers to breastfeed. But this may not be the right choice for everyone. Mothers who choose not to breastfeed, or find that they can't, shouldn't feel a sense of guilt or failure. A balanced formula will provide your baby with all the nutrients he or she needs.
If you do breastfeed, it may take a while for both you and the baby to adjust. If you experience feeding problems or are concerned about how well your baby is feeding, do not delay in alerting your pediatrician. The baby could become dehydrated if he or she is not able to get enough milk:
If your baby is a slow feeder, rub his or her back, abdomen, and legs to stimulate the rooting reflex.
Push aside the part of your breast that covers the baby's nose to make room for him or her to breathe comfortably.
To get the baby to turn toward your breast, place your nipple against the baby's cheek.
Mastitis, a bacterial infection that can occur in one or both breasts during breastfeeding, causes pain, tenderness, and swelling. Other symptoms include a temperature above 100.4 degrees and breasts that are warm and reddish. This occurs most frequently during the first month of breastfeeding.
See your obstetrician if you suspect that you have mastitis. Your doctor may prescribe antibiotics to clear up the infection and will advise you as to whether you can continue breastfeeding. If untreated, mastitis can result in a breast abscess that may require surgical drainage.
Allowing the baby to begin sucking on the end of the nipple rather than a full latch on the nipple and areola, or pulling the baby away from the nipple while he or she is still sucking, can harm the nipples.
If soreness does not subside as you grow accustomed to breastfeeding, check with your doctor. Cracked nipples can lead to mastitis:
Be sure to air dry your nipples after each feeding.
If deep cracks develop in the nipples, or if they bleed, see your doctor.
After vaginal delivery
Whether you have stitches or not, the vagina and the perineum (the tissue between the vagina and the anus) will be sore after delivery. Swelling and bruising also are common:
In the first 24 hours after delivery, use ice packs to reduce swelling and relieve pain. Then switch to warm compresses.
To relieve soreness and promote healing, use a bidet or sitz bath--a small plastic basin that sits atop the toilet--two to three times a day. (The hospital may provide you with a portable sitz bath.) Or, if you have a gooseneck shower attachment, use it to rinse with a low-pressure stream of water.
Cleanse after each time you use the toilet. A bidet, sitz bath, or showerhead can serve this purpose.
Examine the vagina and perineal area for hematomas, collections of blood caused by bleeding from a ruptured blood vessel. If you detect a discolored bluish or reddish mass under the skin, see your doctor. The hematoma may need to be drained to relieve pressure on surrounding tissues.
If you develop a fever above 100.4 degrees Fahreinheit (38 degrees Celsius), you could have an infection. Call your doctor.
Avoid heavy lifting and climbing stairs for the first two weeks after delivery.
Avoid sexual intercourse, douching, and tampons until after your postnatal examination six weeks after delivery.
If you have had an episiotomy, a surgical procedure in which an incision is made in the perineum to facilitate the delivery, or repair of a vaginal tear, you will need to take special care of your incision.
Use a mirror to look for swelling, redness, or bleeding around the incision. While vaginal bleeding is a normal postpartum symptom, blood around the incision requires medical attention.
After childbirth, the body sheds the uterine lining in a vaginal discharge known as lochia. It's usually bright red for up to 10 days and then turns to a pinkish discharge. Next it turns to a brownish color before turning yellowish-white for up to six weeks after delivery. If you are breastfeeding, you may notice more lochia when you breastfeed during these first six weeks because the uterus is stimulated to contract with breastfeeding.
Call your doctor if bleeding persists six weeks after childbirth or if you see blood clots.
A hormone released during breastfeeding causes the uterus to contract and may magnify these afterpains. These pains usually subside gradually over four to six weeks. If the pains are severe, consult your doctor.
Care after cesarean birth
Recovery from a cesarean birth will take longer than recovery from a vaginal birth. After you leave the hospital, you will need to take special care of the area around the incision, which may remain sore for a few weeks:
If you notice any pain, redness, or swelling around the incision, or if blood or yellow fluid leaks out, notify your doctor.
Clean the incision with hydrogen peroxide two to three times a day.
Avoid putting a bandage over the incision. It will heal faster uncovered.
Sutures rarely open. If they do, contact your doctor immediately.
A fever above 100.4 degrees Fahreinheit (38 degrees Celsius) could indicate an infection. See a doctor if your temperature goes beyond this point.
Avoid heavy lifting and climbing stairs. Ask your obstetrician when you can resume these activities.
Sudden and frequent mood swings are to be expected in the first days after you give birth. New mothers not only experience rapid hormonal changes, they are also adjusting to the challenge of motherhood while coping with physical discomforts and lack of sleep. Your spirits should lift as you gain confidence in your ability to care for your new baby.
In rare cases, postpartum depression is more serious. Professional help should be sought in such situations:
Try to avoid overtiring yourself. Your moods should stabilize when you are feeling more energetic.
Before the delivery, arrange for help from family or friends.
If you have suicidal thoughts, or if your depression persists beyond a week, contact your doctor.
Weight loss and dieting
During delivery, you lose the weight of the baby, placenta, and amniotic fluid. Some women lose most of their additional weight in the first two weeks after pregnancy with little effort. Others may need to work at losing the weight. Either way, weight loss should not be an immediate concern.
Maintain a diet with adequate calories and that is high in nutrition. Your body needs to be well nourished during this transition from pregnancy. If you are breastfeeding, you especially need to eat well to maintain your milk supply.
The cardinal rule for new mothers: Always rest when the baby is sleeping. Take advantage of these opportunities for naps because when the baby is awake, you will be busy feeding and diapering.
Listen to your body's cues about how much activity you can handle. If you feel pain, or if your bleeding increases, slow down.
Many obstetricians provide written instructions to help patients remember what they need to do after they leave the hospital. Do not hesitate to ask for them. In the busy pace of new motherhood, it could be easy to forget something important.
Most important, remember that the discomforts you experience after childbirth do subside. In time, you can expect to feel as good as ever and enjoy the pleasures of having a new baby.