Postpartum Care

UR Medicine Obstetrics and Gynecology provides a full range of services for postpartum care. We also partner with our colleagues across the medical center to address additional conditions. We look at the whole patient and ensure all your needs are addressed.

What to Expect After Delivery

Immediately following your baby's birth, you will undergo physical and emotional changes that may require special care. You will want to take good care of your body so that you can more easily recover from childbirth and labor. Be sure to schedule a postpartum follow-up visit with your provider approximately six weeks following your baby's birth and contact them with any concerns or questions. 

Common Postpartum Conditions

The most common medical conditions experienced after delivery include:

Constipation

Normally, bowel movements will resume within the first few days following your baby's birth. If you experience postpartum constipation, here are a few suggestions:

• Drink at least eight to ten large glasses of fluid a day.
• Try eating prunes - they are a natural mild laxative.
• Drink warm liquids each morning.
• Eat bran, fruits, green vegetables, whole-grain cereal, and bread.
• A mild laxative or fiber supplement can be used if other measures do not work.

If you do not have a bowel movement by the third or fourth day after having your baby, call your provider.

Hemorrhoids

A hemorrhoid is a painful swelling of a vein in the rectum. After having a baby, many people develop hemorrhoids. Symptoms include pain, rectal itching, bleeding after having a bowel movement, or a swollen area around the anus.

Treating hemorrhoids: 

• Soak in a warm bath two to four times a day.
• Apply cold witch hazel with cotton balls.
• Sit on a pillow or waffle cushion to relieve pressure on the rectum.
• Hemorrhoid creams, ointments, suppositories, and sprays are available over the counter.
• Increase dietary fiber and intake of fluids to help prevent constipation.

If the pain does not go away within a few days, contact your provider. 

Vaginal bleeding

Every individual experiences postpartum discharge, or lochia, following the birth of a baby. Initially, the bleeding will be bright red with a few small clots - like a heavy menstrual period. This should last only through the first week. Over the next two to six weeks following birth, the color will turn from bright red to pinkish brown then fade to cream or white.

At home, continue to use sanitary pads, and be sure to wash your hands after changing them. DO NOT use tampons, douches, or powders—these may introduce bacteria to your healing uterus and cause infection. 

After delivery, you will be given a peri bottle to squirt warm water over your perineum to keep it clean each time you use the restroom. Squirt the water from front to back, then gently dry yourself (also from front to back). Take a shower or tub bath every day, using soap and water. Do not use bubble bath soap during this healing time.

Report heavy vaginal bleeding (soaking more than one pad per hour), large clots, foul odor, or unusual abdominal tenderness to your provider.

Postpartum blues

The birth of a baby is a joyful and happy time, but for various reasons, many individuals (60-80%) experience a mild and temporary form of depression commonly referred to as the "Baby Blues." 

Possible triggers include:

• Hormonal changes
• Stress
• Lack of sleep

Symptoms of the Baby Blues usually appear within the first week or two following delivery and may last for several weeks. 

Symptoms include:

• Tiredness
• Mood swings
• Feelings of loss
• Frustration or anger
• Unexplained weeping
• Irritability
• Inability to sleep 

If possible, try to get help with the baby so that you can rest. Many mothers find these feelings disappear after adequate rest and sharing feelings with a loved one. If you don’t feel better within a few weeks, it’s important to contact your provider, as you could have postpartum depression.

Postpartum depression

While many people will experience Postpartum Blues ("Baby Blues"), some people develop persistent depression, or Postpartum Depression (PPD). If feelings of depression persist or worsen, medical attention is needed to help you get through this time.

Some symptoms of PPD are similar to the Baby Blues but become more intense. Other symptoms include:

• Insomnia
• Persistent sadness
• Lack of interest in nearly all activity
• Anxiety
• Change in appetite
• Persistent feelings of guilt
• Thoughts of harming oneself or the baby

Contact your provider if:

• You or your family suspect that you are experiencing postpartum depression
• The "Blues" do not seem to go away two to three weeks following delivery, or feelings seem to intensify
• You do not want to be with your baby
• You become so angry or frustrated that you worry that you may harm yourself or your baby
• You are overeating or not eating at all
• You are having increased difficulty coping with everyday frustrations
• You are experiencing little satisfaction and enjoyment with motherhood

Sometimes the feelings of guilt will keep mothers from admitting that they are depressed. Partners or other family members may need to contact your provider.

Postpartum hypertension (elevated blood pressures)

Changes can occur during pregnancy and after pregnancy that affect your blood pressure. While most blood pressure issues improve after delivery, some people will continue to have or develop high blood pressures postpartum.

It is important to recognize and treat these high blood pressures (even if it is only for a short time) to prevent the risk of heart disease, strokes and seizures.

We will be checking your blood pressures while you are in the hospital and if they are elevated, we will make sure you go home with a blood pressure monitor that we will provide and teach you how to use. Sometimes, we may start a blood pressure medicine while you are still in the hospital. If you have elevated blood pressures, we will see you in the office around one week after you are discharged.

Contact your provider if you have:

• Blood pressures higher than 140/90 (if either number is high) on more than 2 checks
• Blood pressure is higher than 160/110 (if either number is high)
• Headaches that do not improve with Tylenol, ibuprofen or caffeine
• Severe pain under your right rib cage
• Vision changes
• Difficulty breathing

Resuming Sexual Intimacy

Sexual intercourse may be resumed after your vaginal bleeding has stopped and the stitches are healed. Usually, you will have fully recovered four to six weeks following delivery. You and your partner should decide together, with the advice of your provider, when to resume sexual intimacy.

Remember that there are other ways to show affection, such as cuddling or kissing. Both partners should be patient and understand one another's needs and reactions. While physical ability for sexual intimacy may have returned, other factors, such as lack of sleep, may affect emotional interest. Many people feel so tired from the demands of being a new parent that they have little time for their partners. Parenthood can be physically demanding, and sex may seem like another physical demand on the body rather than a time of emotional connection.

Fear of pregnancy may also be an inhibiting factor. You can become pregnant again before you have your first period after giving birth.

Your vagina may change in size and shape after birth and typically returns to near its normal size six to eight weeks following delivery. For the first few times, sex following birth may be painful. Use a lubricant and try positions that allow the individual to be in control of penetration. You may leak breast milk during sex.

Continuing a sexual relationship after a new baby is usually a gradual process. It’s important to be patient with yourself and your partner. Desire will eventually return.

Contraception (Birth Control)

Timing is different for everyone for when they will get their periods (menstrual cycle) back after they deliver. You can release an egg even before you get your first period so it is important to know that just because you haven’t gotten a period, you can still get pregnant.

There are lots of safe options for birth control in the postpartum time. Some of these can even be started before you leave the hospital.

Examples of birth control:

• Intrauterine devices (IUDs)
• Birth control rod (Nexplanon)
• Pills, the Shot, etc.
• Condoms
• Lactational amenorrhea

Please see our “Birth Control After Baby” information packet for more information

Nutrition and Exercise

Eating healthy meals will help your body heal. Try to eat a variety of foods from each of the basic food groups, making sure to include lots of vegetables, fruits, and proteins. Drink eight to ten glasses of water daily. If you are breastfeeding, you will need to drink 12-14 glasses daily.

Breastfeeding individuals should not reduce their caloric intake for about six weeks and then only minimally. You will need an extra 500 calories/day to make milk. If your diet becomes unbalanced or is too low in calories, it will affect your recovery from childbirth and may affect your milk production.

Over time, you can gradually increase your level of activity and exercise. Your provider can help you decide when to begin exercise and how to change your diet. Those who have a Cesarean birth will need to recover from surgery (usually about 6 weeks) before starting to exercise. One of the keys to success in postpartum exercise is to build gradually in terms of time and intensity. Working out too long or hard may increase your fatigue or cause injury.

After the birth of your baby, you can expect to lose up to 20 pounds in the first month after delivery. Postpartum weight loss should be a gradual process that allows your body to heal from childbirth and feed your baby if you are breastfeeding. You should discuss postpartum weight loss with your provider before you change your diet and exercise regimen.

Breast Care

Breastfeeding

During your pregnancy, hormones stimulate the development of the milk-producing tissue in your breast. Your breasts may have become fuller, and you may have noticed some leaking of colostrum (early milk) from your nipples as you approach your baby’s due date.

After your baby is born, your hormones cause your breasts to start making milk within the first two to five days, and you may experience engorgement. The more often you breastfeed your baby in the early days, the sooner your full milk production will occur.

You may feel uterine cramps, increased feelings of thirst, or drowsiness. After the first week, the uterine cramps should improve. You may start to feel a tingly sensation in your breast or notice the opposite breast leaks while your baby breastfeeds.

Your breast will make as much milk as your baby drinks. The more often you breastfeed your baby, the more breastmilk your body will make.

Breastfeeding & Lactation Medicine offers lactation consultants—experts in latching, milk production/management and family feeding behaviors.

Leaking Breast Milk

This "letdown" or breast milk leaking may happen when you are not ready to feed your baby. Sometimes this happens when you hear a baby (any baby) cry, when you think about your baby, or when you have sex. Nursing pads can be worn inside your bra to soak up the milk. These should be changed often to keep your nipples clean and dry. You can use a cotton handkerchief or other cotton squares inside your bra, or you can purchase specially made pads. Some are disposable, and some can be washed and used again. Avoid pads that are lined with plastic.

Bottlefeeding

Whether or not you choose to nurse, your body will still prepare to breastfeed. After your baby is born, your hormones will cause your breasts to start making milk. When your baby sucks, these hormones are stimulated to make more milk.

During this time, wear a good support bra. If your breasts leak milk or feel heavy (2-5 days after the baby is born), wrap a snug towel or cloth around your chest. This will help to stop the production of breast milk. Do not touch your nipples, as this will stimulate your breasts to produce more milk. You may use ice packs on your breasts if they are full. Continue this care until your breasts are soft. Call your doctor if you have painful, warm lumps in your breast, feel tired and achy, or have a temperature over 100 degrees.

Pain Management

There are many causes of pain and discomfort following the birth of a baby. For pain from an incision, such as an episiotomy near the opening of your vagina, or labial swelling (inflammation around the outside of your vagina), applying an ice pack will ease the pain.

For pain from a cesarean section incision, a heating pad (set on "low") or warm compresses will ease the pain around your abdomen and incision. You may also want to take a mild pain medication. Ask your provider to recommend the best one for you.

Afterbirth pains are similar to menstrual cramps and occur the first few days following your baby's birth. They are normal and may become stronger with each baby you have. They most commonly occur while breastfeeding. Warm showers or compresses can make you more comfortable, as well as mild pain medication. A full bladder may increase the pain, so try to keep your bladder empty.

Backache can be caused by tense muscles or by not using enough support while breastfeeding your baby. A heating pad may relieve the pain. Exercise will also help your muscles return to normal.

If pain develops in either leg, please call your provider. Mild cramping is normal, but warm, painful areas in your legs are not.