Postpartum Care

Congratulations!

The first few days after delivery can be exciting and joyful, but they can also be exhausting. The following suggestions are meant to help you care for yourself and recover more comfortably during the weeks ahead.

REST!

When you return home, use common sense when deciding what activities you can safely manage. If you feel tired, rest when your baby rests, and allow family and friends to help when possible.

Follow-Up Care / Postpartum Visit

We would like to see you in the office 4–6 weeks after delivery for your postpartum exam. Our office will email or mail you a pre-scheduled appointment time. If the appointment does not work with your schedule, please contact the office as soon as possible to reschedule by calling (919) 788-4444 or sending a message through the patient portal.

Until your postpartum exam, do not place anything in the vagina, including sexual intercourse, douches, or tampons.

Please contact our office if you experience any concerns, including:

• Elevated blood pressure

• Difficulty urinating

• Problems with stitches

• Breast-related concerns

We are here to support you throughout your recovery.

Must Call Situations

If you are experiencing any of the following problems, we would like you to contact our office immediately.

1. Fever greater than 101°F.
2. Severe, persistent abdominal pain.
3. Heavy bleeding that involves changing 1 sanitary pad every hour for 2 hours in a row.

Vaginal or Vulvar Stitches

We recommend that if you have vaginal or vulvar stitches, keep the area clean as possible.  The stitches will dissolve on their own and do not have to be removed.

Cesarean Section Patients

If you had a cesarean section, riding in a car is allowed. However, do not drive for at least 2 weeks after delivery, and never drive while taking narcotic pain medication.

If Steri-Strips (small adhesive strips) are placed over your incision, you may remove them after 7 days.

Showering is permitted, but do not soak the incision in water. Avoid deep tub baths, hot tubs, jacuzzis, and swimming until your health care provider tells you it is safe.

Postpartum Bleeding

Your vaginal bleeding after delivery will gradually decrease but may last 6-8 weeks.  If you are not breast feeding, your first period will probably start 5-10 weeks after delivery.  It will likely be a heavy, prolonged period, often with clots.  Breast feeding mothers frequently find that their periods do not restart until after their babies are weaned.  This, however, is not a rule, and even breast feeding mothers may restart their cycles within 6 weeks after delivery.

Pain Control

Tylenol or Ibuprofen products such as Motrin and Advil will generally take care of most postpartum pain.  If you require stronger medication for pain (narcotics), do not attempt to operate any vehicle while taking this medication.  Drink plenty of fluids to avoid constipation.

Breast Feeding / Breast Care

If you are breast feeding, remember to drink lots of fluids to replace what is being used to make breast milk (at least 8 glasses a day).  The quantity of milk you produce may decrease if you are very tired or dehydrated.  Take your prenatal vitamins for as long as you breast feed.  Maintain a calcium intake of 1,500mg a day as long as you breast feed.  If bottle feeding, you should wear a very supportive bra or sports bra until your breasts have decreased in size.  If they become engorged, ice packs, cabbage leaves in your bra and/or Tylenol are helpful.  Do not stimulate breasts by expressing milk or massaging the breast.  When showering, stand with your back to the spray of water, since this may stimulate the breast to produce milk.

Constipation

This is a common problem in the postpartum period.  Do not ignore it.  Breast feeding, narcotic pain medications, lack of exercise, dehydration and episiotomy pain can all make constipation worse.  Drink lots of fluids and eat fruits and bran cereals.  If needed use a mild laxative such as Milk of Magnesia or Dulcolax.  You may also use Colace as a stool softener.  You should have a bowel movement at least once every 3 days.

Postpartum Activity / Exercise

You may gradually resume most of your usual activities as you feel ready. Listen to your body and pace yourself.

Driving

• Avoid driving for 1 week after a vaginal delivery

• Avoid driving for 2 weeks after a cesarean section

• Only drive if you are not taking narcotic pain medication

Activity Guidelines

• Walking and using stairs are allowed

• Showering is permitted

• Avoid heavy lifting for 2 weeks after a cesarean section

• If you feel tired during any activity, stop and rest

Postpartum Diet

If you are breast feeding, it may take some experimentation to find out if there are foods that your baby cannot tolerate you eating.  Otherwise, please eat normally, but be sure to get plenty of water, fiber and calcium, which is especially important.

Circumcision

If your baby was circumcised, he will need some additional attention for a short while.  For the first few days, there will be some swelling at the circumcision site.  If Gomco® technique was used; you will need to pull the foreskin back from the head of the penis once or twice a day to prevent adhesions of the skin to the glans.  Placing a thin coat of Vaseline over the glans each time you change the diaper will help prevent irritation from the diaper or urine.  If Plastibell® technique was used; the ring should fall off in about 7 days. *Remember to wash your hands before and after cleaning!

Contraception / Birth Control

You should not engage in intercourse until after your postpartum visit.  At your postpartum visit, you can discuss birth control options with your physician and decide which method is best for you.  Contrary to what many women may have heard, breast feeding does not prevent pregnancy and breast feeding mothers should decide on some method of birth control.

Postpartum Depression

Postpartum depression can affect anyone.  Women who have a history of depression are at an increased risk.  Postpartum depression has also been known as baby blues or postpartum blues.  During the first 5-10 days after delivery, many women develop baby blues or postpartum blues.  Symptoms can include mild depressive symptoms such as generalized dissatisfaction with life, insomnia, exaggerated changes in mood and decreased concentration. If you experience any of this, it is normal and will usually last a few days.  If you have experienced any of these that are persistent and occur nearly every day, please contact our office.  There are things we can do to help. Don’t be afraid to reach out.

Reviewing the questions below, may also help you determine if you need a little extra help.

 How often have you been bothered by any of the following problems?

1. Little interest or pleasure in doing things?
2. Feeling down, depressed, or hopeless?
3. Trouble falling or staying asleep or sleeping too much?
4. Feeling tired or having little energy?
5. Poor appetite or overeating?
6. Feeling bad about yourself or that you are a failure or have let yourself or your family down?
7. Trouble concentrating on things, such as reading the newspaper or watching television?
8. Moving or speaking so slowly that other people could have noticed? Or the opposite, being so fidgety or restless that you have been moving around a lot more than usual?
9. Thoughts that you would be better off dead or of hurting yourself in some way?

 Let us know if you feel you need help!

Once again, congratulations!  We hope this has answered some of your questions.  Please do not hesitate to call our office with any questions or concerns.