Postpartum care: What to expect after a vaginal birth

You've been to childbirth classes, and you've read pregnancy books. You know what's happening to your body from week to week, and you know what to expect during labor. But what happens after the baby is born?

Sometimes the most dramatic changes happen after delivery, during the postpartum period. Here's what to expect.

Vaginal soreness

If you had an episiotomy or tear during delivery, the wound may hurt for a week or so — especially when you walk or sit. If you had an extensive tear, the tenderness may continue for two to three weeks. In the meantime, you can help promote healing:

• Soothe the wound. Use an ice pack, or wrap ice in a washcloth. Chilled witch hazel pads may help, too. Witch hazel is the main ingredient in many hemorrhoid pads. You can find witch hazel pads in most pharmacies.
• Keep the wound clean. Use a squirt bottle to rinse the tissue between the vaginal opening and anus (perineum) with water after using the toilet. Soak in a warm tub.
• Take the sting out of urination. Squat rather than sit to use the toilet. Pour warm water over your vagina as you're urinating.
• Prevent pain and stretching during bowel movements. Hold a clean pad firmly against the wound and press upward while you bear down. This will help relieve pressure on the wound.
• Sit down carefully. To keep your bottom from stretching, squeeze your buttocks together as you sit down. If sitting is uncomfortable, use a doughnut-shaped pillow to ease the pressure.
• Do your Kegels. These exercises help tone your pelvic floor muscles. Simply tighten your pelvic muscles as if you're stopping your stream of urine. Starting about a day after delivery, try it for five seconds at a time, four or five times in a row. Repeat throughout the day.
• Look for signs of infection. If the pain intensifies or the wound becomes hot, swollen and painful or produces a pus-like discharge, contact your health care provider.

Vaginal discharge

You'll have a vaginal discharge called lochia for up to eight weeks after delivery. Expect a bright red, heavy flow of blood for the first few days. If you've been sitting or lying down, you may notice a small gush when you get up. The discharge will gradually taper off, changing from pink or brown to yellow or white. To reduce the risk of infection, use sanitary napkins rather than tampons.

Don't be alarmed if you occasionally pass blood clots. Contact your health care provider if:

• You soak a sanitary pad every hour for more than two hours
• You feel dizzy
• The discharge has a foul odor
• Your abdomen feels tender
• You pass clots larger than a golf ball
• You have a temperature of 100.3 F or higher

Contractions

During the first few days after delivery, you may feel contractions sometimes called afterpains. These contractions help prevent excessive bleeding by compressing the blood vessels in the uterus. Afterpains tend to occur when you're breast-feeding and seem to be more noticeable with second or third babies. Medications used to control hemorrhaging after delivery can increase afterpains as well.

Usually these pains resemble menstrual cramps. If necessary, your health care provider may prescribe pain medication. Many medicines are safe even if you're breast-feeding. 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.

Difficulty urinating

Swelling or bruising of the tissues surrounding the bladder and urethra may lead to difficulty urinating. Fearing the sting of urine on the tender perineal area may have the same effect.

To encourage urination, contract and release your pelvic muscles. It may help to place hot or cold packs on your perineum, straddle the toilet like a saddle or pour water across your perineum while you urinate.

Difficulty urinating usually resolves on its own. Contact your health care provider if it hurts to urinate or if you have an unusually frequent urge to urinate. These may be symptoms of a urinary tract infection.

Leaking urine

Pregnancy and birth stretch the connective tissue at the base of the bladder and may cause nerve and muscle damage to the bladder or urethra. You may leak urine when you cough, strain or laugh. Fortunately, this problem usually improves within three months. In the meantime, wear sanitary pads and do your Kegel exercises.

Hemorrhoids

If you notice pain during a bowel movement and feel swelling near your anus, you may 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 may recommend a topical hemorrhoid medication as well.

To prevent constipation and straining, which contribute to hemorrhoids, eat foods high in fiber — including fruits, vegetables and whole grains — and drink plenty of water. Remain as physically active as possible. If your stools are still hard, your health care provider may recommend a stool softener (Colace, Surfak, others) or fiber laxative (Citrucel, FiberCon, others).

Bowel movements

You may find yourself avoiding bowel movements out of fear of hurting your perineum or aggravating the pain of hemorrhoids or your episiotomy wound. To keep your stools soft and regular, eat foods high in fiber, drink plenty of water and remain as physically active as possible. Ask your health care provider about a stool softener or fiber laxative, if needed.

Another potential problem for new moms is the inability to control bowel movements (fecal incontinence) — especially if you had an unusually long labor. Frequent Kegel exercises can help. If you have persistent trouble controlling bowel movements, consult your health care provider.

Sore breasts

Several days after delivery, your breasts may become heavy, flushed, swollen and tender. This is known as engorgement. It happens when your milk comes in. The discomfort usually lasts less than three days. In the meantime, it helps to express milk — preferably by feeding your baby. Stroke your breasts gently but firmly toward the nipple. Apply warm or cold washcloths or ice packs, or try a warm bath or shower.

Leaking milk

Leaky breasts are another common problem for new moms. You can't do anything to stop the leaking, but nursing pads worn inside your bra can help keep your shirt dry. Avoid pads that are lined or backed with plastic, which can irritate your nipples. Change pads after each feeding and whenever they get wet. If nighttime leaking is a problem, place a towel under your breasts at night.

Hair loss

During pregnancy, elevated hormone levels put normal hair loss on hold. The result is often an extra-lush head of hair. But now it's payback time. After delivery, your body sheds the excess hair. Within six months, your hair will probably be back to normal. Shampoo only when necessary, and find a hairstyle that's easy to maintain. Avoid hair dryers, curling irons and harsh chemicals.

Skin changes

You may notice small red spots on your face. These are caused by small blood vessels breaking during the pushing stage of labor. Expect the spots to disappear in about a week.

Stretch marks won't disappear after delivery, but eventually they'll fade from reddish purple to silver or white. Any skin that darkened during pregnancy — such as the line down your abdomen (linea nigra) — may slowly fade as well.

Weight loss

After you give birth, you'll probably feel flabby and out of shape. You may even look like you're still pregnant. Don't worry. This is perfectly normal. Most women lose about 10 pounds during birth, including the weight of the baby, placenta and amniotic fluid. During the first week after delivery, you'll lose additional weight from leftover fluids. After that, healthy eating and regular exercise can help you gradually return to your pre-pregnancy weight.

Mood changes

In addition to physical changes, childbirth also triggers a jumble of powerful emotions. Mood swings, irritability, sadness and anxiety are common. Many new moms experience a mild depression, sometimes called the baby blues. The baby blues typically subside within seven to 10 days. If your depression deepens or you feel hopeless and sad most of the time, contact your health care provider. Prompt treatment is important.

The postpartum checkup

About six weeks after the birth, your health care provider will check your vagina, cervix and uterus to make sure you're healing well. He or she may do a breast exam and check your weight and blood pressure as well. This is a great time to talk about birth control, breast-feeding and how you're adjusting to life with a new baby.

Share any concerns you may have about your physical or emotional health. Chances are, what you're feeling is entirely normal. Look to your health care provider for assurance as you enter this new phase of life.

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