Recovery and Care After Delivery

What to expect after a vaginal birth

Pregnancy changes your body in more ways than you might expect, and it doesn't stop when the baby is born. Here's what to expect physically and emotionally after a vaginal delivery.

Vaginal soreness

If you had a vaginal tear during delivery or your doctor made an incision, the wound might hurt for a few weeks. Extensive tears might take longer to heal. To ease discomfort while you're recovering:

• Sit on a pillow or padded ring.
• Cool the area with an ice pack, or place a chilled witch hazel pad between a sanitary napkin and the area between your vaginal opening and anus (perineum).
• Use a squeeze bottle to pour warm water over the perineum as you're passing urine.
• Sit in a warm bath just deep enough to cover your buttocks and hips for five minutes. Use cold water if you find it more soothing.
• Take an over-the-counter pain reliever. Ask your health care provider about a numbing spray or cream, if needed.
• Talk to your health care provider about using a stool softener or laxative to prevent constipation.

Tell your health care provider if you're experiencing severe, persistent or increasing pain, which could be a sign of infection.

Vaginal discharge

After delivery, you'll begin to shed the superficial mucous membrane that lined your uterus during pregnancy. You'll have vaginal discharge made up of this membrane and blood for weeks. The discharge will be red and heavy for the first few days. Then it will taper, become increasingly watery and change from pinkish brown to yellowish white.

Contact your health care provider if you have heavy vaginal bleeding — soaking a pad in less than an hour — especially if it's accompanied by pelvic pain, a fever or tenderness.

Contractions

You might feel occasional contractions, sometimes called afterpains, during the first few days after delivery. These contractions — which often resemble menstrual cramps — help prevent excessive bleeding by compressing the blood vessels in the uterus. Afterpains are common during breast-feeding, due to the release of the hormone oxytocin. Your health care provider might recommend an over-the-counter pain reliever.

Incontinence

Pregnancy, labor and a vaginal delivery can stretch or injure your pelvic floor muscles, which support the uterus, bladder and rectum. This might cause you to leak a few drops of urine while sneezing, laughing or coughing. These problems usually improve within weeks but might persist long term.

In the meantime, wear sanitary pads and do pelvic floor muscle exercises (Kegels) to help tone your pelvic floor muscles and control your bladder. To do Kegels, imagine you are sitting on a marble and tighten your pelvic muscles as if you're lifting the marble. Try it for three seconds at a time, then relax for a count of three. Work up to doing the exercise 10 to 15 times in a row, at least three times a day.

Hemorrhoids and bowel movements

If you notice pain during bowel movements and feel swelling near your anus, you might have swollen veins in the anus or lower rectum (hemorrhoids). To ease discomfort while the hemorrhoids heal:

• Apply an over-the-counter hemorrhoid cream or suppository containing hydrocortisone.
• Use pads containing witch hazel or a numbing agent.
• Soak your anal area in plain warm water for 10 to 15 minutes two to three times a day.

If you find yourself avoiding bowel movements out of fear of hurting your perineum or aggravating the pain of hemorrhoids or your episiotomy wound, take steps to keep your stools soft and regular. Eat foods high in fiber — including fruits, vegetables and whole grains — and drink plenty of water. Ask your health care provider about a stool softener, if needed.

Tender breasts

A few days after birth, you might experience full, firm, tender breasts (engorgement). Frequent breast-feeding on both breasts is recommended to avoid or minimize engorgement.

If your breasts — including the dark circles of skin around the nipples — are engorged, your baby might have difficulty latching. To help your baby latch, you might hand express or use a breast pump to express a small amount of breast milk before feeding your baby. To ease breast discomfort, apply warm washcloths or take a warm shower before breast-feeding or expressing, which might make milk removal easier. Between feedings, place cold washcloths on your breasts. Over-the-counter pain relievers might help, too.

If you're not breast-feeding, wear a supportive bra, such as a sports bra. Don't pump your breasts or express the milk, which will cause your breasts to produce more milk.

Hair loss and skin changes

During pregnancy, elevated hormone levels mean your hair grows faster than it sheds. The result is often an extra-lush head of hair — but now it's payback time. After delivery, you'll experience hair loss for up to five months.

Stretch marks won't disappear after delivery, but eventually they'll fade from red to silver. Expect any skin that darkened during pregnancy — such as dark patches on your face — to slowly fade as well.

Mood changes

Many new moms experience a period of feeling down or anxious, sometimes called the baby blues. Symptoms include mood swings, crying spells, anxiety and difficulty sleeping. The baby blues typically subside within two weeks. In the meantime, take good care of yourself. Share your feelings, and ask your partner, loved ones or friends for help.

If you experience severe mood swings, loss of appetite, overwhelming fatigue and lack of joy in life shortly after childbirth, you might have postpartum depression. Contact your health care provider if you think you might be depressed, especially if your symptoms don't fade on their own, you have trouble caring for your baby or completing daily tasks, or you have thoughts of harming yourself or your baby.

Weight loss

After you give birth, you might look like you're still pregnant. 

Most women lose 13 pounds (6 kilograms) during birth, including the weight of the baby, placenta and amniotic fluid. In the days after delivery, you'll lose additional weight from leftover fluids. After that, a healthy diet and regular exercise can help you gradually return to your pre-pregnancy weight.

What is postpartum care?

The postpartum period refers to the first six weeks after childbirth. This is a joyous time, but it’s also a period of adjustment and healing for mothers. During these weeks, you’ll bond with your baby and you’ll have a post-delivery checkup with your doctor.

Adjusting to motherhood

Adjusting to everyday life after the birth of a baby has its challenges, especially if you’re a new mother. Although it’s important to care for your baby, you also have to take care of yourself.

Most new mothers don’t return to work for at least the first six weeks after birth. This allows time to adapt and develop a new normal. Since a baby has to be fed and changed often, you may experience sleepless nights. It can be frustrating and tiresome. The good news is that you’ll eventually fall into a routine. In the meantime, here’s what you can do for an easier transition:

1. Get plenty of rest. Get as much sleep as possible to cope with tiredness and fatigue. Your baby may wake up every two to three hours for feeding. To make sure you’re getting enough rest, sleep when your baby sleeps.

2. Seek help. Don’t hesitate to accept help from family and friends during the postpartum period, as well as after this period. Your body needs to heal, and practical help around the home can help you get much-needed rest. Friends or family can prepare meals, run errands, or help care for other children in the home.

3. Eat healthy meals. Maintain a healthy diet to promote healing. Increase your intake of whole grains, vegetables, fruits, and protein. You should also increase your fluid intake, especially if you are breast-feeding.

4. Exercise. Your doctor will let you know when it’s OK to exercise. The activity should not be strenuous. Try taking a walk near your house. The change of scenery is refreshing and can increase your energy level.

Functioning as a new family unit

A new baby is an adjustment for the entire family and can change the dynamic you have with your partner. During the postpartum period, you and your partner may also spend less quality time together, which can be troublesome. This is an overwhelming and stressful period, but there are ways to manage.

For starters, be patient. Understand that every couple goes through changes after the birth of a baby. It takes time to adjust, but you’ll figure it out. Caring for a newborn gets easier with each passing day.

Also, communicate as a family. If someone feels left out — whether it’s a spouse or other children in the home — talk about the problem and be understanding. Although babies require a lot of attention and you and your partner will spend the majority of the day caring for their needs, don’t feel guilty about spending alone time as a couple during the postpartum period.

Baby blues vs. postpartum depression

It’s normal to have the baby blues during the postpartum period.

This typically happens a few days after giving birth and can last for up to two weeks. In most cases, you won’t be experiencing symptoms all the time, and your symptoms will vary.

About 70 to 80 percent of new mothers experience mood swings or negative feelings after giving birth. Baby blues are caused by hormonal changes and symptoms may include:

• unexplained crying
• irritability
• insomnia
• sadness
• mood changes
• restlessness

When should you see a doctor?

The baby blues are different from postpartum depression. Postpartum depression occurs when symptoms last for more than two weeks.

Additional symptoms may include feelings of guilt and worthlessness, and loss of interest in daily activities. Some women with postpartum depression withdraw from their family, have no interest in their baby, and have thoughts of hurting their baby.

Postpartum depression requires medical treatment. Speak with your doctor if you have depression that lasts longer than two weeks after giving birth, or if you have thoughts of harming your baby. Postpartum depression can develop at any time after giving birth, even up to a year after delivery.

Coping with body changes

Along with emotional changes, you’ll experience body changes after giving birth, such as weight gain. Weight loss doesn’t happen overnight, so be patient. Once your doctor says it’s OK to exercise, begin with moderate activity a few minutes a day and gradually increase the length and intensity of your workouts. Go for a walk, swim, or join an aerobics class.

Losing weight also involves eating healthy, balanced meals that include fruits, vegetables, and whole grains. Every new mother loses weight at a different pace, so don’t compare your weight loss efforts to others. Breast-feeding can help you return to your prepregnancy weight faster because it increases your daily calorie burn.

Talk to your doctor if you have questions or concerns about changes to your body during the postpartum period.

Other body changes include:

Breast engorgement

Your breasts will fill with milk a couple of days after birth. This is a normal process, but the swelling (engorgement) can be uncomfortable. Engorgement improves with time. To ease discomfort, apply a warm or cold compress to your breasts. Sore nipples from breast-feeding usually disappear as your body adjusts. Use nipple cream to soothe cracking and pain.

Constipation

Eat high-fiber foods to stimulate bowel activity, and drink plenty of water. Ask your doctor about safe medications. Fiber can also relieve hemorrhoids, as well as over-the-counter creams or sitting in a sitz bath. Drinking water helps ease problems with urinating after birth. 

Pelvic floor changes

The area between your rectum and vagina is known as the perineum. It stretches and often tears during birth. Sometimes a doctor will cut this area to help your labor. You can help this area recover after your delivery by doing Kegel exercises, icing the area with cold packs wrapped in towels, and sitting on a pillow.

Sweating

Hormonal changes can cause nighttime sweating after having a baby. Remove blankets from your bed to stay cool.

Uterine pain

A shrinking uterus after giving birth can cause cramping. The pain subsides in time. Ask your doctor about safe pain medications.

Vaginal discharge

Vaginal discharge is typical two to four weeks after giving birth. This is how your body eliminates blood and tissue from your uterus. Wear sanitary napkins until the discharge stops.

Do not use tampons or douche until your four to six week postpartum appointment, or until your doctor approves it. Using these products in the immediate postpartum period may increase your risk of uterine infection. If your vaginal discharge is foul-smelling, notify your doctor. You may continue to have bloody spotting for your first week postpartum, but heavy bleeding is not expected. If you are experiencing heavy vaginal bleeding, such as saturating one sanitary pad within two hours, contact your doctor.

Outlook

Giving birth can change your family unit and routine, but you’ll eventually adjust. Any emotional and physical changes you experience after birth will slowly improve. Don’t hesitate to talk to your doctor about any concerns, whether it’s related to depression, your baby, or the healing process.