Portpartum Preparation

Recommendations and information provided by Fairfax OB-GYN Associates

Postpartum Instructions / What to Expect

After childbirth, your uterus is firm and round. If you press in at the level of your navel and slightly down, you should feel it, somewhat like a large grapefruit. Usually within 6 weeks the uterus will return to its pre-pregnant size and you will no longer be able to feel it.

Cramping, especially during breastfeeding, is normal. These afterbirth pains may be stronger in those who have had a baby before. Emptying your bladder regularly may help with the discomfort. You can also apply a heating pad to your tummy or take ibuprofen as directed.

Your tummy may still look enlarged but softened, sort of like a deflated balloon. Don’t despair! The abdominal muscles had to stretch to accommodate your baby and they need some time to regain normal tone. To tighten these muscles, start with good posture. Lifting your shoulders to sit up straight and pulling your tummy in will do wonders to get your abdomen back in shape. You can introduce more core exercises over time.

The bloody vaginal discharge after delivery is called lochia. It usually starts out bright red, like a menstrual period, and may have a few clots. Over the coming weeks it should become lighter, transitioning to pinkish brown, then white or yellow. It can last up to 8 weeks. If it goes from brown back to red, you may need to reduce your activity level and get some more rest.

The perineum is the area between the vagina and the anus. During delivery, this area will have stretched and you may have stitches that were placed for repair if it tore. You may feel pain or numbness in the area; it takes time to heal. To care for your perineum: Take sitz baths 3-4 times daily, use the squirt bottle to clean every time you use the bathroom, and take ibuprofen as directed. If you have hemorrhoids: Place witch hazel pads on your anus and avoid constipation (see next entry).

Constipation is common in the first few days after delivery. Eat a high fiber diet, drink at least 8 glasses with 8 ounces of water daily, and take a stool softener if needed. For more information look back under First Trimester, Common Discomforts, Constipation.

You may experience trouble urinating in the first few days postpartum because of swelling from delivery. Using your squirt bottle to pour warm water on your perineum may help to stimulate the flow of urine. You can also try urinating in a warm shower.

You may experience breast engorgement. See Breast Care below.

You may suffer from fatigue or sleep deprivation. Here are some suggestions:

While your baby is sleeping, take a nap yourself.
Limit visitors, especially in the first 4-6 weeks.
Go to bed early.
Only do light housework.
Let others help you clean, cook, and run errands.

You may experience “Baby Blues” or depression. Read more about that below.

We recommend pelvic rest after delivery to allow your body to heal, usually for 6 weeks. You should not have vaginal intercourse until your lochia has stopped and you feel ready. Fatigue and vaginal dryness are common, so don’t rush yourself. You can become pregnant as soon as 4 weeks after childbirth, so have a birth control plan if desired.

Be sure to review the postpartum warning signs below so that you will know when to call us!

For more details, see also: ACNM on What to Expect Postpartum

Pain Medication after a Ceserean

In addition to all the physical changes noted above, women who have had a cesarean are recovering from major abdominal surgery. Rest is critical for healing, but walking around usually speeds recovery by getting the circulation and digestion back to normal.

Hospital discharge instructions contain specific information about warning signs and follow up visits. Here is an example of how to gradually discontinue narcotic pain medication.

For your surgery, you may have had a long-acting morphine through your epidural or spinal. This manages a lot of the pain for the first 12 to 24 hours, and then oral pain medications are usually prescribed. Most women go home with a prescription for either Percocet or Tylenol #3 with codeine. These stronger pain medications are most often alternated with ibuprofen.

Every patient is different, but often toward the end of the first week women find they are ready to reduce their use of strong painkillers. To taper, you can gradually extend the interval between doses. Be sure to continue taking the ibuprofen in between. If at any point your pain level goes above 3 out of 10, you can back up to the dosing frequency that was adequate for a while longer. Ultimately, substituting 2 extra strength Tylenol every 6 hours, interleaved with 600mg of ibuprofen, also every 6 hours, (that means one medication or the other every 3 hours) is a great test for gently finding out if you are ready to discontinue the stronger pain medications completely.

Only you know when your pain is under control; there is no strict time frame that applies to everyone. Call us if you need to discuss your post-operative pain medications.

Breast Care

You can expect swollen breasts about 2-4 days after delivery. This engorgement is caused by milk production; it should resolve in a few days.

If you are formula feeding, you can ease the discomfort by:

Wearing a well-fitting, snug support bra 24 hours a day
Applying cold packs to the breasts
Not stimulating the breasts either by warm showers, sexual activity, or by pumping the breasts
Taking ibuprofen 600mg by mouth every 6 hours as needed

If you are breastfeeding, you can ease the discomfort by:

Breastfeeding whenever the baby shows interest, usually every 2-3 hours
Wearing a well-fitting nursing bra
Applying cold packs between feedings
Taking ibuprofen 600mg by mouth every 6 hours as needed

Breastfeeding Help:

Lactation consultants are available even after you leave the hospital. Go to: Fair Oaks Hospital Breastfeeding Center
If your nipples appear bruised, split, or bleeding, it is likely that the baby is not latching properly. Inova Fair Oaks Hospital has a free latch clinic. Pick up a flyer at our office or call the Lactation Center for time and location (703) 391-3908
For an opportunity to chat with other breastfeeding mothers with a lactation consultant as facilitator, consider Fairfax Hospital’s Weekly Breastfeeding Mother’s Support Group

Hospital Discharge Planning

New mothers are discharged from Inova Fair Oaks Hospital by 11 am on the last day of their stay (usually after 2 nights for a vaginal birth and after 3 nights for a cesarean birth). This allows mothers and babies to get home and settled in the middle of the day. One of our doctors or midwives will advise the hospital staff regarding which day you will be going home.

Please be sure to have your infant car seat and transportation arranged the night before and any prescriptions picked up, so that you will be ready before 11 am. While getting to know your new baby, you will want to take advantage of hospital services such as educational videos and assistance with the birth certificate application. Your nurse is your resource to guide you through the process.

New Mom Support Group

Being a new mother can be amazing and it can also be overwhelming. Sometimes sharing experiences with other new mothers can help with adjusting to a new normal.

There is a weekly “Inova New Moms Group” on the Fair Oaks Hospital campus and also a monthly “Inova New Moms Return to Work Group” near Dunn Loring. Just scroll down to find details at: INOVA childbirth

Portpartum Depression

“Baby Blues” usually begin 2 to 3 days after giving birth. You may be surprised by the feelings of depression, anger, and anxiety that you may experience. You may cry easily for no apparent reason and feel sad or be moody. You may experience trouble eating, sleeping, and making simple decisions. These normal feelings often go away within a couple of weeks. Sometimes, however, they continue and represent true postpartum depression.

If you experience any of the following, please call the office:

Feeling down or sad for 2 weeks or more
Feelings of depression and anger that begin 1 to 2 months after delivery
Increasing feelings of sadness, doubt, helplessness, or hopelessness
Marked changes in appetite and sleeping habits
Losing interest in things that used to be pleasurable
Extreme worry, concern, or anxiety about the baby, or lack of feelings about the baby

Postpartum depression is a serious complication of pregnancy. Please talk with us!

Postpartum Support Virginia is an organization that provides information and support for Moms experiencing postpartum depression. Check out their website: Postpartum Support Virginia OR Postpartum Support International

Postpartum Warning Signs // Call Us

Fever (temperature of 100.4 degrees Fahrenheit or higher)
Nausea and vomiting
Pain or burning when urinating
Excessively heavy or prolonged vaginal bleeding
Foul smelling discharge
Swelling, redness, or tenderness in one area of the breast
Persistent pain in the perineal area with increasing tenderness
Ceserean incision site bleeding, discharge, swelling, redness, or worsening pain
If you are worried or troubled
Feeling sad or down for 2 weeks or more.

If you experience any of the above, please call the office.