Caring for yourself
Focus your attention on you and your infant. Be aware that you and your family are going through an adjustment period. This can also be an emotional time. Proper rest and nutrition will help.
Sleep is important! Take naps when you can and try to sleep at least 8 hours at night. Have family and friends do your household chores.
Limit your activity to caring for yourself and your baby the first few days at home, gradually increasing your activity as tolerated. Don't lift anything heavier than 10 pounds. Avoid movements that put a strain on the abdomen, such as vacuuming.
You will be seen by your doctor 4-6 weeks after giving birth. Mild exercise may begin when approved by your doctor.
Wear a supportive, cotton bra as much as possible.
If you are bottle feeding, you will want to avoid stimulation to the breasts (manual or heat) because your hormones may cause engorgement. You are encouraged to hold your baby during bottle feeding since this is a special time for you and your baby to bond.
If you are breastfeeding:
- Wash your nipples with water (no soap) in your daily shower.
- Avoid lotions to the nipple, as they may clog the nipple and areola and prevent normal lubrication. Expressed colostrum and breast milk placed on the nipple can serve as a natural lubricant. Proper positioning of the baby and air drying your nipples after feeding can prevent sore nipples. (See the section on "Sore Nipples" in your booklet "The Intimate Art of Breastfeeding.")
- Full breasts mean the baby needs to nurse more often, at least every 2-3 hours.
Do not lift anything heavier than your baby. Limit activity to caring for yourself and your baby, gradually increasing activity. Do not take a tub bath until approved by your doctor. Showers are fine. Exercise can include head lifts, single leg lifts in knee-chest position. Ask your doctor about exercises you can perform.
Diet and nutrition
This is not the time to crash diet because your body and your baby will need the nutrition provided by good food.
- Each day, drink at least 8 cups of fluid, including water, juice, milk, and soup.
- Eat a variety of foods, including grains (bread, cereal, pasta), vegetables, fruit, meat, poultry, fish, and milk products. Include foods with increased roughage (whole-grain breads and cereals, cooked fruits, and vegetables).
Continue to take your iron pills after delivery unless your doctor tells you to stop. Iron is a vital part of our red blood cells and carries oxygen to our cells. Iron is the most difficult nutrient to get enough of in our diet.
Take iron pills with a high vitamin C drink such as orange juice for better absorption. Iron should also be taken one hour before a meal or two hours after a meal. Increase your fiber intake, too, since iron may cause constipation in some people.
Iron-rich foods include:
- Chicken, fish, tuna, beef, liver, pork, turkey, lamb, eggs, oysters, shrimp
- Beans, peas
- Spinach, greens, potatoes with skins, Brussels sprouts, cooked peas, tomatoes, leeks
- Wheat germ, Cream of Wheat® cereal, iron-fortified cereals, bread
- Dried fruit, raisins, dates, prunes, blackstrap molasses
Cooking with cast-iron cookware may add additional iron to your food.
Women require 800 mg of calcium per day. If you are breastfeeding, you need 1,200 mg each day. Here are some high-calcium food sources:
- Skim milk powder (1/4 cup = 200 mg)
- Low-fat milk (1 cup = 300 mg)
- Yogurt (1 cup = 350 mg)
- Turnip greens, cooked (1 cup = 100 mg)
- Broccoli, cooked (1 cup = 35 mg)
- Tofu (1/2 cup = 150 mg)
- Corn tortillas (2 = 100 mg)
- Calcium-fortified orange juice (1 cup = 300 mg)
When making soup from bones, add 1-2 tablespoons of vinegar during the boiling process. The vinegar will dissolve the calcium out of the bones and give you a soup stock high in calcium. If you wish to take a calcium pill, choose a calcium carbonate formula. Check with your doctor or a registered dietitian if you have questions about supplements.
Tips to increase your fiber intake:
- Cook and eat fruits and vegetables with their skin. Eat at least 5 servings of fruits and vegetables every day.
- Eat whole fruits rather than drink juice.
- Use brown rice instead of white.
- Use whole-wheat bread, cereal, and pasta.
- Eat beans regularly.
Protein-rich foods include:
- Ice cream
- Wash your hands before picking up your baby.
- Wash your hands after using the bathroom.
- Remind visitors to wash their hands before holding the baby.
- Shampoo and shower as often as you need, because feeling fresh will make you feel better about body changes.
- Do not use tampons, douches, or have sexual intercourse for 4-6 weeks or until your doctor says you are healed.
- Rinse perineum with warm water and wipe from front to back after urinating or having a bowel movement. Avoid straining. Call your doctor if you are not having a bowel movement at least every 2-3 days.
- Do not touch your incision.
- Keep incision clean and dry.
- Do not remove steri strips (paper tape across incision). Leave them on as long as they stick well. If ends curl up, trim them with scissors.
- Wash as usual in shower, avoiding perfumed soaps directly over incision. Wash over incision first with clean washcloth, then rest of body. Do not put lotion or powder directly over incision. Pat dry with clean towel.
- Notify your doctor if your incision is red, swollen, or tender to touch; has drainage; your temperature is above 100.4 degrees Fahrenheit; you have increased abdominal tenderness or pain; you experience heavy vaginal bleeding; you have pain, tenderness, redness, or swelling in any area of the legs; you experience frequency, burning, or pain on urination; you have increased pelvic pain; you are constipated; or your pain medication is not providing sufficient pain relief.
Your doctor must see you to check your incision and recovery. He/she will instruct you when to return to the office for this checkup. You will also need
to see your doctor about 6 weeks after delivery.
To decrease the risk of infection:
- After you urinate or have a bowel movement, rinse your perineum (the area between your vagina and rectum) with warm water, using your peri bottle. Spray and pat dry from front to back.
- Change your pad with each urination/bowel movement.
- Your vaginal drainage (lochia) can continue for several weeks. At first, the drainage is dark red, then brownish, then yellowish or white for 2-6 weeks. Once you're home, if lochia increases, rest with your feet up. If increased bleeding continues after rest, or if you saturate one pad in one hour, call your doctor.
- You may sit in a clean tub with 6 inches of warm water or use a sitz bath several times a day to ease any discomfort from hemorrhoids or your perineum.
- If you have an episiotomy, your stitches will dissolve with time. Keep clean as directed above. Use Dermoplast® spray as instructed by your nurse over sore areas. Tucks® should be placed over stitches and are held in place by pads. They should be changed with pads.
Exercise can help your recovery from childbirth, ease your feeling of being tired, and raise your energy level.
If you had a cesarean, difficult vaginal birth, or complications, ask your doctor before starting an exercise program.
Any exercise program should begin slowly and gradually increase in intensity. Walking is a great way to get back into or begin a new exercise program.
Two areas of your body that need special attention after delivery are your abdominal muscles and your pelvic floor. The following exercises can be started within 24 hours of vaginal delivery:
Abdominal (stomach) wall tightening
- Lie flat on your back with your knees bent.
- Exhale while tightening your abdominal muscles.
- Hold for 2-3 seconds, then inhale and relax your abdomen.
- Repeat several times each day.
Kegels. Perform Kegel exercises daily to tighten stretched perineal muscles and heal your stitches.
First, learn exactly which muscle to exercise by starting and then stopping the flow of urine when you urinate. This is the Kegel muscle. (Do not continue Kegel exercises while urinating).
- Tighten the Kegel muscles, holding your buttocks together for 10 seconds.
- Continue to tighten your Kegels higher up into the vagina by imagining going up to the third, fourth, and fifth floors.
- Repeat several times each day, increasing the length of time you tighten the muscles at each floor.
- Don't hold your breath while doing these exercises.
Pelvic tilts. Tilting your pelvis back toward your spine helps strengthen your abdominal muscles.
- Lie flat on your back with your knees bent.
- Exhale and pull up your buttocks, rotating your pubic bone toward your head.
- Hold for 3 seconds and then inhale and relax.
- Repeat several times each day.
Sex after childbirth
Your body needs time to heal, your hormones are changing, and your energy is being used in many new ways while you get to know your baby. Feeding and caring for a new baby is a lot of work, and you may be very tired in the beginning.
Your doctor will probably suggest that you wait 4-6 weeks before having sex. You may or may not feel ready then. When you do begin to have sex again, you might need to use a lubricant (Hint: The same lubricant you use for the baby thermometer works well for this, too).
If you do not want to become pregnant again right away, be sure to plan with your partner and doctor to ensure some form of birth control. Condoms with foam work very well.
Many new mothers feel sad, afraid, angry, or nervous after their baby is born. These feelings, called postpartum or baby blues, are very common. Signs of postpartum blues start a few days after the baby is born and usually go away in 1 or 2 weeks. Don't feel guilty about feeling sad or worried after your baby is born. These are normal feelings. Having these feelings doesn't mean you are a bad mother. It is normal to have mixed feelings about motherhood as your body adjusts to the changes that follow childbirth.
If, however, your "blues" don't go away or become worse, you may be suffering from postpartum depression. When depressed, you may not be able to care for your baby or yourself. Severe depression usually goes away with treatment. But without treatment, it can get worse and may lead to thoughts of hurting yourself or your baby.
Causes. Postpartum depression may be caused by hormone changes in your blood. Stress, lack of sleep, poor diet, and/or not enough help may cause depression. Women who have mental health problems before childbirth are more likely to feel depressed after having a baby.
Signs and symptoms. You may feel sad, nervous, irritated, or moody. You may feel angry at your baby, your partner, or your other children. You may also have have trouble sleeping, eating, or making decisions. Other signs may be loss of energy, weight changes, or having no interest in doing your usual activities. With severe depression, you may feel like hurting yourself or your baby.
Care. Postpartum depression will often go away with rest and help from your family and friends. Counseling or medicines may be needed to treat your depression, or you may need to be put in the hospital for more treatment.
- Rest is important. Don't try to do everything. Do only what is needed and let other things wait until later. Ask your partner, family, or friends for help, especially if you have other children.
- Try to nap when the baby naps. Ask your partner to help with night feedings or other baby care if possible.
- Share your feelings with your partner, friend, or another mother. Often just talking things out with someone you trust is a big help.
- Take good care of yourself. Shower and dress each day. Don't forget to eat. Try to get out of the house a little each day. Go for a walk or meet with a friend. Get a baby-sitter or take the baby with you. Be sure to spend time with your partner. And it is important to have some time to yourself each day.
When to call a professional
- If you feel more depressed or your depression does not go away.
- If you need to talk about your problems. You may call a caregiver, hospital emergency department, or mental health center. They can help you sort through your feelings. They also may be able to help you find a support group of other women.
Call 9-1-1 or 0 (operator) if you feel like hurting yourself, your baby, or others.
When to call the obstetrician
Call your doctor if you have:
- Fever of 100.4 degrees Fahrenheit or higher
- Frequency, burning, or pain with urination
- Heavy vaginal bleeding - saturating more than one pad in an hour
- Swelling, redness, extra tenderness, bleeding, or pus drainage from your breasts
- Pain, tenderness, redness, or swelling in any area of your legs
- Increased pain, tenderness, redness, swelling, or pus drainage from your episiotomy or incision
- Increased pelvic or abdominal pain
- Depression or feelings that you are unable to cope with the baby
- Questions about your condition or care
Make sure you keep follow-up appointments with your doctor.
Continue prenatal vitamins. If needed, you may take stool softeners such as surface, colace, DDS, or dialose plus. Acetaminophen (Tylenol®) is safe for minor pain and headaches. These medications may be purchased over the counter at your local pharmacy.