About Mom

At last, it finally happened. Your pregnancy is over and you have a beautiful new baby. Regardless of whether this is your first or your fourth birth, you will have questions about your own care. The following information will help you care for yourself before your first visit to your obstetrician.

Most women who give birth recover without problems. However, any woman can have complications after giving birth. Learning to recognize these POST-BIRTH warning signs and knowing what to do can save your life.

These post-birth warning signs can become life-threatening if you don't receive medical care right away because:

• Pain in chest, obstructed breathing, or shortness of breath (trouble catching your breath) may mean you have a blood clot in your lunch or a heart problem
• Seizures may mean you have a condition called eclampsia
• Thoughts or feelings of wanting to hurt yourself or someone else may mean you have postpartum depression
• Bleeding (heavy), soaking more than one pad in an hour, or passing an egg-sized clot or bigger may mean you have an obstetric hemorrhage
• Incision that is not healing, increased redness, or any pus from episiotomy or C-section site may mean you have an infection
• Redness, swelling, warmth, or pain in the calf area of your leg may mean you have a blood clot
• Temperature of 100.4°F or higher, bad smelling vaginal blood or discharge may mean you have an infection
• Headache (very painful), vision changes, or pain in the upper right area of your belly may mean you have high blood pressure or post birth preeclampsia

Always practice good hygiene to prevent the spread of germs. Wash your hands with soap or use hand sanitizer often, especially before and after caring for yourself and your baby.

After giving birth, your uterus is about the size of a large grapefruit and is located in the navel area. It moves around freely because the round ligaments that hold it have stretched and must shorten and return to their former length. This may result in backache or a stretching, pulling discomfort in the groin area. Within the first few days after birth, locate and massage your uterus several times a day until it feels quite firm. Each day, you will notice it is farther down in the pelvis. You should not be able to feel it by the end of the first week.

You may experience uterine cramping or after-birth pains when the uterus is massaged or while nursing. This is more common with your second or third birth. It is nature’s way of contracting your uterus back to its pre-pregnant size and preventing unnecessary blood loss.

These contractions will slowly decrease in their intensity and frequency but can last for several days. If needed, a mild analgesic such as acetaminophen or ibuprofen may help relieve the pain. Check with your healthcare provider before starting any medications.

Right after birth, whether you have delivered vaginally or via cesarean section, your vaginal flow will be bright red, similar to your menstrual flow. Use pads rather than tampons to decrease the risk of infection and to allow your uterus and cervix to heal properly. Don’t use tampons or douche for six weeks.

Nursing, which causes the uterus to contract, may cause some bleeding the first few days after birth. This is normal. If it continues or occurs at other times, you may be overexerting yourself and need to rest more. If moderate or heavy bleeding (more than one pad per hour) continues, notify your healthcare provider.

In three to four days, the discharge becomes more watery and pale. By the second week, lochia is thicker and more yellow in color. Finally, after about four weeks, the discharge decreases to a minimum as the uterine lining heals.

The healing process, which usually lasts about three to six weeks, is completed when there is no further discharge. Full activities can usually be resumed at this time. Your physician will let you know for sure.

Occasionally, you may pass a clot that is very dark red. It may be small or as large as a golf ball. This is old blood that was in the uterus after the birth and is expelled as the uterus contracts. If clots are very large or if your bleeding increases after passing a clot, call your doctor.

To reduce the risk of infection, you should shower every day using soap and water on your perineum. Between showers, keep the area clean and dry. Washing your perineum helps to prevent infection and aid healing after birth. Use a bottle filled with warm water to wash the perineum area after you urinate or have a bowel movement. Blot dry with toilet tissue. Always blot dry from front to back (never from back to front) to avoid introducing bacteria from the rectum into the urethra. Use an anesthetic spray, such as Dermoplast ^®  or Epifoam ^® , if prescribed by your healthcare provider. Change your pads frequently so that a dry surface is next to the healing skin.

Some women suffer from hemorrhoids during and after pregnancy. They are often more painful than the sutures. Use sitz baths, witch hazel pads, anesthetic sprays or other medications as recommended by your physician.

Spend time in standing or lying positions and avoid sitting whenever possible. When you do sit, squeeze your buttocks together first to make it more comfortable. When bathing, lie down to avoid pressure on the hemorrhoids.

An abdominal incision is most commonly closed with small skin staples that are usually removed two to three days after surgery. Steri-Strip^TM skin closures are applied after the staples are removed to keep the skin edges together during the final stage of healing. These skin closure strips should begin peeling off seven to 10 days after application. Please leave them on until they come off on their own. You may shower only; please do not take a tub bath until cleared by your doctor. Pat the incision area dry after getting out of the shower.

A dressing over the incision is not necessary. The incision may feel firm and lumpy as it heals. Any signs of infection such as extreme redness, drainage, swelling, pain or a fever exceeding 100.4 degrees F (or 38 degrees C) should be reported to your doctor.

Bladder sensation and muscle tone are often diminished after birth. Plan to urinate at regular intervals, rather than waiting for the sensation of a full bladder. Symptoms such as burning, frequent urination or urinating in small amounts should be reported to your healthcare provider.

Begin Kegel exercises as soon as possible after birth, and continue to do several sets during the day. Kegel (or pelvic floor) exercises can be performed anywhere or anytime. Simply pull in the sling of muscles through which the baby was born, as if holding back both urine and a bowel movement, and hold tightly for a few seconds, then relax. This pelvic floor exercise tightens the opening of the birth canal. Repeat four to six times at first, building up gradually to 10 times. Practice this exercise several times a day while doing normal activities. Some experts suggest repeating this exercise about 50 times daily.

You can usually expect to have a bowel movement by the second or third day after birth. A balanced diet with adequate fluids will help. Fresh fruits and vegetables, whole-grain bread and cereals, and some prunes or prune juice are good natural laxatives. If necessary, your healthcare provider may suggest a stool softener.

Having your first bowel movement is not as traumatic as you may think it will be, and it will be uncomfortable if you put it off. The pressure of a full rectum can be more painful because of the pressure on the suture area.

Intercourse should not be resumed until after your postpartum checkup with your healthcare provider. You should discuss resuming sex with your partner so that there will be fewer frustrations and misunderstandings. You may not be as interested in having sex as you were before pregnancy because of fatigue and the time demand by the baby. You may also have concern about pain in the area of the episiotomy or cesarean section incision.

You can expect vaginal dryness and diminished vaginal lubrication because of the hormones of pregnancy and/or breastfeeding. A water-soluble cream or jelly can solve this problem.

If you experience difficulty with sexual intercourse, always discuss it with your partner. Set aside time for each other without the baby to become reacquainted. If the problem persists, then discuss it with your healthcare professional. To prevent another pregnancy, use birth control each time you have sex.

Infection is possible, especially after a cesarean section. Call your healthcare provider if you have any of the following warning signs:

• Chills or a fever over 100.4 degrees F (or 38 degrees C)
• Unusual lower abdominal pain
• Foul-smelling vaginal or incision discharge
• Localized, persistent breast pain
• Thick drainage from a cesarean section or tubal ligation incision
• Pain, redness or swelling over perineum, incision or varicose vein

Mild to moderate discomfort can be alleviated with acetaminophen or ibuprofen. Always follow package instructions and check with your healthcare provider first. Episiotomy pain can also be relieved with a sitz bath.

A well-balanced diet is essential for the body to remain healthy and to heal properly after giving birth. A healthy diet consists of foods from the five food groups, which include dairy, protein foods, grains, fruits and vegetables. You should have three meals per day plus nutritious snacks between meals. You should also drink approximately six to eight glasses of liquid per day.

If you are breastfeeding, your dietary needs are greater. You should consume sufficient foods and fluids so that you are not hungry or thirsty. You should eat a variety of foods from the five food groups and continue to take your prenatal vitamin supplements. You do not need to avoid certain foods unless you are allergic to them.

Losing weight will continue for approximately six weeks while consuming a normal amount of calories. Initially, weight loss is rapid. As it slows down, a loss of two to three pounds per week is optimal to maintain good health. A dietitian should be consulted for individualized suggestions on special diets or special dietary needs.

If you stopped smoking before becoming pregnant or when you found out that you were pregnant, congratulations! Quitting smoking not only has health benefits for you, but for your baby, too. If you did not stop smoking, now is another opportunity.

Benefits for you:

• You will have more energy and breathe easier
• You will save money that you can spend on other things
• Your clothes, car and home will smell better
• Your skin and nails won’t be stained and you will have fewer wrinkles
• You will feel good about quitting

Benefits for your baby:

• Your baby will be healthier and have fewer asthma and wheezing problems
• Your baby will have fewer colds and ear infections
• Your baby will cough and cry less
• Your baby will be at reduced risk for sudden infant death syndrome

Get ready:

• Think about how quitting will help you and your baby
• Plan on not smoking once you bring your baby home
• Set a quit date and stick to it—not even a single puff
• Get rid of ALL cigarettes and ashtrays in your home, car or workplace. Make it hard to get a cigarette.
• Set up smoke-free areas in your home, and make your car smoke-free

Get support and encouragement:

• Tell your family, friends and co-workers you are quitting, and ask for their help
• Ask smokers not to smoke around you
• Talk to women who quit smoking when they were pregnant
• Talk with your prenatal care provider about your plan to quit
• For free help, call (800) QUIT-NOW (784 -8669) to be connected to the Texas Tobacco Quit line

Be prepared to handle “slips”:

• If you “slip” and smoke, don’t give up
• People who quit after they “slip” tell themselves, “This was a mistake, not a failure”
• Set a new date to get back on track
• Remember that by quitting, you are protecting your baby’s health and your own
• Breathe deep, inhale through your nose, count to five, slowly exhale through your mouth
• Try to drink eight or more 8-ounce glasses of water a day
• Keep your hands busy. Wash your car. Draw or color in an adult coloring book. Do a puzzle.
• Delay – the urge to smoke only lasts three to five minutes

Postpartum depression occurs in 1 out of 10 women in the postpartum period. It can begin any time after birth and may appear for up to a year after delivery. Contact your healthcare practitioner if any of these symptoms lasts for more than two weeks or get worse:

• Feeling sad, hopeless or overwhelmed
• Crying a lot
• Being excessively worried, irritated or restless
• Sleeping too little or too much
• Having no energy or motivation
• Feeling uninterested
• Having a lack of focus and concentration, withdrawal
• Feeling worthless and guilty
• Eating too little or too much
• Withdrawing from friends and family
• Having headaches, chest pains, heart palpitations or hyperventilation

Resources

• National Maternal Mental Health Hotline: Call or Text 1-833-943-5746 (in English and Spanish)
• National Crisis Text Line: Text HOME to 741741
• MAMA Hotline: Call or Text 1-833-852-6262 (in English and Spanish)

What does it feel like to have postpartum depression or postpartum anxiety? What are the signs and symptoms? How do you know you have it? And if you do have it, what should you do? We’re happy to explain, using words that make sense. When you read the two different symptom lists on the following pages, one for postpartum depression and the other for postpartum anxiety and obsessive-compulsive disorder, please remember a few very important things:

1. You may not have all of the symptoms listed or even most of them. Postpartum depression and anxiety are not “one-size-fits-all” illnesses.
2. We all have bad days. Postpartum depression and anxiety are not just bad days. Women with postpartum depression or anxiety have symptoms like the ones listed much of the time for a period of at least two weeks or longer, and these symptoms make it very hard to live and enjoy your life each day.
3. Postpartum depression and anxiety are sometimes “comorbid.” This means you can have a bit of both or all of both. If you have symptoms on both lists, that’s not unusual.

• You can’t understand what is happening to you or why. You are very confused and scared.
• You feel irritated or angry. You have no patience. Everything annoys you. You feel resentment toward your partner or others. You feel out-of-control rage.
• You feel nothing, just emptiness and numbness. You are just going through the motions.
• You feel sadness to the depths of your soul. You can’t stop crying, even when there’s no reason to be crying.
• You can’t bring yourself to eat, or perhaps the only thing that makes you feel better is eating.
• You can’t sleep. Or maybe you can fall asleep, but you wake up in the middle of the night and can’t go back to sleep no matter how tired you are. Or maybe all you can do is sleep, and you can’t seem to get out of bed to get the most basic things done.
• You can’t concentrate. You can’t focus. You can’t think of the words that you want to say. You can’t remember what you were supposed to do. You can’t make a decision. You feel like you’re in a fog.
• You feel disconnected. You feel strangely apart from everyone for some reason, like there’s an invisible wall between you and the rest of the world.
• Maybe you’re doing everything right. You are exercising. You are taking your vitamins. You have a healthy spirituality. You do yoga. You’re thinking, “Why can’t I just get over this?” You feel like you should be able to snap out of it, but you can’t.
• You might be having thoughts of running away and leaving your family behind. Or you’ve thought of driving off the road, or taking too many pills, or finding some other ways to end your misery.

You may have postpartum anxiety or postpartum obsessive-compulsive disorder if you have had a baby within the last 12 months and are experiencing some of these symptoms:

• Your thoughts are racing. You can’t quiet your mind. You can’t settle down. You can’t relax.
• You may feel the need to check things constantly. Did I lock the door? Did I lock the car? Did I turn off the oven?
• You may be having physical symptoms like stomach cramps or headaches, shakiness or nausea. You might even have panic attacks.
• You feel like a captive animal, pacing back and forth in a cage. Restless. On edge.
• You can’t eat. You have no appetite.
• You’re having trouble sleeping. You are so tired, but you can’t sleep.
• You feel a sense of dread, like something terrible is going to happen.
• You know something is wrong. You may not know you have a perinatal mood or anxiety disorder, but you know the way you are feeling is NOT right. You think you’ve “gone crazy.”
• You are afraid that if you reach out for help people will judge you. Or that your baby will be taken away.

Postpartum psychosis is a rare disorder that occurs in 1 in 1,000 women in the postpartum period. It usually occurs within two to three weeks after childbirth. Symptoms include:

• Hallucinations (seeing objects that aren’t really there)
• Delusions
• Severe insomnia
• No interest in eating
• Extreme anxiety and agitation
• Suicidal or homicidal thoughts or gestures
• Lack of attention to personal hygiene

If you experience any of these symptoms, please go to the emergency room as soon as possible. Postpartum psychosis is a severe medical emergency and requires immediate medical attention. When left untreated, this disorder can have tragic results.

• 1 in every 7 women will get a perinatal mood or anxiety disorder like postpartum depression or anxiety. These illnesses are not normal but very common.
• If you are experiencing any of the symptoms on these lists, call your doctor. Don’t try to wait this out. These illnesses require professional treatment, and there are different types of treatments that work. You WILL get well with help.
• If you are already past 12 months postpartum and still suffering, you could still have postpartum depression or anxiety. Women who haven’t received treatment or who were not effectively helped can have symptoms that continue past the first year. You can still get help.
• If you are having moments when it seems like you are seeing or hearing things that no one else does, are feeling paranoid as if others are out to get you, have more energy than you’ve ever had and feeling like you don’t need sleep, or are having thoughts of harming yourself or others, call for help immediately. These could be signs of postpartum psychosis, an illness that can lead you to act in ways that you wouldn’t normally.

Call your healthcare provider if you:

• Have a fever above 100.4 degrees F (38 degrees C)
• Are passing vaginal blood clots larger than a ping-pong ball
• Saturate more than one pad an hour
• Have a vaginal discharge with a foul-smelling odor
• Feel dizzy or lightheaded
• Experience worsening abdominal pain
• Have severe constipation
• Experience pain, burning or increased frequency when urinating
• Have worsening pain, redness or increasing drainage around your perineum (the skin between the vagina and anus)
• Have increased swelling, redness, drainage or separation around stitches (episiotomy or cesarean section)
• Have areas on the leg or arm that are tender or red (blood clot)
• Find yourself constantly crying or worrying excessively
• Have thoughts of hurting yourself or your baby
• Have problems eating or sleeping
• Are unable to care for yourself or your baby
• Experience any extreme behavior changes
• Feel severe breast pain or have red, tender areas on either breast (mastitis)
• Experience any flu-like symptoms