Post Partum Instructions
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When a woman is about to give birth, she is sad because her hour of suffering has come: but when the baby is born, she forgets her suffering, because she is happy that a baby has been born into the world. — (John 16:21)
Children are a gift from the Lord; they are a real blessing. — (Psalm 127:3)
And He said: “I tell you the truth, unless you change and become like little children, you will never enter the Kingdom of Heaven. And whoever welcomes a little child like this in my name welcomes me.” —(Matthew 18:3,5)
CONGRATULATIONS! from all of us at the Tepeyac Family Center! You have made it through labor and delivery, and the transition to a larger family has begun. The circle continues: the end has become a beginning….
Here are a few tips for the post delivery period to help you take care of yourself, because we look forward to seeing you and the baby at your six to eight week post partum visit.
Other Temporary Symptoms That Can Be Experienced
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THE DAY OF DISCHARGE
Once you arrive home, you should rest for the remainder of the day. Truly try to limit the amount of activity and visitors to prevent excessive fatigue. To be a good mother, you do not have to do everything on your own all the time. Ask for help. People that are helpful, will cook, clean, do laundry, etc. they don’t come over to simply hold the baby. Also, please call Tepeyac to schedule your six to eight week post partum visit. This is the optimal time to assess the cervix for abrasions, eversions, and erosions in preparation for observing the mucus sign of Natural Family Planning after the bleeding and healing have finished.
BABY FEEDING
We at Tepeyac encourage you to breast feed your newborn infant, however your decision to breast or bottle feed your baby will depend on what is best for your family at this time. If you have decided to breast feed, hopefully the class at the hospital has provided you with good practical information. Here are some bits of wisdom:
- This is a learned behavior; it does not come naturally
- There are some situations in which breastfeeding is not possible; do not feel guilty if you truly can not breast feed
- Be persistent; the more you place the child to the breast, the better you will be at breast feeding
- Your nipples may be very sore for the first two or three weeks; the pain will begin to ease off
- Correctly positioning the baby with the jaws on your areola, will minimize sore or damaged nipples
- Breastfeeding your child for at least six months provides an excellent start to the child’s healthy immune system
- Surround yourself with women who have breastfed; they will provide tricks of the trade to help you through any difficulty
- Decide with your husband whether feeding on demand or on a schedule is the path to be taken for your family
- Lactation consultants and the La Leche League are valuable resources
GENERAL ACTIVITY
Fatigue is your number one enemy! "Be ruthless about getting rest.” Remember moderation in planning your activities. Gradually increase your activities each day remembering that resting some in both the morning and the afternoon is extremely important. If there is doubt about doing an activity, either don’t do it, or give us a call. Strenuous work, heavy lifting, and pushing the social calendar are all to be put on hold. Please ask your spouse, family and friends for help during the post partum period. Please make sure that you have at least ten minutes to yourself every day, even if you have numerous children and a busy husband. Don’t feel guilty about this time; we all need some time alone especially when adjusting to the demands of parenting a new baby.
STAIRS
You can climb stairs as soon as you get home. Just remember that fatigue is part of the recovery process. Take stairs one at a time at first with someone else carrying the infant for you. If you live in a multiple level home, try to confine yourself to one level for a few days if at all possible, limiting stair climbing.
DRIVING
You may drive a soon as you are prepared to step on the brake quickly and effectively. (If you had a c-section, please read that section for specific driving restrictions.) Wearing seatbelt correctly positioned on your body, and having someone with you to help drive if you become fatigued are recommended when driving soon after the delivery experience.
EXERCISE
Slowly increasing your regimen after the first four weeks is recommended. Sit-ups, leg lifts, crunches and aerobics are all within reason if you start out slowly taking into consideration your decreased blood count and general fatigue. Kegel exercises, which aid healing and improve pelvic muscle tone, can be started immediately after the delivery along with an increasing walking regimen. For cesarean deliveries, the exercise may begin after the six to eight week check up.
SEXUAL RELATIONS
You may not resume sexual relations until you have seen us for your six to eight week post partum visit and only if the bleeding has stopped.
POST PARTUM CARE
After the birth of your child, the placenta should separate from the womb within thirty minutes. Lower abdominal cramping will accompany this process. You will also notice this when the little one breastfeeds. This is a healthy process to help slow down the bleeding from the healing uterus. The cramping should decrease after 48 hours from delivery, but may increase if your activity increases. Ibuprofen, 600 to 800 milligrams, three times a day is excellent for these pains. If this is your second or third child, some moms say the cramps are more intense. Please take the medicine; it will help you care for your baby better. Lastly, sharp pains in the vagina are not normal, so if you experience this, please contact the office.
You may notice that your ankles are swollen after the delivery, even more than at the end of pregnancy. Your wrists and hands may also be swollen. This is the natural process of your body using these areas to store the extra fluid you accumulated during the pregnancy. You will eventually urinate it out. This may last for ten to twenty days after your delivery; increased activity will hasten this fluid removal.
This is the most commonly asked question after delivery. Your bleeding may continue slight to moderate up to six weeks after delivery. If at any time you pass clots the size of your palm every ten to fifteen minutes, immediately call the office. You may pass more blood if you are more active, and if you rise from a resting position soon after delivery, the blood pooled in the vagina may leave the birth canal in one large lump. This is not the same as a flow of blood continuing for a half an hour or more. Also, the flow may stop and start. This is due to many factors such as physical activity, breastfeeding changes, or infection with fever. Most importantly, it is considered very normal.
We recommend that you do not use a tampon until your first period. Your first period may not only be heavier than normal, but may begin due to your nutritional status, stress level or breastfeeding schedule. We recommend that all patients begin to notice their vaginal secretions after delivery on a daily basis, and bring up the topic at your six to eight week check up.
There are special needs following a cesarean delivery. The pain from a cesarean not only comes from the uterus contracting back to its non-pregnant size, but also from the incision itself. The ends of the incision are where the knots are placed and these areas are the places where the pulling and burning sensations are usually located. Prescription pain medicine will be provided to you for the incision pain as necessary. This, interspersed with 800 milligrams of ibuprofen three times a day, should keep the pain to a minimum. Keep the incision clean with soap and water. The steristrips that cover the incision will become darker and some will peel off in about a week. If they haven’t come off by two weeks after your surgery, please remove them yourself or call the office for help. No special dressing is necessary. It is OK to take a shower and get the steristrips wet. Most commonly, the sutures are buried under the skin so you will not see anything but the incision during the post partum period. A slight separation in the skin edges with oozing of clear fluid may occur, so clean the area with half peroxide and half water. Hardness at the incision site and numbness over the area is expected as is a pulling feeling at the sides. If the incision becomes red and warm to the touch, opens widely, or drains a whitish or yellowish liquid contact the office. Also, using a small pillow to place gently but firmly over the incision while sitting or standing up will lend extra support to the area. The incision will need six weeks to get strong enough for all your usual activities.
Please do not lift your older children routinely during this time, and if you must, use good posture, and sit first before lifting them onto your lap before standing up. A good rule of thumb is to lift no more than your newborn for the first several weeks after delivery. You may not drive until fourteen days after a cesarean. You may not drive if you are still taking the prescription pain medication. You should have another licensed driver accompany you the first few times, and you should wear your seatbelt at all times. The incision will be 85% healed by the twenty-first day post-op.
As Oprah says, the first bowel movement after the birth of your child may be more painful than the birth itself! Go ahead and increase the fiber in your diet: bran cereal, fresh fruits, green vegetables, Metamucil or Citrucel. Drinking six to eight glasses of water daily will help prevent constipation. Pericolace, Senokot, and their generic versions are excellent natural stool softeners which can be taken once or twice daily. Another suggestion would be to use natural laxatives. We recommend prunes or their juice eaten or drunk once or twice daily.
Eating a well balanced diet whether or not you are nursing is crucial to the post delivery time. Multiple small meals of protein and carbohydrates will ward off hypoglycemia (low blood sugar). Continuing to take your prenatal vitamins and iron supplement (if this was prescribed) will help decrease the fatigue that follows the normal blood loss after a delivery. If you are breastfeeding, drinking an extra quart of water is necessary for good milk production, and helps prevent constipation.
Now is the time to reconsider old habits such as cigarette smoking, illicit drug use or alcohol abuse. If you decreased these habits during pregnancy, it is now even more important to continue this trend or stop the habit all together, because the child is now your shadow. Please ask the office for help in this regard.
We have tried to minimize the use of cutting an episiotomy at your birth, as we feel that small tears are much easier for your body to heal than incisions that may extend into your rectum by the pressure of the delivering head of your baby. However, if we feel that the tear would be extensive and/or close to your urethra and bladder, or your child’s decreased heartbeat warrant a rapid delivery, we will place a small episiotomy at the bottom of your vagina. We use absorbable sutures that will dissolve in approximately three to four weeks. The discomfort will gradually decrease as the sutures dissolve. Sitz baths three times daily for the first two weeks will increase their healing, and keep the area clean. Water sprays to the area after using the restroom, and adjusting the pad so as not to rub this area will keep the episiotomy site clean and minimally irritated.
For the relief of pain, we recommend Dermoplast Spray, witch hazel pads, comfrey soaks, ibuprofen, and avoiding constipation. You may see a stitch pass between the second and fourth weeks after delivery, this is normal. If you notice a reddened, tender, pus-filled, foul-smelling episiotomy site, along with a fever of 101 degrees, please call the office. Also, avoiding lifting items larger than the newborn for the first two weeks will facilitate healing. Lastly, if you are breastfeeding, the vagina will be quite dry and this may cause the stitches to itch. An over the counter steroid like Cortaid cream would be helpful to minimize the itching and discomfort.
Pain, itching and bleeding may all accompany hemorrhoids that developed prior to the birth during the pregnancy. Prevention of constipation is key in minimizing the effects of your hemorrhoids. They will also respond to sitz baths and witch hazel pads. Creams such as Anusol and Proctofoam, along with Preparation H may sooth irritated hemorrhoids. A prescription may be obtained from us if needed.
Showering and most forms of personal hygiene are perfectly OK. You should wait until the bleeding has stopped before taking tub baths. Wait until your bleeding has completely stopped before using the local pool, lake or ocean. Also, warm sitz baths help the vaginal heal and decrease the discomfort of hemorrhoids. With a cesarean section scar, the same rules apply for bathing.
Your emotions are on a roller coaster ride after the baby’s arrival. Your lack of sleep that accompanies the newborn’s arrival plays a critical role in this fluctuation from pleasant and pleased over the miracle addition to the family to tired, irritable and perhaps even depressed for no known reason. Being unable to troubleshoot your child’s tears and desires immediately, plus the loss of the hormones that the placenta was dumping into your body just prior to delivery, create the perfect scenario for this emotional snake pit. Getting rest when you are able and napping when the baby naps is helpful. Also, some assistance at home for the first few days will help you get some rest. Being out with friends may be helpful, as well as talking with other new moms. If you find yourself depressed every day after the first three weeks, please call the office. Lastly, if you suffered a prior abortion, the sadness from that pregnancy may piggyback onto this present post partum time, so be sure to call the office if you recognize this depression lasting longer than the first three weeks following delivery.
Symptoms to look for:
- Persistent insomnia, besides being up with the little one
- Extreme restlessness
- Extreme fatigue
- Rapid, unexplained mood swings
- Hallucinations
- Decreased appetite or overeating
- Sense of despair, hopelessness or helplessness
- Thoughts or fears of hurting yourself or your baby
Please call the office if you are experiencing any of these symptoms.
Breastfeeding exclusively may suppress your return to ovulation after the delivery. We recommend that you learn to observe your vaginal secretions which will include cervical mucus. Start this observation four to six weeks after the birth of your child. Your past track record with prior pregnancies may be helpful in identifying the return to menses with or without breastfeeding. If you are minimally breastfeeding, or bottle feeding, your cycles and the possibility of cooperation with God to create another miracle can occur within two to six weeks after the birth. If you are fully breastfeeding and not using a pacifier, the return to fertile cycles may take up to twelve months or longer to occur. Please contact the office for more information, because now is the time to reassess your past contraceptive options, and learn about the reproductive wonders of your body, termed Natural Family Planning. Please do not hesitate to contact us; we would love to help you with this. With good instruction, you can understand the language of your body without the unpleasant side effects of hormonal or barrier methods of contraception.
Other Temporary Symptoms That Can Be Experienced
- Heavy perspiration
- Yellow or brown vaginal discharge
- Skin dryness or oiliness
- Hair loss
WORK
You should also be discussing whether you need to return to work. Many things must be considered. Pray with your husband with regard to this decision. If so, perhaps it would be possible to work part-time or from home. These situations are better, but not always possible. The most important consideration will be who will care for the baby. If you have any willing relatives, they are often an excellent choice. However, if you are not among the few blessed with grandparent daycare providers, there are other options.
SOME FINAL THOUGHTS
Children should be welcomed, not wanted or unwanted. They are the vehicles through which we learn to love unconditionally. They are welcomed because they are His gifts to us and are on loan to us so we can help raise and educate them, so they will be able to one day see Him face to face. This is our duty as parents.
Now is the time to love your spouse and thank him for being a part of this miracle while helping him to see the transition from being his wife to now being both wife and mother to his children. Your primary relationship is still each other, but your duties are no longer exclusively focused on each other but on the family. This change can be a challenge to see and understand at first. You can be instrumental in helping him see this reality, and to realize his own transition to both husband and father. Remember, that men can be slower to perceive certain things.
Just as the best gift a mother can give her children is to love their father, the best gift a father can give his children is to love their mother. His help in doing the dishes, cleaning the home, cooking the dinners, running the errands, giving 30 minute back massages, and setting up travel plans to warm and sunny places for several months after the delivery are not bad ideas either! All things are possible with the Lord!
Most importantly, thank the Almighty Lord for this gift of new life and dedicate or baptize the child formally as soon as possible. As you know, the spiritual soul of your child is as important, if not more so than the physical side. If you are away from your faith, now is the perfect time to go back. Turn the diapers, colic, and spit ups into praises and thanksgiving to our Father in heaven for this miraculous gift of new life, and look forward to the many ways He will bless your family.