Taking Care of Yourself
What's happening to you in the first couple of hours after birth? You have just been through the most intense, life-changing experience there is. You are stunned, exhausted, amazed, thrilled, frightened, and overwhelmed. On top of all that, you have to recover physically and adjust to this major change as soon as possible, because you have a person depending on you who isn't yet aware that she isn't still part of you.
You may be one of the 99 percent of new mothers who give birth in a hospital. You will probably stay there two days — longer if you had a C-section, shorter if you opt to go home early. Your body will go through tremendous hormonal and physical changes in the first few days after you give birth. Here's what's happening:
Your uterus will begin to shrink. This is called involution and it will take four to six weeks before your uterus is back to its pre-pregnancy size (from about the size of a grapefruit immediately after birth to the size of a lime at your six-week checkup).
You may experience after-pains, or contractions that occur as the uterus shrinks after you've given birth. You may feel these pains more intensely when you breast-feed, although not all mothers feel them. Ask your doctor if you can use warm packs to relieve the pain. You can also ask the nurses to massage the fundus, the upper, rounded portion of the uterus, through your abdomen. Ibuprofen also helps.
You will bleed for several weeks as the uterus heals, specifically from where the placenta attached to the uterine wall. The amount of blood may be more than a heavy period. Use sanitary napkins to absorb the blood. Do not use tampons (which might cause an infection) until after you see your doctor at your six-week checkup. You may see blood clots in the first few days, but check with your doctor if you see them after that.
Eventually the blood flow will taper off to what is equivalent to a normal period, and then to spotting. The blood's color will go from bright red to brown to yellow/whiteish. If the blood flow gets heavier or darkens in color, it might mean you're doing too much and should rest. When in doubt, call your doctor.
If your bleeding is so heavy that you soak through a sanitary pad every hour for two hours, contact your doctor or midwife as this may be a sign of postpartum hemorrhage.
You will need to urinate frequently in the first days after giving birth as your body eliminates the extra fluid it stored in the last months of pregnancy. The nurses will keep a close watch on your urine output. Sometimes your bladder may be weakened and overdistended by the large amount of urine produced. Urinary retention can result and require bladder catheterization.
Whether the doctor performed an episiotomy, a surgical incision through the perineum, or you experienced a small-to-medium-sized tear in that area, your bottom is going to be sore for two to ten days.
You may need pain medication. Don't try to be a heroine and tough it out. If you think you need something for the pain: ask. Just remember that narcotic pain-relieving drugs can also cause constipation, so you'll need to eat plenty of fiber and drink lots of fluids. Be sure to remind your doctor if you are breastfeeding so that only safe medications are prescribed.
You will want to ice the area in the first 24 hours to reduce swelling. After the first day, switch to heat. Apply hot compresses and sit in sitz baths to draw blood to the area, which promotes healing.
You may have started to produce colostrum (the first milk) in the last few weeks of pregnancy. The real milk doesn't “come in” until the second, third, or fourth day after giving birth.
What can the nurses provide to keep me comfortable?
There are several simple things that nurses will bring if you ask. These include extra pillows or a donut cushion, topical anesthetic, witch hazel or a sitz bath, stool softener, and as much ice as you can handle. You can also ask them for more food or fluids.
The following symptoms could indicate a post-partum complication, which can be life threatening: fever above 100.4°F (orally); blood clot larger than a walnut; bad-smelling discharge; pain when urinating that gets worse as time passes instead of better; pain in calf or thigh without redness; pain or reddened and tender area on breast.
Keep in mind that in those first couple of days your breasts may become engorged and very painful. They may feel hard and knotty. To relieve the engorgement, you should wear a proper-fitting bra (or a nursing bra if you plan to breastfeed). Apply ice, take some pain medication, and manually express some milk to ease the pain.
If you don't plan to breastfeed, wear a tight-fitting bra as soon after delivery as possible. When you shower, avoid hot water on your breasts.