Infections
Postpartum infections are caused by bacteria entering the uterine cavity, the urinary tract, or the site of an incision or tear. But there are also other kinds of infections that can occur during postpartum, such as breast infections and respiratory infections. Since infections can be serious, it's important to be on the lookout for fever and other signs of infection during postpartum. If you have any concerns, be sure to get in touch with your care provider immediately.
Uterine Infection
Right after you've had a baby, your body is especially vulnerable to infections of the lining of the uterus, or endometrium. If you've had a c-section, or if you've had a long labor accompanied by the early rupture of your amniotic sac, you are at a higher risk of developing a uterine infection.
Symptoms of a uterine infection include fever, lower abdominal pain, or bad-smelling lochia. If you experience any of these symptoms after you've gone home, call your doctor or midwife right away — uterine infections can be serious.
Alert
Your uterus is usually a sterile area, but sometimes during labor and birth — particularly when there has been a lot of interference from hands or other objects in your vagina during or after labor — bacteria from your bowel, vagina, perineum, or cervix may enter the uterus and lead to an infection.
Prevention
The more hands or objects enter your vagina during labor or after birth, the more risk there is that infection-causing bacteria could be pushed upward toward your uterus. Limit internal exams during labor — some midwives and doctors don't do internal exams at all unless you ask for one — and resist the use of internal fetal monitoring, forceps, and any other procedure that would introduce an object into your vagina unless truly medically necessary. Once your baby's born, be religious about caring for your perineal area. Always use your peri bottle to rinse, wipe front to back after using the bathroom, and change your sanitary pad frequently, as pads can be a breeding ground for bacteria.
Treatment
Uterine infections can be dangerous and need to be treated with antibiotics. If it's a serious infection, you may need to be hospitalized to receive intravenous antibiotics.
If you're hospitalized for infection, you should be able to bring your baby along with you, as long as your husband or another support person is there to help you care for him. If you're nursing, be sure to ask your doctor about antibiotics that are safe for breastfeeding — they may not be part of the usual protocol, but your doctor should be able to find medications that will work for you.
Urinary Tract Infection
Sometimes bacteria from your vagina or perineum can move into your urinary tract, causing an infection that can involve just the urethra, or sometimes the bladder and kidneys, too. If you have difficulty urinating, if it hurts while you urinate (besides the initial stinging when your urine touches an abrasion, tear, or episiotomy site), or if your urine is cloudy, dark, scanty, or bloody, it could be that you've got a UTI. Other symptoms include fever, chills, pain in your back or side, and feelings like you have to go to the bathroom all the time, but then little or nothing actually comes out.
Prevention
Frequent trips to the bathroom and drinking enough water are crucial to keeping your urinary tract healthy. Again, using your peri bottle, wiping from front to back after using the bathroom, and frequently changing your sanitary pad will help keep bacteria from your vagina and anus from entering your urethra. If you had an epidural during labor or had trouble urinating afterward, you may have had a catheter inserted, which also raises the risk of UTIs. Unsweetened cranberry juice and cranberry pills have both been shown to help prevent UTIs.
Treatment
Your treatment will depend on how far into your urinary tract the infection has moved. You'll probably be given antibiotics, and depending on how serious the infection, they may need to be given intravenously. You'll be told to drink a lot of water to flush the bacteria out of your urinary tract, and your urine will usually be tested at the beginning and end of the treatment to see how the medication worked.
Incision, Episiotomy, or Tear Site Infection
Incision sites from a c-section or episiotomy are susceptible to infection. If you notice redness, tenderness, or discharge from or swelling around the site of a wound, it could indicate an infection.
Prevention
Avoid an episiotomy if you can. Many experts now agree that routine episiotomy is not justified, and the deep, intramuscular wounds they create can become infected. Pushing gently, with your body's signals, and in the position of your choice, instead of forced “purple-faced” pushing can help you avoid or reduce tearing and lessen the chances of this type of infection. If you've had a c-section, keep your stitches dry and clean. For both tears and episiotomies, follow the infection-fighting rules of peri care, wiping front to back, and changing your sanitary pad often.
Treatment
Sometimes, the sutures at an infected incision site will have to be opened and the wound drained and restitched. You'll probably receive a local anesthetic, similar to the one you received when it was originally stitched, for this procedure. You may also be given antibiotics, depending on how serious the infection is. Remember to ask your doctor for antibiotics that are safe for breastfeeding.
Breast Infection
Engorgement, cracked nipples, and clogged ducts, which are common in the early days of breastfeeding, can lead to mastitis, or breast infections. If you feel like you're getting the flu, with fever or chills, muscle aches, or fatigue, and these symptoms are coupled with a painful, swollen, red, hard area or red streaks on the breast that may feel warm to the touch, you probably have a breast infection.
Fact
Giving birth in water is a growing trend in the United States and has been linked with fewer and less severe perineal tearing during pushing. Some experts feel that warm water helps the perineal tissues open and stretch, while others hypothesize that the slow, low-intervention nature of water birth means fewer hands and objects in the way that could cause tearing. Being able to move about freely and adjust instinctively to your baby's descent and emergence also helps.
Prevention
Avoid underwire bras or anything that's tight on your breasts (if it leaves marks, that's a good indicator that it's too tight). If you start to feel under the weather, go to bed, nurse often, drink plenty of fluids, and rest.
Treatment
If you develop mastitis, drink lots of fluids, eat nutritious food, and rest, rest, rest. Tylenol or Motrin can help relieve discomfort and bring fever down, and vitamin C may help boost your immunity to help you fight off the infection. Use heat to keep the ducts open, and massage your breasts to keep the milk flowing. Some doctors advise women to wean if they develop mastitis. This is not necessary and can actually make things worse! If your care provider prescribes an antibiotic, insist on a breastfeeding-friendly one.
