Recovering From Delivery

After your baby arrives, you'll notice some changes — both physical and emotional.

What to Expect Physically

Physically, you might experience:

• Sore breasts. Your breasts may be painfully engorged for several days when your milk comes in and your nipples may be sore.
• Pain in the perineal or vaginal area. If your perineum (the area of skin between the vagina and the anus) was cut by your doctor (episiotomy) or tore during the birth, stitches might make it painful to sit or walk for a little while during healing. It also can be painful when you cough or sneeze during the healing time. The vagina can also feel sore.
• Constipation. Your first postpartum bowel movement (pooping) may be a few days after delivery, and sensitive hemorrhoids (swollen blood vessels in the rectum or anus), a healing episiotomy, and sore muscles can make it painful.
• Hot and cold flashes. Your body's adjustment to new hormone and blood flow levels can mean your internal thermostat goes up and down.
• Episiotomy. If your perineum (the area of skin between the vagina and the anus) was cut by your doctor or if it was torn during the birth, the stitches may make it painful to sit or walk for a little while during healing. It also can be painful when you cough or sneeze during the healing time.
  
• Hemorrhoids. Although common, hemorrhoids (swollen blood vessels in the rectum or anus) are frequently unexpected.
• Urinary or fecal incontinence. The stretching of your muscles during delivery can cause you to accidentally pass urine (pee) when you cough, laugh, or strain or may make it hard to control your bowel movements, especially if you had a lengthy labor before a vaginal delivery.
  
• Contractions ("afterpains"). After giving birth, your uterus will continue to have contractions for a few days. These feel like strong menstrual cramps. They are most noticeable when your baby nurses or when you get medicine to reduce bleeding.
• Vaginal discharge (lochia). Initially bloody, heavier than your period and often containing clots, vaginal discharge gradually fades to white or yellow and then stops within several weeks.
• A little weight loss. Your postpartum weight will probably be about 12 or 13 pounds (the weight of the baby, placenta, and amniotic fluid) below your full-term weight, before additional water weight drops off within the first week as your body regains its balance. It can take months to a year (or even longer) to get back to your original pre-pregnancy weight, though.

If you had a cesarean section (C-section), it can take longer to recover because abdominal surgery requires a longer healing time. Pain is greatest the first few days after the surgery and should ease over time. Your doctor will advise you on precautions to take after surgery (such as avoiding physical activity, heavy lifting, and driving for a while), and give you directions for bathing and how to begin gentle exercises to speed recovery and help avoid constipation.

What to Expect Emotionally

Emotionally, you may be feeling:

• "Baby blues." Many new moms have irritability, sadness, crying, or anxiety, beginning within the first several days after delivery. These baby blues are very common and may be due to physical changes (including hormonal changes, exhaustion, and unexpected birth experiences) and the emotional transition as you adjust to changing roles and your new baby. Baby blues usually go away within 1 to 2 weeks.
• Postpartum depression. More serious and longer lasting than the baby blues, this condition may cause mood swings, anxiety, guilt, and persistent sadness. PPD can be diagnosed up to a year after giving birth, and it's more common in women with a history of depression, multiple life stressors, and a family history of depression.

Also, when it comes to intimacy, you and your partner may be on completely different pages. Your partner may be ready to pick up where you left off before baby's arrival, whereas you may not feel comfortable enough — physically or emotionally — and might crave nothing more than a good night's sleep. Doctors often ask women to wait a few weeks before having sex to allow them to heal.

The Healing Process

It took your body months to prepare to give birth, and it takes time to recover. If you had a C-section, it can take even longer because surgery requires a longer healing time. If unexpected, it may have also raised emotional issues.

Pain is greatest the first few days after the surgery and should gradually ease. Your doctor will advise you on precautions to take after surgery, and give you directions for bathing and how to begin gentle exercises to speed recovery and help avoid constipation.

Birth Control

You can become pregnant again before your first postpartum period. Even though this is less likely if you are exclusively breastfeeding, have not had a period, and your baby is younger than 6 months old, it is still possible.

If you want to protect against pregnancy, discuss your options with your doctor. This may include barrier methods (like condoms or diaphragms), an IUD, pills, a patch, an implantable device, or shots.

Breastfeeding

You need plenty of sleep, lots of fluids, and good nutrition, especially if you're breastfeeding. An easy way to stay on top of drinking enough fluids is to have a glass of water whenever your baby nurses. At least until your milk supply is well established, try to avoid caffeine, which causes loss of fluid through urine and sometimes makes babies wakeful and fussy.

If you have any breastfeeding problems, talk to your doctor, midwife, or a lactation specialist. Your clinic or hospital lactation specialist can advise you on how to deal with any breastfeeding problems. Relieve clogged milk ducts with breast massage, frequent nursing, feeding after a warm shower, and warm moist compresses applied throughout the day.

If you develop a fever or chills or your breasts get tender or red, you may have an infection (mastitis) and need antibiotics. Call your doctor if this happens. Continue nursing or pumping from both breasts, though, and drink plenty of liquids.

Engorged Breasts

Engorged breasts means that the breasts are full of milk. This makes them feel full and hard. Sometimes it’s painful and can make it hard for a breastfeeding baby to latch on. It will feel better as your breastfeeding pattern becomes set or, if you're not breastfeeding, when your body stops making milk — usually within a few days. In the meantime, you can apply cool compresses to the breasts and take pain medicine.

Episiotomy Care

Continue sitz baths (sitting in just a few inches of water and covering the buttocks, up to the hips, in the water) using cool water for the first few days, then warm water after that. Squeeze the cheeks of your bottom together when you sit to avoid pulling painfully on the stitches. Sitting on a pillow may be more comfortable than sitting on a hard surface.

Use a squirt bottle with warm water to wash the area with water when you use the toilet; gently pat dry. After a bowel movement, wipe from front to back to avoid infection. Reduce swelling with ice packs or chilled witch hazel pads. Local anesthetic sprays also can help.

Talk to your doctor about taking an anti-inflammatory medicine like ibuprofen to help with the pain and swelling.

Exercise

Exercise as soon as you've been cleared by your doctor to help restore your strength and pre-pregnancy body, increase your energy and sense of well-being, and reduce constipation. Begin slowly and increase gradually. Walking and swimming are excellent choices.

Hemorrhoids and Constipation

Alternating warm sitz baths and cold packs can help with hemorrhoids. It also can help to sit on an inflatable donut cushion.

Ask your doctor about a stool softener. Don't use laxatives, suppositories, or enemas without your doctor's OK. Drink more liquids and eat fiber-rich fruits and vegetables. After your doctor says you can, exercising can be very helpful.

Sex

Your body needs time to heal. Doctors usually recommend waiting 4-6 weeks to have sex to reduce the risk of infection, increased bleeding, or re-opening healing tissue.

Begin slowly, with kissing, cuddling, and other intimate activities. You'll probably notice reduced vaginal lubrication (this is due to hormones and usually is temporary), so a water-based lubricant might help. Try to find positions that put less pressure on sore areas and are most comfortable for you. Tell your partner if you're sore or frightened about pain during sexual activity — talking it over can help both of you to feel less anxious and more secure about resuming your sex life.

Incontinence

Pee or poop accidents or other problems often ease gradually as your body returns to its normal pre-pregnancy state. Encourage the process with Kegel exercises, which help strengthen the pelvic floor muscles. To find the correct muscles, pretend you're trying to stop peeing. Squeeze those muscles for a few seconds, then relax (your doctor can check to be sure you're doing them correctly).

Wear a sanitary pad for protection, and let the doctor know about any incontinence you have.

Getting Help From Others

Ask your partner, friends, and family for help. Jot down small, helpful things people can do as you think of them. When someone offers to help, check the list. For example:

• Ask friends or relatives to pick things up for you at the store, stop by and hold your baby while you take a walk or a bath, or just give you an extra hand. Or ask loved ones to drop off a meal.
• Hire a neighborhood teen — or a cleaning service — to clean the house occasionally, if possible.

When Should I Call the Doctor?

Call your doctor about your postpartum health if:

• you have a fever of 100.4°F (38°C) or higher
• you soak more than one sanitary napkin an hour, pass large clots (larger than a quarter), or if the bleeding increases
• you had a C-section or episiotomy and the incision becomes very red or swollen or drains pus
• you have new pain, swelling, or tenderness in your legs
• you have hot-to-the-touch, reddened, sore breasts or any cracking or bleeding from the nipple or areola (the dark-colored area of the breast)
• your vaginal discharge smells bad
• it hurts to pee, you have a sudden urge to pee, or you can't control your peeing
• pain increases in the vaginal area
• you have new or worse belly pain
• you have a cough or chest pain, nausea, or vomiting
• you have bad headaches or vision changes
• you feel depressed or have hallucinations, suicidal thoughts, or any thoughts of harming your baby

While recovering from delivery can be a lot to handle, things will get easier. Before you know it, you will be able to fully focus on enjoying your new baby.