Postpartum Recovery

Introduction

The puerperium , postnatal or postpartum , period is the time during which your body adjusts, physically and psychologically, to the process of childbearing. By definition, it begins immediately after delivery and continues for approximately six weeks or until your body has completed its adjustment and has returned to a near pre-pregnant state.

Physical Changes

1. Involution of the Uterus

This is the process of the uterus contracting to a non-pregnant size, although it will never return completely to its former, pre-pregnant size. Approximately 10 days after birth, you will no longer be able to feel the top of your uterus (called the fundus) in your abdomen. The first menstrual period post-pregnancy usually appears in three to eight weeks, or it may be delayed for five months or longer if you are breastfeeding. It is important to remember that you will ovulate before you get your period, and you may even ovulate without a period. Therefore, you may want to take precautions against pregnancy; ask your physician about birth control. Your first period may be much heavier than normal, but your second period should be closer to normal.

Lochia is the vaginal discharge you will have over the next four to six weeks. It is the debris that the uterus sheds after delivery. The discharge will change from red to pinkish to yellow to white and will increase with activity or breastfeeding. It will probably be heaviest in the morning because the lochia pools in your uterus and your vagina while you are lying down and is passed when you stand.

Psychological Changes

Hormonal changes, changes in your lifestyle and family influences can sometimes impact your adjustment to motherhood. Postpartum mood changes can range from transient "blues" immediately following childbirth to an episode of major depression to severe, incapacitating, psychotic depression. (cf. postpartum depression )

Breast Care after Birth

Wash your breasts and nipples with a clean wash cloth and warm water only - do not use soap. When you are in the shower, gently massage your breasts, starting near your armpit and moving toward the nipple to help prevent clogged milk ducts. Air dry your nipples (no towelling) after your bath or shower and after breastfeeding. Wear a well-fitting, supportive nursing bra during the day and at night. If your nursing bra has a plastic insert or liner, remove it at night to allow air to circulate around your nipples.

Properly positioning your baby on your breast will help avoid a lot of soreness. Your baby should be positioned on your breast so he or she is grasping the entire areola. If your nipples do become cracked or sore, nurse your baby for shorter feedings, but more often. Breast milk is a natural cream and is encouraged as a coating for sore, cracked nipples.

If your breasts become engorged, apply warm towels to them for 10 to 15 minutes prior to feeding. Or you may take a shower and allow the warm water to flow over your breasts for 15 to 20 minutes. Nursing more frequently will help relieve engorgement. You may also apply cold packs to your breasts after nursing to help ease discomfort. If your breast is too full or too hard for your baby to nurse, manually express some milk from your nipple before feeding your baby.

Postpartum Nutrition

While you are breastfeeding, you should eat a diet high in protein (meat, fish, eggs or legumes). Have at least four servings of fresh fruits or vegetables each day. Your diet should also include two to four servings of milk or milk products every day. If you have trouble digesting dairy foods, or don't like them, ask your doctor about calcium supplements. As a nursing mother, it is important for you to drink plenty of liquids. A good rule to follow is to try and have something to drink every time you nurse your baby.

You should avoid alcoholic beverages. Do not take any medications without consulting your doctor and your baby's doctor first. While there are no specific dietary restrictions while you are nursing, you may want to limit the foods you eat which disagree with your baby's system. If a food seems to irritate your baby, avoid it. It's also not recommended that you diet while you are breastfeeding.

Breast self-exam

Breast self-exam enables a woman to know the normal consistency of her breasts so she will be able to identify any changes in them.
Breast cancer is the second leading cause of death from cancer in women. 95% of all breast cancers are discovered by women themselves. 80% of the lumps that are found are not malignant. There is an increased chance of developing breast cancer if your mother, sister, aunt or grandmother had breast cancer.
Breast self-examinations should be done monthly, about seven to 10 days after your period.
Notify your physician immediately if you find any lumps, dimpling, swelling or discharge, or if you note any other changes to your breasts. Remember to always wipe from front to back after going to the bathroom. Change your sanitary pad often to avoid irritation, and try to avoid touching the inside of the pad. Wrap used pads in tissue before disposing of them in a wastebasket. Consult your physician about the use of tampons.

Danger Signs

Consult your doctor if you experience any of the following:

• Fever - 38° C/100.4° F or above
• Increased pain in the abdomen or perineum
• Increased pain, swelling, redness or discharge from the episiotomy or caesarean-section incision
• Increased pain, swelling, redness or discharge from the episiotomy or caesarean-section incision
• Soaking through more than one sanitary pad or tampon per hour
• Foul smelling discharge
• Passing plum-sized clots
• Tender, warm, reddened breasts
• Cracked, bleeding nipples
• Burning when urinating or feeling unable to completely empty the bladder
• Leg tenderness or redness
• Post-partum blues lasting more than three days
• Any other unusual problems

The information in this page is presented in summarised form and has been taken from the following source(s):
1. Alexian Brothers Medical Center: http://www.alexian.org