Normal Postpartum care & support

Postpartum care: What to expect after a vaginal delivery

Your newborn might be your top priority — but postpartum care counts, too. From vaginal soreness to urinary problems, here's what to expect as you recover from a vaginal delivery. Pregnancy changes your body in more ways than you might expect, and it doesn't stop when the baby is born. Here's what to expect physically and emotionally after a vaginal delivery.

Vaginal soreness: If you had an episiotomy or vaginal tear during delivery, the wound might hurt for a few weeks. Extensive tears might take longer to heal. To ease discomfort while you're recovering:

•Sit on a pillow or padded ring.

•Cool the wound with an ice pack, or place a chilled witch hazel pad between a sanitary napkin and the wound.

•Use a squeeze bottle to pour warm water on your perineum as you're passing urine.

•Sit in a warm bath just deep enough to cover your buttocks and hips for five minutes. Use cold water if you find it more soothing.

•Herbal Sitz Bath

•Talk to your health care provider about using a stool softener or laxative to prevent constipation.

Tell your provider if you're experiencing severe, persistent or increasing pain, which could be a sign of infection.

Vaginal discharge: After delivery, you'll begin to shed the superficial mucous membrane that lined your uterus during pregnancy. You'll have vaginal discharge consisting of this membrane and blood (lochia) for weeks. This discharge will be red and heavy for the first few days. Then it will taper, become increasingly watery and change from pinkish brown to yellowish white. Contact your provider if you have heavy vaginal bleeding — soaking a pad in less than an hour — especially if it's accompanied by pelvic pain, fever or uterine tenderness.

Contractions: You might feel occasional contractions, sometimes called afterpains, during the first few days after delivery. These contractions — which often resemble menstrual cramps — help prevent excessive bleeding by compressing the blood vessels in the uterus. After pains are common during breast-feeding, due to the release of oxytocin.

Incontinence: Pregnancy, labor and a vaginal delivery can stretch or injure your pelvic floor muscles, which support the uterus, bladder, small intestine and rectum. This might cause you to leak a few drops of urine while sneezing, laughing or coughing (stress incontinence). These problems usually improve within weeks but might persist long term. In the meantime, wear sanitary pads and do Kegel exercises to help tone your pelvic floor muscles. To do Kegels, imagine you are sitting on a marble and tighten your pelvic muscles as if you're lifting the marble. Try it for three seconds at a time, then relax for a count of three. Work up to doing the exercise 10 to 15 times in a row, at least three times a day.

Hemorrhoids and bowel movements: If you notice pain during bowel movements and feel swelling near your anus, you might have hemorrhoids — swollen veins in the anus or lower rectum. To ease discomfort while the hemorrhoids heal:

•Apply an over-the-counter hemorrhoid cream or suppository containing hydrocortisone.

•Use pads containing witch hazel or a numbing agent.

•Soak your anal area in plain warm water for 10 to 15 minutes two to three times a day.

•Golden Seal, also known as Indian turmeric or yellow root, is used as a potent herbal medicine across the world. The herb has anti-inflammatory properties that are found effective in treating hemorrhoid problems. It reduces swelling and also stops internal bleeding of hemorrhoids

•Get apple cider vinegar and dilute it with water. Soak a cotton in it and apply the cotton with the vinegar on the hemorrhoids. Apply this method for 7 days straight to shrink the hemorrhoids quickly. For faster results you can use pure vinegar but this will cause stinging pain.

If you find yourself avoiding bowel movements out of fear of hurting your perineum or aggravating the pain of hemorrhoids or your episiotomy wound, take steps to keep your stools soft and regular. Eat foods high in fiber — including fruits, vegetables and whole grains — and drink plenty of water. Ask your health care provider about a stool softener, if needed.

Tender breasts: A few days after birth, your breasts might become full, firm and tender (engorgement). Frequent breast-feeding is recommended to avoid or minimize engorgement. If your breasts — including the dark circles of skin (areolae) around the nipples — are engorged, your baby might have difficulty latching. To help your baby latch, you might manually express or use a breast pump to express a small amount of breast milk before feeding your baby. To ease breast discomfort, apply warm washcloths or take a warm shower before breast-feeding or expressing, which might make milk removal easier. Between feedings, place cold washcloths on your breasts. Over-the-counter pain relievers might help, too. If you're not breast-feeding, wear a supportive bra, such as a sports bra. Don't pump your breasts or express the milk, which will cause your breasts to produce more milk.

Hair loss and skin changes: During pregnancy, elevated hormone levels increase the ratio of growing hair to resting or shedding hair. The result is often an extra-lush head of hair — but now it's payback time. After delivery, you'll experience hair loss for up to five months.

Stretch marks won't disappear after delivery, but eventually they'll fade from red to silver. Expect any skin that darkened during pregnancy — such as dark patches on your face (chloasma) — to slowly fade as well.

Mood changes: Childbirth triggers a jumble of powerful emotions. Many new moms experience a period of feeling down or anxious, sometimes called the baby blues. Symptoms include mood swings, crying spells, anxiety and difficulty sleeping. The baby blues typically subside within two weeks. In the meantime, take good care of yourself. Share your feelings, and ask your partner, loved ones or friends for help.

If you experience severe mood swings, loss of appetite, overwhelming fatigue and lack of joy in life shortly after childbirth, you might have postpartum depression. Contact your doula and ask for additional postpartum care and support and be sure to tell your spouse if you think you might be depressed, especially if your symptoms don't fade on their own, you have trouble caring for your baby or completing daily tasks, or you have thoughts of harming yourself or your baby.

Weight loss: After you give birth, you might look like you're still pregnant. This is normal. Most women lose 13 pounds (6 kilograms) during birth, including the weight of the baby, placenta and amniotic fluid. In the days after delivery, you'll lose additional weight from leftover fluids. After that, a healthy diet and regular exercise can help you gradually return to your pre-pregnancy weight.

The postpartum checkup: The American College of Obstetricians and Gynecologists recommends that postpartum care be an ongoing process rather than just a single visit after your delivery. Have contact with your health care provider within the first 3 weeks after delivery. Within 12 weeks after delivery, see your health care provider for a comprehensive postpartum evaluation. During this appointment your health care provider will check your mood and emotional well-being, discuss contraception and birth spacing, review information about infant care and feeding, talk about your sleep habits and issues related to fatigue and do a physical exam. This might include a check of your abdomen, vagina, cervix and uterus to make sure you're healing well. This is a great time to talk about any concerns you might have, including resuming sexual activity and how you're adjusting to life with a new baby.