Going Home: The First 6 Weeks

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You're ready to go home. Now what? What should you expect the First Six Weeks after Delivery?

	AFTER VAGINAL DELIVERY		AFTER CESAREAN SECTION
	PHYSICAL CHANGES		EMOTIONAL CHANGES
	COMPLICATIONS THAT CAN OCCUR		WHEN TO CALL YOUR DOCTOR
	ADDITIONAL RESOURCES		EXIT THIS PAGE

AFTER VAGINAL DELIVERY

REST
You will need a great deal of rest the first few weeks after delivery. The delivery, the increased demands of the baby, and the interruption in your sleep will make you tired. You should rest when the baby sleeps.

EXERCISE
Exercise will actually help decrease fatigue, as well as increase your muscle tone and energy level.
You may begin exercising as soon as you feel like it. Pelvic tilts, modified sit-ups, hip-walking, stretches, and other abdominal exercises are excellent. There are numerous books and videos available that will show the correct way to do post-partum exercises.

DIET
You should lose up to twenty pounds the first two weeks after delivery. Follow the healthy pre-pregnancy diet and you should lose the rest of your baby weight by six to eight weeks after delivery.
If you are breastfeeding, you will need to increase your pregnancy diet by 300 calories a day. You also need extra fluids, calcium and protein. You should avoid spicy foods, alcohol, nicotine, and drugs while breastfeeding since these can be passed on to your baby through your breast milk.

BREAST CARE
Colostrum will be made the first 2-3 days after delivery. Engorgement of the breasts occurs 2-4 days after delivery due to milk letdown. If you experience pain, ice packs to the breasts four or five times a day and Tylenol may help.

BOTTLE FEEDING
Your doctor may give you medication to keep your milk from coming in, however other measures may work equally well. Discuss side effects of the medication with your doctor before taking it. Do not express milk if you have letdown. This will just encourage more milk production. Binding your breasts and using ice will help. Tightly wrap a cloth approximately 10-12 inches wide around your chest 2-3 times. You should rewrap every few hours and sleep with the wrapping in place. Continue wrapping for 5-7 days. Avoid bending over. After wrapping, wear a good supportive bra. If you wear your bra for twenty-fours hours a day for the first few weeks after delivery, your breasts should not sag.

BREASTFEEDING
Wear a good supportive nursing bra. Keep nipples clean and soft. If nipples become dry and cracked, use Vitamin E oil to soften them. Be sure to wash and dry nipples before breastfeeding if you use Vitamin E oil or lotion. Breasts do leak and this can be embarrassing. Using disposable breast pads inside your bra will keep your clothing from being stained and may decrease your chances of having dry, cracked breasts. If you wear a good supportive bra, your breasts will not sag. They will return to pre-pregnancy size. If you have breast implants, check with your doctor to see if you should breastfeed. It is not currently recommended that you breastfeed if you have silicone implants, however this could change and your doctor will recommend what is best for you and your baby.
A breast infection, called mastitis, is common. The bacteria that causes the infection comes from the baby's mouth. The breast will be painful, hot and swollen. You may have a fever. Your doctor will prescribe antibiotics. You can continue to breastfeed while taking the antibiotics.

PERINEAL CARE
If you have had an episiotomy or a tear, you may find that it is difficult to sit on hard surfaces. Carry a soft pillow with you. It may make it easier to sit.
Continue the same episiotomy and perineal care you began in the hospital. After showers, use a blow dryer instead of a towel to dry the perineal area. Continue until your episiotomy is well-healed.

AFTER CESAREAN SECTION

REST
You will require more rest for a longer period of time after a c-section. Gradually increase your activity to normal over several weeks. Avoid heavy lifting, and going up and down stairs often.

INCISION CARE
Keep the incision clean and dry. Avoid heavy lifting and stretching.

DIET
For the first few weeks, follow the same diet your followed while pregnant. Then you should eliminate the extra three hundred calories a day that you added to your normal, healthy diet.

EXERCISE
You should not exercise until your doctor has given her permission.

FEEDING THE BABY
This will be the same as after a vaginal delivery.

PHYSICAL CHANGES

Your body will undergo many physical and hormonal changes during the first weeks after delivery.

UTERUS
Involution of the uterus will continue for several weeks. By the end of the second week your uterus will be about the size of a twelve week pregnancy. Five to six weeks after delivery, it will be almost pre-pregnancy size.

CERVIX
The cervix will close and firm by the time the uterus involutes to pre-pregnancy size.

VAGINA
Your vagina was stretched during the vaginal delivery, but should regain its muscle tone by six weeks post-partum. You can accelerate the process and increase muscle tone by doing Kegel exercises. Kegel exercises, which tighten and relax your pelvic floor muscles, use the same muscles that you utilize to stop a flow of urine or have a bowel movement. Tighten by thinking of stopping urine flow or stopping a bowel movement. Begin with five repetitions three times a day. Increase by one or two repetitions a day until you are doing twenty-five repetitions three times a day. You can begin Kegel exercises twenty-four hours after delivery.

HORMONAL CHANGES
Progesterone and estrogen levels fall dramatically in the first seventy-two hours after delivery. Progesterone decreases to 1/20th of the pregnancy levels and estrogen decreases to 1/100th of the pregnancy levels. These changes remain in effect until ovulation occurs.

RETURN OF MENSTRUATION
    Ovulation can return as early as four weeks after delivery in a woman who is not breastfeeding, but it can be as long as twelve weeks.
    In breastfeeding women, it can take as long as thirty-six months for ovulation to return if breastfeeding is continued the entire time.
    Ovulation precedes a period, so you must use birth control with sex. Up to 5% of breastfeeding women will ovulate the first six months; you cannot be sure you aren't one of them.

CIRCULATION
Your blood volume, which increased by 35% during pregnancy, will begin decreasing rapidly immediately after delivery then slow until pre-pregnancy levels are reached by six weeks post-partum. Some of this decrease will result from delivery. The balance will of excess fluid will be eliminated by the kidneys. You will notice an increase in urination and sweating after delivery.

ABDOMEN
Abdominal muscles have been stretched throughout the pregnancy. It will take time and work to get them back to pre-pregnancy control and tone. You can begin abdominal exercises twenty-four hours after a vaginal delivery, but if you have had a c-section wait until your doctor advises you when to begin.

SKIN
Skin changes will gradually return to normal. Stretch marks fade to a silvery color by six months to a year after birth. The linea nigra will fade some but will always be darker than before pregnancy.

EMOTIONAL CHANGES

Your emotions and mental processes are profoundly affected during the first few weeks after delivery. Although the sudden drop in hormone levels is usually blamed, research has not supported this theory. There may, however, be a relationship between low levels of tryptophan, an amino acid, and the emotional changes seen after delivery. Sleep deprivation and increased work caused by demands of the baby may also contribute.

"BABY BLUES"
Up to 70% of women will have "baby blues". The symptoms include: crying for no apparent reason; depression; sudden mood swings; headaches; restlessness; irritability; confusion; forgetfulness; feelings of resentment toward the baby and/or your partner; insomnia; and elation. You probably will not have all of the symptoms. "Baby blues" can happen any time during the first two weeks after delivery and may last for a week. Support from those around you, adequate rest, and good nutrition may all help. "Baby blues" are so common that if you don't get them, you are lucky. Know that you are normal and they will go away.

POST-PARTUM DEPRESSION
Approximately 10% of new mothers will develop post-partum depression. This can be a serious medical problem and requires intervention by your doctor. The symptoms are the same as for "baby blues" but also include: a loss of self-esteem; a sense of hopelessness; an inability to care for yourself, family or the baby; and negative feelings toward your baby.
With medication, you should be better in a few weeks. Family support is essential. You need adequate rest and help in caring for your home and family. They need to understand what is happening to you.

POST-PARTUM PSYCHOSIS
This is a very rare schizophrenic and manic-depressive disorder that can happen in approximately 1/1000 women. Most women recover in 2-3 months with medication and psychiatric intervention.

COMPLICATIONS THAT CAN OCCUR

In addition to post-partum depression, possible complicationsthat can occur include:

uterine infections
bladder infections
thrombophlebitis or a blood clot in a vessel
breast infections
retained fragments of placenta
infection in the episiotomy
infection in the abdominal incision

WHEN TO CALL YOUR DOCTOR

Call Your Doctor Immediately:

If you develop a fever.
If you begin bright red bleeding after your lochia has changed to brown or yellow.
If you notice redness, tenderness or a hot feeling lump in your breasts.
If you develop a foul-smelling vaginal discharge.
If you notice increased pain in your episiotomy.
If you notice a drainage or redness in your abdominal incision.
If you are depressed, have loss of appetite, extreme mood swings, uncontrollable crying, or feelings that you want to hurt your baby.

ADDITIONAL RESOURCES THAT MAY HELP:

	Post Partum Depression
	Consider a Doula
	Post Partum Information
	Great Source of Information
	Post Partum Depression

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Excerpts from: The Family Pregnancy © 1995: MJ Bovo, The Family Pregnancy, Second Edition, currently in production, and Do You Have Any Questions? © 1995: MJ Bovo, are contained within this page. Reprints are not permitted under any circumstances. Please see Terms of Use for full expanation. Violations of the Copyright Code are taken seriously and appropriate action IS TAKEN AGAINST VIOLATERS.