Postpartum Concerns: Information for new mothers

Rest and support: It is important to accept help and gather support in the early weeks after giving birth so that you can rest, recover, and learn to care for your baby. Plan for this time before you have your baby. Consider who you will ask to help you and make arrangements. You may want to have trusted friends, loving family members, and/or an experienced postpartum doula come to your home. Accept offers of help with chores and cooking from friends and neighbors - you might even ask a friend to create a schedule for this and get other friends to sign up to help! Make sure to keep visits from those coming over just to see the baby short - or put them to work watching the baby while you take a nap. Try sending a clear signal to yourself and others that you need your rest by keeping your pajamas on until you get your 8 hours of sleep - even if that means you don't get dressed until 2:00 in the afternoon!

Lochia: In the first few days, bleeding may be much like a menstrual period. (Talk to your health care provider if you soak a pad in one hour.) It will gradually decrease in amount and turn from red to pink or brown tinged and eventually to yellowish white. Discharge may last from 3 - 6 weeks.

Afterpains / cramps: These are due to your uterus reducing to its normal size. They may be more noticeable during breastfeeding, for women who have had previous children, or for women who had cesareans. Try urinating before nursing, gentle massages, and laying on your stomach with a small pillow under your abdomen.

Healing: Ice packs are applied to the perineum immediately after birth - for up to 24 hours. Later warm sitz baths and warm water sprays are helpful in increasing circulation, promoting healing, and decreasing pain (also helpful for hemorrhoids). At 6 weeks the cervix and vagina are usually nearly completely healed. Initial healing of the perineum occurs in 2 - 3 weeks although it can take up to 6 months for an episiotomy site to completely heal. Also, remember your Kegals!

Constipation and first BM: Walk, eat a diet high in fiber, drink plenty of fluids, and follow your health care provider's instructions regarding stool softeners. Many women fear their first BM but it is usually nothing to worry about.

Return of menses and fertility: This varies greatly among women. Women who breastfeed for only a short time or not at all will generally menstruate sooner than breastfeeding women. Ovulation usually occurs after the first period. Breastfeeding women will usually not ovulate sooner than 10 weeks but depending on the length of breastfeeding may not menstruate for one or two years. Women who do not breastfeed usually menstruate sometime around 7 - 9 weeks and most will have menstruated by 24 weeks.

Resumption of sexual activity: It is usually recommended that women refrain from sexual intercourse until lochia has stopped and any episiotomy has healed (usually around 3 weeks). Many doctors recommend that a woman wait until after her postpartum visit (usually at 6 weeks). Desire for sex may also be affected by fatigue, a normal decrease in sexual desire due to physical and emotional changes, mood swings, and hormonal changes. Note that breastfeeding women may initially experience a leaking of milk during sexual stimulation. You may want to use lubrication for vaginal dryness. Also remember that ovulation can occur before the return of menses so you may want to think about birth control.

Baby blues: You may feel slightly depressed, moody, tearful, anxious, or irritable for a few days during the first week after birth. These feelings may even last for a few weeks. You need rest, reassurance, and support from those closest to you. If these feelings persist for more than 2 or 3 weeks or become more intense, contact your health care provider.

Source: Francine Nichols & Elaine Zwelling, Maternal-Newborn Nursing (1997)

For information about Postpartum Depression (in the DC Metro area): Call 1-800-PPD-MOMS or e-mail ppdmoms@fmhf.org

For help finding a postpartum doula: