After a Vaginal Delivery
You will usually be discharged 24-48 hours after you deliver. Insurance companies do not allow you to stay longer unless you have a medical problem.
We will give you prescriptions for Ibuprofen 600 mg (or you can take 3 over the counter strength tablets at one time) and Norco (Tylenol with non-codeine narcotic) which you can take as needed. It is OK to take both of these together if necessary. We also recommend staying on your prenatal vitamin if you are breastfeeding, as well as taking an additional calcium supplement daily.
If you have stitches it is normal to have some discomfort for about 2 weeks. All the stitches dissolve and do not need to be removed. You may feel some suture material for 1-4 weeks depending on what type of suture was used.
Bleeding after delivery will continue for 4-8 weeks but should get lighter after the first few days. You may have a return of bright red bleeding 7-10 days after delivery, this is normal if it is similar to a period or less. You may pass some clots of blood, since blood tends to pool in the vagina and will form a clot which comes out when you stand up or move around, and sometimes bleeding seems heavier when you are active for the same reason. Call us if you are bleeding more than a heavy period for more than a few hours (for example repeatedly filling a pad more than once an hour).
It is very normal to have an increase in swelling in your feet and legs in the first few days postpartum. This will resolve in a few days and is caused by the excess of fluid that you have in your system after delivery, both from the pregnancy itself and the fluids you were given in labor.
We recommend showering only for the first 2 weeks so any suture material does not dissolve too rapidly and any tear is allowed to heal. After 2 weeks it is OK to take a bath or submerge in water if you like. If you don’t have stitches you can take a bath right away. (There are no germs in Houston water, there are way more germs in the vagina, so this does not increase the risk of infection.)
Generally, we recommend waiting 6 weeks until you resume sexual activity or tampon use. There is certainly no harm in using tampons before 6 weeks if you are not having any pain and the vaginal area is clearly well healed.
There are very few activity restrictions after a vaginal delivery, with the exception of intercourse as above. Some women feel ready to go back to the gym as soon as 2 weeks postpartum, while others do not. Listen to your body and don’t do anything that hurts. There is no limit to what you should lift, and you can drive as soon as you are not taking narcotic pain medicine.
After a C-Section
You will usually be discharged 2-4 days after you deliver. Insurance companies do not allow you to stay longer than 4 nights after delivery unless you have a medical problem. We would like to see you in the office approximately 2 weeks after delivery.
We will give you prescriptions for Ibuprofen 600 mg (or you can take 3 over the counter strength tablets at one time) and Norco (Tylenol with a non-codeine narcotic) which you can take as needed. It is OK to take both of these together if necessary. We also recommend staying on your prenatal vitamin if you are breastfeeding, as well as taking an additional calcium supplement daily.
It is normal to have some discomfort for about 2-4 weeks. All the stitches dissolve and do not need to be removed. You will notice small tapes or “steri-strips” over the incision. These need to be left in place for 2 weeks if possible in order to reduce the risk of scar separation. If they fall off on their own before 2 weeks that is fine, but do not remove them deliberately, we will take them off at your 2 week postpartum visit. It is normal to have some swelling, mild redness and superficial bruising around the incision. Call us if the redness or bruising seems to be getting worse or expanding. If you feel swollen we recommend wearing a supportive garment over the incision to apply gently pressure. Even “Spanx” or similar underwear will work. It is normal to see a small amount of bleeding or clear drainage from the incision. If you see more than a small amount of bleeding or drainage, please call us to schedule an appointment for an incision check.
While there is no strict limit on what you should lift, we recommend not lifting anything heavier that the baby for the first 2 weeks. Get help with the car seat, baby bag and other heavy equipment for the first 2 weeks. Driving requires movements that could be harmful to the incision in the first 2 weeks so it is generally better not to drive until you come to your 2 weeks checkup. It is fine to leave the house if someone else drives and you don’t have to walk too far when you get there. Staying confined at home increases the risk of postpartum blues and depression, so getting out and about is a good idea within the boundaries listed above. After your 2 week visit you can usually drive, carry the car set and baby bag, and do most normal activities. You can generally start gently walking (or other low impact activities) for exercise after 2 weeks. We recommend waiting 4-6 weeks before resuming a full exercise program, particularly exercise that uses the abdominal muscles.
Bleeding after delivery (even a C-section) will continue for 4-8 weeks but should get lighter after the first few days. You may have a return of bright red bleeding 7-10 days after delivery, this is normal if it is similar to a period or less. You may pass some clots of blood, since blood tends to pool in the vagina and will form a clot which comes out when you stand up or move around, and sometimes bleeding seems heavier when you are active for the same reason. Call us if you are bleeding more than a heavy period for more than a few hours (for example repeatedly filling a pad more than once an hour).
It is very normal to have an increase in swelling in your feet and legs in the first few days postpartum. This will resolve in a few days and is caused by the excess of fluid that you have in your system after delivery, both from the pregnancy itself and the fluids you were given during the surgery.
We recommend showering only for the first 2 weeks so the steri-strips do not come off too quickly. You do not need to use any soap or other products on the incision, just let water run over it and pat it dry. It is important that the incision is kept as dry as possible between bathing. After 2 weeks it is OK to take a bath or submerge in water if you like.
Generally, we recommend waiting 6 weeks until you resume sexual activity or tampon use. There is certainly no harm in using tampons before 6 weeks if you are not having any pain in that area.
Pregnancy Prevention
Occasionally patients will begin to ovulate (and therefore be fertile) as soon as 6-8 weeks postpartum. Exclusively breastfeeding patients have a low risk of pregnancy in the first 6 months but we recommend starting some form of birth control as soon as you are sexually active (condoms) if you do not want to become pregnant again right away. We will go over other birth control options with you at your postpartum visit.
Breastfeeding
Breast milk does not normally appear for 3-5 days after delivery. Initially the baby will be sustained by colostrum which is small in volume but high in nutrition. When your milk “comes in” you may feel that your breasts grow very large and firm. Occasionally you can get a low grade temperature elevation (99-100) when your milk comes in. If your breasts are “engorged” (remain very full, painful and firm without milk being released) applying hot compresses, standing in the hot shower, and gentle massage can help. If you have not experienced significant milk production by the 5th day postpartum please call us so we can offer assistance. If you feel that your milk volume is low (less than 1 ounce /hr total, or 3-4 ounces every 3-4 hours when pumping) please refer to our “Information on Increasing Milk Production” document in the “Pregnancy Information” section of our website.
Mastitis or breast infection is diagnosed if you have a fever, redness and pain in the breast accompanied by symptoms similar to the flu-body aches, chills, headaches. It is usually caused by the organisms in the baby’s mouth so is not infectious to the baby and you should continue to breastfeed and/or pump. Please call us if you feel that you have mastitis so that you can start on antibiotics.
Postpartum Depression
Postpartum depression is a serious condition that generally starts 4-8 weeks after delivery. We all feel a little overwhelmed or tearful at times, but if a sad or depressed mood continues for several days and starts to affect your function (for example if you stop getting out of bed, stop taking appropriate care of the baby, or stop doing other normal activities), or if you have thoughts of hurting yourself for the baby it is important to seek immediate help.
Pain medications while breastfeeding
It is normal to experience some pain after any type of delivery, both vaginal and c-section. These should improve greatly as the days pass after delivery and your body heals and recovers from pregnancy and delivery. You will receive pain medications upon discharge from the hospital including Ibuprofen (anti- inflammatory) and Norco (a non-codeine narcotic pain medication). It is important to use and alternate between the two options as they treat pain and inflammation differently. It is important to use these only until you do not feel severe or intense pain. We are no longer using Tylenol with codeine (T-3) or Tramadol in the postpartum period. There is concern that these medications could cause sleepiness in the newborn breastfed infant. If you do not feel that your pain from delivery is improving with the pain medications, it is important to notify us to schedule an early postpartum follow-up.
Please call us if you have a fever greater than 100, persistent very heavy bleeding, severe pain, or any other problems that we can assist with. We would like to see you approximately 6 weeks after delivery to do a gentle pelvic exam, talk about birth control, and any other issues that you may have.
Best Wishes from the CWCC Doctors and Staff.