Keeping your midwife informed: If you have any problems, call a midwife immediately. You can expect to see a midwife at your home every day for the first 2-3 days and then gradually decreasing for the rest of the week. You will come into the clinic to see the midwife at 2 weeks, 4 weeks, and 6 weeks after the birth.
Up to 80% of women get the ‘blues’ within the 1st three to four (sometimes up to 10) days after birth. You may be surprised by sudden periods of crying, anxiety, quick mood changes and irritability. The good news is that these feelings usually don’t last long and you can do something about them;
- Have regular breaks during the day
- Talk to others about how you feel
- Rest as much as possible
- Take part in activities you enjoy
- Accept help from others
- Take time for relaxing exercise, even a simple walk
- Remember that household chores can wait while you get to know your new baby
IF YOU ARE STILL EXPERIENCING NEGATIVE FEELINGS after the first 2 weeks after childbirth, OR IF YOU HAVE THOUGHTS OF HARMING YOURSELF OR YOUR BABY AT ANY TIME you could have postpartum depression or anxiety which occurs in about 20% of mothers (for more information see ‘Babies Best Chance’ p86). You may need help. It is important to let your midwife know how you are feeling.
Rest: Get plenty of rest for the first two weeks. You will be able to care for yourself and the baby, but don’t expect too much of yourself. You will need someone to substitute for you in general household duties (cooking, cleaning, laundry, shopping and caring for older children) for at least one week. Rest when the baby is sleeping and keep visitors to a few close friends or relatives who are willing to help. Remember that fatigue decreases your breast milk supply and your ability to cope with these new added responsibilities.
Baths & Showers: Sitting in a warm sitz bath for 10-15 minutes several times a day will help your stitches heal, keep your perineum clean, and decrease discomfort from haemorrhoids or stitches. You may choose to add herbs or epsom salts to the bath. Thoroughly clean and rinse the tub before using. Have a shower to cleanse your body, rather than washing yourself in the tub and then soaking in the same water. Showers are also useful to relieve breast discomfort associated with engorgement.
Vaginal Bleeding: Normal lochia (flow) lasts for 3 to 4 weeks, and can continue until 6 weeks in some women. Generally, during the first 24 hours after birth, the bleeding should be like a heavy period. By the third or fourth day it will have thinned and become reddish/brown in colour. By the tenth day it is often like a pale, pink, watery fluid, spotting enough to require a light pad. If after the third day the bleeding becomes bright red and heavy again, it is often a sign that you are overactive and need to slow down. Sometimes a sudden but transient increase in bleeding may occur between day 7 to 14. This is sometimes related to the shedding of the old placental scar from the uterine wall and should stop within 1 to 2 hours. If you bleed heavily at any time (i.e., soaking through a heavy pad in one hour or less) you must: empty your bladder, lie down with an ice bag on your abdomen, and nurse the baby. Massage your uterus and ensure your uterus stays firm. Call your midwife.
Activity & Exercise: Listen to your body and let it be your guide to activity and exercise. You should limit your stair climbing for the first week. You may go out for a ride or dinner when you begin to have “cabin fever” and drive your car in two weeks. Begin Kegel exercises within the first week and abdominal exercises when you feel ready after delivery. Start going for short walks 10-14 days after the birth. Remember that you have to get home again, so make the first walks very short, and then gradually increase the distance each day.
Sex: Again, listen to your body. Women vary greatly in when they feel like having intercourse again: some will start in 2 days, others not for 6 months. This depends on how the birth went, the amount of trauma to the perineum, how much time is spent with the baby, how tired you are, and what your relationship with your partner is like. Whatever you feel is right for you. Talk to the midwives as you feel the need. Breastfeeding can also reduce women’s natural vaginal lubricant – a synthetic, water-based lubricant, such as ‘astro glide’ can be used.
Contraception: You CAN become pregnant again soon after childbirth even if you are breastfeeding.
*See pages 92 – 95 in ‘Babies Best Chance’ or talk to your midwife for an outline of your options
Combined oral contraceptives (birth control pills that have both oestrogen and progesterone) can suppress milk supply and are not recommended while breastfeeding. The Progesterone-only pill is safe during breastfeeding, however it is best delay starting this until breastfeeding is well established.
Natural family planning – methods which depend on predicting the time of ovulation by use of basal body temperature or assessment of cervical mucus cannot be used until regular menstrual cycles have resumed.