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II. Postpartum Period (for the mother)
A. Body Changes After Childbirth
1) Reproductive Organs
(a) "Shrinking" of uterus: Should
be at the level of the navel and firm. If it is above the navel or feels
spongy and soft, there is a much greater risk of increased bleeding. If
the uterus is off to the side, your bladder is probably full. It should
move down in the abdomen about one fingerbreadth/day, approaching nonpregnant
size in 4 to 6 weeks.
(b) Lochia (discharge): Should be
dark red for 2 to 3 days, pinkish brown for 3 to 10 days, creamy/yellowish
for 1 to 2 weeks more. If clot is greater in size than a nickel, or unusual
odor noted, or your bleeding gets heavier and darker, call your OB care
provider.
(c) Cervix: closes slowly after birth
(d) Vagina: May be swollen and bruised.
Do not use tampons or douches, because infection can occur.
(e) Perineum: May appear swollen and
bruised. An episiotomy or laceration may be present with or without sutures.
Ice can be used during the first 24 hours. Ask OB care provider about sitz
baths before discharge.
(f) Recurrence of menses/ovulation: You
will ovulate and can get pregnant before your first period occurs; recurrence
of period varies person to person.
2) Abdomen
(a) Uterine ligaments and your abdominal
wall have been stretched and need time to recover. Your abdomen may appear
flabby for a time, but with exercise (and depending on your prepregnant
condition), tone should return in 2 to 3 months. Consult with OB provider
as to when you may begin to exercise.
(b) Stretch marks should lighten to silver/white
appearance.
(c) If unusual tenderness or pain noted,
notify OB provider immediately.
(d) Those delivering by cesarean may
experience severe gas pain, which can be reduced by walking. Peppermint
tea has been helpful to many women. OB provider can also prescribe or recommend
remedy.
3) Lactation
(a) Regardless of whether you will
be breastfeeding, your breasts have developed, and will begin to produce
milk after birth of baby.
(b) If bottle feeding, breasts may get
engorged and sore. To help reduce milk and promote "drying up," wear a
supportive bra that fits well all the time, except for bathing. If the
discomfort of swelling increases, use ice packs on chest and avoid hot
showers hitting directly on breasts to prevent increased swelling.
(d) Breastfeeding provides increased,
special immunities to help protect the baby from infection that only mother
can provide when the baby is more vulnerable.
(e) Always consult your clinician or
pharmacist before taking any type of medication in any form if you are
breastfeeding. It may affect the baby.
4) Gastrointestinal
(a) Mother is usually very hungry
and thirsty after labor and should be able to eat (unless she has delivered
by cesarean, in which oral food will be withheld until bowel sounds return).
(b) First bowel movement may be delayed.
Many mothers will fear tearing their stitches and wait to have bowel movement,
but this will increase chance of constipation and discomfort; stool softeners
may also help.
(c) Flatus is common, especially after
cesarean. Flatus results especially after cesarean because of manipulation
of intestines during surgery, resulting in temporary decreased motility.
Early ambulation and "anti-gas" medication will help relieve this.
5) Urinary Tract
(a) May have decreased sensation
of need to void, and overfilling of bladder is possible. Be sure to attempt
to void every few hours; notify OB care provider if unable to void, there
is burning with urination, blood in the urine, or if urine is cloudy or
foul smelling.
(b) May experience slight incontinence
when active. This is common because of decreased tone of voiding muscles.
Kegel exercises will help strengthen these muscles and decrease leaking.
6) Temperature
(a) A temperature up to 100.4
F is normal within the first 24 hours. If fever is present after that,
notify clinician.
7) Weight Loss
(a) Initial loss can be 10 to 12
lbs. after birth.
(b) Five pounds may be lost soon after
birth because of increased urination and excretion of extra fluid.
(c) After 5 to 6 weeks, you should be
near prepregnant weight if you gained 25 to 30 lbs. and maintain an appropriate
diet.
8) Postpartum chill
(a) Women sometimes experience a
"shaking chill" shortly after delivery. This is normal and fine, as long
as it is not accompanied by continued fever (a warm beverage and blankets
often help).
9) Postpartum sweating
(a) Increased sweating after birth
occurs to eliminate extra water and waste products from the body (and often
occurs at night).
10) Afterpains
(a) Caused by intermittent uterine
contraction
(b) Increased in women who have had more
than one child
(c) May cause little to severe discomfort
2 to 3 days after birth
(d) If Pitocin given after birth to help
with uterine firmness, this will increase discomfort.
(e) Breastfeeding often stimulates afterpains.
(f) Rocking in a chair, or propping
a pillow under abdomen while lying on your side may assist with discomfort.
11) Breasts
(a) Often enlarged and sore, often
leak breast milk, but if a reddened area noted, notify clinician.
(b) If breastfeeding, watch breasts
for cracking and open sores; increased chance of infection
(c) Interventions for common breast
discomforts, in Family Information Handouts,
Section V, E.
12) Skin
(a) If tearing or episiotomy
occurred, sutures may be present. Be alert for any bleeding from suture
site (do not confuse with lochia), any unusual drainage, odor, separation
of skin at injured site, or pressure in that area. If so, notify clinician.
13) Extremities
(a) If swelling of legs or ankles
occurred during pregnancy, it should resolve. If new swelling, tenderness,
or redness noted in legs (especially if just one), let clinician know.
14) Postpartum guidelines for mothers.
(See Family Information Handouts, Section III,
A-I)
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