Congratulations on the birth of your baby. The following recommendations will help with your care and recovery in the postpartum period.
• Before discharge or as soon as possible after you return home, call the office to schedule your six-week postpartum visit. This appointment should be with the physician who delivered your baby. If you had a cesarean section, you will need to be seen at two weeks as well.
• It usually takes six to twelve weeks for your body to return to normal. This is a progressive process. You should feel stronger and better every day. The most important thing to remember is moderation in all activity.
- Rest as much as possible especially in the first few weeks. The importance of rest cannot be overemphasized.
- Try to avoid stairs if possible. If you must take stairs, do so as infrequently as possible.
• You can expect vaginal bleeding for up to six weeks. The flow is usually heavier and brighter immediately after delivery and gradually becomes lighter.
- An increase in bleeding may indicate that you have been too active and should increase rest for the next day or two.
- If you are not breastfeeding, you can expect your first period between four and eight weeks after delivery.
• You may shower or take a tub bath immediately if you had a vaginal delivery. You may wish to wait a week or two to take a tub bath if you had a cesarean delivery.
• You may take acetaminophen or ibuprofen as needed for pain.
• Do not lift anything heavier than your baby for two weeks if you had a vaginal delivery, six weeks if you had a cesarean section.
• Eat a well balanced diet, drink plenty of fluid, and continue your prenatal vitamins. If you are breastfeeding, you will need a few more calories (500 calories/day) and more fluids.
• Keep the perineum (the area between the vagina and anus) clean and dry if you had a vaginal delivery. Rinse the area with a mild soapy solution after voiding or having a bowel movement. Pat dry with soft tissue.
• You should observe pelvic rest for six weeks. This means no intercourse, douching, or tampons.
• Avoid driving for at least two weeks if you had a cesarean section.
• If you experience constipation, try increasing the fiber in your diet (bran cereal, leafy green vegetables, fresh fruit, etc.). Your may also take Colace, Fibercon, or Metamucil. For hemorrhoids, you can try over the counter medications such as Tucks, Preparation H, or Anusol.
• Limit visitors for the first few weeks. This is important for both you and you baby.
• Avoid strenuous exercise for six weeks. You may, after two weeks, enjoy moderate activity such as strolls (accompanied at first).
• Don’t be surprised if you experience postpartum “blues” for a few days after coming home from the hospital. Your body is adjusting to lack of sleep and normal hormonal changes. Please call us if this feeling persists beyond two weeks.
• Call the office for any of the following:
- Fever (persistent temperature of 100.4 of higher)
- Excessive, heavy, or prolonged bleeding that does not respond to bed rest
- Difficulties urinating
- Abdominal pain
- Worsening episiotomy pain unrelieved by sitz baths and Tylenol
- Vaginal discharge that has a foul odor
- Painful, red or swollen breasts
- Redness, drainage or bleeding from a cesarean incision
- Severe, prolonged, or restricting depression
Could you be Struggling with Depression?
How common is depression during and after pregnancy?
1 in 7 pregnant and postpartum women experience depression.
What is the difference between postpartum blues and postpartum depression?
Postpartum blues generally start 2-3 days after birth and resolve within 1-2 weeks, where some women feel depressed, anxious, or angry which can affect their ability to care for their baby.
Postpartum depression starts about 1-3 weeks after delivery and is marked by intense feelings of sadness, anxiety, or despair that affects daily functioning and can last up to 1 year.
Other symptoms include sleeping too much or too little, lack of energy and little enjoyment in activities, feelings of guilt when things go wrong, feeling overwhelmed, changes in appetite, weight, and desire to have sex, and thoughts of harming oneself or others.
Am I more likely to have depression?
Risk factors during and after pregnancy include:
A personal or family history of depression, neuroticism (tendency to worry about things in ways that are not healthy), low self-esteem, history of anxiety disorder, history of substance abuse, history of behavioral disorder, trauma, stressful events in the past year, parental loss, poor social support, and history of divorce or marital problems.
Why am I experiencing depression?
Hormone levels change after childbirth which can trigger depression and mood swings similar to pre-menstrual syndrome. Women who have had depression before, during, or after pregnancy – or those currently treated for depression – have an increased risk of developing depression during and after pregnancy. Exhaustion and lack of social support, in addition to stressful life events, can contribute greatly to depression.
Will I be screened for depression during pregnancy and after delivery?
You will be administered an Edinburgh Postnatal Depression Scale to screen for depression at your 32 week visit during pregnancy. After delivery, you will be screened once again.
How is depression treated?
Taking medications such as anti-depressants and/or talking with a therapist (psychiatrist, psychologist, or social worker) can be used in the treatment of depression. Your healthcare provider or psychiatrist will weigh the risks and benefits of using medication during pregnancy and while breastfeeding.
What if I want to get pregnant again?
Women who experience depression during and after pregnancy are at a higher risk of developing it again. If you have had depression before and took a medication that helped you feel better, your doctor may recommend that you take that medicine again. Always tell your healthcare provider if you have dealt with depression.
How do I get help?
Call your healthcare provider if you think you are struggling with depression. If you feel like you might want to hurt yourself or others, please call 911.
Postpartum Support International. http://www.postpartumsupport.net
Patient Information: Postpartum depression (The Basics). www.uptodate.com
Medline Plus. www.nlm.nih.gov/medlineplus/postpartumdepression.html
The American College of Obstetricians and Gynecologists. FAQ, December 2013. http://www.acog.org/Patients/FAQs/Postpartum-Depression
We are very proud to offer RHJ patients access to in-house lactation consultation by our very own board-certified lactation consultant and Nurse Practitioner, Katie Blanchette.
Breastfeeding is an experience unique to each woman and pregnancy, and is a learning process for mom and baby. Katie sees pregnant and postpartum patients alike for a 30 minute appointment to offer guidance, teaching, and support. Topics covered in the consultation range from:
- personal breastfeeding goals
- breastfeeding best practices
- breastfeeding challenges
- using and understanding lactation devices and breast pumps
- supplements to breastfeeding and more
Currently, consultations for postpartum patients who will be bringing their newborn with them can only be scheduled in our Chevy Chase location. Katie utilizes a breastfeeding specific scale that is calibrated to one-hundredth of a gram for maximum accuracy in pre and post-feed weight recording to best measure how much baby is taking in at breast feedings.
For more information about lactation consulting and breastfeeding, please visit the following resource pages: