What to expect physically after birth

Normal vaginal bleeding

Whether your baby is born vaginally or in a Cesarean birth, you will bleed from the vagina, rather like a menstrual period, for a period of time -- possibly several weeks. This is caused by the gradual healing inside your uterus at the site of the placenta and to the gradual tightening of the muscles of your uterus as it returns to nearly its pre-pregnancy size.

If you are breastfeeding your baby, your bleeding may stop earlier than if you formula feed. Your baby's suckling action helps your uterus contract and heal more quickly.

The first few days after the birth of your baby, the blood will be bright red and heavier than a normal period, and it may contain small blood clots (smaller than a golf ball). When you get up out of bed or stand after breastfeeding, you may have a gush of blood. Over time, the bleeding will gradually decrease, changing color from red to pinkish to brown to white to clear by about four to six weeks after birth. If you are breastfeeding, this flow may decrease by 10 to 14 days. If you are too active too soon, the bleeding may become bright red again. Your body is telling you to slow down. Lie down and rest.

Do not use tampons until after your six-week post-birth exam with your health care provider. Use sanitary pads and change them often.

When will you start menstruating again?

There is no way to accurately predict when your period will resume. If you are not breastfeeding, your period will probably resume within four to six weeks after the birth of your baby. If you are breastfeeding, your period may not resume for three months or longer. Remember, you can still become pregnant! Some mothers don't begin menstruating again until after they have weaned their baby from nursing. When your period does begin again, it may be heavier than normal for a while.

Episiotomy and perineal care

If you have an episiotomy, the stitches will dissolve and do not need to be taken out. The site of the stitches may feel sore and bruised at first, but it should heal in about three to four weeks. Your perineum (the vulva, vagina and area covered by pubic hair) may feel sore from pushing and birth.

Some suggestions for perineal care:

To help your episiotomy heal and to relieve tenderness, sit in warm water several times a day.
To help prevent your stitches from pulling, sit squarely on your bottom and do Kegel exercises.
To cleanse the site, use a "squirt" water bottle (you may be given one at the hospital). Fill it with warm water, and after you go to the bathroom, rinse the area from the front to the back. Continue with the rinses at home for as long as you are bleeding.
Pat (don't wipe) the area dry from front to back.
To help relieve soreness and swelling, you may choose to use topical medicine, such as Tucks® medicated pads, Epifoam®, or magnesium sulfate and glycerin packs. These are available at drug stores.

After-birth pains

Your uterus will continue to have contractions -- although much milder than those in labor -- to help it shrink and to help the placenta site heal. These may feel like cramps, or they may feel quite strong, especially if this is not your first baby. If you are breastfeeding, you may feel these cramps more when you are nursing. Typically, these "after-birth pains" feel stronger during the first few hours after birth, and then last off-and-on for several days.

To help ease your discomfort:

Gently massage your lower abdomen or uterus.
Lie face down with a pillow under your stomach.
Use a heating pad where you feel the cramps.
Take acetaminophen (Tylenol®) or ibuprofen (Motrin® or Advil®).
If the cramping is worse when you nurse, take pain relievers at least 30 to 40 minutes before the feeding.
Relax and take deep breaths, or try one of the breathing techniques you used during labor.

Your health care provider may recommend any of a variety of medicines to help you with pain relief after birth. Be honest with your health care provider about the amount of discomfort you are feeling. Talk about what you can do for the best relief. Ask how medicine can affect your breastfeeding.

Constipation

Constipation after giving birth is common. It can be caused by being less active and by using pain medicine.

Try these suggestions:

Drink six to eight glasses of water a day;
Include whole grains, fruits, and vegetables in your diet.
Increase your activity as you feel more comfortable.
If you think you need a laxative or stool softener, talk to your health care provider. Your health care provider may recommend that you take milk of magnesia at bedtime or may prescribe stool softeners such as Pericolace®.

Perspiration

Heavy perspiration or sweating, especially at night, is common during the first week after birth. This is due to changes in your hormones. Try lighter weight nightclothes and drink plenty of fluids. Placing a small fan in your room to circulate the air should help, too.

Breast care for non-nursing mothers

Even if you have decided not to breastfeed your baby, your breasts still need special care at this time:

Wear a supportive bra 24 hours a day (sleep in it) for at least four weeks after birth.
Expect some leaking of breast milk. Express only a little of this milk for comfort -- expressing more will signal your body to make more milk, which can make you feel more uncomfortable.
If your breasts become full and tender two to four days after your baby is born:
1. Apply ice packs to the sides of your breasts under your arms.
2. Drink only when you are thirsty.
3. Take acetaminophen (Tylenol®) as needed. It will take several days for the fullness to go away.

Follow-up care with your health care provider

Your health care provider will tell you when your postpartum check-up should be scheduled. If you have any questions or concerns before that visit, call your health care provider or the birth center at your hospital.

After a Cesarean birth

If you go through hours of labor and then have a Cesarean birth, you will be recovering from the physical exertion of labor and from major surgery. Remember that your recovery will take longer than that of a woman who has a vaginal birth. You'll have surgery, anesthesia and blood loss during the birth. You'll feel more tired and need more time to rest and recuperate.

See Cesarean birth recovery for more detailed suggestions to aid your recovery.