Physical Changes of the Uterus

Your nurse will be checking your uterus every shift. You will need an empty bladder for her to do so. A full bladder presses on the uterus, causing it to relax and bleed more than usual. If your uterus is not firm, your nurse will massage it using pressure rubbing gently in a circular motion. The uterus may increase bleeding for a few minutes and increase cramping briefly. The massage causes the uterus to become smaller and firmer. Breastfeeding also causes the uterus to contract and is an excellent source to keep the uterus firm and decrease vaginal bleeding. Vaginal bleeding will occur for 2-6 weeks. The color will change from a bright red to a watery red/pink to a yellow/white/clear color. Do not use tampons or douche until you talk with your health care provider at your scheduled six-week checkup. Your periods will probably start again in about six to eight weeks. If you are breastfeeding, your periods may begin later.

Breast Care

If breastfeeding: Clean your nipples with water only. Wear a supportive bra and allow nipples to air-dry after each feeding. Apply Lansinoh cream to nipples if soreness, cracking, or redness develops. Change breastfeeding positions to lessen soreness. Contact health care provider if problems arise. Wear a supportive bra.

If bottlefeeding: A bra that is supportive should be worn at all times. Do not let hot water from a shower directly hit your breasts. For discomfort from encouragement, pain medications may be taken as ordered and ice packs can be applied. The ice will reduce milk production and swelling.

Nutritional Needs

Eat foods from the four food groups-especially those with iron (meat, beans, green leafy vegetables, dried fruit, enriched breads), calcium (milk, yogurt, cheese), and protein. Continue taking your prenatal vitamins and any iron supplements ordered by your health care provider. Drinking orange juice with your iron will enhance its absorption. Drink enough fluids to satisfy your thirst. Do not diet to lose weight during this postpartum period. Discuss weight management with your health care provider at your six-week appointment. Some babies are sensitive to some of the foods you eat. Be aware that dairy foods, onions, broccoli, cauliflower, cabbage, tomatoes, chocolate, and caffeine drinks can possibly affect your newborn.  

Restarting Normal Activities

Gradually increase your activity while in the hospital as long as you are not dizzy or light-headed. Ask for assistance as needed. In 1-2 weeks after delivery, you may resume normal activities as soon as you feel up to it. Begin Kegel exercises to help strengthen perineal muscles. Drive a car when you feel up to it, when you are not taking narcotics, and when your health care provider has agreed. Avoid stair climbing if possible. If not possible, slowly climb stairs. No engagement in any regular exercise program is recommended until you see your health care provider at the six-week check-up.  

Bladder/Bowel Function

Bladder Function

Now your bladder muscle has room to stretch with the extra fluid your body needs to get rid of, but you do not always feel like your bladder is full. This sensation will return in a few days as the bladder muscle is exercised and regains tone. You may notice a heavier flow in the first few days at home when your bladder is full. Therefore, empty your bladder every two hours even if you do not feel full.     

Bowel Function

Most moms will have their first bowel movement within 3-4 days after delivery. Eat foods high in fiber (whole grains, fruits, vegetables), drink plenty of fluids, and take a stool softener beginning in the hospital twice a day if ordered by your health care provider. Milk of Magnesia or Metamucil may also be used.

Swelling/Fluid Retention

It is normal to see an increase in swelling in your legs during the first week or longer after delivery. The body cannot quickly remove the extra fluid volume from pregnancy so it is temporarily stored in the tissues. As your body works to eliminate the extra fluids of pregnancy, you may notice an increase in perspiration, urination, and, ultimately, swelling. Elevate legs, avoid canned foods, and avoid adding salt to your meals.

Pain Management

Perineal Pain

Use the peribottle filled with warm water as instructed by your nurse to cleanse your stitches every time your use the bathroom. When wiping with toilet tissue, gently pat the area, cleansing from front to back. Ice packs are recommended for the first 24 hours after delivery. After 24 hours, the sitz bath is recommended for use twice a day for 1-2 weeks or until the perineal discomfort lessens. Witch hazel (brand name=Tucks) pads may also be used for relief from perineal pain. Wear cotton underwear and do not wear tight fitting clothing.  

Afterbirth Contractions

These contractions signal your body to return the stretched uterus to its pre-pregnant size and muscle tone. They may be stronger after each succeeding pregnancy, while nursing, and with a full bladder. A heating pad or hot water bottle or lying on the stomach may help provide relief from the cramping. Medications such as Motrin are helpful.

Care of the Episiotomy and/or Laceration

Use of the peribottle, witch hazel pads, and ice/sitz baths as noted above are useful in caring for an episiotomy and/or lacerations. Always use a new pad after using the bathroom. Wash hands frequently.

Care of Perineum after Use of Forceps and/or Vacuum

Utilize the same care as above; however, be aware of any increased bleeding or difficulty urinating due to increased perineal swelling and possible decreased ability to urinate.  (Link here to forceps/vacuum page) 

When to call your Health Care Provider

See "postpartum warning signs" link.