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Middlesex-London Health Unit

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After Pregnancy - Physical Recovery and Self-Care

Many changes happen to your body in the 40 weeks of pregnancy. Recovery from pregnancy and birth will take some time. Go easy on yourself and make sure you take time to look after your needs. The postpartum (after birth) period is both exciting and exhausting for many new mothers.

The World Health Organization (WHO) guidelines recommend that you are assessed by your healthcare provider several times after birth to ensure you are recovering and healing well (within 24 hours, 48-72 hours, 7-14 days, 6 weeks).

If your care is provided by a midwife, a client-centered schedule of 3 assessment visits within the first week and 3 additional visits in the first 6 weeks after birth will be arranged with additional visits or phone calls as needed.

If your birth care is provided by a family physician or obstetrician in hospital, it’s recommended that you are assessed by your healthcare provider at 6 weeks after birth unless you have a specific health concern. You will need to schedule this appointment with your healthcare provider yourself.

 

Below are some of the physical changes you can expect during the first few months after the birth of your baby.

Vaginal Discharge (Lochia)

When to Expect your Period to Return

Perineal Pain

Cramping (After-Pains)

Problems Urinating (Peeing)

Constipation

Hemorrhoids

Tender Breasts

Sweating

Fatigue

Emotions

Caesarean Section

 

 

Vaginal Discharge (Lochia)

 
 

Questions?

Call 519-663-5317 to speak with a Public Health Nurse at the Middlesex-London Health Unit.

  • Monday - Friday
  • 8:30 a.m. - 4:30 p.m.

After hours, call Telehealth Ontario: Toll-free: 1-866-797-0000 to speak to a Registered Nurse or a Registered Dietitian.

If you have an urgent medical concern, call your healthcare provider or go to your nearest hospital Emergency.

 

After giving birth, you will have vaginal discharge called lochia. Lochia is made of blood and tissue from the lining of your uterus. It's normal for this discharge to last from 4 to 8 weeks after birth. From day to day, lochia changes in colour and amount. It should smell like normal menstrual bleeding.

In the first few days, your blood flow (lochia):

  • May be  bright red or brown and have a few small clots like a heavy menstrual period.
  • May gush after laying down because of blood collecting in your vagina.
  • May gush during or after breastfeeding because of the contraction of your uterus from the natural release of the hormone oxytocin.

Lochia flow will change in colour from bright red to pink or brown, then yellow-white. The flow will slow down over the first few weeks. It is important to use sanitary pads, not tampons or menstrual cups. Change pads every time you go to the bathroom to prevent infection. Your flow may be heavier with increased activity and breastfeeding but should resolve with rest.

Contact your healthcare provider if:

  • Your lochia is heavier than a period (e.g. Soak a pad in less than 1 hour).
  • Your vaginal discharge smells foul.
  • You have clots larger than a $2 coin (Toonie) (2.5 cm or 1”).
  • You have perineal &/or vaginal itch or flow with a bad odour.
  • You are concerned about your lochia flow.

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When to expect your period to return

  • If you are not breastfeeding, your period can return from four to nine weeks after birth. Your period may be longer, shorter, heavier or lighter than before your pregnancy. It should return to what is normal for you after a few cycles.
  • If you are breastfeeding, it may take months for your period to return or, you may not have a period the entire time you are breastfeeding.
  • It is important to remember that your ovaries begin to work before your period returns. You can become pregnant again without ever having your period. If you do not want to become pregnant, you should use birth control as soon as you plan to have sex. Talk to your healthcare provider about the many birth control options to see which option may be best for you.

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Perineal Pain

It is normal for your perineum (the area between your anus and vagina) or bottom to be swollen, bruised and tender after a vaginal birth. Generally, a longer labour may lead to greater pain related to more swelling. How fatigued you are may also affect your perception of pain. If you have stitches, you may feel itching as they dissolve and completely heal. Soreness may last up to six weeks, but you should feel less sore with each passing day. If your pain has been managed and is improving and then worsens, check with your healthcare provider as this could be a sign that something is wrong. The severity of your pain depends on several factors:

  • The extent of swelling and bruising.
  • Tearing of muscles and skin.
  • If this is your first birth or not.
  • Need for stiches.
  • Previous pain experiences.

To help with healing and manage pain:

  • Keep your perineum clean by changing your pad every time you go to the bathroom.
  • Use a plastic squirt bottle filled with warm tap water to clean the area after going to the bathroom.
  • Always wipe from front to back after going to the bathroom to prevent infection.
  • Apply ice packs to reduce pain and swelling for 10-20 minutes right after your birth and every hour as needed throughout the first 24 hours after birth (wet and freeze a clean sanitary pad and apply to the area with a thin layer of cloth or tissue over the ice pack to protect your skin).
  • After the first 24 hours, soak your bottom in a couple of inches of warm water in your bathtub several times a day for 20 minutes - allow the area to air dry after soaking.
  • Get as much rest as you can - put your feet up to take pressure off of the area.
  • Take pain medication as recommended by your healthcare provider.
    • If you are breastfeeding, talk to you healthcare provider about medications that are safe for you to take. 

Contact your healthcare provider if:

  • You feel burning in your perineum.
  • Your stitches open and/or begin to bleed.
  • You have a fever (temperature over 38 °C or 100.4 °F).
  • You feel increasing pain.
  • You have foul-smelling vaginal discharge.

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Cramping (After-Pains)

After-pains (contraction like pains in your abdomen) are caused by the uterus shrinking as it contracts. It feels like strong menstrual cramps. They can feel stronger during breastfeeding in the first few days after birth, especially if this is not your first baby. If you are breastfeeding, talk to you healthcare provider about medications that are safe for you to take.

Contact your healthcare provider if:

  • Pain or cramping in your abdomen does not seem to be getting better after 1 week.

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Problems Urinating (going pee)

  • Empty your bladder within six hours of birth and regularly after.
  • In the first few days after giving birth, you may find it hard to urinate (pee).
  • To help start the flow of urine, turn on the taps in the bathroom sink - listening to running water may help.
  • To help take away the sting of urine on a sore bottom, use a plastic squirt bottle to pour warm or cool water over the area while peeing.

Since the muscles in this area have been stretched during childbirth, you may leak urine when you cough, sneeze or laugh. To help strengthen and tone these muscles, try doing Kegel exercises a few times every day (see below). If you find that these are not helping enough, you might want to speak to a pelvic floor physiotherapist. They can do an assessment and provide perineal exercises that can assist you in recovering more of your pelvic floor functioning.

Kegel exercises:

  • Squeeze and hold your pelvic floor muscles for five to ten seconds (like stopping your pee).
  • Relax the muscles for ten seconds.
  • Repeat the squeeze/hold/relax routine ten times at each session. Do 10 sessions per day.

Contact your healthcare provider if:

  • You feel pain or burning when you urinate (pee).
  • You feel like you need to pee often and urgently.
  • You have a fever (temperature over 38 °C or 100.4 °F).
  • You notice a foul smell or change in colour to your urine.
  • You feel like your bladder is still full after peeing.

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Constipation

You may not have a bowel movement for two to three days after giving birth because of decreased muscle tone in the intestines during labour, not eating or drinking as much, or from taking pain medications. Also, if your bottom is already sore, you may worry about having a bowel movement. However, straining at stool can worsen hemorrhoids and tear stitches. To help prevent constipation:

  • Drink plenty of fluids (water, milk, unsweetened soy beverages).
  • Eat foods that are high in fibre (fresh fruits and vegetables, whole grain products, beans, lentils, nuts and seeds).
  • Talk with your healthcare provider about safe stimulant laxatives. Stool softeners are not effective and not recommended.

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Hemorrhoids

Hemorrhoids are stretched and swollen veins around your anus that look like grape-like clusters. They can be painful and itchy and can even bleed when you are having a bowel movement. To help prevent hemorrhoids:

  • Take the pressure off your bottom, lie down rather than sitting.
  • Apply ice-packs, witch hazel, and hemorrhoid creams to reduce pain, itching and swelling.
  • Speak with your healthcare provider about safe medicated creams or suppositories that may help. If you have a 3rd or 4th degree tear, DO NOT use suppositories in your rectum as this can interfere with the stitches.

Contact your healthcare provider if:

  • You have any rectal bleeding or blood in your stools.
  • Your constipation is getting worse.
  • You have pain with a bowel movement beyond 1-2 weeks.

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Tender Breasts

When your milk changes in volume, about two to four days after birth, your breasts may feel full, heavy and tender (engorged). Breastfeed your baby often (at least 8 or more times in 24 hours) to help remove the milk from your breasts and reduce engorgement.

Other things that may help:

  • Apply cold compresses between feedings to help reduce swelling and tenderness.
  • Apply warm compresses before feedings to help with milk flow - this can also feel soothing.
  • If you are not breastfeeding, wear a supportive bra day and night.
  • Apply ice packs to reduce swelling and relieve pain.
  • Pain medications that also reduce swelling may be helpful.
  • Talk to your healthcare provider before using a breast pump as pumping will make you produce more milk.

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Sweating

You may find that you sweat a lot in the first few days and weeks after having a baby, especially during the night. This is due to changes in hormones and your body getting rid of the extra fluid from pregnancy. You may also pee more often.

To help you feel better:

  • Drink fluids to replace the fluids you have lost.
  • Wear lightweight clothing when you sleep.
  • Use light blankets instead of heavy or thick ones.
  • Have a fan near your bed.

Contact your health care provider if:

  • Your temperature is higher than 38 °C (100.4 °F) - this could be a sign of infection.

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Fatigue

Your body has worked very hard over the last 10 months and gone through tremendous changes. Disturbed sleep patterns are common related to your infant’s demands. It’s very normal to feel tired after the birth of your baby. It may take a few months to return to your usual energy level.

Take care of yourself by:

  • Resting while your baby sleeps.
  • Keeping visitors to a minimum unless they are willing to help so you can rest.
  • Accepting help from family and friends with meals, buying groceries, cleaning your house and laundry.
  • Eat well and drink plenty of fluids.
  • Explore ways you can make your sleep environment more conducive to sleep (e.g. privacy, darkness, quiet, relaxing).

Contact your healthcare provider if:

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Emotions

Emotional changes are another big part of recovering from childbirth. Please visit Mental Health and Well Being for more information.

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Caesarean Section

Caesarean birth (or c-section) is an operation for the birth of a baby through an incision (surgical cut) in the mother’s abdomen and uterus. Full recovery from a C-section usually takes four to six weeks. It is important to take good care of yourself and your baby. You will need lots of rest when you get home.

Take care of yourself by:

  • Asking family and friends for help.
  • Not lifting anything heavier than your baby.
  • Starting to walk as soon as possible - this can prevent problems like blood clots and gas pains.
  • Listening to your body - stop and rest if you feel pain or discomfort.

Pain Relief

Pain in and around your incision is normal. You might also feel numbness and itching as your incision heals. Your pain should lessen every day. Breastfeeding makes your uterus contract, so you may want to take medication, if needed, before you breastfeed.

  • To help you feel less pain, hold a pillow against your incision when you move, cough or laugh. Use relaxation techniques such as deep breathing.
  • To manage intestinal gas pain: walk as often as you can, do not eat or drink gas-forming foods such as carbonated beverages or ice, do not use straws, lie on your left side to expel gas or rock in a rocking chair.
  • Talk to your healthcare provider about pain medications. 
    • If you are breastfeeding, talk to you healthcare provider about medications that are safe for you to take.

Contact your healthcare provider if:

  • You have a fever ( temperature over 38° C/100.4 °F).
  • You notice swelling, redness, warmth or pus around your incision or notice the incision opening up.
  • Pain or cramping in your abdomen does not seem to be getting better after 1 week.
  • You have sudden worsening pain around your incision or in your abdomen.
  • You feel pain or burning when you pee.
  • You have foul-smelling vaginal flow.
  • You have pain in your calf (lower leg).
  • You experience difficulty breathing or chest pain.

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Date of creation: February 22, 2013
Last modified on: February 20, 2020
 
 

References

1Middlesex-London Health Unit-Healthy Start Division. (2018). Postpartum Nursing Guidelines. London, ON: Middlesex-London Health Unit.
2World Health Organization. (2013). WHO recommendations on postnatal care of the mother and newborn., Retrieved from
https://www.who.int/maternal_child_adolescent/documents/postnatal-care-recommendations/en/
3Association of Ontario Midwives: Midwifery Task Force on Postpartum Visit Schedules. (2019). Guideline on postpartum visit schedules. Retrieved from
https://www.ontariomidwives.ca/sites/default/files/2019-07/Postpartum%20visit%20schedules%20web_V06.pdf
4Provincial Council for Maternal and Child Health. (2018). Standards of Postnatal Care for Mothers and Newborns in Ontario. Retrieved from
http://www.pcmch.on.ca/wp-content/uploads/2018/05/Standards-of-Postnatal-Care-for-Mothers-and-Newborns-in-Ontario-Final-Report-Part-I-2018May16.pdf
5Gunter, J. (2019). The vagina bible: the vulva and the vagina--separating the myth from the medicine. Toronto: Random House Canada.
6London Health Sciences Centre Women’s Care Program. (2017). Having a Baby at London Health Sciences Centre. Retrieved from
https://www.lhsc.on.ca/media/2429/download
7Society of Obstetricians and Gynaecologists of Canada. (ND). Postpartum Vaginal Recovery. Retrieved from
https://www.pregnancyinfo.ca/postpartum/postpartum/vaginal-recovery/