Labor and delivery, postpartum care

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Postpartum care: What to expect after a vaginal birth

Postpartum care involves managing sore breasts, hair loss, mood changes and more. Here's what to expect as you recover from childbirth.

By Mayo Clinic staff

Pregnancy changes your body in more ways than you may have guessed, and it doesn't stop when the baby is born. Postpartum care involves managing sore breasts, skin changes, hair loss and more. Here's what to expect after delivery.

Vaginal soreness

If you had an episiotomy or vaginal tear during delivery, the wound may hurt for a few weeks — especially when you walk or sit. More extensive tears may take longer to heal. In the meantime, you can help promote healing:

  • Soothe the wound. Use an ice pack, or wrap ice in a washcloth. Chilled witch hazel pads may help, too. Witch hazel is the main ingredient in many hemorrhoid pads. You can find witch hazel pads in most pharmacies.
  • Keep the wound clean. Use a squirt bottle filled with water to rinse the tissue between the vaginal opening and anus (perineum) after using the toilet. Soak in a warm tub.
  • Take the sting out of urination. Squat rather than sit to use the toilet. Pour warm water over your vulva as you're urinating.
  • Prevent pain and stretching during bowel movements. Hold a clean pad firmly against the wound and press upward while you bear down. This will help relieve pressure on the wound.
  • Sit down carefully. To keep your bottom from stretching, squeeze your buttocks together as you sit down. If sitting is uncomfortable, use a doughnut-shaped pillow to ease the pressure.
  • Do your Kegels. These exercises help tone the pelvic floor muscles. Simply tighten your pelvic muscles as if you're stopping your stream of urine. Starting about a day after delivery, try it for five seconds at a time, four or five times in a row. Repeat throughout the day.
  • Look for signs of infection. If the pain intensifies or the wound becomes hot, swollen and painful or produces a pus-like discharge, contact your health care provider.

Vaginal discharge

You'll have a vaginal discharge for up to six weeks after delivery. Expect a bright red, heavy flow of blood for the first few days. If you've been sitting or lying down, you may notice a small gush when you get up. The discharge will gradually taper off, changing from pink or brown to yellow or white. To reduce the risk of infection, use sanitary napkins rather than tampons.

Don't be alarmed if you occasionally pass blood clots. Contact your health care provider if:

  • You soak a sanitary pad every hour for more than two hours
  • The discharge has a foul odor
  • You pass clots larger than a golf ball
  • You have a fever of 100.4 F (38 C) or higher

Contractions

You may feel contractions, sometimes called afterpains, during the first few days after delivery. These contractions help prevent excessive bleeding by compressing the blood vessels in the uterus. Afterpains tend to occur during breast-feeding sessions and seem to be more noticeable with second or third babies. Medications to control heavy bleeding after delivery can increase afterpains as well.

Usually afterpains resemble menstrual cramps. If necessary, your health care provider may prescribe pain medication. Many medicines are safe even if you're breast-feeding. Contact your health care provider if you have a fever or if your abdomen is tender to the touch. These signs and symptoms could indicate a uterine infection.

Difficulty urinating

Swelling or bruising of the tissues surrounding the bladder and urethra may lead to difficulty urinating. Fearing the sting of urine on the tender perineal area may have the same effect. To encourage urination, contract and release your pelvic muscles while sitting on the toilet. It may help to place hot or cold packs on the tissue between the vaginal opening and anus, straddle the toilet like a saddle or pour water across your vulva while you urinate.

Difficulty urinating usually resolves on its own. Contact your health care provider if:

  • It hurts to urinate
  • You don't think you're emptying your bladder fully
  • You have an unusually frequent urge to urinate

These may be symptoms of a urinary tract infection.

Leaking urine

Pregnancy and birth stretch the connective tissue at the base of the bladder and may cause nerve and muscle damage to the bladder or urethra. You may leak urine when you cough, strain or laugh. Fortunately, this problem usually improves within three months. In the meantime, wear sanitary pads and do your Kegel exercises.

Hemorrhoids

If you notice pain during a bowel movement and feel swelling near your anus, you may have hemorrhoids — stretched and swollen veins in the anus or lower rectum. To ease any discomfort while the hemorrhoids heal, soak in a warm tub and apply chilled witch hazel pads to the affected area. Your health care provider may recommend a topical hemorrhoid medication as well.

To prevent constipation and straining, which contribute to hemorrhoids, eat foods high in fiber — including fruits, vegetables and whole grains — and drink plenty of water. Remain as physically active as possible. If your stools are still hard, your health care provider may recommend an over-the-counter stool softener or fiber laxative.

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PR00142

March 1, 2008

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