Following are several types of changes that you may experience after giving birth. In addition to these changes, you need to be alert for the following warning signs. If any of these warning signs occur after you are discharged from the hospital, contact your health care provider immediately.

Warning Signs  |  Bleeding  |  Breastfeeding  |  Episiotomy  |  Hemorrhoids  |  Menstruation  |  Changes in Your Uterus/After-Birth Pain  |  Other Physical Changes

Warning Signs

1. Bright red, heavy bleeding (soaking more than one sanitary pad in less than one hour) or passing large blood clots.

2. Severe abdominal pain — different than after birth cramps.

3. Fever over 100.4 degrees Fahrenheit (38º Celsius).

4. Persistent headache, changes in your vision such as spots in front of your eyes. Rapid swelling of face, feet, fingers, and overall swelling.

5. Increased redness, swelling, tenderness, odor, or discharge from the episiotomy site.

6. Caesarean incision which has opened, has foul odor, is red, or has discharge.

7. Area in the calf or legs which is tender, swollen, hot, hard or red. (May indicate phlebitis or blood clot.)

8. Area in the breast which is hot, hard, red and painful to the touch. (May indicate a breast infection and antibiotics may be necessary; usually accompanied by a fever.)

9. Persistent postpartum depression.
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Bleeding

Vaginal discharge after birth is called lochia. It is a combination of the sluffed uterine lining and blood. The lochia usually changes from bright red, to pink, to whitish over the course of several weeks.

It is very common for the bleeding to stop and start intermittently as well as to contain clots. Decrease your activity if you notice an increase in the amount of bleeding as it is a signal for you to slow down and rest more. If you are concerned about the amount of your bleeding, contact your health care provider. See “Warning Signs” above.

Use sanitary pads instead of tampons until you have your first menstrual period after birth. Vaginal bleeding after a caesarean will usually be less than after a vaginal birth.
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Breastfeeding

If You Are Breastfeeding
When your milk supply increases, approximately 48-72 hours after delivery, your breasts may become firm and a little tender. Fullness in your breasts is a result of a naturally occurring increase in blood flow which prepares your breasts for increased milk production. Frequent nursing will help keep your breasts soft and prevent engorgement.

If You Are Bottle-feeding
If you are not breastfeeding, a snug-fitting bra or towels wrapped tightly around both breasts will help minimize breast engorgement. If your breasts become painful, avoid nipple stimulation and milk expression. Apply ice packs to decrease the swelling and consider taking a mild pain reliever. When showering, avoid warm water directly on your breasts as this may increase milk production.

For more information on self-breast exam or a referral to the Breast Health Center at California Pacific Medical Center, please call (415) 750-6474.
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Episiotomy

If you had an episiotomy, the stitches used to repair your incision will dissolve in about two weeks and therefore do not need to be removed. The skin heals in about two to three weeks. You may see small pieces of the stitches in your underwear as your episiotomy heals; this is normal and is no cause for concern.

Care of Your Episiotomy
Immediately after birth and whenever swelling is present, use an ice pack for comfort. You may also use a portable Sitz bath or sit in a shallow amount of warm bath water. Repeat three to four times a day for about 10 minutes, until the swelling has gone. Alternating heat and cold may be helpful.

Episiotomy pain usually improves daily. Take a mild pain reliever (such as Advil or Tylenol) if needed. Many women find that sitting on a hard surface is usually more comfortable; squeeze your buttocks together before sitting. Keep the perineum dry and wear cotton underwear. Begin Kegel exercises as soon as possible.
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Hemorrhoids

Many women develop hemorrhoids during pregnancy and after giving birth. Hemorrhoids are varicose veins of the rectum caused by the weight and pressure of the baby and the force of pushing. Hemorrhoid pain may be relieved with ice packs, ice cold pads containing witch hazel (such as Tucks), or your health care provider may suggest other creams or suppositories.

Avoid constipation by including fruits, vegetables, and whole grains in your diet, and by drinking lots of fluids. Prunes and bran are helpful remedies if you have a tendency toward constipation. You may also be prescribed a stool softener. Contact your health care provider for his or her recommendations. Hemorrhoids will eventually shrink and become less uncomfortable.
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Menstruation

While breastfeeding, your menstrual period may not resume. However, if it does, it should not interfere with breastfeeding but may slightly diminish the amount of breast milk available during the flow. Drink lots of fluids and nurse frequently.

NOTE: Breastfeeding is NOT a reliable form of contraception. Even though you may not have a period, you may still be ovulating.

If bottle-feeding, your period may return within four to eight weeks. Your first period may be heavier than normal, there may be clots, and it may start and stop intermittently.
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Changes in Your Uterus/After-Birth Pain

The uterus begins to return to its pre-pregnant size immediately after delivery. It changes from approximately the size of a basketball during pregnancy, to the size of a grapefruit immediately after delivery and, finally, to the size of a small pear six weeks postpartum. At first, the uterus will shrink to your navel and gradually descend back into your pelvis.

If your uterus does not feel hard immediately after birth, apply deep massage until it is firm. Pitocin, a medication which causes the uterus to contract, is frequently given immediately after birth to ensure that the uterus remains firm and helps prevent excessive vaginal bleeding. An additional medication may be needed if your uterus does not respond to the Pitocin and massage. After-birth pains can also be triggered by breastfeeding and orgasm. If you have had other children, your contractions may be more painful due to the stronger force of the contractions needed to compensate for previous stretching.
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Other Physical Changes

Many postpartum changes are a result of the hormonal shifts and fluid adjustments which occur after delivery. The most noticeable changes are:

• Retention of fluid/swelling
• Initial hair loss (your hair will come in again later)
• Hot flashes
• Night sweats
• Dry skin
• Mood swings
• Increased urination
• Vaginal dryness

Empty your bladder every four to six hours and start Kegel exercises as soon as possible.

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