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After birth—care of the new mother

Education

During your stay, midwives and nurses will provide education and information to enable you to confidently care for yourself and your baby in preparation for going home. There are also a range of talks available for you to attend—your midwife or nurse can direct you as to the time and venue. We recommend that you attend as many as you can.   

Physical care

Normal vaginal bleeding

  • For the first two to three days after the birth, your blood loss may be like a heavy period. Over the next week the amount will gradually lessen and the colour will change from red to brownish/pink. Spotting can continue for four to six weeks after the birth and a small number of women may have a scant loss up to twelve weeks.
  • It is normal to experience period like cramps and slightly heavier blood loss during breastfeeding in the first few days.
  • If you pass any clots you need to keep these and show your midwife or doctor.
  • If you have a sudden increase in blood loss once you are home you need to see your doctor as soon as possible.
  • Do not go swimming until your bleeding has stopped.
  • Do not use tampons until after your six week check.

Perineal care

The perineum is the area of skin and muscle between the vagina and anus. At the very end of your labour these skin and muscle layers thin and stretch to allow your baby to be born. If you have had some form of perineal or vaginal tearing, or an episiotomy (a cut made into your perineum to enlarge your vaginal opening), the following recommendations will assist you to heal and become comfortable.

  • Use ice regularly, leaving on for 10 minutes at a time, and reapplying each hour as necessary for the first few days, or while it still feels helpful. Ice should be wrapped in a thin piece of dampened cloth and then placed on the perineum, or ice packs can be placed in the inside lining of a sanitary pad.
  • Keep the perineum clean by showering each day.
  • Change sanitary pads at least every four hours—this can help reduce the risk of infection.
  • Lie down for approximately 20–40 minutes in each hour for the first 24 hours, if you can, as this reduces any swelling and assists healing. Lying on your side is often more comfortable than on your back if you have any low back ache.
  • Resist sitting with crossed legs, or any sitting position that allows your labia to gape open, if you have a tear or stitches. This assists to reduce strain on your perineum or stitches.
  • Practice several very gentle pelvic floor “pulses” each hour without trying to “hold”. This helps to reduce swelling and promotes healing.
  • Move smoothly and carefully, avoiding any straining, holding your breath or lifting anything heavy—especially toddlers!
  • Be careful to draw in the pelvic floor before you go to move, lift, cough or sneeze—this will protect the perineum.
  • If you have stitches, they are dissolvable and will fall out between one to three weeks after the birth. You may find some stitches on your toilet paper or in the shower.
  • If you have had a third or fourth degree tear, you will be given Mater’s Recovering from third or fourth degree perineal tears brochure, which outlines recommendations for care in these situations.

Involution of your uterus

By the end of the first week your uterus is nearly as small as it was before you became pregnant and has usually returned to its pre-pregnancy size by six weeks.

It is important to remember that your abdominal muscles have stretched to allow your baby to grow and may take several months to recover.

Bladder care

You need to try to pass urine every three to four hours. Passing urine may be difficult after the birth because you may not be able to feel what you are doing.

If you have stitches or grazes, passing urine may sting so try doing this in the shower, leaning forward on the toilet or tipping warm water over your perineum as you sit on the toilet. Drinking water dilutes your urine which may also help.

You will be asked to undergo a bladder assessment within four hours of giving birth. For further information about this assessment, please see Mater Mothers' Hospital's After birth—bladder assessment brochure.

Bowels

  • It is normal not to open your bowels for a few days after the birth; however your bowel motions need to remain soft and easy to pass as this allows stretched muscles and a stitched perineum to heal quickly and well. It is important to eat fresh fruit, brown bread and wholegrain cereals and to drink plenty of water.
  • When you go to the toilet use the lean forward position and use a clean pad to gently support your stitches. Do not strain—just relax and take your time. This remains important for at least six weeks after the birth while the affected tissues heal properly and is also a lifelong good habit.
  • Note: See the diagram to the right for the correct “lean forward” position. Remember to keep the curve in your back as you lean forward from the hips. Lean through your forearms onto your thighs. Come up onto the balls of your feet if comfortable. Allow your abdomen to relax forward and do NOT hold your breath or strain. A small footstool may enhance the position.
  • If constipation is a long-term problem for you, please discuss this with your doctor—a consultation with a dietician may be indicated.
  • Try not to strain as this may worsen any haemorrhoids you may have. There are ointments available from the pharmacy to aid in lessening the discomfort from haemorrhoids.

Pain management

You may require regular pain relief after the birth of your baby. For more comprehensive information please read Mater’s Pain management—after childbirth brochure.

Physiotherapy

  • You can start to do gentle pelvic floor “pulses” as soon as it is comfortable to do so: they will help you to move easily and recover quickly.
  • It is important that the muscles which form the deep muscular “corset” of your body (the pelvic floor and deep transverse abdominal muscles) start to work again as quickly as possible, because they support and protect your uterus, bladder, bowel, spine and pelvic joints and will help you avoid pain in the perineum, tummy and back.
  • After having a baby, you should always get in and out of bed on your side, as this reduces the strain on your perineum, back and tummy. If you have pain as you move be extra careful to get in and out of bed the right way.
    • Lie on your back with both knees bent up.
    • Roll over on your side without twisting too much.
    • With your upper arm well in front of you, push your upper body forward and up, as you allow your legs to go down at the same time.
    • Remember to keep breathing, keep your knees bent and come forward in one smooth action.
    • If you are able to gently draw in the pelvic floor before and as you get up, this may feel more comfortable
  • Always try to sit up tall (using good chair support when possible)—avoid sitting on the edge of the bed where your back has no support.
  • Make sure you keep your back straight, especially when caring for your baby i.e. adjust the height of your bed or change table, or sit or kneel down as this is better for your back.

Postural stretches

Sit up well supported in a chair

  • Take a deep breath in and lift your chest as you breathe in. As you let go of your breath, release tension and let your shoulders go back and down.
  • “Roll” your shoulders forward, up, down and back.
  • With your hands on your shoulders, draw as large a circle as you can with your elbows. Slowly repeat three times in each direction.
  • Sit with the crown of your head as tall as can be. Tuck your chin under to create a “double chin”. Hold, then release.
  • Stretch shoulders and spine backwards using the chair as a “pivot”—place your arms behind the back of the chair, to assist with the stretch.
  • Sit tall, facing forwards. Slowly tilt your head over to one side, keeping your shoulders down.
  • Pause, and then come up. Repeat to the other side.

Activity

  • When you go home, continue to do your Home Exercise Program that you started in hospital—postural stretches and gentle strengthening.
  • Ensure that you move carefully and smoothly, drawing in the pelvic floor before and during movements, especially more strenuous activities such as lifting, pushing, coughing etc.
  • Return to all activities at home gradually, starting with short sessions only—as your muscles recover and get stronger, you will feel able to gradually increase your activities.
  • If the activity hurts or strains your tummy or perineum or you are holding your breath, stop what you are doing—this is not good for you.
  • It is very important to return to a general fitness program after having a baby. Because the ligaments and support structures of your body are not back to full strength for up to a year postnatally, it is important to choose from the many safe sports and exercise programs available, while avoiding a few risky activities. Walking, swimming, aquarobics, Pilates, Fitball based programs, gym stations with light/medium weights, cross-training and cycling are all good exercise choices at this stage.
  • If high impact is involved, try to avoid the activity. Even if you have strong muscles, your supporting ligaments may not cope with the sudden strain of high impact aerobics classes or jogging. Try social rather than competitive team sports.
  • A physiotherapist can help you make a good recovery and if further treatment is required an outpatient appointment can be arranged before you go home.
  • To assist your physical recovery the experienced physiotherapists at Mater Mothers’ Hospitals offer postnatal exercise classes including mother and baby classes. For further information, or to book for these classes phone 07 3163 6000.

Diet

  • It is important to eat healthily after the birth of your baby, just as it was when you were pregnant. Your body needs food from all five food groups to help it recover from the birth.
  • When you are breastfeeding, eating everything in moderation is the general rule. Breastfeeding mothers often have large appetites and you need to satisfy your appetite with healthy food choices.
  • Thirst is also increased when breastfeeding but drink to thirst only. Thirst is satisfied best by water and not by soft drinks or juice. It can be useful to have a drink ready when you are feeding.

Postnatal emotions

  • Approximately 80 per cent of women experience the baby blues around three days after birth. Baby blues can be caused by hormone changes; tiredness; pain from stitches; a wound or full breasts or even feeling flat after all the excitement of the birth. You may feel anxious about small things and become very weepy.
  • Your partner can be most helpful by being supportive, listening to you and caring for your baby while you get some rest.
  • Some new parents find it difficult to bond with their new baby. You should not feel guilty if you don’t instantly bond or do not feel how you expected to. Your feelings will change and grow over time.
  • About 10 to 20 per cent of women can go on to develop postnatal depression (PND) which may include one or more of the following signs or symptoms:
    • persistent low mood
    • extreme anxiety, confusion and panic
    • difficulties in sleeping or excessive sleeping
    • not eating or overeating
    • inability to enjoy anything or cope with routine tasks
    • inability to think clearly or make decisions
    • feelings of wanting to harm baby or self
    • wanting to run away.
  • Postnatal depression is a treatable condition and it is most important to get help early. You can seek help through your midwife, GP, child health nurse, Belmont Private Hospital or Ellen Barron Family Centre. Please refer to the resources section at the end of this brochure for contact details.
  • It is also important to seek help if you found your childbirth experience stressful, disappointing or traumatic so please ask your midwife or doctor if you have any questions, regarding the birth of your baby. Approximately seven per cent of women develop post traumatic stress disorder (PTSD) due to the severity of distress they feel. Symptoms may include flashbacks, being on guard, nightmares, avoidance, depression and anxiety. For information about birth trauma contact the Birth Trauma Support Group or Birthtalk (details at the bottom of page).

Sex and contraception

  • Sexual relations can be resumed when you feel comfortable, unless advised otherwise by your doctor or midwife.
  • Be aware that it is still possible to become pregnant while breastfeeding.
  • Lactational Amenorrhea Method (LAM) is an effective natural method of family planning that research has shown to be more than 98 per cent effective if certain situations exist (i.e. if you are fully breastfeeding, if you have not yet had a period and if your baby is less than six months old). A trained natural fertility consultant can advise you with this method of family planning.
  • There are other options for family planning which you can discuss with your doctor or a natural fertility consultant. If you would like assistance please contact Mater’s Fertility Services on 07 3163 8437.
  • If you have chosen not to breastfeed, are partially breastfeeding or are expressing for a preterm or sick baby, ovulation may occur before the return of your period and; therefore, it is possible that pregnancy could occur any time after your baby is three weeks old. Your first period may start as early as one month after birth or up to 12 weeks.
  • The longer it takes for your period to return, the more likely it is that you will ovulate before it does and so pregnancy could occur before having a period.

When to seek medical attention

It is important to seek medical attention as soon as possible if:

  • you have increased blood loss, with or without clots
  • your blood loss starts to smell
  • you experience high temperatures
  • you have increasing pain
  • you find a red, hard, hot area on your breast that does not clear with breastfeeding, with or without flu-like symptoms such as aches and pains and shivers
  • you have difficulty passing urine or a bowel motion
  • you have increased tenderness or swelling of the perineum
  • your abdominal wound is oozing fluid, or the skin is red or hot to touch (caesarean sections)
  • you have symptoms of postnatal depression.

If you are concerned in anyway about yourself, or your baby, you should seek medical attention.

Resources and contact numbers

Mater services

  • Accident and Emergency—Mater Hospital Brisbane 07 3163 8484
  • Accident and Emergency—Mater Private Hospital Brisbane 07 3163 1000
  • Breastfeeding Support Service 07 3163 2229
  • Fertility Clinic—Family Planning 07 3163 8437
  • Mater Health and Wellness Clinic for allied health support (physiotherapy, occupational therapy, nutrition etc.): 07 3163 6000 
Mater acknowledges consumer consultation in the development of this patient information.
Mater Doc Num: PI-CLN-430077
Last modified 15/11/2017.
Consumers were consulted in the development of this patient information.
Last consumer engagement date: 20/7/2014
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