As you leave the birth center with your baby, you will begin a new time of discovery, change, and recovery. Many changes will take place for you during the next few months, both physical and emotional. Your body took nine months to produce a baby, and it will take time to return to its non-pregnant state.
Your partner and other family members will also find the first few months of living with a new baby exciting and full of challenge.
This booklet will guide you through what you may expect of the next few months.
When to call your health care provider
- Your vaginal discharge (lochia) becomes heavy – one pad or more per hour for more than two hours.
- You have abdominal pain and foul smelling discharge.
- You feel ill or have a fever 100.4° F or greater.
- You have burning, frequency, or urgency as you empty your bladder.
- You have chest or abdominal pain, a severe headache, blurred vision, or excess swelling.
- You have pain, redness, or swelling in your legs.
- You have problems with nursing – sore or cracked nipples, pain, or redness in your breasts.
- You have redness, swelling, or discharge from any area with stitches or staples.
- You have a constant low mood, feel depressed longer than a day or two, have trouble sleeping, feel anxious, or have trouble coping.
When to call your baby’s health care provider
- Your baby has a fever over 100.5° F.
- Your baby is listless or very sleepy.
- Your baby will not stop crying or is very fussy.
- Your baby is not nursing well or has a loss of hunger.
- Your baby does not have at least six wet diapers a day – the urine should be light in color and not have any odor.
- Your baby vomits often or with force after feedings.
- Your baby becomes jaundiced (yellow), bluish, or very pale.
- Your baby has trouble breathing or has a cough that won’t go away.
- Your baby’s eyes are red, swollen, or there is discharge.
- Your baby has a rash or his stomach bloats.
- Your baby has foul smelling drainage from the umbilical cord.
- Your baby has swelling or drainage from his penis after being circumcised.
After pains or Cramping
After the baby’s birth, the uterus shrinks back to its non-pregnant size and place in the pelvis. You may feel uterine contractions or “after pains”. They are brought on when you breastfeed your baby. This increased cramping during feeding rarely lasts more than a few days. By the tenth day you will no longer be able to feel the uterus above the pubic bone.
It may help if you:
- Drink raspberry leaf tea.
- Rest with a hot water bottle on your stomach.
- Keep your bladder empty.
- Lie on your stomach.
- Take ibuprofen if your cramping is very strong. Take 600 mg every four to six hours not to exceed 2400 mg in 24-hours.
When you are pregnant, hormone changes cause the milk glands in your breasts to grow to prepare them for their role in making milk for your baby. Right after your baby is born, you will produce the first milk (colostrum). This is the perfect food for your baby. It has sugar, proteins, fats, and antibodies that will protect your baby from many diseases.
If you are breast feeding, the milk changes from clear to yellow to more mature white milk by the second or third day. Your breasts may become very full and painful. This fullness is called engorgement. It is caused by increased milk being made and breast tissue swelling as it gets used to its new job. Feeding the baby often, eight to ten times a day, will reduce the soreness. Over the first few days, your breasts will adjust to the amount of milk they need to produce, and this painful swelling will go away.
During this time, wear a well-fitting nursing bra 24 hours a day for comfort. You may also try cold or warm moist cloths, or hot showers. A gentle massage of the breasts can help the milk let down. It may help to place cold green cabbage leaves over the engorged breast. Peel off the outer leaves from the uncooked cabbage, flatten with a rolling pin, and place on your breast. They may be held in place with your bra and should be changed after feedings and when the leaves wilt. Do not use more than three times a day for one hour.
If you do not breastfeed, wear a well-fitting support bra or wrap your chest with a large ace bandage to help decrease milk supply. The milk supply will slowly decrease unless more milk is produced by breast or nipple stimulation. Apply ice packs and take one or two tablets of acetaminophen (Tylenol®) every four to six hours or up to 600 mg of ibuprofen (Advil®) every four hours to provide relief. A cool, green cabbage leaf compress may also help. There is no time limit for use of the cabbage if you do not breastfeed.
Cracked nipples and/or nipple soreness may start during the early days when you breastfeed. To prevent this problem:
- Expose the breasts and nipples to air. Wear your nursing bra with the flaps down when you can.
- Expose the breasts to sunlight for three minutes or less at a time.
- Help the infant’s mouth to open wide before latching on. Hold the baby high on your chest wall with his entire body facing your body. The nurses and lactation team members in the hospital can help you with this.
- Try using varied positions that prevent pressure on the same part of the nipple during each feeding.
- Nurse often so that the baby doesn’t get too hungry and suck too strongly.
- Start on the least sore breast since the suck is strongest at the start of a feeding.
- Avoid washing the nipples with soap as it removes natural oils and may cause chapping and cracking.
- Express milk after the feeding is over and rub some on the nipple and areola and allow to air dry.
If your nipples become sore and cracked do not despair, they should heal quickly. These tips may help.
- Apply crushed ice in a wet cloth to the nipples just before nursing. Ice helps the pain and helps to make your nipple erect so the baby can latch on with more ease.
- Apply safe lanolin products like Purelan® or Lansinoh® to nipples after feedings.
- Feed your baby more often to prevent the strong sucking of a hungry baby.
If you have burning or shooting pain, which lasts through the feeding, you may have a yeast infection in your breasts. The nipple area may appear normal or red. Your baby may have a yeast infection in her/his mouth (white patches). Treatment is needed for both the mother and child. Call your nurse midwife, doctor or the hospital Lactation Consultant for help.
It may take two or three days for your bowel function to return to normal. This is common after having a baby and does not mean you are constipated. If you drink enough fluids and your diet has fiber and roughage, your stools will remain soft and you should not have to strain to have a bowel movement. Resume gentle exercise as you are able to help your bowels return to normal. The continued use of a magnesium supplement will support intestinal health. If you have not had a bowel movement by the 4th day, call your nurse midwife or doctor.
Perineal Care – Episiotomy Care – Hemorrhoids
During the birth, the perineal muscles that surround the rectum and vagina are stretched. This stretching may cause tears in the skin and muscles. Sometimes, an episiotomy (an incision near the opening of the vagina) is done if the baby is large or the birth process needs to be hurried because of the baby. Stitches may be placed to repair this, but they will dissolve over the next few weeks and do not have to be removed.
As you look at your perineum with a mirror, you may see areas of swelling and bruising. The stitches may be seen, or they may be hidden inside your vagina. Your perineum may be very painful, but the soreness should decrease each day. Use ice packs for the first 24 hours to provide comfort and reduce the swelling. Apply the soothing cream or ointment, which will be given to you in the hospital to ease the pain.
It is vital to keep your perineum clean. Wash your hands well before you touch this area. Keep using your spray bottle at home each time you go to the bathroom. Change your pads often. After you go to the bathroom, pat dry gently from the front to the back using pads soaked in witch hazel. After the first 24 hours, soaking in a warm bath with chamomile or comfrey leaf can be soothing and aid healing. Kegel exercises will help healing and tone the muscles.
Hemorrhoids often occur while pregnant or during the pushing stage in labor. As you look in the mirror or feel around your rectum, you may observe swollen and painful bumps which are enlarged varicose veins. Sitting in a tub of warm water 2 to 3 times a day will promote healing. Be sure to clean with witch hazel pads after bowel movements and avoid constipation. Maintain a diet high in fiber, with lots of fresh fruits and vegetables. Drink 8-10 glasses of water each day. Your hemorrhoids should shrink slowly and become less painful. If they become larger, more painful and tender, please call your nurse midwife and doctor.
Loss of Extra Fluids
During the first two weeks after your baby’s birth your blood volume is reduced by 30%. The excess fluid stored in your tissues is expelled. You will notice that you sweat and have more urine. This is normal and, despite this, you should still drink a lot of fluids. Try to drink eight or more glasses of water, juice, or milk each day.
Night sweats are also common. These are due to hormone changes and are like “hot flashes”. Increased sweating could also be caused by a fever so, if in doubt, take your temperature and call if it is over 100.4° F.
Just as healthy eating was vital while you were pregnant, it remains vital now for your good health, healing, and caring for your baby. After giving birth, your body needs enough protein, vitamins, and minerals to combat fatigue and promote healing. Women who breastfeed need an extra 500 calories each day compared to women who do not breastfeed. This is an average of 2,500 to 2,700 calories each day. You will need to add foods high in iron such as green leafy vegetables and foods high in Vitamin A such as carrots and squash. You should eat three or more servings of milk products each day to make sure you get enough calcium. Keep taking a good multivitamin while you breastfeed.
Despite this increase in food, you will slowly lose weight over the next five or six months. Most women lose about 20 pounds by six weeks after birth. If your total calorie intake is around 2,200 to 2,500 calories each day, you will lose about 4 ½ pounds each month after the first six weeks. Avoid diets that promote rapid weight loss because your milk supply will decrease in quality and quantity.
It is often hard to find the time to eat well, but avoid skipping meals or eating junk food. Eating small, frequent meals around the clock with the baby works well. Have your house stocked with fresh fruits and vegetables and drink at least eight glasses of fluid each day. Enjoy offers of food from family or friends.
Soon after giving birth, you may get the “baby blues”. It often occurs on the third or fourth day and lasts only a day or two. You may have a fleeting sense of sadness to a full-blown depression that makes it harder for you to function. You may cry without warning, feel you can not cope, or feel fear about your new life with your baby.
This happens to more than half of new mothers and often occurs just as your mature milk comes in. Sudden mood changes from laughter to tears are common. These shifts are partly caused by hormones, but can be increased by fatigue or anemia.
These tips may help you with these feelings.
- Get enough rest. Listen to your body and allow yourself to take the time you need to sleep and rest.
- Allow other people to take care of you. New mothers need to welcome and accept care and love from friends and family.
- Share your feelings with your partner and family. Don’t hide what you are going through or feel ashamed. This is your signal that huge changes are taking place.
- Eat healthy foods and drink healthy liquids during the day and night. Have others help to prepare these.
- Take a good daily multivitamin. Think about adding a B complex capsule and a 50 mg B6 capsule three times a day.
- Talk to other women who have had these symptoms so you can feel assured that these changes are “normal”.
If these symptoms last for more than a day or two, you may have more than the “baby blues”. Call your midwife or doctor right away if you are unable to sleep or are sleeping all day, you are not hungry and cannot care for your baby, you are feeling depressed, anxious, or cannot cope, have thoughts of harming yourself or the baby.
Recovery – Rest
The first six weeks after having a baby are full of new demands. You will get less sleep because babies need care every few hours. New mothers need to get plenty of rest to take care of themselves and the baby. These tips may help you order the demands in your life during the early weeks.
- Since you are awake with the baby at night, you should sleep during the day when the baby sleeps.
- Keep things simple. You may not have all things done to your standard, but babies are small for a very short time. Let the weeds in the garden grow and don’t worry if the dog doesn’t get a bath.
- Allow or ask other family members to do all household jobs for at least the first two weeks.
- If grandma comes to help, let her cook, clean, shop, and wash while you tend the baby.
- Limit guests to one time per day when your partner or other family members are home and ask that they stay for less than ½ hour.
- Allow other family members to provide care for older children. This is a good time to accept friends’ and neighbors’ offers of help.
For the first six weeks after your baby’s birth you should set aside time each day for exercise. Walking should be done each day. A walk around the block can improve mind and body and be enjoyed by your baby and family.
Conditioning exercises will help you re-gain your former body shape and muscle strength. The two areas of your body that need special help are your stomach and pelvic floor muscles. After months of stretching, your abdomen needs toning. Your pelvic floor muscles need exercise to increase blood flow, reduce swelling, promote healing of the perineum, and restore vaginal muscle tone.
Life with a new baby is hard to predict, but you can do these simple exercises while you perform daily tasks. Starting after birth, gently tighten and relax the muscles of your pelvic floor or perineum. You may know these “Kegel” exercises from before birth. The first day it may be hard to feel the muscles contract, but after a few days you will be able to hold them for a count of five. Try to do these with each diaper change and feeding to quickly tone your pelvic floor.
Shortly after the birth you may want to begin abdominal strengthening exercises. Sit on the bed or in a chair. Place your hands on your stomach. As you breathe in, allow your stomach to bulge. As you breathe out, slowly tighten your muscles by pulling them in toward your backbone until your lungs are empty. Repeat for five times and rest. Abdominal crunches also strengthen these muscles. While lying on your back with your knees bent and feet on the floor, gently raise your head and shoulders off the floor while reaching with your hands towards your knees. Repeat five times at least three times a day.
Within a few weeks after the birth, you may want to resume a more strenuous exercise program. Allow your body to guide your program. There are great classes for women and babies offered at the YMCA and private clubs. Many women choose to resume athletic activities by four to six weeks postpartum. As long as you get enough rest, good food and fluids, exercise will make you feel better.
If this is not your first child, your older children will be going through their own period of adjustment. Helping them to prepare for the new baby can help, but the real baby is often hard for children to imagine. Joy as well as feelings of resentment, anger and jealousy are normal and expected.
Younger children often go back to behaviors they had outgrown such as thumb sucking, wetting their pants, or temper tantrums. Be sure to tell your children that you love them and how they are still a vital part of the family. It may be very helpful during the first weeks if other family members spend time with your older children. Your energy will be with the new baby and gaining your strength, but it is vital to make sure you also spend time alone with the older children each day.
Sexuality – Couple Relationship
Couples decide to have a child for many reasons, but the love and caring you share with your partner is often threatened by the new baby. A baby changes your relationship with your partner. Your role as wife, lover, playmate, homemaker, and moneymaker needs to expand to add the role of mother. For the first few months, this role seems to take up all of your time and energy with little left for the other roles. The same change happens to your partner. To parent a child and be a supportive partner requires re-thinking of many aspects of your lives. How your relationship survives will depend upon open and caring communication between you. Sharing both the good and bad feelings helps ease the stress of this time. This is a time of marriage stress for many couples. There are counselors and support groups to help you.
During the first year, touching or close talk between adults often lose out to a cry from the crib. Change in your sex life is just one of the changes new parents have to make. Many factors can impact your sexual desire: feelings about your body image, fatigue, hormone changes, depression, pain and soreness from healing, and breastfeeding.
Intercourse may be resumed after your baby’s birth if your perineum has healed, and you feel ready. There are other ways to show affection and caring. It is vital to talk with your partner about your concerns and feelings. Be assured that if you enjoyed sex before the baby was born, you will enjoy it again.
It is hard to know the exact time when ovulation and periods will begin again. Some women ovulate by six weeks after the baby is born. If you decide to have sex, use some form of birth control unless you want to become pregnant again right away. We suggest that you wait for at least one year before you become pregnant again. If you breastfeed your baby, give no supplemental feedings and have not had a period, you are 94% protected from becoming pregnant for the first 6 months. Please discuss your birth control options with your nurse midwife or doctor.
The Exciting Journey
There are so many great things about being a new parent: holding your baby close and smelling that unique baby smell, watching as your baby unfolds like a flower with new abilities each day, and feeling deeply attached to this little person. Although the demands and stresses are many, so are the rewards of being a parent. The chaos of the early weeks will slowly ease into a more relaxed “normal” life.
Please call UW Women’s Health at (608) 263-0150 with questions or concerns.
Spanish Version is Health Fact for You #5886
The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.
Last Updated: 09/09/2013
Copyright © 09/09/2013 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#4331
Print Health Fact For You