What to Expect After Your Vaginal Delivery?

1. Bleeding:  Blood loss at the time of delivery does not end immediately after delivery.  While in the hospital, you may have noticed that you have had heavier vaginal bleeding than ever before.  This will slowly taper down over the course of the next few weeks.  Bright red bleeding that occurred immediately after delivery will slowly change to a darker color and eventually green and yellow.  This is all a normal part of the postpartum transition of the uterus.  Occasionally, a week or two after your bleeding seems to have stopped, you may have a sudden gush of bright red blood.  This is the normal process of the placental site scab coming off.  This too will taper off over a few days.  Bleeding more than a pad an hour for more than three hours is not appropriate and we would like you to contact us immediately.
2. Pain:  The most significant pain that most patients experience after delivery is related to uterine cramping.  This may feel similar to contractions while in labor.  This too is associated with the uterus returning back to its normal, non-pregnant size.  Often times, cramping is worse after a breastfeeding session.  The best pain medication to ease the discomfort of uterine cramping is ibuprofen (600 mg every 6 hours or 800mg every 8 hours).  Though we do not advise the use of ibuprofen during pregnancy, it is completely safe during the postpartum period and while breastfeeding.
3. Restrictions:  Because you had a vaginal birth, the only real restriction is to avoid sexual intercourse until you are evaluated at your 6-weeks postpartum visit.  Once you feel up to it, feel free to exercise and drive.
4. Vaginal Tear:  Most women will have some tearing of the vagina during vaginal delivery, especially with delivery of your first baby.  The postpartum nurses will teach you about caring for your bottom in the first few days after delivery.  We advise the use of witch hazel pads, dermoplast spray and frequent cleansing of the area with the peri-bottle.  Because urine is very acidic, it often will sting a fresh wound.  A good way to alleviate this pain is to keep the urine very dilute by being well hydrated.  You can also gently sprinkle water over the perineum while voiding.  Generally, it is better to blot your bottom than to use toilet paper to wipe.  The stitches that we use to repair any vaginal lacerations will dissolve on their own; they do not have to be removed.
5. Hemorrhoids:  Similar to vaginal tearing, most women will develop hemorrhoids during pregnancy and delivery.  Most hemorrhoids will resolve on their own as your body recovers from delivery.  Care of hemorrhoids can be accomplished with use of witch hazel pads, dermoplast and other over-the-counter hemorrhoid treatments.  Again, cleansing your bottom with water after a bowel movement and blotting to dry will alleviate a great deal of discomfort associated with hemorrhoids.
6. Breast Pain:  Shortly after your discharge from the hospital, you likely will notice your breasts becoming sore, tender and hard.  This is engorgement, or your breasts filling with milk.  Engorgement is a normal process that provides milk for your baby.  Using a hand held pump before latching your baby on to the breast can help relieve some of the discomfort.  You can also hand express a small amount of milk while in the shower to relieve some of the pressure.  The amount of milk you produce will eventually match up to the amount of milk your baby drinks, but it may take a few weeks for you and your new baby to reach this balance.  Ibuprofen is also a good choice for management of breast discomfort caused by engorgement.  You may also find that your nipples are painful at the time of latching, and this too is normal.  The tender skin overlying the nipple takes a bit of time to become toughened up.  A small amount of lanolin applied sparingly can be very soothing.
   
   If you notice redness or streaking of the breast or develop fever, chills or flu like symptoms you may be developing mastitis, an infection of the breast tissue.  We would like for you to call the office right away.
   
   If you choose not to breastfeed, it is important that for the first few days after delivery you keep your breasts tightly compressed, either with a tight sports bra or an ace bandage.  Try to avoid emptying any milk from your breasts as this will stimulate your breasts to produce more milk and take longer to dry up.
7. Fatigue:  The first few weeks and months of caring for a newborn can be some of the most exhausting of a new mom’s life.  Fatigue is very normal in the postpartum period.  Most moms (and dads) will be functioning on a lot less sleep than they are used to.  It is very important that you sleep when the baby sleeps.  Though it may feel like there are many other things you need to do, rest is very important to a successful recovery.  If you have a baby that is awake multiple times through the night, try to take turns with your partner, so each of you can get a little uninterrupted sleep.
8. Swelling:  Swelling of the legs after delivery is very common.  This happens because of the redistribution of the fluid and blood volume of your body from the pregnant state to the non-pregnant state.  This may take two weeks or longer to resolve.  You can help decrease the swelling by walking, elevating your legs and drinking a lot of water.  Rarely, after delivery, a blood clot can form in the legs.  Signs of a blood clot include warmth, swelling and redness of only one leg.  If you suspect you have a blood clot, please contact the office immediately.

If you have any questions or concerns, please feel free to contact the office.  Once you are home and settled in, please call the office to arrange your postpartum visit for six weeks after delivery.