Changes in the uterus
As soon as the baby is born, your uterus starts to shrink. Don’t be surprised, however, if you still have a “big stomach” for a while. It usually takes about six weeks for the uterus to go down gradually from about 2 pounds to about 2 ounces. Its muscles keep on contracting during this time, as they did during pregnancy. The changing back to normal of the uterus is called involution, which means “the act of turning in.”
As the uterus grows smaller, clots of blood and tissue pass out of your body as “lochia.” Although this discharge from the vagina is often called menstruation, it is not. At first it comes quite freely, and has a good deal of blood in it. Gradually, it subsides. At the end of the first week it has changed in color from bright red to dark red or brown. At the end of the second week it may be yellow or white, but it is not unusual for the dark discharge to persist for a while longer. It has the odor of menstrual blood.
The contractions of the uterus after delivery are called “afterpains,” and are very much like menstrual cramps. They may be more uncomfortable with a second or third baby than with a first one. They usually stop in a few days. You may notice them more if you are breast-feeding your baby, since the sucking of a baby at the breast stimulates the uterus to contract. Even if these afterpains are a little uncomfortable, you will probably not mind since this will mean that your figure is returning to normal.
You will probably sleep for most of the first day after your baby is born. Don’t try to wake up until you feel like it. You have been working hard for a long time, and will need rest. Your husband will be allowed to see you briefly after you get back to your room. If your pregnancy and delivery have been normal, you are likely to feel fine by the next day. How long you stay in bed depends on the wishes of your doctor and the policy of the hospital. You may be up for a while the first day. Although you may be out of bed soon after delivery, it is best not to try to hurry your recovery at this point, even though you are naturally wondering about what is happening at home. You may drag around for weeks if you don’t give your body a fair chance now to get back into its normal, nonpregnant condition.
After the baby is born, you will probably be extremely hungry. Most doctors let their maternity patients have regular food as soon as they want it. Whatever your previous food habits were, you will have become used, during your pregnancy, to well-balanced meals. Don’t give up these good food habits now. You still need to eat the same foods you ate during pregnancy, plus an extra pint of milk a day and another serving of oranges, grapefruit, or tomatoes, especially if you are breast feeding your baby.
As you begin to be busy again about your home, you will need more protein food in order to keep up your supply of breast milk. Another serving each day of lean meat, eggs, dried beans or dried peas will supply the extra protein you need.
At the time of delivery, your bladder will be emptied of urine through a tube called a catheter. The nurse will give you a bedpan and suggest that you try to urinate as soon as you are back in bed. After that, you should empty your bladder every six hours at least. It is important not to let it get too full. A full bladder keeps the uterus high in the abdomen and interferes with its contracting. A well-emptied bladder makes it easier for the uterus to get back into its normal position.
Most women have no trouble urinating after delivery. But sometimes, the urethra is pressed so tightly against the pubic bone during the baby’s birth that this is bruised. This bruising makes it harder for you to pass urine normally but usually clears up in a few hours. Meanwhile the doctor or nurse may relieve you by catheterizing you again. This is not usually a painful process. Be sure to let the nurse know if there is pain when you urinate.
Going to the bathroom
Usually you are allowed to go to the toilet within 24 hours after your delivery. A nurse or a nurses’ aid should go with you on your first trip to the bathroom, just to be sure that everything is all right.
You can help to prevent infection around your vagina by observing a few simple rules of personal hygiene. You will be wearing a sanitary napkin for a few days or perhaps for 2 or 3 weeks. Each time you take this off, unfasten the front safety pin first, so that you can let the napkin fall away toward your back without touching you.
After urinating or having a bowel movement, pat yourself clean, going from front to back, not back to front. Don’t use a stroking motion. Some doctors insist that their patients use cotton dipped in sterile water for this cleansing instead of toilet tissue. Ask the nurse what the hospital wants you to use if your doctor has not given you directions about this. When you put on a fresh napkin, place the inner (folded in) surface next to you, pin it first in the front and then in the back. Be sure to wash your hands both before and after using the toilet. Tell the nurse if you notice any bleeding that seems to you excessive.
You will be told when it is safe for you to take a bath. Most doctors recommend that you wait a week or so. You will probably be permitted to take a shower or sponge bath on the second day. The nurse will show you how to wash your breasts and the perineal area (the region around the vagina). The cleaner you keep yourself, the better you will feel.
Aftercare of episiotomies
Most episiotomies heal soon and cause comparatively little discomfort. Heat applied during the first few days after delivery may be soothing. The nurse will probably bring you a heat lamp, anyway, and suggest that you try it. She will also show you how to take care of the place where the stitches are. You should continue to follow her directions after you go home until there is no longer any tenderness in the area.
Constipation is very common in the first week or two after a baby’s birth. If you are constipated, your doctor may prescribe a mild laxative or recommend some changes in your diet. He will certainly advise you not to take strong laxatives. These are bad not only because they tend to cause cramps but because some of their ingredients may get into the milk and give a nursing baby diarrhea.
The production of milk in the breasts is called lactation. True milk does not come for at least 3 days after the birth of a baby. Colostrum, the liquid that comes from the breasts during the first few days, is rich in protein and nourishes the baby until the milk is formed. It also contains substances that protect the baby from certain infections. On about the third day, you will notice that your breasts are becoming tense and firm, the veins standing out clearly. This means that milk is about to begin to flow. Should your breasts be a little painful at this time, a good nursing brassiere will make you comfortable.
Proper support for your breasts is important. Even while you are in bed, you should wear a firm, well-fitting brassiere, preferably one designed for nursing mothers. Sagging breasts are not the result of breast feeding. They are often due to poor support during pregnancy and the nursing period. They may be a family trait.
Wash your breasts once a day with soap and water at the beginning of your bath or shower, using a clean wash cloth for this purpose. If the nipples leak enough to need protection, use the small, sterile pads.
Resuming marital relations
It is usual for husbands and wives to wait for a while after the birth of a baby before resuming marital relations. Advice about this is usually given by doctors on an individual basis. A delay of 3 weeks is commonly suggested but your physician may recommend that you and your husband postpone sexual intercourse until after you have had your first postnatal checkup at 6 weeks.
The return of menstruation
The time when menstruation begins again after delivery is different with different women. Most women have a period within five or six months, anyway. If you breast feed your baby, it usually takes a little longer. In fact, you may not menstruate again until the baby is weaned. If you bottle feed your infant you will probably have a period within five or six weeks. Either way, the first period may be longer or shorter than usual, or the flow may stop and start again. Once menstruation has actually started again, these irregularities usually smooth out and most women are soon back in their old cycles.
Menstruation need not interfere with breast feeding, and you do not need to wean your baby because you have started to menstruate. He may be fussy while you are menstruating. If so, it is probably because your milk supply has decreased enough to make him hungry. You may have heard that as long as you do not menstruate, you cannot become pregnant while you are nursing. This is not true. Whether you nurse your baby or not, the ovaries begin to function again soon after delivery and it is possible for you to be pregnant before you start to menstruate again.
Your doctor may or may not recommend exercises to help you tighten up again after your pregnancy. Some doctors think that special exercises are not necessary if a woman gets out of bed and becomes active within a few days after the birth of her baby. Moving about will certainly help you to get your strength back more quickly. For this and other reasons, it is a good idea to move around as much as possible while you are still in bed. If you learned exercises during your pregnancy to improve your posture and make your body more flexible, your doctor will probably approve of your going on with these now.
The simplest exercises are done lying flat on your back, arms at your sides, with no pillow. One of the easiest is to raise your head from a flat position and try to touch your chest with your chin several times. Another is to try to sit up, after a few days, without bracing yourself, or moving your legs. This may be hard to do at first; if so, try it only once the first day, twice the next day, and so on.
Another good exercise is in two parts. Lie on your back, raise one leg, and bring it up as far as possible without bending the knee or raising your head. Still keeping your back flat, bend your knee, and pull your leg in as close to your body as you can. Try these exercises, first with one leg then the other. Each day try to do them one more time. After a while you will be able to bring both legs up together.
You may be discouraged when you find out how hard it is to do these exercises at first. Take them easily. Do each one slowly until you can repeat it several times without getting tired. Your old energy will not all come back right away. Don’t try to hurry the process too much. Do no exercises at all until you have checked with your doctor.
In place of or in addition to exercises, your doctor may want you to take what is called the “knee-chest” position for 10 or 15 minutes a day. When you do this, you bend over on the bed or the floor until you are resting your weight on your knees and your chest. When you do this, your uterus flops forward into a better position for drainage.
A new baby is exciting to his family and to his parents’ friends. Indeed, so many people want to congratulate his mother in person that hospitals have to limit visiting in their maternity wings. You will probably be allowed only two visitors during any one visiting period. Husbands are sometimes allowed some special privileges. As a rule, children under 14 years of age may not visit at all. Visitors are usually able to see your baby through the nursery window during regular visiting hours.
These regulations are for the protection of you and your baby. You need these few days to rest. You need, even more, an opportunity to become acquainted with your new baby, to get the “feel” of his personality, and to begin to learn his language.
Let the people who are taking care of you carry your responsibilities for a while. You will have more to give to your family later if you can relax now in the friendly security of your hospital room, enjoying your husband and your baby but seeing as few other visitors as possible.