Birthing Client Postpartum Care

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What can I expect in the postpartum period?

Self-care is hugely important in the postpartum period. Pregnancy has made a significant number of changes to the birthing client’s body. The postpartum period is full of its own changes. Some of these changes are your body returning to its original state, other parts will continue to change. Being self-aware and knowing what is normal, will help guide you through the postpartum period. The information below should help answer some of the most common questions about the postpartum period.

Sleep and Mental Health Awareness

  • Sleep: Getting enough sleep is one of the most difficult aspects of postpartum recovery. Sleep should be the most prioritized aspect of birthing client care. Clients who get more sleep recover faster physically, have better mental health and have fewer delays in milk supply. You will probably hear it a hundred times but, ‘sleep when the baby sleeps’ really does improve client sleep quantity and quality. It is ok to have many small naps in between breastfeeds. Partner/Family/Friend support at this time is crucial, allowing others to settle the baby after feeds.
  • Baby Blues: Mood changes are very normal during the first few weeks postpartum. The most common is ‘baby blues’ affecting up to 75% of postpartum clients (Sharma & Sharma 2012). Baby blues usually present on day 3 to day 4 postpartum, most commonly in conjunction with the milk supply coming in. Baby blues present with symptoms of mood swings, tearfulness, anxiety, insomnia, and irritability (Sharma & Sharma 2012). Most clients find that their mood improves and stabilizes after several days. However, for approximately 10%-15% of clients, postpartum depression will develop (Sharma & Sharma 2012).
  • Postpartum Depression (PPD): Postpartum depression can present at any time up to 1 year after birth. Symptoms include depressed mood, lack of pleasure or interest (especially in babies), insomnia or hypersomnia, weight loss, loss of energy, agitation, feelings of worthlessness/guilt, diminished concentration, and frequent thoughts of death/suicide (Sharma & Sharma 2012). It is important to notice the signs early and seek help. The postpartum client may not notice all the symptoms, so it is crucial for support people (partners, family, friends) to speak up if they have concerns. Midwives are very aware of client moods and any significant changes will be addressed. If symptoms present after the 6-week midwife discharge, please seek help from your family doctor or any of the below resources.

 

Breast Care

  • Breastfeeding is a full-time job for new parents. More information about breastfeeding techniques can be found in Newborn Feeding (add link). Breast care is equally important, as breastfeeding becomes much more difficult with sore and engorged breasts.
  • Nipple pain can be very uncomfortable as the nipples adjust to breastfeeding frequency and build a protective callus. Your midwife will ensure that your baby has a good latch and does not have a tongue tie (see Newborn Feeding). Your nipples may have some cracking, blistering or bleeding. Applying breastmilk to the nipples before and after feeds and allowing them to dry freely exposed to the air can be beneficial. Additionally, applying nipple cream after every feed can help prevent/repair damage. Ask your midwife which cream is best for you.
  • Yeast can also develop on the nipples and areola. Symptoms include burning and deep or sharp pain, especially during/ after feeds. Babies can also develop yeast in the mouth, therefore, both client and baby are treated at the same time. Ask your midwife if she thinks treatment is appropriate.
  • Breast engorgement can be very uncomfortable for some clients, especially around day 3 to day 4 postpartum, when the milk supply is coming in. It is important to feed your baby regularly from the breast. If your baby is not removing enough milk from the breasts, it is ok to use hand expression or pumping until you are comfortable (the breasts do not need to be empty, as this will actually increase your milk supply).
  • Mastitis is an inflammation of the breast which may involve infection. Symptoms include the development of a tender, red, hot spot on the breast, fever, malaise and occasionally nausea/vomiting. If you have concerns about mastitis please page your midwife as you may require antibiotic treatment.

 

Bleeding Care

Postpartum bleeding is a normal and necessary part of postpartum recovery. The bleeding process ensures the uterus is completely empty after the pregnancy and prepares to start again with the regular menstrual cycle. There are three stages to postpartum bleeding:

  1. Rubra: dark or bright red blood, flow like a heavy period, some clots are normal, period like cramping
  2. Serosa: pink or brown in colour, more watery, moderate flow, fewer clots
  3. Alba: yellowish or white discharge, spotting, no clots

Each stage of postpartum bleeding varies in length depending on the individual client. As long as your bleeding is gradually getting lighter, it is a good indication that everything is normal.

What is not normal? Page your midwife with any of the following symptoms

  • Filling a postpartum pad (heavy and full) in 30 minutes or less
  • Clots larger than your fist or many clots larger than a toonie
  • Green or gray discharge
  • Foul-smelling discharge (not like your usual personal or period smell)
  • Fever, chills or flu-like symptoms
  • Severe pelvic cramping/pain

What supplies will I need?

  • Postpartum pads and/or overnight disposable period underwear (all found in the period care section of the stores)
  • Large/old comfortable underwear, as they are not provided by hospital or midwife clinic
  • Padsicles (frozen pads) can be purchased or made at home by simply soaking postpartum pads with water, rewrapping and putting them in the freezer. A few drops of witch hazel can be added to each
  • Witch hazel liquid for postpartum pads and/ or premade witch hazel pads for haemorrhoids
  • Extra Strength Tylenol and Extra Strength Ibuprofen to help with cramping and perineal pain
  • Peri-bottle will be provided by the hospital/midwifery clinic, but you can always get your own if you want a specific one

 

Perineal Care and C-section Wound Care

It is very common for clients to tear during their first labour/birth, it is less common during subsequent labours/births. Depending on the severity of the tear, the client may or may not need stitches. Perineal tears are grouped into four categories:

  • 1st Degree: a small tear only affecting the skin, only needs stitches if the bleeding does not stop.
  • 2nd Degree: a tear affecting the muscle of the perineum and the skin, generally requires stitches
  • 3rd Degree: the tear extends into the outer part of the anal sphincter, and requires suturing by the OB
  • 4th Degree: the tear extends completely through the anal sphincter involving the bowel lining

Prevention of tears

  • Many factors are involved in perineal tears and sometimes tearing can not be prevented. However, your midwife will try her best to prevent or reduce the amount of tearing at birth.
  • Midwives protect the perineum at the time of birth and assist with gentle stretching during the birth. Controlled delivery of the baby’s head greatly helps to reduce the amount of tearing for clients. Your midwife will give you specific instructions during your labour.
  • Prior to the birth, clients can do perineal massage at home to help increase the elasticity of the perineum (see Perineal Massage for instructions).

Wound Care

  • For both perineal tears and for c-section scars the care is relatively the same
  • All stitches will dissolve on their own (unless otherwise instructed)
  • It is important to keep the area as clean and dry as possible (use peri-bottle after voiding, change pads regularly), pat dry and don’t rub at it
  • Open air time is important for quick healing
  • It is good to shower, only use water on the wound. Don’t put soap or body wash directly on the wound (it is ok to wash the rest of your body regularly), pat dry
  • Do not apply any lotions or other ointments directly to the wound
  • Use “padsicles” to reduce swelling
  • Take Tylenol and ibuprofen as directed to reduce pain and swelling

Signs of infection (Page your midwife)

  • Green or gray discharge
  • Foul-smelling discharge (not like your usual personal or period smell)
  • Fever, chills or flu-like symptoms
  • Severe perineal pain or pelvic cramping/pain

 

Activity Levels

‘When can I get back to normal activities,’ is a very common question for clients in the postpartum period. There is no set timeframe for when to begin physical activity again. Depending on the type of delivery a client has, the timeframe can range from a few days to several weeks. Ask your midwife when is a good time for you to start physical activity. Good rules to follow are: don’t start physical activity until you feel ready and stop if anything hurts.

Benefits of Physical Activity

  • Boosts energy
  • May help to prevent/improve postpartum depression
  • Promotes good sleep
  • Reduces stress
  • Helps strengthen and tone abdominal muscles
  • Reduces pregnancy weight gain

Pelvic floor exercises (Kegel exercises)

  • Help to reduce incontinence now and in the future
  • Help to prevent prolapse (cervix, bladder, uterus) now and in the future
  • Every client can see a pelvic floor physiotherapist, no matter what type of delivery they have had
  • Whenever you are ready to start physical activity again, start slow and work up to your pre-pregnancy fitness level.

 

Resuming Intercourse

The idea of having intercourse for the first time after recently having had a baby can be daunting for some and very exciting for others. Your feelings are valid no matter what they are. Intercourse involves both the physical and the emotional, thus it is important to feel ready in both respects before resuming intercourse. Depending on the type of birth a client had, some clients may be ready for intercourse by 2 weeks postpartum. Other clients may take up to 6 weeks or more to feel recovered and ready.

Important to note, is that while bleeding is still present, the pathway from the vagina through the cervix into the uterus is still open. This means that anything put into the vagina could potentially cause infection until which point the bleeding has stopped. Some clients have a lot of physical recovery involved in the postpartum period (stitches, c-section surgery, blood loss). Other clients will recover physically very quickly, but may not be ready emotionally for quite some time to resume intercourse. Any and all of these scenarios are normal, you do not have to resume intercourse until you are ready. You are more than welcome to ask your midwife her opinion on your recovery, but you do not need ‘clearance’ to resume intercourse. You can start whenever feels right for you.

When you are ready, it is important to remember that clients are very fertile after having given birth. Additionally, clients ovulate before they menstruate. This means that an egg is released and can be fertilized, before the client’s first period returns. Meaning you can get pregnant without having ever had a period between giving birth and your next pregnancy. When ovulation and menstruation return is different for each client. Therefore, it is very difficult for providers to give an exact timeframe for this return.

As we can not accurately predict the return of the ovulation and menstruation cycle, it is important for clients to use contraception if they do not want to become pregnant quickly. Please see Birth Spacing and Family Planning for more detailed information.

Additional Resources:

Mental Health

Breast Care

Bleeding Care

Perineal and Wound Care

Physical Activity

Resuming Intercourse

Postpartum Care
Partner Support