Vaginal Birth Recovery & Cesarean Birth Recovery. What Real Postpartum Will Look Like.

ALL POSTPARTUM MAMAS: VAGINAL RECOVERY & CESAREAN RECOVERY

RECOVERY OF YOUR UTERUS

Involution starts immediately after the birth of your baby and helps expel the placenta. Once your placenta is out your uterus works to fully return to it’s pre-pregnancy size. This happens over the course of 2 to 3 weeks after birth. The initial involution that happens right after birth is truly a life saving mechanism. When your uterus is clamping down continuously, it is actually pinching off all of the open vessels that used to be where your placenta was attached to the inside uterine wall. If your uterus were to remain boggy (not clamped down) it would create an emergency situation. This is because mama would lose blood through the uterine wound & open vessels that were created when the placenta detached. This process is automatic and not troublesome for most mamas. Hospital birth mamas can anticipate having fundal massages to encourage the uterus to remain firm. Administering postpartum pitocin is also common & even routinely done in hospitals to ensure that your uterus is staying firm and clamped down on itself. This brings me to afterpains. These are the contractions that continue to happen after you’ve given birth and as you initiate breastfeeding. They are what you feel as your uterus is doing it’s work to remain firm and clamped down. They are notoriously known for becoming more noticeable and more painful with each subsequent birth. You will likely notice your afterpains have gone away by the 1st week after birth.

You will begin to have vaginal bleeding immediately after birth. This postpartum vaginal bleeding is called lochia. The bloody and fleshy discharge that is lochia happens with cesarean birth mamas and vaginal birth mamas because it is the process the uterus goes through to shed the lining of the inside uterine walls that held your placenta and pregnancy. Each mama’s lochia is of varying shades of red and varying consistency of clots. Some mama’s experience a pretty heavy discharge of lochia and others not so heavy. Both can be normal.

• Lochia flow should decrease as the days go by
• Typically within 10 days a mamas bleeding reduces to a small amount of pale pink or rust colored discharge. For the next few weeks thereafter lochia should become even white, yellowish or tan.
• It is normal to pass jelly like clots, especially in the 1st few days postpartum
• Your lochia should never have a foul smell. Yes it will stink because it’s blood & clots but it should never smell awful. If it does. Call your provider
• Your bleeding should not be consistently decreasing and then suddenly pick back up again. This warrants a call to your provider
• Keep in mind you can have a heavier flow of lochia if you are trying to do too much too soon. Listen to your body. If you are up and moving around and become easily fatigued and your bleeding increases, you need to do less
• You can expect to have slightly more lochia when you are changing positions, breastfeeding, are overactive or are having a bowel movement
• You can expect to have postpartum lochia for about 4 to 8 weeks
• Be aware that 1% of mamas do experience a late postpartum hemorrhage. Where there is a lot of vaginal blood loss 24 hours to 6 weeks after birth.

Here are some key points to remember when it comes to what postpartum bleeding is normal for you and what is not.

• The golden rules for how much is too much bleeding are:
  • No clots should be larger than a golf ball. Golf ball sized clots are NORMAL.
  • Your bleeding overall should not soak through a peripad within 1 hour or it is too much
  • If you are questioning whether or not you are having too much bleeding CALL YOUR PROVIDER! No matter how many weeks postpartum you are.
• NORMAL vs. NOT NORMAL
  • NORMAL= having normal flow of lochia followed by a couple golf ball sized clots followed by a return to normal flow. You should not have signs of lightheadedness, dizziness, faintness, nausea, or difficulty breathing or catching your breath.
  • NOT NORMAL= having normal flow of lochia followed by a couple golf ball sized clots. Followed by more gold ball sized clots. Then a couple more golf ball sized clots. Then return to normal flow. All within an hour. This is likely too much if it has soaked through a peri pad this warrants a call to your provider. 
  • NOT NORMAL= You should never have signs of lightheadedness, dizziness, faintness, nausea, rapid heart rate, feelings of impending doom, trembling, feeling cold, pale skin, sweating or difficulty catching your breath accompanied by your vaginal bleeding. This warrants a call to your provider or to emergency services if you feel it is needed.

WHEN WILL I GET MY PERIOD BACK??

• Return of your menstrual cycle will likely depend on whether or not you are breastfeeding. Breastfeeding mamas typically do not see a return of their menstrual cycle for several months. Exclusively breastfeeding mamas can even see this delayed for a year or longer while exclusive breastfeeding is maintained. If you reach a point and become concerned that your cycle has not returned, talk to your provider about your specific circumstances.
• For mamas who are not breastfeeding, you can expect your cycle to return within 4 to 8 weeks. 
• All mamas should be aware that you can ovulate prior to the return of your menstrual cycle. So this means that you can ovulate unexpectedly and become pregnant before you even knew your cycle was coming back.
• When your period does return, it is normal for it to be heavier or lighter the 1st few times but typically does return back to your normal flow thereafter.

Recommendations for HEMORRHOID HEALING

Hemorrhoids are swollen varicose veins in the rectal area. They are usually quite uncomfortable and may itch, bleed, sting and be tender. Many mamas will develop these during pregnancy and some during vaginal birth. Often they will go away on their own within a few weeks after birth but here are some tips for relief & healing. Prevent constipation (you can even take a stool softener), spray witch hazel, do a sitz bath, avoid lifting anything heavier than your baby and contract your pelvic floor and rectum habitually a few times every hour. Persistent hemorrhoids warrant a call to your provider.

HORMONAL CHANGES

Estrogen and progesterone levels drop rapidly after birth and remain low until your ovaries kick back into gear again. If you are breastfeeding, you will maintain production of prolactin and oxytocin while estrogen and progesterone levels stay low until you wean from breastfeeding.

POSTPARTUM NIGHT SWEATS

In the 1st couple days postpartum your body is readjusting back to its normal blood volume and getting rid of excess fluid that was being held while you were pregnant. This natural process causes you to have to urinate more frequently and gives most mamas the sweats (especially at night). 

ABDOMEN & SKIN CHANGES

Most mamas experience some degree of abdominal skin stretching, stretch marks and skin discoloration. It can be normal to see a full return back to your pre pregnancy abdominal skin coloring and tone/elasticity, but for the majority of mamas this will not be the case. Most mama’s stretch marks fade to a less noticeable color, but do not completely disappear. Depending on your abdominal skin’s elasticity and how much stretching it endured to carry your pregnancy, it is also normal to have loose skin there for an extended period of time or for it to never go away. Some skin stretched to a certain point does not regain its tightness. If you experienced darkening of your skin in certain spots, this pigmentation typically will fade and in some cases remain present but faded. Any change in hair growth returns to your normal as well.

POSTPARTUM BREASTS

• Breastfeeding mamas:
  • During your initiation of breastfeeding in the 1st 1 to 3 days your baby will be getting nutrient dense colostrum from your breasts until your milk comes in thereafter. Once your milk comes in (anywhere from days 1-3) you will likely experience engorgement of the breasts. When this happens your breasts will be overflowing with milk. They can be painful to the touch, warm, tender, hard and leaky. It is also normal to feel rushes of heat waves coming over your body as if you have a fever. Engorgement can be difficult to get through but your milk supply usually levels out with 2-3 days. During this time my best tips for you are to latch your baby often and hand express or pump out small amounts of milk just to regain some comfort. (This was really tough for me to handle after my 1st baby because I didn’t know what to expect. I hope this helps you mama!)
  • I always recommend contacting an IBCLC for a prenatal consult so you can be informed about what is normal and not normal and how to get breastfeeding off to a good start!

• Not planning to breastfeed??
  • You will likely experience many of the initial discomforts as breastfeeding mamas. Here are a few tips to start right away after birth to decrease production of milk and increase your comfort: put cold packs on your breasts for the tenderness, avoid breast stimulation, avoid nipple stimulation, avoid soothing your breasts in the warm shower or bath water, wear a snug fitting bra or wrap your breasts for a couple days until you feel relief. Taking ibuprofen may help decrease the pain and inflammation occurring as your milk comes in.
  • You can apply green cabbage leaves (chilled or at room temperature) to your breasts and leave them on until they wilt, then apply new leaves as often as needed for comfort. This helps decrease your milk supply coming in and decreases your engorgement. 
  • WARNING. Do not apply cabbage leaves if you do not plan to wean or decrease your milk supply.

WARNING SIGNS FOR ALL POSTPARTUM MAMAS

(in no particular order)

1. Fever
2. Burning with urination.
3. Inability to urinate.
4. Swollen, red, painful area in particularly one leg.
5. Sore, red, hot, painful area(s) on breast(s) AND fever or flu-like symptoms.
6. Passage of blood clot larger than s golf ball, heavy vaginal bleeding, return to bright red vaginal bleeding or any bleeding that soaks through a maxi pad within 1 hour.
7. Foul smelling vaginal discharge or vaginal itching.
8. Increased pain at the site of episiotomy or tear.
9. Opening of cesarean incision.
10. Rash or hives, especially when itchy.
11. Severe headache.
12. Any sudden onset of NEW pain (such as new abdominal pain or new burning with urination).
13. Pain and tenderness in front or back of pelvis.
14. Feeling extremely anxious, panicky or depressed.
15. Frightening relationship with partner. Experiencing emotional or physical abuse.

OTHER SYMPTOMS TO BE AWARE OF

• During the 4th trimester, you may experience some leakage of urine. Especially when you have a full bladder, exercise, cough or sneeze. If this leakage has not gone away within a few weeks after birth it would be wise to tell your provider and seek out an evaluation with a pelvic floor physical therapist for a healing care plan. 
• In the first couple weeks postpartum you may also experience leaking from your rectum. This is also related to your pelvic flood and should resolve on its owner else you should let your provider know. 
• It’s also good to be aware of symptoms of thyroid problems after birth. Postpartum thyroiditis can often go undetected leaving you feeling not like yourself until it is corrected. Symptoms to be aware of include: feeling hot, muscle weakness, shakiness, rapid heart rate, inability to concentrate and weight loss. Many of those may seem like normal postpartum events but it is good to be aware in case anything persists or if you are feeling off.
• You may experience numbness, tingling, weakness or pain in your hands and wrists caused by swelling and fluids leaving your body over time that were retained during pregnancy. Swelling and symptoms should go down within a few weeks.
• Some mamas experience lower back and hip pain after birth. This may last only a few days or weeks. This should be pretty mild. If you experience hip pain that is severe or makes walking difficult, you should notify your provider.

VAGINAL BIRTH MAMAS

PERINEUM RECOVERY

Let’s clear up what I mean by perineum & have a simple anatomy lesson. The perineum  is the tissue between your anus and your vulva. Your vulva is the umbrella term used to name all of the female structures down there. See the image below for clarification. I feel this is important so you understand where your healing has to occur and where your tears or episiotomy have occurred.

After birth your vagina gradually regains its tone. Your labia will remain somewhat larger and looser than before giving birth but your vagina will regain it’s tone. You can expect to have perineum swelling and bruising especially if you have a tear, stitches or an episiotomy. If you receive stitches for your tear they will dissolve within 2-4 weeks. 

A sore perineum, 1st or 2nd degree tears and stitches usually heal within 4-6 weeks. You may feel discomfort during this period of time or longer. Discomfort with intercourse can be normal during this time period. If any vaginal discomfort persists or pain during intercourse persists this would warrant a call to your provider. You should also consult with a pelvic floor physical therapist. Your provider will ask about your recovery at your typical 6 week postpartum check up. I encourage you to reach out sooner if needed.

If you’ve had a 3rd degree or 4th degree tear, you might need a few checkups before the typical 6 week postpartum checkup. Your provider will want to keep an eye out for any complications or signs of infection.

No matter your postpartum vaginal situation, call your provider at any point in your recovery if you are experiencing ongoing, severe or worsening vaginal pain. Also, if you experience vaginal discharge that is foul smelling or an unexpected color (other than red, pink, rust, tan or white). 

Recommendations for PERINEUM HEALING:

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• Apply a cold pad to your perineum. I urge you to continue to do so after you have returned home from your birth place as well. (I totally regret not continuing to do so!)
• Utilize a peri squirt bottle for rinsing after you pee or while you pee to decrease burning and discomfort. Use a cloth to pat dry to avoid the discomfort of wiping with toilet paper.
• You can spray your perineum with herbal spray to promote healing.
• You can spray numbing spray to your perineum. Be aware that some pain relief sprays are not meant to be sprayed on wounds such as a healing vagina.
• Place witch hazel soaked pads into your maxi pad for soothing.
• You can make padsicles or buy them. Padsicles usually are made using a full size maxi pad, pouring pure aloe gel onto the pad, pouring witch hazel onto the pad and adding a few drops of lavender essential oil. Don’t soak the pads, but do add a healthy amount. Then fold back up and store in the freezer in a sealed bag. Thaw one out a few minutes before you plan to change out your pad.
• Try sitting on soft surfaces or on a doughnut pillow. This will lift your perineum off of the surface you are sitting on. You can use pillows, your boppy breastfeeding pillow, or towels to form a doughnut to sit on.
• Sit on both buttox evenly as this can apply even pressure to your sore bottom and decrease discomfort.
• Try sitting on firm surfaces if soft surfaces are uncomfortable. This may be best for you as soft surfaces may allow more uneven pressure on your perineum tears and stitches.
• Sit in a shallow bath or sitz bath that covers your buttox and perineum. You might find warm or cold water to be soothing.
• Good advice I was once told, try resting for “5 days in the bed, 5 days on the bed and 5 days near the bed” for promotion of rest, postpartum healing, establishing breastfeeding and bonding with your new baby!
• Nothing is allowed in your vagina until you are completely healed. No tampons, no douching, no intercourse.

POSTPARTUM BOWEL MOVEMENTS AFTER VAGINAL BIRTH

In preparation of your 1st postpartum bowel movement, I recommend you talk to your provider about using a stool softener immediately after birth. Bring your own from home even! (I did this for both of my births) This will make it so you have an easy time going poop while you are still sore in your vagina. It also helps you to not have to bear down causing you discomfort in your perineum. Especially mamas with episiotomy stitches or 3rd and 4th degree tears. THIS IS A MUST FOR YOU! Continue taking the daily stool softener until your perineum is not sore anymore or is completely healed. No need to thank me for this tip. I will just say you’re welcome!

CESAREAN BIRTH MAMAS

YOUR HOSPITAL STAY

After your cesarean, you can expect to stay in the hospital for about 2-4 days. During this time you will be monitored closely. Your postpartum nurse will be checking your vital signs, lochia flow, incision, pain level, return of bowel sounds & passing gas and that you are able to pee with no problems. You will be given several options for pain management after birth. It is best to talk with your provider on what medications they usually give and then decide what’s best for you. 

PHYSICAL ACTIVITY

You will be encouraged to move around as soon as possible after your belly birth. As soon as your nurse feels your surgery medications have worn off enough and you have enough leg power back, you will need to get up and walk. With assistance you should try to sit at the side of the bed within a few hours, get up to the bathroom within 8 hours, walk a few laps in your room within 12 hours and go down the hallway within 24 hours. Early movement will decrease your overall body aches, lower your risk of blood clots, encourage your digestive tract to wake up and get your lungs filled with air. Always listen to your body and try not to over do it. You will know if you did because you will have more bleeding or have increased pain.

For the first 2-4 weeks after surgery you will need to take it easy. You should not lift anything heavier than your new baby (not even older children). You should not do any driving. Also, make an effort to limit movements such as bending over for laundry, pushing a vacuum and going up and down stairs. Wait until your incision is healed before you resume intercourse. Talk to your provider when you feel ready to ease back into any exercising.

DIGESTION, GAS & BOWEL MOVEMENTS

Your cesarean will slow down your digestion and possibly give you a difficult time passing gas, having a bowel movement and urinating after your surgery. Your hospital nurse will be assessing for any complications related to this and make sure you are able to use the bathroom after surgery and eventually start passing gas again as well. You can expect to eat as soon as you feel up to it after your belly birth. I would recommend you start with simple whole foods (not processed) and ease back into high fiber foods. Drink half your body weight in ounces of water a day for good hydration. Avoid drinks that are iced or carbonated to reduced gas pains. Changing positions often and walking as soon as it is safe for you are also ways to help jumpstart your digestion. Severe nausea, a painfully distended belly and not being able to pass gas are all things you should be aware of and report to your postpartum nurse.

INCISION CARE

You will be taught by your postpartum nurse how to care for your incision after you arrive home. You will need to be aware of signs of infection & complications including: angry red areas, significant draining or oozing, foul smell, increasing pain at the incision, opening of the incision or unusual swelling. Some redness, pain, itching and drainage of pink or yellowish fluid is normal. You will be allowed to bathe and shower as usual after 24 hours. Gently clean and dry your incision daily. Be sure to wash your hands before touching your incision. Wear loose clothing over your abdomen.

Talk to your provider about what type of incision closure they use. If tape is used on the outside, it will come off on its own within about a week. If staples are used they need to be removed by your provider either before you are discharged home or shortly after at your 1st follow up visit.

BREASTFEEDING CONSIDERATIONS POST CESAREAN

I wanted to include this section because it is important to know that if you have a cesarean you may find that it is difficult to find a comfortable breastfeeding position. If this is the case for you, ask for help from your nurse and ask to be seen by the hospital lactation consultant. Keep in mind you will want to protect your incision while breastfeeding. If your baby is sleepy after birth, be patient as you both figure out positioning and latching. Frequent and prolonged skin-to-skin time will promote breastfeeding. Also, initiate breastfeeding within the first hour after birth and latch often!

How To Have The Best Possible, Gentle C-Section

This is a very important topic for mamas to be informed about and will promote a calming cesarean environment and smooth transition for mama and baby. Learn How You Can Have The Best Possible, Gentle Cesarean.

Well there you have it mama friend. So much postpartum goodness all packed into one blog post. If I did not answer your postpartum recovery question here, please send me a message or email me! A mama who is prepared for postpartum, is a mama who will have a smoother transition. Keep learning. You got this mama!
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