Postpartum: First 6 Weeks After Childbirth

Overview

What is postpartum?

The days and weeks after your baby is born are called the postpartum period. After childbirth, your body will start to heal and go through many changes as it recovers. Some of these changes happen over several weeks. So rest whenever you can, ask for help from friends and family, and eat well.

What happens to your body during this time?

Your body may feel sore and very tired for several weeks. You may continue to have contractions, called afterpains, as the uterus returns to the size it was before your pregnancy. You will also have some vaginal bleeding. Breast engorgement is common between the third and fourth days after delivery.

How does postpartum affect your emotions?

Having a new baby is exciting, but it's common to feel tired and stressed. Your focus may change. You may feel that you don't have the time or energy for other things or people. You may also feel sad. Talk to your doctor or midwife if you feel sad for more than a few weeks.

What should you know about newborn care?

During your baby's first few weeks, you will spend most of your time feeding, diapering, and comforting your baby. You may feel overwhelmed at times. It is normal to wonder if you know what you are doing, especially if you are first-time parents. Newborn care gets easier with every day. Soon you will know what each cry means and be able to figure out what your baby needs and wants.

Common Physical Problems After Childbirth

You may have problems that last for a while after childbirth. Common problems include:

• Constipation and hemorrhoids. These problems often start during pregnancy and continue after delivery.
• Soreness in the vagina and the perineum. You may have discomfort or pain if this area was torn or cut (episiotomy) during delivery. It may take several weeks to recover from a perineal tear or episiotomy.
• Breast engorgement. This means your breasts are painfully overfull with milk. It's common between the third and fourth days after delivery, when the breasts start to fill with milk. Your breasts may become firm and swollen, which may make it hard for your baby to breastfeed.
• Pelvic bone problems. As the pelvic bones loosen during pregnancy, they may temporarily separate. This isn't dangerous, but it can be painful. Pain or discomfort usually lingers for about 2 months after childbirth. It can take 3 to 8 months for this problem to heal on its own.

Many postpartum problems can be managed with home treatment. If your doctor or midwife gave you specific instructions, be sure to follow those instructions.

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Taking Care of Your Body

Care after a vaginal birth

You may need some time after a vaginal delivery to return to your normal activities. It's important to focus on healing and taking care of your body.

• Use pads for postpartum bleeding.
  • Do not use tampons until your doctor or midwife says it's okay.
  • Do not douche.
  • Bleeding may last for 4 to 6 weeks, but you should have a lot less bleeding after 2 weeks.
• Ease cramps, called afterpains, with over-the-counter pain medicines, such as acetaminophen (Tylenol) or ibuprofen (such as Advil).

  Read and follow all instructions on the label. If the doctor or midwife gave you a prescription medicine for pain, take it as prescribed.

  • Do not take aspirin, because it can cause more bleeding.
  • Do not take two or more pain medicines at the same time unless the doctor or midwife told you to. Many pain medicines have acetaminophen, which is Tylenol. Too much acetaminophen (Tylenol) can be harmful.
• Take measures to ease hemorrhoids and pain around the opening of your vagina.
  • Put ice or a cold pack on the area for 10 to 20 minutes at a time. Put a thin cloth between the ice and your skin.
  • Use witch hazel or hemorrhoid pads (such as Tucks) to reduce soreness.
  • Try sitting in a 8 to 10 centimetres (3 to 4 inches) of warm water (sitz bath) 3 times a day and after bowel movements.
  • Clean yourself with a gentle squeeze of warm water from a bottle instead of wiping with toilet paper. Pat the area dry with a soft cloth.
• Drink lots of fluid and eat high-fibre foods if you have constipation.

  Ask your doctor or midwife about over-the-counter stool softeners and fibre supplements.

• Wait until you are healed to have sexual intercourse.

  Healing usually takes about 4 to 6 weeks. Your doctor or midwife can tell you when it's okay to have sex.

• Try not to travel with your baby for 5 or 6 weeks.

  If you take a long car trip, make frequent stops to walk around and stretch.

Care after a C-section

It can take 4 weeks or more for a caesarean (C-section) incision to heal. It's important to take care of yourself while you're healing.

• Rest when you feel tired.

  Getting enough sleep will help you recover.

• Try to walk each day.

  Walking boosts blood flow and helps prevent pneumonia, constipation, and blood clots.

• Avoid strenuous activities for 6 weeks or until your doctor or midwife says it's okay.

  This includes bicycle riding, jogging, weight lifting, and aerobic exercise.

• Don't do sit-ups or other exercises that strain the belly muscles.

  Avoid these exercises for 6 weeks or until your doctor or midwife says it's okay.

• Don't lift anything heavier than your baby until your doctor or midwife says it's okay.
• Wear pads if you have vaginal bleeding.
  • Do not use tampons until your doctor or midwife says it's okay.
  • Do not douche.
• Hold a pillow over your incision when you cough or take deep breaths.

  This will support your belly and decrease pain.

• Follow your doctor's instructions about caring for your incision.

  You can shower as usual. Pat the incision dry when you're done.

• Drink lots of fluid and eat high-fibre foods if you have constipation.

  Ask your doctor or midwife about over-the-counter stool softeners or fibre supplements.

• Ask your doctor or midwife when it is okay for you to have sex.

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Coping With Emotions

Having a new baby is exciting. But it also can be exhausting and stressful. It's common to feel a range of emotions at this time.

Expect changes in your relationship

If you have a partner and this is your first baby, your focus may shift from being a couple to being parents. That's a common and wonderful change. But it can take some time to adjust. You and your partner may not have as much time or energy for each other for a while. But you also will get to know each other in new ways, as parents.

It's common to have little interest in sex for a while after childbirth. While your body is recovering and your baby has many needs, you and your partner will need to be patient with one another. You will have more energy when you get used to having a new baby and are healed, more rested, and settled in a routine.

Watch out for depression

"Baby blues" are common for the first 1 to 2 weeks after birth. You may lose sleep, feel irritable, cry easily, and feel happy one minute and sad the next. Hormone changes are one cause of these emotional changes. The "baby blues" usually peak around the fourth day and then ease up in less than 2 weeks.

Talk to your doctor or midwife if your symptoms last for more than a few weeks or if you feel very depressed. You may have postpartum depression. It can be treated. Support groups and counselling can help. Sometimes medicine can help too.

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Postpartum Checkup

In the first couple of weeks after you give birth, your doctor or midwife may want to check in with you and make a plan for any follow-up care you may need. You will likely have a complete postpartum visit about 4 to 6 weeks after delivery. At that time, your doctor or midwife will check on your recovery from childbirth. You will also be asked about your mood and checked for signs of postpartum depression.

You may have a pelvic exam to make sure that you are healing well. If you had a C-section, your doctor will check your cut (incision).

Your doctor or midwife may talk with you about birth control and find out how you're doing with breastfeeding.

Keep a list of questions to ask your doctor or midwife. Your questions might be about:

• Changes in your breasts, such as soreness.
• When to expect your menstrual period to start again.
• What form of birth control is best for you.
• What foods and drinks are best for you, especially if you are breastfeeding.
• What types of exercise would be good for you.
• When you can have sex.

Getting Rest and Support

It's easy to get too tired and overwhelmed during the first weeks after childbirth. Be sure to rest whenever you can, and accept help from others.

• Make time to rest every day.

  Try to nap when your baby naps. Stay flexible so you can eat at odd hours and sleep when you need to.

• Ask another adult to be with you for a few days after delivery.
• Limit visitors.

  Everyone will want to come see the baby right away, just when you're at your most tired. It's okay to limit visitors to as few as you feel you can handle or to ask them not to visit for a while. It's also okay to set a limit on how long they stay.

• Ask for help with housework, cooking, and shopping.

  Remind yourself that your job is to care for your baby.

• Plan for child care if you have other children.
• Plan small trips to get out of the house.

  Change can make you feel less tired. For example:

  • Go for walks with your baby.
  • Find an exercise class for you and your baby.

Getting the Nutrition You Need

Good nutrition is important to help you keep your energy and lose extra weight you gained during your pregnancy.

• Eat a variety of foods to help you get all the nutrients you need.

  Your body needs protein, carbohydrate, and fats for energy.

• Eat foods that are high in fibre.

  A high-fibre diet can help prevent constipation. Include foods such as whole grain breads and cereals, raw vegetables, raw and dried fruits, and beans.

• Drink plenty of fluids, especially water.
• Eat small snacks throughout the day to keep up your energy.

  Don't skip meals or go for long periods without eating.

• Limit alcohol if you're breastfeeding.

  Alcohol can cause a lack of energy and other health problems for your baby if you drink too much while breastfeeding. It can also get in the way of your ability to feed your baby or to care for your baby in other ways. There isn't a lot of research about exactly how much alcohol can harm a baby. Having no alcohol is the safest choice for your baby. If you choose to have a drink now and then, have only one drink. And limit the number of occasions that you have a drink. Wait to breastfeed at least 2 hours after you have a drink to reduce the amount of alcohol the baby may get in the milk.

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Birth Control After Childbirth

Birth control is any method used to prevent pregnancy. If you have vaginal sex without birth control, you could get pregnant—even if you haven't started having periods again. You're less likely to get pregnant while breastfeeding, but it's still possible. Finding birth control that works for you can help avoid an unplanned pregnancy.

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Newborn Basics

You may feel prepared for your baby. But the reality of the constant care a newborn needs can shock many parents. A newborn affects your life in ways that you simply can't expect. Only through experience can you fully understand the impact of these new responsibilities and how your roles will change. Many parents shift between feeling confident and ecstatic one minute, and drained, scared, and unsure the next.

When you realize that your baby is physically completely dependent on you, you may worry whether you are giving your baby the best care. Common concerns in this first month include:

Umbilical cord care.

Basic care of your baby's umbilical cord is keeping it clean and dry. To keep the cord dry, give your baby a sponge bath instead of bathing your baby in a tub or sink. Keep your baby's diaper folded below the stump. If that doesn't work well, before you put the diaper on your baby, cut out a small area near the top of the diaper to keep the cord open to air. The stump usually falls off within a couple of weeks.

Your newborn's sleepiness.

In the first few days after birth, your baby may sleep a lot and only be awake to eat or have a diaper change. Your baby will become gradually more alert throughout the month. By the end of the first month, your baby will likely start to form sleeping and eating patterns. In general, your baby will likely have periods where they're awake for 2 or 3 hours straight. Around 3 months of age, the patterns will become more predictable.

Your exhaustion and sleep deprivation.

Newborns sleep a lot. But they also wake up a lot for brief periods and need feeding, diapering, and attention. Nights of long, restorative sleep can seem a foggy memory to parents. This may be especially true for those who start with a deficit after the physical exertion of and recovery from giving birth. Be sure to ask for help when you need it. Ask a family member, friend, or neighbour to help you with daily tasks, such as laundry, cleaning, or making meals. This can help you to nap instead of doing chores while your baby sleeps.

Worry over whether your baby is getting enough to eat.

This is especially a common concern among breastfeeding parents. As long as your baby feeds regularly (every 1 to 3 hours in the first few weeks, then every 2 to 4 hours over the next few weeks), your baby should be fine. Sometimes you may need to wake a sleepy baby to eat. It's good to check your baby's diaper for signs that your baby is getting enough breast milk. For example, your baby may have about 3 wet diapers a day for the first few days. After that, expect 6 or more wet diapers a day throughout the first month of life. During routine checkups, the doctor or midwife will track your baby's weight gain and growth.

Urine colour.

The urine should be yellow. Don't be alarmed, though, if you notice a pink colour to the urine during your newborn's first 3 days of life. It's common for newborns to pass crystals in the urine (highly concentrated urine) which makes the urine look pink. If the pink colour lasts, or if at any time your baby seems to be in pain while urinating, call your doctor or midwife.

Newborn jaundice.

Many babies get jaundice (also called hyperbilirubinemia) in their first few days of life. Jaundice is a condition in which the skin and the whites of a baby's eyes appear yellow because of a buildup of bilirubin in the blood. Bilirubin is a yellow-brown substance produced by the breakdown of red blood cells. Jaundice should be monitored by your baby's doctor. But it most often doesn't need medical treatment. Usually, increasing the number of feedings helps reduce jaundice. Phototherapy, in which a baby is placed under special lights may be used if bilirubin levels are too high. Keep your baby's routine checkups with your doctor or midwife, and call anytime if you're concerned about jaundice or your baby's skin.

Skin care.

In general, use mild shampoo or soap when you bathe your baby. Avoid lotions and other skin care products unless your doctor or midwife tells you to use them. Newborns have sensitive skin, and healthy newborn skin doesn't need skin care products applied.

A misshapen head.

Right after birth, especially after lengthy vaginal deliveries, your baby's head may look misshapen. This is normal, and your baby's head will most likely take on a more normal shape within a few days to weeks after delivery. In rare instances, a misshapen head can be a sign of an abnormal condition, such as craniosynostosis (say "kray-nee-oh-sih-noss-TOH-sus"). After your baby is born and during your baby's routine checkups, your doctor or midwife will track your baby's head shape and skull growth. If you're concerned that your newborn's head hasn't gone back to a normal shape within several weeks, talk with your doctor or midwife.

It's common to question your feelings for your baby. A bond doesn't always happen the moment you set eyes on your child. But you will develop stronger feelings and love for your baby every day. For some parents, it takes time to build this bond, especially when the baby's physical demands take a great deal of time and energy. Talk to your doctor or midwife if you don't feel that you are bonding with your baby in the first week or two.

Also keep in mind:

• Your baby will soon be able to engage with you. But in this first month, your baby may seem to be in a semi-conscious state. Sleeping and eating are a newborn's main activities. Your baby will gradually emerge from this groggy state. And you can rest assured that your loving care will be rewarded with interaction very soon.
• Gradually within the first month, your newborn will start to look more "baby-like." Many parents don't like to admit it, even to themselves. But they may feel disappointed that their baby isn't as cute as they had hoped. If you feel this way, don't despair. Labour and delivery takes its toll on your baby's appearance. Your baby may have an odd-shaped head, swollen or squinty eyes, blotchy skin, and a flattened nose in the first few weeks. Soon, these irregularities will fade away. Your baby will start to have more normal-looking features.
• Your baby may have a birthmark that you notice at birth or during the first month. Most birthmarks need no treatment. They often fade as a child grows older. But sometimes a birthmark needs treatment or close monitoring. Talk to your doctor or midwife if you have concerns.

You will go through some major adjustments to this new little person in your life. But your baby's first month is also a period of amazing growth and change. Treasure these first weeks as you slowly introduce your baby to the world.

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When to Call a Doctor

Share this information with your partner, family, or a friend. They can help you watch for warning signs.

Call 911 anytime you think you may need emergency care. For example, call if:

• You have thoughts of harming yourself, your baby, or another person.
• You passed out (lost consciousness).
• You have chest pain, are short of breath, or cough up blood.
• You have a seizure.

Where to get help 24 hours a day, 7 days a week

If you or someone you know talks about suicide, self-harm, a mental health crisis, a substance use crisis, or any other kind of emotional distress, get help right away.

• Call or text Canada's suicide and crisis hotline at 988.
• Call Talk Suicide Canada: 1-833-456-4566 or text 45645 (4 p.m. to midnight ET).
• Go to the Talk Suicide Canada website at https://talksuicide.ca for more information.

Consider saving these numbers in your phone.

Call your doctor or midwife now or seek immediate medical care if:

• You have signs of hemorrhage (too much bleeding), such as:
  • Heavy vaginal bleeding. This means that you are soaking through one or more pads in an hour. Or you pass blood clots bigger than an egg.
  • Feeling dizzy or light-headed, or you feel like you may faint.
  • Feeling so tired or weak that you cannot do your usual activities.
  • A fast or irregular heartbeat.
  • New or worse belly pain.
• You have signs or symptoms of infection, such as:
  • A fever.
  • Frequent or painful urination or blood in your urine.
  • Vaginal discharge that smells bad.
  • New or worse belly pain.
• You have symptoms of a blood clot in your leg (called a deep vein thrombosis), such as:
  • Pain in the calf, back of the knee, thigh, or groin.
  • Swelling in the leg or groin.
  • A colour change on the leg or groin. The skin may be reddish or purplish, depending on your usual skin colour.
• You have signs of preeclampsia, such as:
  • Sudden swelling of your face, hands, or feet.
  • New vision problems (such as dimness, blurring, or seeing spots).
  • A severe headache.
• You have signs of heart failure, such as:
  • New or increased shortness of breath.
  • New or worse swelling in your legs, ankles, or feet.
  • Sudden weight gain, such as more than 1 to 1.3 kilograms (2 to 3 pounds) in a day or 2.3 kilograms (5 pounds) in a week.
  • Feeling so tired or weak that you cannot do your usual activities.
• You had spinal or epidural pain relief and have:
  • New or worse back pain.
  • Increased pain, swelling, warmth, or redness at the injection site.
  • Tingling, weakness, or numbness in your legs or groin.

Watch closely for changes in your health, and be sure to contact your doctor or midwife if:

• Your vaginal bleeding isn't decreasing.
• You feel sad, anxious, or hopeless for more than a few days.
• You are having problems with your breasts or breastfeeding.