Postpartum care: What to expect after a vaginal birth

Pregnancy changes a body in more ways than you might expect. And that doesn’t stop when you give birth. Here’s what can happen physically and emotionally after a vaginal delivery.

You might have had a tear in your vagina during delivery. Or your healthcare professional may have made a cut in the vaginal opening, called an episiotomy, to make delivery easier. The wound may hurt for a few weeks. Large tears can take longer to heal. To ease the pain:

• Sit on a pillow or padded ring.
• Cool the area with an ice pack. Or put a chilled witch hazel pad between a sanitary napkin and the area between your vaginal opening and anus. That area is called the perineum.
• Use a squirt bottle to spray warm water over the perineum as you urinate.
• Sit in a warm bath just deep enough to cover your buttocks and hips for five minutes. Use cold water if it feels better.
• Take a pain reliever that you can buy without a prescription. Ask your healthcare professional about a numbing spray or cream, if needed.
• Talk to your healthcare professional about using a stool softener. Or ask about taking a laxative. Those medicines may help prevent problems with bowel movements — a condition called constipation.

Tell your healthcare professional if you have intense pain, lasting pain or if the pain gets worse. It could be a sign of an infection.

After delivery, a mix of blood, mucus and tissue from the uterus comes out of the vagina. This is called discharge. The discharge changes color and lessens over 4 to 6 weeks after a baby is born. It starts bright red, then turns darker red. After that, it usually turns yellow or white. The discharge then slows and becomes watery until it stops.

Contact your healthcare professional if blood from your vagina soaks a pad hourly for two hours in a row, especially if you also have a fever, pelvic pain or tenderness.

You might feel contractions, sometimes called afterpains, for a few days after delivery. These contractions often feel like menstrual cramps. They help keep you from bleeding too much because they put pressure on the blood vessels in the uterus. Afterpains are common during breastfeeding. That’s because breastfeeding causes the release of the hormone oxytocin.

To ease the pain, your healthcare professional might suggest a pain reliever that you can buy without a prescription. They include acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin IB, others).

Pregnancy, labor and a vaginal delivery can stretch or hurt your pelvic floor muscles. These muscles support the uterus, bladder and rectum. As a result, some urine might leak when you sneeze, laugh or cough. The leaking usually gets better within a week. But it might go on longer. Leaking urine also is called incontinence.

Until the leaking stops, wear sanitary pads. Do pelvic floor muscle training, also called Kegels, to tone your pelvic floor muscles and help control your bladder.

To do Kegels, think of sitting on a marble. Tighten your pelvic muscles as if you’re lifting the marble. Try it for three seconds at a time, then relax for a count of three. Work up to doing the exercise 10 to 15 times in a row, at least three times a day. To make sure you’re doing Kegels right, it might help to see a physical therapist who specializes in pelvic floor exercises.

If you notice pain during bowel movements and feel swelling near your anus, you might have swollen veins in the anus or lower rectum, called hemorrhoids. To ease hemorrhoid pain:

• Use a hemorrhoid cream or a medicine that you put into your anus, called a suppository, that has hydrocortisone. You can buy either without a prescription.
• Wipe the area with pads that have witch hazel or a numbing agent.
• Soak your anal area in plain warm water for 10 to 15 minutes 2 to 3 times a day.

You might be afraid to have a bowel movement because you don’t want to make the pain of hemorrhoids or your episiotomy wound worse. Take steps to keep stools soft and regular. Eat foods high in fiber, including fruits, vegetables and whole grains. Drink plenty of water. Ask your healthcare professional about a stool softener, if needed.

A few days after giving birth, you might have full, firm, sore breasts. That’s because your breast tissue overfills with milk, blood and other fluids. This condition is called engorgement. Breastfeed your baby often on both breasts to help keep them from overfilling.

If your breasts are engorged, your baby might have trouble attaching for breastfeeding. To help your baby latch on, you can use your hand or a breast pump to let out some breast milk before feeding your baby. That process is called expressing.

To ease sore breasts, put warm washcloths on them or take a warm shower before breastfeeding or expressing. That can make it easier for the milk to flow. Between feedings, put cold washcloths on your breasts. Pain relievers you can buy without a prescription might help too.

If you’re not breastfeeding, wear a bra that supports your breasts, such as a sports bra. Don’t pump your breasts or express the milk. That causes your breasts to make more milk. Putting ice packs on your breasts can ease discomfort. Pain relievers available without a prescription also can be helpful.

During pregnancy, higher hormone levels mean your hair grows faster than it sheds. The result is more hair on your head. But for up to five months after giving birth, you lose more hair than you grow. This hair loss stops over time.

Stretch marks on the skin don’t go away after delivery. But in time, they fade. Expect any skin that got darker during pregnancy, such as dark patches on your face, to fade slowly too.

Childbirth can trigger a lot of feelings. Many people have a period of feeling down or anxious after giving birth, sometimes called the baby blues. Symptoms include mood swings, crying spells, anxiety and trouble sleeping. These feelings often go away within two weeks. In the meantime, take good care of yourself. Share your feelings, and ask your partner, loved ones or friends for help.

If you have large mood swings, don’t feel like eating, are very tired and lack joy in life shortly after childbirth, you might have postpartum depression. Contact your healthcare professional if you think you might be depressed. Be sure to seek help if:

• Your symptoms don’t go away on their own.
• You have trouble caring for your baby.
• You have a hard time doing daily tasks.
• You think of harming yourself or your baby.

Medicines and counseling often can ease postpartum depression.

It’s common to still look pregnant after giving birth. Most people lose about 13 pounds (6 kilograms) during delivery. This loss includes the weight of the baby, placenta and amniotic fluid.

In the days after delivery, you’ll lose more weight from leftover fluids. After that, a healthy diet and regular exercise can help you to return to the weight you were before pregnancy.

The American College of Obstetricians and Gynecologists says that postpartum care should be an ongoing process rather than a single visit after delivery. Check in with your healthcare professional within 2 to 3 weeks after delivery by phone or in person to talk about any issues you’ve had since giving birth.

Within 6 to 12 weeks after delivery, see your healthcare professional for a complete postpartum exam. During this visit, your healthcare professional does a physical exam and checks your belly, vagina, cervix and uterus to see how well you’re healing.

Things to talk about at this visit include:

• Your mood and emotional well-being.
• How well you’re sleeping.
• Other symptoms you might have, such as tiredness.
• Birth control and birth spacing.
• Baby care and feeding.
• When you can start having sex again.
• What you can do about pain with sex or not wanting to have sex.
• How you’re adjusting to life with a new baby.

This checkup is a chance for you and your healthcare professional to make sure you’re OK. It’s also a time to get answers to questions you have about life after giving birth.