Your Postpartum Health

• The lochia is heavy the first two or three days following birth, and bright red in color. It will change to pink, then a dark red or brown, and finally to yellow/white. Lochia can last for about two to six weeks, can come and go, and can increase when you nurse. Lochia can also increase when you get up from sitting or lying down (as it collects in the vagina). And if you're too active, lochia can turn bright red again (so be sure to slow down!). You can use sanitary pads during the lochia flow but not tampons. If you are at all concerned about the color, smell, or amount of lochia, don't hesitate to call your health care provider.
• Perspiring, especially at night, is very common during the first few days following birth. This is because your body is trying to get rid of the extra fluids that built up throughout your pregnancy.
• Stitches from an episiotomy can be cared for in a few ways. For the first 12 to 24 hours, ice packs can be helpful. After that, warm tub baths or sitz baths can be very soothing. Just be sure to clean the tub beforehand. Stitches absorb on their own within about two weeks.
• Soreness of the perineum is very common after birth, with or without stitches. It usually disappears within about 7 to 10 days. Keep in mind that it's very important to keep the area clean and dry in between bathing to prevent infection. You can try the same comfort measures as for stitches. And Kegel exercises (which you learned in pregnancy to help strengthen the muscles in your perineum) can also promote healing.
• Urinating can sometimes be difficult the first day after you give birth. Many women are afraid to go, especially if they've had an episiotomy. Urine can sometimes burn when the perineum is bruised or sore. And even though your bladder is full, it may not give the signal to go. (This is because it's been pressed by the uterus for such a long time that the signal that it is full may take some time to work again.) Just be sure to drink plenty of fluids and urinate often (at least every two to three hours when you're awake).
• Constipation right after birth is common. One reason is that your bowel may still be sluggish, as it was throughout your pregnancy. And the abdominal muscles (which were stretched during birth) may not function at first. To avoid constipation, eat a diet that is very rich in fiber (including plenty of fruits and vegetables, whole grain products, and dried fruit like raisins, prunes, and figs), and drink a lot of water and other fluids. Try not to strain during bowel movements, as this can lead to hemorrhoids. A stool softener may be a big help.
• Afterpains are caused by contractions that help the uterus return to its pre-pregnant size. They are stronger and more uncomfortable if this is not your first baby. Ask your health care provider about comfort measures.
• Women recovering from a cesarean will also experience lochia, perspiration, and possibly difficulty with urination and bowel movements. In addition, because a cesarean is major surgery, you may experience pain around the incision (and later, itching), nausea (from the anesthesia), and gas pains in the belly, often reaching as high as the shoulders. If you've had a cesarean birth, be sure to speak to your health care provider about special comfort measures you can use to relieve these symptoms. You may also need assistance at first in finding comfortable breastfeeding positions. Give yourself about a month of limited activity to fully recover and regain your energy.
• Your breasts will become engorged (swollen, sometimes hard, and warm) during the first week as your milk comes in. Cold compresses can help reduce the swelling. Short frequent nursing helps too. If you are not nursing, wear a good supportive bra day and night until the engorgement subsides, usually by the end of the first week postpartum.

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