Care after your C Section or Vaginal birth is very important and can make a difference in your health and wellbeing for many years. When mom is nurtured and cared for after birth of baby, post partum depression is reduced, body responds well and mom can focus on baby.

 Bind, Massage, Get Love and Support and Eat well…..Here are some topics that you may find helpful. Your body expanded over 9 months so take the time to help it heal and return back to your prepregnancy state.

 Ask your Dr to do the Misgav Ladach Method for Cesarean, as it has been shown through research to have  fewer secondary complications.

Incision Care

Ask your nurse to help you put on your binder before rolling over to get out of bed the very first time you move after the surgical birth. Rolling over and getting up without binder can allow tearing and pain to occur, please, wear a binder to reduce secondary complications.

Place your binder on before rolling over or getting out of bed. To reduce pain and increase mobility use your binder. To support incision and organs wear your binder. Also helps stabilize hips and pelvis, reducing back pain.

Your incision was closed by either sutures (stitches) or staples. It is very important that you keep your incision clean with warm soap and water daily. Allow the warm, soapy water to run over your incision – that is all that is needed to keep the incision clean. Do not use a washcloth on the incision or scrub it. Be sure to pat dry along the incision line after showering. It should remain dry to heal quickly and properly. You or someone else should look at your incision each day. You may need to use a mirror to see the incision. If you see any redness or drainage, please call your doctor. Gently massage area around incision and get to know your tummy post partum. It made room for a baby and now everything needs to go back into place. Remember low or high fevers can indicate a infection, so call your Dr if you have a fever.

 Sutures: If your incision was closed with sutures, it will be also covered with skin glue (Dermabond). The Dermbond will keep the incision clean so please resist the urge topick or scratch it off. The sutures will not be visible as they are below the top layer of skin. They will dissolve on their own within 4-6 weeks.

 Staples: These are best  removed before you leave the hospital. Try to avoid going into your doctor’s office in a week for  a staple removal check-up. After they are removed, Steri-strips (cloth appearing tape) will be placed over the incision. These strips usually fall off on their own within a week. If they have not, please peel them off yourself.

Wear your binder and wash it fequently to support your tummy and incision and wear it as much as is comfortable.

Nutrition

 Good nutrition is important for your health and recovery. Eat a variety of foods, including foods high in fiber, such as whole grains and cereals, fruits and vegetables- a diet that is bland and nutritious is best for the first few months. A protein-rich diet helps your body to heal. Drink enough fluids to quench your thirst. Water, as well as juice and milk, are best. Limit the amounts of soda and caffeinated beverages you drink. Plan to have three meals a day with nutritious snacks in between.

Avoid onions, garlic, cabbage & broccoli family vegies, Soy or GMO products to reduce gas and allergens for  baby.

Eat lots of whole grains, good fluids like fresh cocoanut water, or clean water, herbal teas to take in your daily fluid intake, which is much higher when breastfeeding.

 Breast Care

If you get a red, tender lump in your breast or have fever and chills, you may have a breast infection or mastitis. Call your doctor. (It is safe to keep breastfeeding).Massage or go into shower and stretch breasts to increase circulation, and increase your water intake! Wear your binder so that moving and holding baby is easier.

  Breastfeeding Mothers: Your daily bath or shower is sufficient for cleansing your breasts. Avoid getting soap or shampoo on the nipple and areola (the dark skin behind the nipple), as this can cause excessive dryness. Some amount of nipple tenderness is normal in the first week of nursing, but it should be comfortable to nurse the baby. The amount of nipple tenderness or breast discomfort should decrease after the first week.

Change your shirt and bra daily to reduce bacteria exposure.

If it does not, contact your lactation consultant. After nursing, leave your nipples exposed to the air for five to 10 minutes. You may express (gently squeeze out) a few drops of colostrum or milk and smooth that over the nipple to avoid dry, cracked nipples. Additionally, you may apply a pea-sized amount of Lanolin cream (Pur-Lan 100 or Lansinoh) to your nipples following a feeding. (Do not use this product if you are allergic to wool.) This modified lanolin cream does not need to be removed before the next feeding. You may want to wear a bra for comfort and support, especially when your milk comes in.

Massage your breasts, keep them supported, and massage breasts and arm pits to move fluid, and help prevent mastitis.

 Bottle-Feeding Mothers: Your breasts may become engorged (filled with milk) anytime in the first three weeks following your baby’s birth. You should wear a comfortable- fitting bra. If your breasts begin to fill with milk, take a clean head of green cabbage, pull the leaves off and use the back of a butter knife to chop the veins slightly. Cut out a hole for the nipple and place the leaves in your bra around your breasts. When the leaves wilt, replace them with fresh leaves. You may still leak milk off and on for several weeks, but your breast should feel more comfortable in 24 to 48 hours. You also may use ice packs on your breasts to decrease the swelling and reduce the discomfort. If directed by your doctor, you may take ibuprofen or acetaminophen at regular intervals to decrease breast soreness. There is also a  homeopathic remedy for this, but the best is to feed your baby with your breasts.

POSTPARTUM CARE

Massage: Do massage on yourself, tummy, legs everyday. Massage baby with clean oil and get to know baby’s body, gently moving arms and legs. Don’t be afraid to touch your tummy or around your incision, though it will feel lumpy, over the next several months, the incision area will model and flatten, which massage will greatly help do for a smoother flatter scar. Over 4-6 months you will be able to go right onto the incision and really work the tissue so that its soft and healthy without adhesions that can cause issues.

Elimination

It is normal to urinate often in the first week after delivery. Empty your bladder regularly (every two to three hours) while awake. The amount of vaginal bleeding you have will increase with a full bladder. You may have some discomfort with urination in the first few days after childbirth. Use your flush bottle to rinse water over your perineum while you are urinating to decrease your discomfort. Drink plenty of fluids and continue to do Kegel exercises daily. After the first day, any difficulty with urinating, such as frequency or burning, should be reported to your doctor.

It is normal not to have a bowel movement in the first few days following your baby’s birth. Enjoying a well-balanced diet, including plenty of fluids and fiber smoothies/soupls, will promote regular bowel habits. A mild stool softener (Colace), taken once or twice a day, may be helpful. If these measures have not worked and you have not had a bowel movement in several days, call your doctor. Always follow your doctor’s orders if using laxatives, rectal suppositories or enemas. Focus on fruit, walking and water intake, and this will help.

After childbirth, some women may experience urinary incontinence (leakage of urine) or bowel incontinence. Strengthening the muscles of your pelvic floor helps this incontinence. These muscles, which may have weakened during delivery, help you hold your urine. Please tell your doctor /midwife at your six-week visit or earlier. Do kegals everyday and increase the frequency. Take the time to tune into the lower part of your body.

POSTPARTUM CARE

Activities

In the Hospital: Please call a member of our staff to assist you the first time you get out of bed following your baby’s birth and wear a binder. Put on before rolling over to side and getting out of bed….wear while walking and moving around, to help you feel supported and increase your mobility.Nurse will need to measure your urine, and be sure you do not get dizzy when standing up. After this, if you are not lightheaded, we encourage you to begin participating in your care and the care of your baby.

At home: Restrict your activity to care for yourself and your baby for about the first several weeks. Arrange for family and friends to come over, bring food over to house for first month, to support family and help in transition. It is good to avoid any housework or carrying anything heavier than your baby in the first few weeks. Both of these activities may cause you to bleed more heavily. Increase activities gradually and avoid becoming overtired. Go up and down steps more slowly and as infrequently as possible. Three weeks after child birth, you may resume more normal activities, but continue to rest at least once a day. Further activities will be discussed when you visit your doctor/midwife. Continue to wear your binder for the first month or longer to help you move and walk, so you can gain strength to do more.

Postpartum Emotional Changes

The changes in emotions that are associated with the postpartum period, commonly called the “Baby Blues,” can last up to six weeks after the birth of a baby. These feelings are not unusual. They occur in up to 90 percent of women who have had a baby, and they include feeling sad and crying for no apparent reason, impatience, irritability, restlessness, mood swings, anxiety and feeling overly emotional, overwhelmed, confused or easily rejected. You also may experience a loss of appetite and fatigue and the inability to sleep. These feelings may be coupled with the guilt that you don’t find motherhood 100 percent blissful. The exact reason for these feelings is unknown. Reach out to people for help, support, and ask them to help. It has been shown that when mom is taken care of for up to 1 month post partum, and even fed, she regains her strength, focuses on baby and feels loved and nurtured so she can do the same thing! Rest up, get loved, and feel the love for the baby. Get massage to get the oxytocin flowing to help with bonding.

Some of the things that have been found to be related to these emotional changes are:

 Having another baby in the past year. Your body may have not completely recovered from the last pregnancy and birth.

 Changes in your physical and psychological states.  The new obligations of motherhood.  Hormonal fluctuations.  Strained marital or family relations.

 Lack of sufficient personal resources.

The postpartum blues can be impacted by the exhaustion that accompanies the care of a newborn, feeling like you have no time for yourself and that you are housebound, your insecurity about your mothering skills and poor nutrition. 

Sleep or rest when your baby sleeps. Let household chores go while you rest. Limit or stagger visitors. Accept offers of help, such as assistance with meal preparation and household chores. Take time for yourself each day. This may be a nap, a walk, a soothing bath or time to read or watch TV, even if for a brief time. Talk about your feelings with family, friends, your doctor and nurse and other new mothers. Eat a nutritious diet and drink plenty of fluids. When approved by your doctor, exercise daily.

After a emotionally or if things seems to get worse, you may be one of the many women who experience postpartum depression. Up to 20 percent of all new mothers develop postpartum depression. This can be treated, but it must first be recognized by the woman. If you are unsure whether your emotions are normal or are of concern, do not hesitate to talk with your doctor, midwife, friends or therapist.

Fathers also may experience physical and emotional adjustments after the birth of a baby. They may become exhausted as a result of changes in household routines, interrupted sleep, increased responsibilities and concern for their partner. For many men, get some exercise and  talk to a friend or family member about your feelings, doubts and concerns can help you feel connected and be very helpful. 

Bleeding (Lochia)

You will have vaginal bleeding and discharge (this is called lochia) for up to six weeks after your baby’s birth. The site where the placenta had been attached inside your uterus must go through several stages of healing, and the discharge you have reflects that healing process.

It is normal to have red to red-brown discharge for up to two weeks. You may pass blood clots up to the size of a plum. If you have larger than plum-sized blood clots, are bleeding more heavily than you did in the first 24 hours after the birth or your bleeding has a bad odor, call your doctor immediately.

Following the red discharge, you will have a yellow to white vaginal discharge. This may last up to four more weeks. The amount of this discharge should decrease every couple of days. You should not have any further red bleeding during this time. If you do, you should call your doctor.

Do not use tampons until you have been given the okay by your doctor. Doing so too soon will increase your chances of developing a uterine infection. Douching is never recommended. Change your pad every time you use the bathroom.

Peri Care

Use your flush bottle with warm tap water each time after you use the toilet until all the vaginal discharge has completely stopped. Afterwards, pat dry from front to back. If you were given hydrocortisone cream, you may use these for as long as they make you more comfortable. 

Bathing

You may usually shower once you are out of bed without feeling dizzy and the dressing on your abdomen has been taken off by your doctor. If you labored prior to your cesarean, please refrain from tub baths or pools until you are cleared by your doctor.

Hemorrhoid Care

Some women will have a new onset of hemorrhoids (swelling of blood vessels around the rectum) with pregnancy or after a vaginal birth. If the hemorrhoids were not present before the pregnancy, they will often disappear within a few weeks following child birth. Things that may help decrease your discomfort include:

 Sitting in a warm tub of water or using the Sitz Bath (plastic container that fits on the toilet) you may have been given in the hospital. Soak your bottom for 20 minutes at a time, replacing the water as necessary to keep it warm.

 Keep the area clean by using the flush bottle with warm tap water after each time you use the bathroom. Pat dry from front to back, and change your pad each time you use the bathroom. This will decrease your chances of developing an infection and will promote healing.

 An anesthetic spray can be used if ordered by your doctor.  Tucks (witch hazel pads) and hydrocortisone cream applied to the area also can be comforting. Once home, do not leave Tucks on for more than 15 minutes.  A side-lying position and avoiding prolonged sitting can help to decrease swelling and discomfort.

 Maintain adequate fluid intake, eat a healthy diet that includes soups,smoothies, fruits and vegetables, and if needed, use a stool softener (Colace) to decrease constipation and ensure greater comfort and bowel movements.

When to call your Doctor:

 Temperature above 100.4 degrees (oral)  Excessive vaginal bleeding: soaking one pad in an hour  Blood clots bigger than a plum or a continued increase in clots  Foul smelling vaginal discharge  Burning or pain when you urinate/radiating up and down back  Pain, tenderness or reddness in your calves  Tender or painful breasts (one or both)  Postpartum emotions that are becoming more intense or frequent over time, oremotions that you feel are interfering with your daily activities  If you have any concerns or questions call a friend, midwife, nurse or your Dr.

Exercise

A postpartum exercise program can begin as soon as you have been given the go-ahead by your doctor. Be gentle with yourself and give yourself time to get back into your pre pregnancy routine. The type of delivery you have had along with how you are recovering will guide your doctor’s recommendation. As you begin to exercise and increase your activity, be aware of the color and amount of vaginal discharge that you are having. If the amount increases or if it returns to bright red, you may need to decrease your activity for a time.It also is important to be aware that for up to six months after your delivery, your joints may be more prone to injury because of the relaxation of ligaments by the hormones of pregnancy. Again, gradually increasing your activity will help you to exercise safely and build up your strength. Walking is an excellent way to start getting back to your normal activity level.

Exercise with your binder on if you had a c section. Begin with walking and work up to a more rigorous workout, after the 2nd month of post partum care.

Medication

There are a number of medications you may take during your recovery period. They may be taken for various reasons. All the medications discussed here are safe for breastfeeding mothers to use. Always follow your doctor’s instructions regarding medications, and talk to her if you have any questions or concerns.

 Pain: o Many women find ibuprofen (Advil, Motrin, etc.) gives them relief from uterine

cramping (afterpains), generalized aches, soreness and perineal discomfort. Do not take this medication on an empty stomach. Before taking ibuprofen, check with your doctor if you are allergic to aspirin. You may take 400 or 600 mg of Ibuprofen every 6 hours as needed. Always use the lowest dose necessary to relieve your pain.

o Your doctor may prescribe a stronger pain reliever for you at the time of discharge. This medication may be a narcotic; be sure to carefully follow the directions for use. This should be used only when Ibuprofen alone is insufficient. Pain pills will increase constipation, so go easy, drink water and try to  avoid the pills by wearing your binder.

o Acetaminophen (Tylenol) is another common pain reliever used during the postpartum recovery period. This may be used only if you have not taken your prescription pain reliever in the last 24 hours. The recommended dose of Tylenol is 500 to 1000 mg every 4 hours. Do not take more than 3000 mg in 24 hours.

 Vitamins: Most women benefit from continuing to take one prenatal vitamin a day for the first six weeks after delivery. If you are breastfeeding, you may want to continue taking your prenatal vitamin as long as you breastfeed. DHA fish oils, and green food can help mom regain her strength and benefit baby.

 Iron: If you are anemic (have a low blood count), your doctor may have you take additional iron tablets. In order for your body to best absorb iron, take it after a meal with a citrus juice. Do not take it at the same time as your prenatal vitamin. Iron is constipating for some women; be sure to drink a lot of fluid and eat plenty of fiber, fruits and vegetables.

 Stool Softener (Colace): You should take Colace twice a day for as long as you are taking your prescription pain medication in order to minimize straining with bowel movements. If you are having diarrhea, you may discontinue this medication. You may continue this medication after you have finished your pain medications if you are still experiencing constipation. Please make sure you take this medication with a large glass of water or it will not help. Stool softeners (Colace) can be purchased without a prescription.

 Sexuality and Contraception

Women vary greatly in their physical recovery from childbirth, as well as their desire for intimacy. Some find they want physical closeness in the first few postpartum weeks, and others prefer to wait. Intercourse should be avoided until your doctor says it is all right. Introducing anything into your vagina before it is recommended can increase your chances of infections and discomfort. You can be physically close in other ways. Massage eachother and check into the body…discuss the surgery and take pressure off the whole scar thing from the C/S…..it brought in a new life, and your healthy- the scar will heal, lighten in color and with some massage, shrink in size.

Talk with your partner about your feelings and needs, and don’t feel you need to rush into resuming your sexual relationship until you are ready. It is not unusual for women to be fearful of becoming pregnant too soon, or to worry that intercourse might be uncomfortable. It is important to speak with your partner about these concerns. Many women experience vaginal dryness in the postpartum period, especially if they are breastfeeding. Use a water-soluble vaginal lubricant (such as K-Y Jelly) during intercourse to ease this condition. These products can be purchased without a prescription. There are alot of products that use natural ingrediants so do some online shopping!

Avoid the use of petroleum jelly or oil-based lubricants. This dryness will self- correct in time. About half of all postpartum women (both bottle-feeding and breastfeeding women) will ovulate before they get their first period. You should consider yourself able to get pregnant at any time. A contraceptive is recommended for at least one full year between pregnancies, for your health and the health of your baby. 

 Birth Control Pills: If you chose to take birth control pills to prevent you from becoming pregnant, your doctor may prescribe them during your recovery period. Be sure to start them when instructed to do so, and take them daily. Birth control pills are not started until you are at least three weeks postpartum. There is an increased risk of blood clots before this time. Birth control pills can impact the amount of breast milk you produce if you are a breastfeeding mother. The impact on milk production is less once breastfeeding is well-established, usually after three weeks of regular breastfeeding.

 Depo-Provera is an injectable form of birth control that may be given before discharge from the hospital. It is very important to get your next injection no more than 12 weeks after the first one. Many women find that they have red vaginal bleeding for longer than two weeks following the birth of their baby when they use Depo-Provera. This is normal. (A calcium supplement should be taken daily when using Depo-Provera. Please discuss this with your doctor.) If you call your doctor with any problem, be sure to remind him or her that you are using this medication. Depo-Provera can impact the amount of breast milk you produce if you are a breastfeeding mother. The impact on milk production is less once breastfeeding is well-established, usually after three weeks of regular breastfeeding.

Other Birth control options include: Condoms, the Diaphram, the Cap, a Tubal Ligation at time of C/S, a Vasectomy for him.