Recovery is a progressive process and you will feel stronger every day.

In the first few days following delivery, caring for yourself and the baby will provide enough exercise. Allowing yourself additional rest periods each day will help you cope with the stress of a new baby in your life. You may gradually return to normal activity as tolerance and endurance improve. You may resume a light exercise program after the first two weeks and increase the activity as your endurance and bleeding allow. Usually you are able to return to work by the time the baby is four to six weeks old. Unless otherwise indicated, you should see your doctor six weeks after delivery for a postpartum check-up.

Pain in the area of the episiotomy is caused by swelling of the tissue in the region of the incision. This swelling and discomfort will gradually subside. Your stitches dissolve in about two to four weeks.

Taking sitz baths for 15-20 minutes, three to four times a day will promote the healing process and help alleviate some of the discomfort.

Apply the anesthetic spray to your stitches as needed. Bowel movements will not harm the stitches, but care should be taken to wipe from front to back after each bowel movement. Each time you use the bathroom, pour warm water over the perineal area and pat the area dry with a soft tissue.

When you experience milk "let down" approximately two to three days postpartum, the breasts will suddenly become very heavy, swollen, painful and hot. This condition is known as "breast engorgement" and is a combination of congestion of the blood vessels and glandular congestion from the milk production. The breasts will become softer and less congested after the first week or two following delivery. Your body will produce sufficient quantities of milk to meet the baby's changing needs. We encourage you to continue with prenatal vitamins as long as you are breastfeeding.

Breast infections are common in breastfeeding moms. The infection is caused by the bacteria in the baby's mouth entering the breast. The baby is in no danger of becoming infected. If either breast should become red, swollen, tender or hot, associated with an elevated temperature, please call our office. It is important to continue feeding the baby from the affected breast, as the prescribed antibiotics will be much more effective if the breasts are emptied. If breastfeeding becomes extremely uncomfortable, use manual expression to empty the breast.

When you plan to wean the baby, decrease feedings gradually. There is no effective medication available to prevent the breast engorgement. If engorgement should occur, the following instructions to bottle-feeding mothers will be helpful to you.

Mothers who bottle-fed may still notice engorgement or evidence of milk production despite medication administered in the hospital. This normal response is due to hormonal changes that occur at the time of birth.

Your body will stop milk production without need for further medication.

The following hints may be helpful if you are uncomfortable:

1. Wear a good support bra (even at night).
2. Avoid stimulation to the nipple, such as showers aimed at chest.
3. Burp the baby on the knees rather than across the chest.
4. Apply ice packs to the breast for an hour three to four times a day.
5. Take Tylenol for discomfort every four hours as needed.

Your bleeding will gradually decrease over the next two weeks. The passage of an occasional blood clot is not unusual and should not be a cause for concern. If you should engage in excessive activity, heavier bleeding can be anticipated. If you notice a marked increase in the bleeding, you should decrease your activity. If there is no improvement, notify our office. Avoid douching prior to your six weeks check-up.

Hemorrhoids are varicose veins of the rectum. Pelvic pressure during pregnancy, pressure on the rectum during labor and constipation following delivery will aggravate them still further. The discomfort of hemorrhoids will gradually subside after the first week postpartum. The following measures may be beneficial:

1. Take sitz baths for 15-20 minutes, three to four times per day.
2. Use rectal suppositories (Anusol) or stool softeners (Colace).
3. Avoid straining at bowel movements.
4. Increase fiber intake.
5. Drink six to eight glasses of fluid per day.(The increased fiber and fluids will help avoid constipation.)

A 20-30 pound weight increase during the past nine months is a direct effect of the pregnancy. Unfortunately, this weight does not disappear with the delivery, since time is needed for redistribution of fluid spaces (especially when breastfeeding). Care should be taken not to diet too drastically. Some "paunchiness” of the abdomen is very common and can only be reduced with the use of an exercise program (e.g., sit-ups).

The return of the menstrual period after childbirth is unpredictable.

Non-nursing mothers may anticipate resumption of menses four to 12 weeks postpartum. The first period maybe irregular and heavier with associated clots. Nursing mother's menstruation usually resumes after cessation of lactation. Menstruation may begin while still breastfeeding. Lack of menses does not guarantee infertility, and adequate contraceptive measures should be taken because a pregnancy can occur prior to the first menstrual period.

You may resume your sexual activity three to four weeks after delivery.

The stitches should be adequately healed by that time, but some discomfort may be experienced because of the associated scarring from the episiotomy repair. This will usually abate after a few weeks.

Your physician will discuss contraceptive measures with you prior to your release from the hospital. Birth control pills are usually started two weeks following the delivery. Continuous vaginal spotting may be anticipated throughout the first cycle of pills. It is encouraged to utilize back-up barrier methods until you have been on the pill for two weeks. Barrier methods such as condoms (rubbers), foam, sponge or suppositories may be used safely while breastfeeding. There is some disparity of opinion regarding the use of birth control pills while breastfeeding and we encourage you discussing this with your physician.

Many new mothers will go through several days of emotional distress following the birth of their baby. This is usually mild and short-lived, but occasionally lasts for several weeks. The cause of this is believed to be hormonal and does not usually require treatment. If you feel that your symptoms are excessive, please notify your physician.

You may shower and wash your hair at any time. Breast tenderness may be aggravated under a strong shower stream. Tub baths are not longer considered harmful postpartum and may help soothe perineal discomfort.

You may travel after the baby is two weeks of age. Remember not to become too fatigued and to stop at regular intervals on long trips.

Notify our office if any of the following symptoms occur:

1. Fever greater than 101 degrees orally
2. Frequency or burning upon urination
3. Heavy or prolonged vaginal bleeding¬
4. Fainting
5. Swelling and redness or tender area in the breasts
6. Foul vaginal discharge.
7. Leg cramps or swollen, reddened and tender areas on the legs.

Delivery of your child by cesarean section may result in a slightly longer recovery time. Your incision may have been closed with stitches underneath the skin or with stainless steel staples. If you are released from the hospital with the staples still in place, please call the office for their removal five to seven days after surgery.

The first two weeks following cesarean section are most crucial for a speedy recovery. During this time, you should limit your activity by avoiding heavy lifting, pushing or shoving. Climbing stairs will not present a problem, as long as it is not done to excess. After two weeks, you may gradually increase your activity, including a light exercise program.

You may experience some drainage from the incision. This is due to collection of body fluids within the incision and is no cause for concern. Application of hot compresses to the area will speed up the healing. Should the area become red, hot or swollen, please notify the office.

If you had a postpartum sterilization procedure done, you will have a small incision under your umbilicus. The dressing may be removed after 12 hours and does not have to be replaced. The stitches will dissolve on their own. Wound care is the same as for the cesarean section. Lifting in moderation will not harm the incision.

The tubal ligation will be effective immediately, so no additional measures of contraception need to be considered. However, no sterilization procedure can ever be guaranteed.