Congratulations! Now the hard part’s over, right? Let the enjoyment of your expanded family begin! Your discharge paperwork from the hospital will give you some basic guidance from Arbor ObGyn.

Within a few days we will send a letter to your home (and/or to your web portal) for a postpartum appointment with the delivering doctor five or six weeks after childbirth. If you don’t like the specific appointment day or time just call to reschedule. We figure most new moms are generally available and it’s one less thing you need to arrange. Please bring the baby with you if possible – our staff loves to see the product of your hard work!

At your appointment we will complete a physical exam, screen for postpartum depression, and discuss contraceptive options. We’ll also review the pregnancy, follow-up on any unresolved medical issues, and strategize for optimal care in future pregnancies.

After this appointment we prefer to see you again around 8-12 months later for your regular wellness exam. This is where we address any lingering concerns, update your pap test if necessary, and review family planning. If you already have a gynecologist (who may have referred you to Arbor for the pregnancy) go ahead and schedule this appointment with him/her. If you don’t have a doctor we’d love to continue to be your women’s health providers!

We certainly hope that your pregnancy and labor and delivery have gone smoothly and below we offer some additional suggestions to help you get through the next several weeks as easily as possible.

The First Days at Home

Diet

• Please eat normally, but be sure to get plenty of water, fiber and calcium.
• If you are breastfeeding, you should drink a glass of water or milk each time you feed the baby, otherwise you may get dehydrated and decrease your milk supply.
• You should have a bowel movement at least once every 3 days. If you become constipated, you may drink prune juice, take a stool softener or a mild laxative.

Activity

• You may resume most of your usual activities once you feel up to them. If you tire during an activity, stop to rest.
• You may drive when you can press on a brake and are no longer taking narcotics for pain – approximately one week following a vaginal delivery and 7-14 days following a c/section
• No heavy lifting more than 35 lbs. for at least four weeks after a cesarean section. (But picking up and hugging older children is always okay!)
• You can walk as far as you want and can also walk up and down steps-even if you had a C-Section.
• Showers are permitted, but if you had a C-Section please do not soak your incision in water. This includes deep tub baths, hot tubs, Jacuzzis and swimming. You may let warm soapy water run over the incision; do not apply powder or lotions over the incision.
• You should put nothing in the vagina until after your postpartum visit – no tampons, no sex. Remember, your vaginal bleeding will gradually decrease, but may last 6-8 weeks. It will change from bright red, to brown, to a yellowish color.

General Instructions

• After a cesarean section, if there are any tape Steri-Strips, remove when the baby is one week old — otherwise they get filthy. Just peel off. The incision is sewn with dissolvable suture just under the skin which will keep it strong.
• Use the peri-bottle to rinse off the outer vagina as needed during urination so that there is less urethral and perineal stinging.

Must Call Situations

If you are experiencing any of the following problems, we would like you to contact our office immediately:

• Red or swollen incision.
• Temperature is greater than 101.0 F (38.3 C) degrees.
• Heavy bleeding that involves changing 1 sanitary pad every hour for 2 hours in a row.
• Pain or burning with urination.
• If either leg becomes warm, red, painful and/or swollen unexpectedly.
• Severe, persistent abdominal pain.
• Persistent nausea and/or vomiting.
• Elevated blood pressure or severe headache (signs of pre-Eclampsia).
• Pain/burning/difficulty urinating.
• Breast mastitis symptoms: Severe redness and pain on one side, a fever, and body/muscle aches.

Report Issues to:

• For a life-threatening emergency, call 911.
• Our main office number is 919-781-9555. Please call us during regular Arbor ObGyn business hours for non-urgent issues: Mondays – Fridays: 8:00am – 4:30pm.
• A physician is available by phone at all times to assist our patients with urgent medical needs. If you need to speak with a physician after-hours for any urgent needs, please call our main office number 919-781-9555 and follow the telephone prompts.

Rest!

Nothing puts a better start to a day than a good night’s rest. And nothing keeps you up more than a newborn. Be a little selfish and try to rest when the baby does. Let others help! Remember that they’ll get to sleep while you’re up with the new arrival.

Care of Stitches

If you had an episiotomy or vaginal laceration repair these stitches will dissolve on their own and need little additional care. Keep the area as clean as possible. Warm sitz baths or tub soaks two to three times a day will ease some of the soreness. Sometimes the breakdown of the suture material can give an off-putting odor. If you have a fever or vaginal pus please call the office for an exam appointment.

Cesarean section stitches will likewise dissolve over time. The incision should be kept dry and clean. You may shower or tub bathe after a C-Section. Just pat the incision dry afterward. Only use soap and water on a washcloth gently rubbing side to side. No dressing or bandage is necessary. If you have tape strips on the incision remove them one week after surgery, or the incision will get grungy and smelly. Just peel them off; don’t be scared! If Dermabond skin glue was used let it flake off on its own over the first two weeks.

Women with C-Sections should avoid lifting more than 35 pounds for the first six weeks. Limit other abdominal motions or activities that put strain on the abdomen. Expect some numbness at the incision line. Also, the majority of the pain persists approximately one inch above the incision particularly near the corners. Most of this discomfort will be relieved by the time of your postpartum visit.

Bleeding

Vaginal bleeding after your delivery will vary day to day but will end for the most part by three to four weeks postpartum. It will change from bright red, to brown, to a yellowish color. Spotting can last for eight weeks depending on your activity level. Some women experience a single episode of heavy bleeding 7 to 10 days after delivery – from the remnants of the placental attachment. You should not put anything in the vagina until after your postpartum visit — no tampons, no sex. If you are breastfeeding, your regular periods may not begin again until after weaning.

Constipation

This is a common problem in the postpartum period and should not be ignored. Breastfeeding, narcotic medications, lack of exercise, and episiotomy pain can all make constipation worse. Drink lots of fluids, eat fruits and bran cereals, and if needed use over-the-counter stool softeners containing docusate (such as Colace or Surfak). If a stimulant laxative is needed try a mild one such as Citrucel, Miralax, or Milk of Magnesia.

Exercise

Begin exercise again gradually but deliberately after delivery; pregnancy and childbirth have probably taken more out of you than you think. You may begin walking and participating in light exercise as soon as you feel comfortable doing so. Sit-ups and targeted abdominal exercises should be deferred until after your post-partum appointment in C-Section patients, but then they are encouraged.

If you do too much activity too soon you may notice increased pain and bleeding. This will resolve with lessening of your activity.

Breastfeeding & Mastitis

If you are breastfeeding remember to drink lots of fluids to replace what is being used for making breast milk. The quantity of your milk may decrease if you are especially tired or dehydrated. Take your prenatal vitamins and DHA while you are nursing, and eat a well-balanced diet including plenty of calcium and protein

If you are not planning to breastfeed you should wear a very supportive bra day and night for at least the first week or until breast swelling has decreased. Ice packs can be helpful if painful engorgement occurs. Do not do anything to stimulate the breasts such as expressing or pumping milk or even allowing prolonged contact with a hot shower.

Mastitis is an infection of the breast tissue that results in breast pain, swelling, warmth and redness of the breast. The bacteria comes from the baby’s mouth, so it is okay to continue breastfeeding. If you have mastitis you might also experience fever and chills. Mastitis most commonly affects women who are breast-feeding (lactation mastitis), although sometimes this condition can occur in women who aren’t breast-feeding.

In most cases, lactation mastitis occurs within the first three months after giving birth but it can happen later as well. The condition can leave you feeling exhausted and run-down making it difficult to care for your baby. Sometimes mastitis leads a mother to wean her baby before she intends to, but you can continue breast-feeding while you have mastitis.

With mastitis, signs and symptoms can appear suddenly and may include:

• Breast tenderness or warmth to the touch
• Generally feeling ill (malaise) and chills
• Swelling of the breast
• Pain or a burning sensation continuously or while breast-feeding
• Skin redness, often in a wedge-shaped pattern
• Fever of 101 F (38.3 C) or greater

Lactation mastitis tends to affect only one breast — not both breasts. In most cases you will feel ill with flu-like symptoms for several hours before you recognize that there’s a sore red area on one of your breasts. As soon as you recognize this combination of signs and symptoms, it’s time to contact Arbor ObGyn. We would like to see you for a breast exam to ensure there is no abscess, and/or prescribe antibiotics. Visit the arbor-obgyn.com Obstetrics-Mastitis page for helpful information.

Also, if you are concerned about medications not prescribed by your obstetrician while breastfeeding, please call your Pediatrician or Lactation Consultant for their guidance.

Driving

Our threshold regarding resumption of driving is that you be completely ready to drive well. This is less likely if your stitches are still uncomfortable, if you are requiring pain medication, or if you are exhausted. Pain could cause you to hesitate switching from the accelerator to the brakes. Therefore, wait until it is totally comfortable to ride before considering actually driving. This may be up to several weeks. Remember, we are concerned not only about you and your new baby’s safety but also everyone else on the road. Check with your auto insurance company regarding specific restrictions.

Contraception

You should wait until after your postpartum Arbor office visit and exam to resume sexual intercourse. At that time long-term plans for contraception can be made with your doctor. Breastfeeding is usually not a reliable method for contraception. We will review your options at your postpartum visit.

Estrogens can diminish breast milk supply in 10-15% of women. If breastfeeding you may consider a non-estrogenic option. These include:

• progestin only pills, also known as the “mini-pill” (norethindrone, Micronor, Nor-QD, Errin, Heather, Camilla)
• progestin IUD (Mirena)
• non-hormonal copper IUD (Paragard)
• injectable progestin (Depo-Provera)
• barrier methods (condom, diaphragm)
• natural family planning / calendar methods

Pain Relief

Generally, ibuprofen is the most effective for cramping pain. Doses up to 800 milligrams three times a day (four of the over-the-counter 200 milligram-strength tablets) may be taken if needed although you should find that you need less over the first week. Regular and Extra-strength Tylenol (or equivalent acetaminophen) may be used per the package instructions.

If you’ve had a C-section you will be sent home with a prescription for oxycodone tablets. Use these to supplement the ibuprofen if you’re not finding adequate relief. You should let us know if these suggestions are not diminishing most of the pain.

PreEclampsia

Pregnancy Induced Hypertension (PIH) and Preeclampsia are two of the most common pregnancy conditions, and frequently reasons to be induced. Although delivery is thought to be the ‘cure’, some women can develop symptoms weeks after delivery. Please notify us right away if you have high blood pressure, chest pain, difficulty breathing, debilitating headaches, or severe abdominal pain.

Postpartum Blues and Depression

Some new mothers feel especially overwhelmed by their new duties. These feelings can be exacerbated by lack of sleep, hormonal changes, and even by well-meaning comments of others. Postpartum “blues” are very common. These feelings may become severe and outside help may be necessary to get things back on track. Thirty percent of women experience a perinatal mood disorder – you are not alone! Do not hesitate to contact us if you think you need help, 919-781-9555.

If you do have a perinatal mood disorder (PMD) we can offer counseling and medication through our office. There are many community services and clinicians who specialize in PMD and we would recommend consultation there as well. If you’re just beginning to explore PMD go to the weblinks below for Moms Supporting Moms community group and the UNC Perinatal Mood Disorders Clinic.

« More Information

www.safechildnc.org/programs/welcome-baby-msm/ … Postpartum Education & Support groups.  Welcome Baby program, and Moms Supporting Moms program.  Very local, very real. 

www.med.unc.edu/psych/wmd/mood-disorders/perinatal … UNC Department of Psychiatry Center for Women’s Mood Disorders.  A very well respected program able to offer multidimensional support including individual and group counseling, and prescription medications.

Pregnancy Paperwork

Please send employment forms that need our signature to the Arbor Office, with Attention to Billing.  This includes FMLA, disability claims, breast pump authorizations, and return to work notices.  Make sure that you have completed all of your required information on the forms.  We will process your forms as fast as possible.

In Conclusion

Once again, congratulations!  Parenthood is a challenge but a uniquely rewarding one.  With a good helping of common sense and the above suggestions things should go well.

In conclusion, have fun, get plenty of rest and take lots of pictures!  We’d love to receive a photo birth announcement too.  We will post it on one of our office bulletin boards; expectant moms really enjoy your creativity!