For many months you have prepared for the birth of your baby. Now it is important to take some time for yourself. As a new mother, you will find that adequate rest, nutrition, and exercise are as important after delivery as they were during pregnancy.

This section will provide general information about your personal care following delivery. If you have specific needs or questions, talk to your nurse or healthcare provider.

The Kintzinger Women’s Health Center was made possible by a gift from John and Jewel Kintzinger.

Afterpains
Afterpains are the uncomfortable contractions of the uterus after birth as it shrinks back to its pre-pregnant size and position (involution). You will feel the uterus contracting while you are nursing and they are more common if you have had a child before. To cope with the pain, relax and use the slow-breathing pattern you used in labor. Your doctor will also have ordered a pain medication if you need it. Afterpains usually disappear after the first week.

Vaginal Discharge
Right after birth, your vaginal flow will be bright red, similar to your menstrual flow. After the first several days the discharge will gradually change to a pale pink or brownish color. By the end of the second week most women will have little more than a clear discharge, which may continue for several weeks. However, some women do have a reddish discharge for three to six weeks. Use pads rather than tampons to decrease the risk of infection and allow your uterus and cervix to heal properly. Don’t use tampons or douches for six weeks.

You should report any of the following changes in your discharge to your physician: a foul odor; a return to bright red color after it has paled or turned brown; a sudden increase of discharge (more than one pad per hour); or the presence of large (the size of an orange) bloody clots.

Episiotomy and/or Hemorrhoids
If an episiotomy was performed or a tear occurred during delivery, you have had stitches that will dissolve of their own accord. To relieve soreness, try sitting or lying in a warm tub of water for 15-20 minutes, two to three times per day. Use the squirt bottle filled with warm water to cleanse your stitches after going to the bathroom. Blot dry with plain white toilet paper from front to back. Change your peri-pads frequently. Using an anesthetic spray, hygienic wipe pads such as Tucks, and warm or cold packs may also help to relieve soreness.

Avoid prolonged sitting. When you do sit, squeeze your buttocks together first to make it more comfortable. Include lots of fluids and fiber in your diet to avoid constipation and straining with a bowel movement. Stool softeners may be purchased at a drugstore without a prescription.

C-Section incision
Your staples are usually removed and steri-strips applied before leaving the hospital. Keep the incision clean. Let it air dry thoroughly after bathing. The steri-strips will gradually peel off. Notify your physician of redness, swelling, drainage, foul odor, increased pain or elevated temperature.

Rest and Activities
Getting enough rest is essential for all new moms, but we realize it may be very difficult to do so. Think of ways to minimize your work and accept help whenever offered. Limit visitors to close family members and those who bring food or help with the other children or housework. Try to rest when the baby sleeps and go to bed as early as possible.

Limit the time you spend sitting each day. Lying down or standing up provides comfort and promotes healing. If the weather permits, take short walks outside each day.

Women who have had either vaginal or cesarean deliveries should gauge their activity by how they feel. Be sensible and do things in moderation. Avoid heavy lifting greater than 20 pounds for the first two to four weeks. Climb stairs carefully. It is OK to drive a car unless taking prescription medications that may cause drowsiness.

Breast Care
Breasts should be kept clean with water only—soap is too drying. Mothers who do not breastfeed should wear a good supportive bra, 24-hours-a-day for one or two weeks. This helps prevent engorgement. If the breasts do become full and engorged, ice bags should be applied. Do not pump or stimulate the breasts. Tylenol (not aspirin or ibuprofen) every three to four hours may also help. You may also try a warm shower.

Breastfeeding mothers should wear a nursing bra 24-hours-a-day, which has flaps that drop so nipples can be exposed to air. A clean bra should be worn daily. It is important to keep the nipples dry. At no time allow wetness to remain over nipples. Allow nipples to air day after nursing.

Breast Self-Examination
One out of eight women in the United States will develop breast cancer in her lifetime. Thanks to modern treatments, many will go on to live full lives.

The key to successful treatment, however, lies in early detection through regular breast self-examinations. Ninety percent of breast lumps are found by women themselves. Eight out of every 10 lumps are not cancerous, but that does not lessen the need to do breast self-examinations monthly.

Diet
Foods provide the energy necessary to feel your best. Dieting to lose weight too soon after birth can make you tired and unhealthy. Instead, concentrate on regaining your strength and energy by eating healthful foods.

Once you’ve regained your energy, you may begin to gradually lose weight, about four to five pounds per month. Increasing your physical activity can also help you lose those pregnancy pounds.

Eat a well-balanced diet including foods from the food pyramid. Drink enough fluids to satisfy your thirst, because fluids are essential if you are breastfeeding or if the weather is hot. If your urine is dark in color, drink more fluids.

Fluids: 8-12 cups daily

• Water, milk, fruit juice, soup.

Milk: 3-4 servings daily (4 servings daily if breastfeeding)

3-4 (8 oz.) cups of milk daily, (1% or skim milk is preferred), or choose from the following alternatives.

Alternatives to replace the calcium in 1 cup of milk:

• One 1/2 ounces cheese
• One 3/4 cup ice cream
• Two cups cottage cheese
• One cup yogurt or pudding

If you don’t consume enough calcium from dietary sources, ask your doctor for information on calcium supplements or ways to improve your calcium intake.

Fruits and Vegetables: 5 or more (1/2 cup) servings daily

Include at least one serving of a Vitamin C source daily to promote healing.

• Citrus fruit juices (or juices fortified with Vitamin C).
• Fresh Fruits: Oranges, grapefruit, tangerines, strawberries, cantaloupe, kiwifruit, mangoes, pineapple, and tomatoes.
• Fresh Vegetables: Asparagus, broccoli, cauliflower, Brussels sprouts, cabbage, spinach, green peppers, potatoes.
• Include one source of Vitamin A four times weekly. Dark green or deep yellow vegetables and fruits apricots, broccoli, cantaloupe, carrots, spinach, sweet potatoes, winter squash.
• Include four or more servings daily of additional fruits and vegetables. Besides being good sources of vitamins, foods from this group will provide fiber in your diet. Apples, grapes, peaches, pears, beets, corn, cucumbers, green beans, wax beans, peas, potatoes.

Meats: 2-3 (2 oz.) servings daily

• 4-6 ounces daily of meat, fish, or poultry (6 oz. if breastfeeding).
  Protein alternatives to replace one ounce of meat:
• 1 egg
• 1/2 cup cooked dried peas and beans
• 1 ounce cheese
• 1/4 cup cottage cheese
• 2 tablespoons peanut butter

Breads and Cereals: 6-11 servings daily (whole grain or enriched)

Six or more servings daily of:

• 1 slice bread, biscuit, dinner roll, muffin, pancake, or waffle
• 1/2 cup cooked cereal, grits, pasta, or rice
• 3/4 cup dry cereal
• 5-10 crackers (3 graham crackers)
• 1/2 bagel, English muffin, hamburger, or hot dog bun
• 6 medium pretzels or 20 thin pretzel sticks

The servings in this group are important for fiber, B complex vitamins and carbohydrates. If you have questions, contact Grinnell Regional Medical Center’s dietitian at 236-2435

Iron
After childbirth you need to restore your body’s supply of iron. Eat several foods each day that are high in iron and take your prenatal vitamins or iron tablets as directed by your physician.

Iron rich foods: Several servings daily

• Meat is the highest most usable source of iron.
• Try to get at least 6 ounces of meat per day. (2 portions the size and width of a deck of cards)
  
• Dried fruits and green vegetables.
• Include Vitamin C–rich foods daily to help the absorption of iron (especially from plant sources). It is best to eat vitamin C sources along with iron-rich foods.
• Dried beans & peas (kidney, navy, pinto).
• Iron enriched cereals, breads, and grains. (Cream of wheat, oatmeal, bran flakes)
• Avoid excessive milk intake, antacids, and caffeine. These slow the body’s absorption of iron.

Increasing Your Fiber Intake: General Principles
Remember that fiber is crucial to a new mother’s diet. It adds necessary bulk and serves as a natural laxative to prevent irregularity.

• Consume at least 20-30 grams of fiber daily.
• Drink plenty of fluids. Increase your fiber intake over a period of one to three weeks.
• Limit fried foods, fatty foods, and table fats.
• Restrict sugar in the form of candy, desserts, syrups, preserves, tabletop sweeteners, and regular pop. (These may dull your appetite for the bulky foods you should emphasize).
  Foods high in fiber include:
• Whole grain breakfast cereals made from bran or wheat such as All Bran, Corn Bran, Bran Chex, Raisin Bran, Shredded Wheat, Wheaties, Total, and Cheerios.
• Whole grain breads or bread products such as bran muffins, whole wheat bread, and Rye Krisp crackers.
• Legumes such as baked beans, kidney beans, and peas.
• Vegetables such as corn, broccoli, spinach, boiled sweet potatoes, baked potatoes (with the skin), green beans, carrots, and tomatoes.
• Fruits including prunes, raspberries, bananas, blueberries, dates, grapefruit, oranges, apples, pears, peaches, or nectarines (include skins on last four fruits).

Emotions
You will go through a period of emotional changes after giving birth. You may feel anxious, sad, angry, frustrated, helpless, and uninterested in the baby or yourself. These emotions are common and often referred to as the “baby blues.” About 50-80 percent of all new mothers usually experience this the second or third day after the baby is born. (Some may have a delayed reaction within a week after delivery). Hormonal changes that accompany childbirth, in addition to fatigue, contribute to the “blues.”

Even though “baby blues” are common, you should pay attention to these feelings. You may find it helpful to share your feelings, thoughts, or fears with your partner, friends, family, or health professionals. Sharing relieves stress and helps you feel better about yourself.

Eating right, exercise, and getting plenty of rest are also important to your emotional health. With a new baby to care for, getting the proper amount of rest is often difficult.

Try the following tips to help you gain more control in your life and to feel better:

• Wash and dress as soon as you can after waking up.
• Rest whenever your baby naps. Put a note outside your door asking visitors to come back later.
• Activate your answering machine or take your phone off the hook.
• When someone offers to help, LET THEM! Give these generous people a specific task to do, such as the laundry, fixing meals, or doing some cleaning.
• Ask a relative, friend, or neighbor you can trust to watch your baby for an hour or two so you can have some time to yourself.
• Share your feelings and experiences with other new moms.
• Remember there is no “perfect” parent. Don’t set high expectations for yourself.
• Try to keep a sense of humor.

Sometimes the normal “baby blues” can turn into postpartum depression. If you have more intense feelings of deep sadness, crying, panic attacks, sleeplessness, feeling out of control and not wanting to touch the baby you may be experiencing postpartum depression. This may last for more than two weeks and may get worse. You need to contact your healthcare provider without delay.

For more information on the blues contact:
Depression after Delivery
P.O. Box 1282
Morrisville, Pa. 19067
1-800-944-4773

If you feel in danger of hurting your baby contact
National Child Abuse Hotline
1-800-422-4453

Couples—Time Together
Now that you are new parents, you may find that having a baby affects many parts of your life together. Everyone tells you how to care for your baby, but no one talks about sexual feelings and relations in the first few weeks after the birth. Most couples need a time of adjustment after the baby’s birth before their sex lives become gratifying again.

You may wonder, “When will things return to normal?” Actually things will never be exactly the same, never the “normal” you used to know. You will find yourselves working toward a new normal. As you do, think about making each other feel as loved as possible. Both of you have needs that are important and should not be entirely pushed aside for the baby’s sake. A new mother needs love and the reassurance that she is still desirable. A new father needs to be loved as well. He needs to be told that all the time mom is spending caring for this new baby does not lessen her feelings for him.

Remember that you will be friends and lovers after the baby has grown into adulthood. It is important to talk about your feelings, including your sexual love for each other.

A common problem with making love for the first time after the baby is born is that the woman may be nervous and tense up. Do familiar things that will relax you. Perhaps taking a warm bath or shower (either alone or together) or spending more time with sexual foreplay will help. Holding, cuddling, and giving back rubs or massages are other physical ways of showing that you love one another.

Some doctors advise a delay in sexual intercourse until after the six-week postpartum check-up. Others suggest waiting until the vaginal discharge has stopped and the soreness is gone. This waiting period insures that all healing has taken place at the episiotomy site as well as at the placental site within the uterus. With a cesarean birth, the healing of the abdominal scar is also important.

You may prefer an intercourse position with shallow penetration, such as lying side to side, or woman on top. Hormonal changes resulting in decreased vaginal lubrication may cause intercourse to be painful. This is easily remedied by applying a water soluble lubricant (K-Y Jelly) or Ortho Personal Lubricant to the penis and vagina. Non-water soluble lubricants (such as petroleum jelly) should not be used as they keep air out and allow bacteria to grow. If you are breastfeeding, be aware that sexual activity may cause your milk to let down. It may be more comfortable for you to wear a bra during sexual activity if leaking is a problem.

It may be difficult to find the “right time” for making love. Be creative. Try the early morning, at lunchtime, or during the baby’s nap when you both are rested. Make time to do things together as a couple. Making love may be more pleasurable when you both feel love and closeness throughout the day.

The concerns that you have as new parents are not isolated problems. They are typical of the kinds of concerns that you will encounter during your life together: different moods, tiredness, hormonal changes, and work and job responsibilities. If you learn how to talk about your feelings and needs, you will find that making love will be more fulfilling for the rest of your life together.

Birth Control
Whether you are breastfeeding or not, you can become pregnant at any time after childbirth even if you have not had a period. We recommend using both foam and condoms until your six-week check-up, then talk with your healthcare provider about the most appropriate method of birth control for you. Listed below are the various types of birth control that are available.

1. Coitus Interruptus (withdrawal method): Removal of the penis from the vagina prior to ejaculation. Success rate is 77-84 percent.
2. Fertility Awareness Method (rhythm method): Determining probable fertile period during a menstrual cycle, using body temperatures and graph, and avoiding intercourse during these fertile times. Success rate is 75-98 percent.
3. Vaginal Spermicides: Foam, suppositories, tablet, or jellies inserted into the vagina before intercourse. Success rate is 82-95 percent.
4. Condom: A rubber or processed collagenous sheath worn over the penis during genital contact. It acts as a barrier to transmission of semen and/or organisms that may cause sexually transmitted diseases (non-latex condoms do not act as a barrier for HIV). Success rate is 90 percent.
5. Diaphragm: Vaginal barrier method used in combination with spermicidal cream or jelly. Success rate is 77-81 percent.
6. IUD (intrauterine device): A small device placed in the uterus that doesn’t allow the fertilized egg to implant in the uterine wall. Success rate is 95-98 percent.
7. Oral Contraceptives: Combined estrogen and progestin pill taken in a series. It suppresses ovulation, diminishes growth of endometruim, and increases the thickness of mucus around the cervix, preventing passage of sperm through the cervix. Success rate is 98-99 percent. Check with your doctor if you are taking any other prescription medications as they may decrease the effectiveness of the birth control pill.
8. The Mini-Pill (progestin only): Success rate for breastfeeding women is nearly 100 percent. For those women not breastfeeding, success rate is 99.5 percent. With the minipill, it is very important to take the pill the same time every day. If there is more than a four hour variance you should use backup contraception such as condom for 48 hours.
9. Operative Sterilization: A permanent method of contraception with a 99.5 percent success rate for either method. Vasectomy: An incision is made over the vas deferens on each side of the male scrotum. Ducts are severed (cut) and ligated (tied). Tubal Ligation: An incision is made below the belly button and fallopian tubes are severed (cut) and ligated (tied).
10. Contraceptive Injection (Depo-Provera): A hormonal injection that stops ovulation and prevents eggs from entering the uterus. It is given every 12 weeks and starts working 24 hours after injection. Success rate is 99.5 percent.
11. Lunelle: A once-a-month injectable contraceptive. Must be done 28 to 30 days of each previous injection, and no later than 33 days after last injection. May experience no bleeding, irregular bleeding, or spotting. May have weight gain of four to 10 pounds. Success rate is 99 percent.
12. Transdermal Patch. A small adhesive patch that may be applied to any of four sites: lower abdomen, upper outer arm, buttock, or upper torso. The patch is applied weekly on the same day of each week for three weeks followed by one patch free week. Success rate is 98–99 percent.
13. Vaginal Ring: A soft flexible transparent ring inserted into the vagina and used for one cycle, which consists of three weeks of continuous use followed by one ring-free week. Success rate is 98–99 percent.

Health and Sexuality
Many people have questions about sexually transmitted diseases (STDs). Some of these include gonorrhea, chlamydia, genital ulcers, herpes simplex, and human immunodeficiency virus (HIV/aids). STDs are among the most common infectious diseases and they can cause serious health problems (even death) for men, women, and babies.

STDs are caused by organisms that live in body fluids like blood, breast milk, semen, and vaginal secretions. These diseases are spread from one person to another through direct contact with infected skin or body fluids. HIV infections and other STDs can be passed to another adult or child before the infected person is aware of the disease. Therefore, do not depend on the other person to know if they have HIV or other STDs. Abstinence from sexual intercourse or restricting sex to an uninfected partner is the most effective way to prevent infection. Studies show that correct and consistent use of latex condoms (rubbers) during sex also helps in preventing the spread of HIV infection and other STDs.

If you are concerned about the possibility of HIV, you can protect your baby by early testing to find out if you are infected. If you are HIV positive, certain medications taken during your pregnancy can greatly reduce the chance that your baby will be born with HIV. Also, in the United States, it is recommended that you not breastfeed if you are HIV positive since the virus may be passed from mother to baby through the breast milk. In addition to these suggestions, there are medications and treatments available today that keep HIV infected mothers and babies healthy longer. For more information about STD, and HIV/AIDS call the STD National Hotline at 800-227-8922.

Exercise
You have just had your baby and your tummy feels so flat until you stand up! Don’t worry! It takes a little time and effort to get back in shape. Your muscles have been stretching for nine months; but you can do it! The muscle work involved in these immediate postpartum exercises is not strenuous or harmful and will help to tone your abdominal muscles more than abdominal binders or control top undergarments. You may do these exercises after vaginal or cesarean deliveries.

Begin the exercises when you leave the hospital. The general rule is to do three to four of these exercises twice each day and increase the number of repetitions as you feel stronger. You are the best judge of how tired you are. Relax and breathe deeply between each exercise. When you begin, only do exercises 1-6. Add exercise 7-9 a few days later.

1. Diaphragmatic Breathing—Lie on your back with your knees bent up, feet flat on the bed, using a pillow under your shoulders and head. Let one hand rest on the chest and the other hand on the abdomen just below chest level. Breathe in slowly through the nose, swelling the abdomen. Put your teeth together and breathe out slowly, as long as possible making an “s-s-s” sound and tightening your stomach muscles. Relax. Repeat five times. When you have mastered this technique lying down, practice while sitting, standing, and then walking.
2. Stretch out the Kinks—Lie on your back with arms at your sides, palms down, and legs out straight. Bend your feet upward, toward your face, to stretch the calf muscles as you press your knees into the bed. Tighten the abdominal muscles, flatten the hollow of your back, and pull your shoulder blades together. Hold for five seconds. Repeat five times.
3. Buttock Squeezes—Lying on your back with your legs straight, pinch the buttocks together tightly. Hold five seconds. Repeat five times.
4. Pelvic Floor Exercise (Kegel)—Slowly tighten your pelvic floor muscles as you would to stop the flow of urine and passage of gas. Hold and count slowly 1.2.3. Relax the muscles completely between each tightening. Repeat five times. Do these sets of five frequently during the day. They can be done while feeding the baby, watching TV, or standing in line at the store. Whether or not you have an episiotomy, you should be doing this exercise repeatedly. After childbirth these muscles were stretched and now need to regain their strength and shape. Doing Kegel exercises promotes healing by increasing circulation and tone. Some women have a problem with urine leakage during coughing or exercising. Others leak urine and cannot get to the bathroom on time. Doing these Kegel exercises strengthens the muscles necessary to prevent this problem. It takes weeks and months of properly performed pelvic floor exercises to notice results. This is an exercise you should do for the rest of your life.
5. Pelvic Tilt—Lie on your back with knees bent and feet flat on the floor. Tighten stomach and buttock muscles so your lower back flattens. Hold five seconds and relax. Repeat five times. Once you can do this exercise easily while lying down, move on to the following positions: lying on back with legs straight, sitting, standing, and walking.
6. Leg Slide—Start with both knees bent, feet flat. Do a pelvic tilt; hold it while straightening one leg, sliding your heel slowly along the floor. Maintain flattened back while bending your knee back up. Repeat five times with each leg.
   If you are just beginning, STOP HERE. Add the following exercises after you have done numbers 1-6 for several days.
7. Double Knee to Chest—Lying on your back with knees bent and feet resting on bed, lift one leg toward your chest (keep knee bent) and grasp the knee with your hands. Raise your other knee towards your chest and grasp it. Gently stretch by pulling knees further toward your chest. Hold three seconds. Return to the starting position by lowering one leg at a time. Repeat seven times.
8. Partial Curl Up—Lie on your back, knees bent, feet flat on bed, pelvis tilted. Hold this position and slowly raise your head, shoulders, and upper back slightly off the bed, hands reaching toward your knees. Come up only enough to clear your shoulder blades. Return to the starting position. Repeat five times.
9. Bridging—Lie on the bed with knees bent and feet flat. Lift buttocks up off the bed as high as you can. Hold three seconds, and then slowly lower. Repeat six times.

Final Exercise Instructions
When you are feeling ready for more activity, walking is a good choice. Begin walking short distances and gradually increase.

Exercise is encouraged when breastfeeding but avoid exercising to the point of exhaustion. Vigorous exercise causes a rise of lactic acid in your milk. This is not harmful to your baby, but it may cause the milk to take on a slightly sour taste.

For more information on fitness and exercise contact one of the wellness specialists at Grinnell Regional Medical Center’s Fitness Center at 236-2999. They will give you personalized attention and help you get started on an aerobic and weight lifting program.

Posture and Body Mechanics
Good posture and proper body mechanics are important aspects of recovery from childbirth. Fatigue and muscle weakness are factors that will affect your posture and increase the possibility of back strain. To avoid muscle strain and discomfort, special considerations should be given to handling your baby, maintaining posture, and performing daily tasks.

1. Avoid prolonged standing and sitting. Change your positions often—standing, walking, sitting, and lying on your stomach or back. When performing household tasks like vacuuming, mopping, or sweeping, place one leg out in front of the other. With prolonged sitting (feeding, nursing, or rocking your infant) rest your feet on a footstool and put a small pillow in the lower back area.
2. Train yourself vigorously to use your abdominal muscles to flatten your lower abdomen and tuck in your buttocks.
3. If you are diapering your baby on your bed, sit next to him or her. Don’t stand and bend over at the waist to change the diaper.
4. Alter the height of the changing table, and the place for the baby’s bath so that you can stand or sit with good posture. Avoid bending forward or stretching when caring for your baby.
5. Do not carry the baby on your hip. Carry the baby in front of you and close to your body, keeping your head high and shoulders back.
6. When wearing a baby carrier in the front, make sure you keep your posture with the pelvis tilted back. Do pelvic tilts frequently. Keep your shoulders back to avoid neck strain.