Postpartum care: What to expect after a vaginal birth

Postpartum care involves managing sore breasts, hair loss, mood changes and more. Here's what to expect as you recover from childbirth.

Pregnancy changes your body in more ways than you may have guessed, and it doesn't stop when the baby is born. Postpartum care involves managing sore breasts, skin changes, hair loss and more. Here's what to expect after delivery.

Vaginal soreness

If you had an episiotomy or vaginal tear during delivery, the wound may hurt for a few weeks — especially when you walk or sit. More extensive tears may take longer to heal. In the meantime, you can help promote healing:

Soothe the wound. Use an ice pack, or wrap ice in a washcloth. Chilled witch hazel pads may help, too. Witch hazel is the main ingredient in many hemorrhoid pads. You can find witch hazel pads in most pharmacies.
Keep the wound clean. Use a squirt bottle filled with water to rinse the tissue between the vaginal opening and anus (perineum) after using the toilet. Soak in a warm tub.
Take the sting out of urination. Squat rather than sit to use the toilet. Pour warm water over your vulva as you're urinating.
Prevent pain and stretching during bowel movements. Hold a clean pad firmly against the wound and press upward while you bear down. This will help relieve pressure on the wound.
Sit down carefully. To keep your bottom from stretching, squeeze your buttocks together as you sit down. If sitting is uncomfortable, use a doughnut-shaped pillow to ease the pressure.
Do your Kegels. These exercises help tone the pelvic floor muscles. Simply tighten your pelvic muscles as if you're stopping your stream of urine. Starting about a day after delivery, try it for five seconds at a time, four or five times in a row. Repeat throughout the day.
Look for signs of infection. If the pain intensifies or the wound becomes hot, swollen and painful or produces a pus-like discharge, contact your health care provider.

Vaginal discharge

You'll have a vaginal discharge for up to six weeks after delivery. Expect a bright red, heavy flow of blood for the first few days. If you've been sitting or lying down, you may notice a small gush when you get up. The discharge will gradually taper off, changing from pink or brown to yellow or white. To reduce the risk of infection, use sanitary napkins rather than tampons.

Don't be alarmed if you occasionally pass blood clots. Contact your health care provider if:

You soak a sanitary pad every hour for more than two hours
The discharge has a foul odor
You pass clots larger than a golf ball
You have a fever of 100.4 F (38 C) or higher

Contractions

You may feel contractions, sometimes called afterpains, during the first few days after delivery. These contractions help prevent excessive bleeding by compressing the blood vessels in the uterus. Afterpains tend to occur during breast-feeding sessions and seem to be more noticeable with second or third babies. Medications to control heavy bleeding after delivery can increase afterpains as well.

Usually afterpains resemble menstrual cramps. If necessary, your health care provider may prescribe pain medication. Many medicines are safe even if you're breast-feeding. Contact your health care provider if you have a fever or if your abdomen is tender to the touch. These signs and symptoms could indicate a uterine infection.

Difficulty urinating

Swelling or bruising of the tissues surrounding the bladder and urethra may lead to difficulty urinating. Fearing the sting of urine on the tender perineal area may have the same effect. To encourage urination, contract and release your pelvic muscles while sitting on the toilet. It may help to place hot or cold packs on the tissue between the vaginal opening and anus, straddle the toilet like a saddle or pour water across your vulva while you urinate.

Difficulty urinating usually resolves on its own. Contact your health care provider if:

It hurts to urinate
You don't think you're emptying your bladder fully
You have an unusually frequent urge to urinate

These may be symptoms of a urinary tract infection.

Leaking urine

Pregnancy and birth stretch the connective tissue at the base of the bladder and may cause nerve and muscle damage to the bladder or urethra. You may leak urine when you cough, strain or laugh. Fortunately, this problem usually improves within three months. In the meantime, wear sanitary pads and do your Kegel exercises.

Hemorrhoids

If you notice pain during a bowel movement and feel swelling near your anus, you may have hemorrhoids — stretched and swollen veins in the anus or lower rectum. To ease any discomfort while the hemorrhoids heal, soak in a warm tub and apply chilled witch hazel pads to the affected area. Your health care provider may recommend a topical hemorrhoid medication as well.

To prevent constipation and straining, which contribute to hemorrhoids, eat foods high in fiber — including fruits, vegetables and whole grains — and drink plenty of water. Remain as physically active as possible. If your stools are still hard, your health care provider may recommend an over-the-counter stool softener or fiber laxative.

Bowel movements

You may find yourself avoiding bowel movements out of fear of hurting your perineum or aggravating the pain of hemorrhoids or your episiotomy wound. To keep your stools soft and regular, eat foods high in fiber, drink plenty of water and remain as physically active as possible. Ask your health care provider about a stool softener or fiber laxative, if needed.

Another potential problem for new moms is the inability to control bowel movements (fecal incontinence) — especially if you had an unusually long labor. Frequent Kegel exercises can help. If you have persistent trouble controlling bowel movements, consult your health care provider.

Sore breasts and leaking milk

Several days after delivery, your breasts may become heavy, swollen and tender. This is known as engorgement. The discomfort usually lasts less than three days. In the meantime, it helps to express milk — preferably by feeding your baby. If your baby isn't able to nurse, use a breast pump to ease engorgement. You may also want to apply warm or cold washcloths or ice packs to your breasts, or take a warm bath or shower. Over-the-counter pain relievers such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others) may help, too.

If you're not breast-feeding your baby, wear a firm, supportive bra. Compressing your breasts will help stop milk production. In the meantime, don't pump your breasts or express the milk. This only tells your breasts to produce more milk.

Leaky breasts are another common problem for new moms. You can't do anything to stop the leaking, but nursing pads worn inside your bra can help keep your shirt dry. Avoid pads that are lined or backed with plastic, which can irritate your nipples. Change pads after each feeding and whenever they get wet. If nighttime leaking is a problem, place a towel under your breasts at night.

Hair loss

During pregnancy, elevated hormone levels put normal hair loss on hold. The result is often an extra-lush head of hair. But now it's payback time. After delivery, your body sheds the excess hair all at once. Within six months, your hair will most likely be back to normal. In the meantime, shampoo only when necessary, and find a hairstyle that's easy to maintain. Avoid hair dryers, curling irons and harsh chemicals.

Skin changes

You may notice small red spots on your face. These are caused by small blood vessels breaking during the pushing stage of labor. Expect the spots to disappear in about a week.

Stretch marks won't disappear after delivery, but eventually they'll fade from reddish purple to silver or white. Any skin that darkened during pregnancy — such as the line down your abdomen (linea nigra) — may slowly fade as well.

Mood changes

In addition to physical changes, childbirth triggers a jumble of powerful emotions. Mood swings, irritability, sadness and anxiety are common. Many new moms experience a mild depression, sometimes called the baby blues. The baby blues typically subside within seven to 10 days. In the meantime, take good care of yourself. Try to get as much sleep as possible. If your depression deepens or you feel hopeless and sad most of the time, contact your health care provider. Prompt treatment is important.

Weight loss

After you give birth, you'll probably feel flabby and out of shape. You may even look like you're still pregnant. Don't worry. This is perfectly normal. Most women lose about 10 pounds during birth, including the weight of the baby, placenta and amniotic fluid. During the first week after delivery, you'll lose additional weight from leftover fluids. After that, healthy eating and regular exercise can help you gradually return to your pre-pregnancy weight.

The postpartum checkup

About six weeks after the birth, your health care provider will check your vagina, cervix and uterus to make sure you're healing well. He or she may do a breast exam and check your weight and blood pressure, too. This is a great time to talk about birth control, breast-feeding and how you're adjusting to life with a new baby.

Share any concerns you may have about your physical or emotional health. Chances are, what you're feeling is entirely normal. Look to your health care provider for assurance as you enter this new phase of life.