Mother’s Care After Delivery

Vaginal discharge (lochia)

During the first few days following delivery, your vaginal discharge (lochia) will be red/red-brown. In the next two to three weeks, the lochia becomes increasingly watery and pinkish brown. Ultimately, the lochia turns yellowish white. The lochia will decrease from heavy to light to spotting. Most women have lochia for up to six weeks after birth. There may even be some clots in the early days. If you soak more than one pad in an hour for two consecutive hours, or pass clots the size of a golf ball or bigger, go to the nearest emergency room immediately.

The lining of the uterus remains open until your flow stops, so you are more susceptible to infection. For this reason, do not have sex,  or use tampons, or put anything else in your vagina until you stop having lochia and have healed. Change your sanitary pad regularly to prevent infection – at least every 3 to 4 hours or every time you go to the bathroom. Use a peri-bottle filled with water to clean yourself after you urinate or have a bowel movement. Wipe from front to back. Remember to wash your hands before and after changing your pad. If you develop a fever (temperature above 38°C or 100.4° F, a foul-smelling discharge or uterine tenderness, contact your health care provider.

Care after a vaginal delivery 

Sometimes, giving birth vaginally can cause tearing around the vagina and perineum. The perineum is the area between your vagina and anus. Doctors and midwives sometimes cut the perineum just before the baby comes out. This is called an “episiotomy”. A deeper tear or episiotomy is repaired with stitches. These stitches dissolve over time and do not need to be taken out. If you have stitches, you may feel a tightness or pulling sensation as your tissues heal. Some perineal discomfort is normal after a vaginal birth. The discomfort will be more severe in the first few days after the baby is born, but will become less severe with each passing day.

• Follow-up with your health care provider in 6 weeks. Contact their office to schedule the appointment.
• Use a peri-bottle after going to the bathroom until your bleeding stops – a peri-bottle is a small squeeze bottle that you fill with warm water to clean yourself after you urinate or have a bowel movement. Squirt the water from front to back. Then, dab the area dry with toilet paper from front to back. Do not rub.
• Apply ice packs – put an ice pack in your underwear to reduce swelling and relieve pain. Do not put the ice pack directly on your skin. Use a thin towel or piece of cloth between the ice pack and your skin.
• Take medications to relieve pain if needed – acetaminophen (Tylenol) and ibuprofen (Advil, Motrin)/naproxen (Aleve). Do not take ibuprofen and naproxen together as they are both non-steroidal anti-inflammatory drugs (NSAIDs). Also, do not take ibuprofen or naproxen if you have an allergy to any of these medications or if you have high blood pressure outside of pregnancy.
• Take sitz baths – A sitz bath is a warm, shallow bath in a small plastic basin you sit in to relieve pain, itching and discomfort in your perineal region. You should use a sitz bath if you have had an episiotomy or vaginal tear, or if you have hemorrhoids. The warm water increases blood flow to your perineal region, which promotes healing.
  • Fill the clean basin with warm water and place it over the toiletOne cup of Epsom salt may be added to the water but is not required. Do not add soap, bubble bath, or anything else to the water. Sit in the water for 10 minutes at least 3 times a day. after your sitz bath, gently pat the area dry with a clean towel. Do not rub.
  • Clean the tub after each use.
• Eat a high-fiber diet and drink plenty of water. Take stool softeners and laxatives as needed.
• Do not have sex, insert tampons or anything else in your vagina for 6 weeks.

Vaginal Tear – What does it mean?

First degree – a very minor tear in the vaginal mucosa (inside the vagina)

Second degree – the most common kind of tear; it extends into the perineal muscle layer (in between the vagina and anus).

Third degree – third degree tear is a tear that extends into the rectal sphincter. The rectal sphincter allows you to hold your gas in when you don’t want to pass gas.

Fourth degree – tear that extends through the rectal sphincter and into the rectum.

Third and fourth degree tears must be carefully repaired by an obstetrician. If you had one of these tears, make sure you keep your stools soft and don’t use enemas or suppositories until you are completely healed.   

Care after a c-section 

Cesarean delivery (c-section) is a surgery to deliver your baby through a cut (incision) made in the abdomen and uterus. A foley catheter will be placed into your bladder before surgery to help drain urine. Usually, your catheter is removed within 12 hours after the surgery when you are able to safely walk to the bathroom. The dressing covering your incision will be removed after 24 hours. There is usually no need to apply another dressing.

Gas pains are common in the first few days after a c-section. You can help relieve gas pains by getting up and walking around as much as possible. Drink plenty of fluids and try gentle abdominal massage. Plan to have help for the first week or two when you return home as you will tire easily. Resume household tasks gradually and as you feel able. 

Walking around will help get your bowels moving again and also help prevent the development of blood clots.       

• Follow-up with your health care provider in 6 weeks for routine postpartum follow-up. Contact their office to schedule the appointment.
• Take acetaminophen (Tylenol) and ibuprofen (Advil, Motrin)/naproxen (Aleve). You will likely need to take these pain medications until about postoperative day five.  Do not take ibuprofen and naproxen together as they are both non-steroidal anti-inflammatory drugs (NSAIDs). Also, do not take ibuprofen or naproxen if you have an allergy to any of these medications or if you have high blood pressure outside of pregnancy.
• Take a stool softener if you are taking narcotic medications (e.g. hydromorphone, morphine, oxycodone) as they can make you constipated.
• You may shower on postoperative day two. Pat dry your incision afterwards. However, do not put your incision underwater, such as in a bath, pool, or lake for six weeks. This can slow healing and increase your risk for infection.
• If you have tape (steri-strips) on your incision, allow tapes to fall off naturally. However, if they have not fallen off by postoperative day 7, you should remove the tape manually after getting it wet in the shower.
• If you have blue stitches for your incision, it needs to be removed, typically by your doctor 1 week after your c-section unless instructed otherwise.
• Do not use any creams, powders or ointments on the incision.
• Do not bind the incision.
• Do not have sex, insert tampons or anything else in your vagina for 6 weeks.
• Do not lift more than 10 pounds of weight or anything heavier than your baby for 6 weeks.
• Do not drive until your pain is well controlled and you can do defensive maneuvers such as slamming on the breaks and shoulder checks easily and without pain. Practice in the driveway in “Park” first. You must not drive if you are taking narcotic medications (e.g. hydromorphone, morphine, oxycodone).

Seek urgent medical care if you experience

• Heavy vaginal bleeding (e.g. soaking more than one pad per hour for two consecutive hours)
• Passing clots that are the size of a golf ball or bigger
• Fever (>38°C or 100.4° F), chills, fast heartbeat, cold or clammy skin, and/or dizziness
• Having severe headaches with vision changes, nausea and/or vomiting
• Having shortness of breath or chest pain
• Having pain or tenderness in the upper right side of the abdomen, just below the ribs
• New or worsening perineal or uterine pain
• Having foul-smelling or greenish-coloured vaginal discharge
• Decreased urination or pain when urinating
• Noticeable swelling/pain/redness in one of your legs

Problems with your incision:

• Opening of the incision
• Worsening redness/swelling/heat/pain around your incision
• Foul-smelling discharge from the incision

Uterine cramps

Expect some menstrual-like cramps in your abdomen and/or back in the first week. These cramps are caused by the uterus contracting back to its normal size. The cramps may be more severe when you have a full bladder (need to go pee) and when you are breastfeeding. Acetaminophen (Tylenol) and Ibuprofen (Advil) can be taken together to help reduce your discomfort.

Urinating (going pee)

After your delivery, your pelvic floor muscles may be weak, which can cause occasional bladder control problems. Empty your bladder at least every two or three hours. Doing pelvic floor exercises can make your pelvic floor muscles stronger and can help keep you from leaking urine, gas, or bowel movements. Do not perform pelvic floor exercises if you had an injury to your pelvic muscles during the delivery.

Pelvic Floor Muscle Exercises (“Kegel” Exercises):

• Consider seeing a pelvic floor physiotherapist
• You can find your pelvic floor muscles by squeezing the muscles you would use to avoid passing gas. Know that the muscles involved are not in your belly, thighs, or buttocks.
• Do a set of exercises 3 times a day. For each set, do the following about 10 times:
  • Squeeze your pelvic muscles
  • Hold the muscles tight for about 10 seconds
  • Relax the muscles completely

• Keep up this routine for at least a few months. It might take a few weeks of doing the exercise regularly before you notice the results
• Consider seeing a pelvic floor physiotherapist

Constipation 

Eating lots of dietary fiber, whole grains, bran, cereal, fresh fruit and vegetables and drinking plenty of fluids can prevent constipation. Do pelvic tilts and perineal exercises to speed up the return of good muscle tone. Walk and remain active. Limit codeine and caffeinated beverages because they can contribute to constipation.

If you are having difficulty or are unable to have a bowel movement  within three days after birth, you may take over-the-counter stool softeners such as docusate sodium (Colace, Dulcolax) or laxatives such as polyethylene glycol 3350 (RestoraLAX) and senna (Senokot). These medications are safe to use when you are breastfeeding. You should always take stool softeners if you are taking narcotic medications (e.g. hydromorphone, morphine, oxycodone) as they can cause constipation. Your pharmacist can provide you with information about laxatives and/or stool softeners if you need assistance.

If stool softeners and laxatives are not working for you, you may also take rectal suppositories such as glycerin or sodium biphosphate (Fleet Enema). Do not take these medications if you have had a third or fourth-degree perineal tear.

Hemorrhoids 

Hemorrhoids are varicose veins in the lower rectum that can cause itching, pain, swelling and bleedingof the rectum. In some cases, you can see or feel hemorrhoids around the outside of the rectum. In other cases, you cannot see them because they are inside the rectum. If you notice bleeding when you have a bowel movement, or if your bowel movements look black or tarry, please see your health care provider. Bleeding could be caused by something other than hemorrhoids, so you should have it checked out.  

Hemorrhoids are common and can be uncomfortable before and after birth. The most important thing that you can do is try to prevent constipation and keep your bowel movements soft. Here are some steps that you can take:

• Eat lots of fruits, vegetables and other foods with fiber
• Drink plenty of water and other fluids
• Limit fatty foods and alcohol
• Take stool softeners such as docusate sodium (Colace, Dulcolax)
• Take your time having a bowel movement. But do not spend too much time on the toilet and do not push hard or strain when having a bowel movement
• Walk and do light activities regularly
• Use sitz baths and/or ice packs

Hemorroid treatments that are safe in breastfeeding

Do not use over-the-counter treatments for more than one week without speaking to your health care provider. They can damage your skin.

• Anusol
• Preparation H
• Tucks pads
• Do not use over-the-counter treatments for more than one week without speaking to your health care provider. They can damage your skin.

Breast care for breastfeeding mothers

If you are breastfeeding, only wash your breasts with water when you shower or bath. Avoid using soap, body wash and shampoo on your nipples as it can remove your natural lubrication and cause dryness and irritation. It is not necessary to wash your breasts before feeding. Breast milk has healing properties. Rub a small amount of breast milk on your nipples after nursing. Air dry your nipples before putting your bra back on. Avoid waterproof breast pads because they can reduce air circulation and can contribute to skin breakdown. If you would like an all-purpose nipple cream, speak to your health care provider for a prescription.

Download Best Start: Breastfeeding Matters for more information on breastfeeding

Visit Breastfeeding Info A to Z from La Leche League International

Visit our Newborn Follow-up Clinic for postnatal breastfeeding consults

If you have sore nipples:

• Gently apply your own milk over the nipple or an emollient that is safe for the baby to ingest, such as HPA® lanolin. It does not need to be removed before you feed the baby.
• Keep your nipples dry and change nursing pads whenever they become damp
• Avoid bras that are too tight or put pressure on your nipples
• Breastfeed on the least sore side first until your nipple feels better
• Try laid-back breastfeeding or try a different position. Refer to Best Start: Breastfeeding Matters for more information on breastfeeding positions.
• Get help to make sure your baby has a deep latch or to check what is causing your nipples to be sore

If you have engorged breasts:

• Apply warm compress to your breasts for a few minutes before or during breastfeeding until letdown occurs.
• Apply ice pack/cold compress to your breasts between feedings.
• Take your pain medications (e.g. acetaminophen and ibuprofen) to relieve discomfort.
• Use reverse pressure softening (Best Start: Breastfeeding Matters, pg 33) before offering your breast to your baby.
• Feed baby on cue or at least 8 to 12 times in 24 hours.
• If your baby is unable to latch effectively, pump your breasts at least 15 minutes every 3 hours using a hospital grade double electric breast pump. 
• If your breasts are uncomfortably full, pump or express until they are comfortable.  Avoid excessive pumping. Pumping more than your baby needs may create too much milk.
• Wear a bra that is well-fitting, supportive, and not tight.

If you develop a hard, painful lump in your breast, have a fever and flu-like symptoms for over 24 hours, you may have mastitis. You need to see your health care provider to be assessed regarding the need for antibiotic treatment. You should continue with breastfeeding. Pump if your baby is unable to feed on the affected side.

Breast care for non-breastfeeding mothers

It takes several weeks for the breasts to stop producing milk. Here are some suggestions to make you feel more comfortable: 

• Wear a well-fitting bra
• Use ice packs for 20 minutes at a time
• Take over-the-counter pain medications such as acetaminophen and ibuprofen to reduce pain and swelling
• Use pads to absorb leaking milk

Fatigue

It is normal to feel tired after the hard work and emotions of birth. Getting to sleep in the Postpartum Unit can also be a challenge. Try to nap whenever your baby goes to sleep. Turning off your phone may help to minimize disruptions. Please let us know if we can support you to encourage family and friends to keep visits short so you can get some rest. 

Activity 

Avoid heavy lifting in the early weeks after your delivery as your abdominal muscles are weak and less able to provide support for your back. When you go home, stair climbing, driving a car and going for walks are all activities that you can resume as long as you feel able to do so. 

If you had a c-section:

• Do not lift more than 10 pounds of weight or anything heavier than your baby for six weeks.
• Do not drive until your pain is well controlled and you can do defensive maneuvers such as slamming on the breaks and shoulder checks easily and without pain. Practice in the driveway in “Park” first. You must not drive if you are taking narcotic medications (e.g. hydromorphone, morphine, oxycodone).

Emotions

Nearly all women experience some crying and mood swings in the first few weeks after birth. The blues usually last only a very short time. Try to get as much rest as possible. You might want to pump some milk so that someone else can do one feed for the baby. Limit your visitors and phone calls and accept all offers for household help. Try to arrange for some time for yourself and activities that you like to do. Even a brief walk around the block can sometimes help you feel refreshed. Talk to others about your feelings. Knowing that others often experience similar feelings is helpful. 

Your partner will experience some ups and downs too. It is important to communicate your thoughts and feelings to each other. Try and find some time to spend with your partner. 

If the blues do not improve in a few weeks and you are starting to feel depressed, discuss your feelings with your health care provider. 

A small number of women do develop postpartum depression and it is important to get help to deal with this. Women who have had depression in the past are at greater risk for developing postpartum depression and should get prompt attention for persistent mood swings or feelings of depression. 

Get help right away if you are thinking of hurting or killing yourself or your baby! If you think that your partner might have depression, or if you are worried they might hurt themselves, get them help right away.

Learn more about Peripartum Mood Disorders.

Join our Postpartum Support Group if you are experiencing symptoms of postpartum anxiety, postpartum depression and/or would like support with coping with a newborn.

Sexuality

Even if you are breastfeeding and haven’t had your period yet, you can still get pregnant. Find out about your birth control options.

You must not rely on the information on this website as an alternative to medical advice from your doctor or other professional healthcare provider. If you have any specific questions about any medical matter you should consult your health care provider. If you think you may be suffering from any medical condition you should seek immediate medical attention. You should never delay seeking medical advice, disregard medical advice, or discontinue medical treatment because of information on this website.

We want your birth experience to be as safe and satisfying for you as possible. You can help us help you by considering these options. Use can this guide as you prepare. We will accommodate your wishes as much as we can.

Remember, every labour and birth is unique. Some events are unexpected and others may be unavoidable. Try to keep an open mind. Remember, together our objective is to have a healthy baby and a healthy mother in a family-focused environment.