POSTPARTUM CARE

WHAT TO EXPECT AFTER YOU DELIVER

Vaginal Discomfort or Soreness

This can last up to 6 weeks. If you had a large tear or an episiotomy, you might have more pain. After delivery, it can be helpful to use ice packs (never apply ice directly to skin!), acetaminophen and ibuprofen to help with pain. Sitz baths and squeeze bottles filled with room temperature water are helpful to soothe and keep the area clean. Donut-shaped pillows might be more comfortable to sit on. If you have severe pain, discharge, heavy bleeding or fever, you need to see your obstetrical provider as soon as possible to make sure it's not infected. 

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Vaginal Bleeding and Discharge

It is normal to have bleeding after you deliver. It can last up to 4 - 6 weeks. Initially, it might be like a moderate period flow and it should lessen over time. It might also change colour over time. If you are soaking through pads (about 1 full pad per hour for 2 hours), you should for urgent assessment in your emergency department to make sure there are no clots or placenta pieces in your uterus. 

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Abdominal Pain and/or Contractions

It is normal to have contraction-type pain when you are breastfeeding. Oxytocin is released during breastfeeding (the same oxytocin that is used to increase contractions in labour) and this causes mild contractions. It is also normal to have some abdominal pain after a Caesarean section, especially when changing positions or turning. If you have severe abdominal pain, regardless of the type of delivery, you should see your obstetrical provider as soon as possible or go to the emergency department. They will want to make sure you don't have an infection in your uterus or in your abdomen.

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Breastfeeding and Infant Formula

Breastfeeding can be challenging for both the parent and the baby. It is very possible that you are not able to breastfeed, that you are not producing enough milk for baby or baby is having difficulty latching. While breast milk carries the best nutrients for baby, it is more important that your baby is fed and healthy. This might mean that you need to supplement with formula or have baby fed entirely with formula. Here are some good sites if you need help with breastfeeding or want some information about feeding babies.

• Sunnybrook Breastfeeding Clinic - Clinics are only for patients who deliver at Sunnybrook. Please see your own obstetrical provider for clinics at your hospital.

• City of Toronto: Breastfeeding

• International Breastfeeding Centre (The Newman Breastfeeding Clinic)

• City of Toronto: Infant Formula 

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Mood Changes & Depression

It is very common to feel sad or anxious after your delivery. Sometimes this lasts for a few days and other times it lasts several weeks. If you or your family are worried about your mood, the Edinburgh Postnatal Depression Scale (EPDS) online calculator can be used to determine if you should get help. If you get a score above 10, you should call your family doctor or your obstetrical care provider. If you have thoughts of hurting yourself or your baby, you should call for help (either family member, a friend, or 911) and go to the emergency department to be assessed. Here are some other resources that might be helpful:

• BC Children's Hospital - Reproductive Mental Health

• Sunnybrook Women's Mood and Anxiety Clinic: Reproductive Transitions

• City of Toronto: Postpartum Depression and Anxiety

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Incontinence: Leaking of urine, gas or stool

Immediately after delivery, especially a vaginal delivery, it is very common not to be able to control voiding, passing gas or sometimes stool. Pelvic floor physiotherapy can be very helpful to retrain and strengthen your pelvic floor muscles. If you have incontinence for more than 3 to 6 months after you deliver, see your family doctor or your obstetrical care provider to follow up. 

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Contraception

You may or not may not be thinking about your next pregnancy already. While breastfeeding can temporarily stop your periods from coming, it is not the best form of contraception! There are many reversible options including calendar method (only once your periods return), barrier methods (ie: male and female condoms, diaphagms), combined hormonal contraception (ie: birth control pills, injections, patches or vaginal rings) and intrauterine devices (IUDs). There are also permanent forms including tubal ligation or vasectomy. In order to choose the best option for you, ask yourself what would happen if you accidentally got pregnant. If it's ok, then you could use a less effective form. If you would not able to cope with a new pregnancy, then you should choose a more effective form. The Society of Obstetricians and Gynecologists of Canada has a great site that goes over all the different forms of contraception. Click here for more information.