Postpartum Recovery

During the first few weeks after delivery, you can expect many noticeable changes in your body. We offer this guide to help you recognize what’s normal and what’s not.

Keep in mind that recovery is different for different kinds of deliveries. Recovery from vaginal delivery after a 2-hour labor is different than recovery after a 3-day induction or a c-section. Still, there are common themes, and patients usually ask similar questions. Here’s our A-to-Z guide that describes common issues, what to do about them, and when to be concerned.

Bleeding

Vaginal bleeding is normal after delivery. The blood that comes out after delivery is called lochia (“low-key-a”). Initially, the lochia is red and the flow is moderate. After a few days, the lochia turns pink or brown. Finally, after 2 to 3 weeks, you’ll notice a yellow-white discharge that starts to taper off. Most women will have to wear protection for a couple of weeks after delivery.

What to do about bleeding after delivery:

• Use only pads, not tampons during the first 6 weeks after delivery.
• Track the amount of bleeding each day and call us if it’s excessive.

When to be concerned:

• If you are soaking more than one pad per hour for two consecutive hours, you should call us. This is excessive bleeding.
• If your blood has a foul odor, you should call us. This may indicate an infection, especially if foul-smelling lochia occurs in the presence of a fever.
• If your stitches are bleeding significantly (more than a teaspoon), you should call us.

Bloating

It takes a while for your belly to deflate after delivery.  Often, women still look a little bit pregnant. This is especially common if you delivered by c-section.

What to do for bloating:

• Walking promotes bowel activity and will help you to pass gas and have bowel movements.
• Avoid using narcotic pain medication.
• Avoid foods that make you gassy (like beans, broccoli, and Brussel sprouts).
• If you’re having trouble moving your bowels, use a mild laxative like Senokot, Milk of Magnesia, or Dulcolax.
• Work on toning your abdominal muscles (e.g., sit-ups or crunches), but not until cleared by your doctor (usually not for a month after delivery).

When should you be concerned about bloating:

• If you go two consecutive days without a bowel movement, you should call us.
• If you have a lot of bloating with nausea or vomiting, you should call us.
• If you have bloating and a fever over 100 degrees, you should call us.

Breast Pain

After delivery, the breasts can become engorged. They may feel full, hard, sensitive, and sometimes painful. Milk typically comes in on day 2 or 3 after delivery.

What to do about breast pain:

If you’re breastfeeding, you’ll get relief when you pump or feed.

• Don’t go a long time between feedings. You should nurse your baby every 2 to 3 hours or on demand. Use our daily feeding log sheet to keep track.
• Don’t skip night feedings.
• Make sure your baby is latching on correctly and getting enough milk.
• Take warm showers or use warm towels on your breasts to promote milk flow.
• You can use a breast pump to facilitate flow.

If you’re NOT breastfeeding:

• Do not pump or express milk…this makes more milk come in.
• Wear a tight-fitting bra like a sports bra.
• Use cold packs on your breasts for a few minutes every few hours.
• Take 400 mg ibuprofen (Motrin or Advil) up to 3 times per day.

When to be concerned about breast pain:

• If you have a particularly tender, red area on your breast, especially with a fever, you may have mastitis, a breast infection that requires antibiotic treatment.
• Breasts are usually lumpy while women are breastfeeding, but if you notice a specific, isolated lump, you should bring it to our attention.

Breastfeeding Problems

This is what breasts are for! The first “milk” that your breasts will develop is colostrum, a thick, yellow, highly nutritious liquid. This “liquid gold” is produced for approximately the first week, before the breasts produce milk that looks more like milk. In the first week of life, full-term infants will need to nurse 8 to 12 times in each 24-hour period.

What to do if you’re not producing enough milk:

• Make sure you’re feeding frequently. Don’t skip overnight feedings.
• Make sure your baby is latching on correctly.
• Try not to supplement with formula, as long as your baby is getting sufficient nutrition and fluids.

When to be concerned about producing enough milk:

• If your baby is not wetting a diaper at least 5 times per day and having at least 3 stools per day, you should consult your pediatrician. You can use our feeding and diaper log sheets to keep track.
• Babies will normally lose about 7% of their weight immediately after birth. If your baby loses more than 10% of its initial birth weight, you should consult with your pediatrician.

Constipation

Constipation is expected after delivery. This occurs because of hormonal changes that make the bowels less active. Some women may also be afraid to push/strain because of vaginal discomfort.

What to do about constipation:

• Drink plenty of fluids.
• Increase the fiber in your diet with lots of fruits and vegetables.
• Add additional fiber to your diet with Benefiber or Metamucil.
• Take a mild laxative like Senokot, Milk of Magnesia, or Dulcolax.
• If your stools are hard and painful to pass, use a stool softener like Colace.

When to be concerned about constipation:

• If you do not have a bowel movement for 2 consecutive days, call us.
• If you have nausea and vomiting and are not having bowel movements, call us.
• If you are constipated and you have a temperature over 100 degrees, you should call us.

Cramps

Immediately after delivery, the uterus is about the size of a cantaloupe, but it will shrink down to the size of a pear within a month or 2. As your uterus shrinks, you may feel mild contractions or afterpains. These cramps can be particularly intense if you are breastfeeding.

What to do if you have cramps:

• Over-the-counter ibuprofen (e.g., Motrin or Advil) works wonders for cramps. Ibuprofen works much better than Tylenol for this purpose.
• If ibuprofen doesn’t help or you’re hesitant to use medication, you can try a heating pad or hot water bottle to relieve cramps.

When to be concerned about cramps:

• If your cramps are severe and ibuprofen doesn’t help, you should call us.
• If you have severe cramps with heavy bleeding or fever, you should call us.

Depression

It is common to feel overwhelmed and emotional after childbirth, and it’s normal to cry. A combination of hormonal changes, sleep deprivation, and physical discomfort contribute to the “baby blues,” which typically begin a couple of days after delivery and last up to 2 weeks. It’s also quite normal to have ambivalent feelings towards your baby or to feel that you’re not immediately connected to him/her emotionally.

What to do about mood changes after delivery:

• Reach out to friends and family for support.
• Be a “joiner”: There are plenty of support groups for new moms.
• Be sure to arrange time to take care of yourself.

When to be concerned about mood changes after delivery:

• If you have serious thoughts about harming yourself or your baby, you should contact us immediately.
• If you are overwhelmed with feelings of guilt, hopelessness, or worthlessness, you could have postpartum depression. You should call us for help.
• If you have hallucinations, delusions, or paranoia, you could have postpartum psychosis, a rare but serious psychiatric problem. You should call us for help.

Episiotomy Pain

See Vaginal Pain.

Hair Loss

Many women will notice increased hair loss after delivery, peaking at about 3 months postpartum. You may notice hair on the drain after taking a shower or increased hair in your hairbrush. Hair loss usually occurs because the hair cycle becomes synchronized during pregnancy, so that hairs fall out together. It’s rare for this to become cosmetically noticeable; it typically resolves 9 to 12 months after childbirth.

What to do about hair loss after delivery:

• Don’t worry. It’s likely that your hair loss is much more noticeable to you than others.
• Avoid using a comb or brush that pulls the hair.
• Use high quality shampoo and volumizing conditioner.
• Continue to take your prenatal vitamins.

When to be concerned about hair loss:

• If your hair loss seems excessive, you should contact us.
• If you have bald patches, you should contact us.
• Hair loss that does not resolve may indicate anemia or thyroid problems. You should call us if the problem persists.

Hemorrhoids

Hemorrhoids are swollen blood vessels around the anus. These may become larger and more bothersome in pregnancy and tend to be especially difficult after delivery.

What to do if you have hemorrhoids:

• Use an over-the-counter hemorrhoid cream or suppository that contains hydrocortisone.
• Use hemorrhoid pads that contain witch hazel or a numbing agent.
• If constipated, use a mild laxative like Senokot, Milk of Magnesia, or Dulcolax.
• If you have hard, painful stools, use a stool softener like Colace.
• To control hemorrhoids, eat high-fiber foods like fruits and vegetables.
• For additional fiber, you can add Benefiber or Metamucil to your diet.

When to be concerned about hemorrhoids:

• If your hemorrhoids are bleeding significantly (i.e., more than just when you wipe), you should call us.
• If your hemorrhoids are acutely painful so that it’s painful to sit, you should call us. Occasionally, women will develop a thrombosed hemorrhoid (a blood clot inside a hemorrhoid); it isn’t dangerous, but it is quite painful. We can help you with this.

Incision Pain (After C-section)

Expect your C-section incision to be painful, especially during the first week after delivery. Physical activity may be difficult, but we encourage activity to prevent blood clots. To care for your incision, simply use soap and water in the shower, then blot dry. You shouldn’t soak in a tub or pool. Avoid lifting anything heavier than your baby.

What to do if you have incisional pain after C-section:

• You can use both ibuprofen (Motrin or Advil) and Tylenol for C-section pain. The two medications work differently and can be used together.
• If necessary, we can provide prescription pain medication.
• Make sure you’re getting plenty of rest and giving your body a chance to heal.

When to be concerned about incisional pain after C-section:

• If you have a temperature above 100 degrees and lot of incision pain, you should call us.
• If you have significant drainage from the incision (more than a teaspoon of fluid or blood) you should call us.
• If the incision looks particularly red or swollen, you should call us.

Leg Swelling

Because of fluid shifts during labor and delivery, most women will wake up on the day after delivery with swelling in both legs. Don’t worry, your new “cankles” are not permanent! Usually the legs go back to normal size after about a week.

What to do if you have excessive leg swelling:

• Rest with your legs elevated.
• Try to lay on your left side to increase circulation.
• Avoid salty foods.
• Drink plenty of fluids, preferably water.

When to be concerned about leg swelling:

• If you have leg swelling that seems to affect only one leg, call us immediately. This can be a sign of a blood clot.
• If you notice a lot of leg swelling together with shortness of breath or chest pain, call us immediately. This can be a sign of a blood clot.
• If swelling is so extreme that you cannot put on your shoes, and doesn’t resolve within a few days after delivery, you should call us.
• If you have significant leg swelling and a bad headache or visual changes, call us immediately. This can be sign of preeclampsia.

Nipple Pain

Your nipples may be sore and even cracked as a result of injury from breastfeeding. Nipple sensitivity is common, but nipple soreness that worsens while breastfeeding may indicate an injury.

What to do if you have sore nipples:

• Make sure the baby is latching on properly and is positioned correctly for breastfeeding; consultation with a lactational professional can be helpful.
• Do not use harsh soaps or cleansers on your breasts.
• Avoid the use of breast pads that have a plastic backing.
• Try to keep your nipples dry and allow them to air-dry after feedings.

When to be concerned:

• If you have a hard area in your breast that is tender, you should call us.
• If you have a fever over 100 degrees, you should call us.
• If you have drainage of pus from your nipple, you should call us.

Skin Pigmentation

During pregnancy, many women will notice pigmentation around their nipples and a line down the middle of their belly called the linea nigra (“black line”). Some pigmentation on the cheekbones (the “mask of pregnancy”) is also common, especially in olive-skinned women. This pigmentation is causes by hormonal changes in pregnancy. It typically fades over several months after delivery.

What to do about skin changes after delivery:

• Avoid sun exposure, which can make the pigmentation darker.
• Be patient. This usually gets much better with time.

When to be concerned about skin pigmentation:

• This is generally not a medically serious problem, but see a dermatologist if you are concerned.

Stretch Marks

Stretch marks are very common after pregnancy. Usually these start out as pink, red, or purple, but they fade and become less noticeable over time.

What to do about stretch marks after pregnancy:

• Use moisturizing creams or lotions to keep the skin supple.
• Use cover-up makeup if you feel that stretch marks are unsightly.

When to be concerned about stretch marks:

• Stretch marks are generally not serious. If you’re seeking a cosmetic solution, we recommend that you consult with a dermatologist.

Vaginal Pain

Your vaginal area may be really painful, depending on if you had skin tears during delivery and especially if you have stitches down there. The area can get very swollen, but this generally resolves after a few days.

What to do if your vaginal area is very painful:

• Use over-the-counter ibuprofen (Motrin or Advil) or Tylenol
• Soak your bottom in a warm tub with some Epsom salts (sitz bath) a couple of times per day.
• Ice packs or chilled maxi-pads are helpful. You can soak pads in witch hazel and store in the freezer to make a “padsicle.”
• Sitting on a donut-shaped pillow or inflatable ring helps keep the pressure off.
• Wear comfortable, loose-fitting clothes.
• Use topical lidocaine spray, cream, or gel on the tender area.
• Use witch hazel to cool the area.
• Avoid intercourse, tampons, or douching for 6 weeks after delivery.
• Avoid strenuous exercise, heavy lifting, or bicycling for 6 weeks after delivery.

When to be concerned about vaginal pain:

• If you have a fever (temperature over 100 degrees) and a very tender bottom, you should call us.
• If you have pus or significant drainage from a stitched area, you should call us.
• If you have excessive pain, you should call us.

Urinary Incontinence

Many women will note difficulty holding urine after delivery. They may notice that urine leaks when they cough or sneeze. This urinary incontinence occurs because of damage to the pelvic muscles during pregnancy and delivery. In most women, urinary control slowly improves over several months after delivery. Occasionally, women are left with bothersome incontinence even after recovery.

What to do about urinary incontinence after delivery:

• Kegel exercises help to restore strength to the pelvic floor. You should do Kegels daily during the postpartum period.
• Work on losing excess weight. Excess weight worsens incontinence.
• Avoid caffeine, which can irritate the bladder.
• Wear a pad if you have to.

When to be concerned about urinary incontinence?

• If you have urinary incontinence together with burning on urination, frequent urination, and/or cloudy or foul-smelling urine, you should call us. You may have a urinary infection.
• If it’s been 6 months since delivery and you still have to wear protection because of incontinence, you should be evaluated.

When to Call Us

It’s hard for new mothers to know what symptoms are significant and when to call us. Use this helpful table.

Symptom	You Should Be Evaluated If
Bleeding	You’ve soaked a pad per hour for 2 consecutive hours. You’ve had persistent bleeding that soaks through to your clothes. You’re passing clots larger than a golf ball.
Breast pain	You have a tender, red lump or area, or fever >100 degrees.
Chest pain	You should be evaluated for any continuing chest pain.
Depression	You have serious thoughts of harming yourself or your baby.
Headache	Any persistent headache that doesn’t go away with Motrin, Advil, or Tylenol. Headache with blurry vision or other vision changes. Headache with slurred speech or weakness.
High blood pressure	You are taking measurements at home, and you’ve had two consecutive measurements higher than 140/90. You are taking measurements at home, and you’ve had readings less than 90/60, especially if you feel dizzy or faint.
Incision pain (C-section)	You have a fever. You have pus or drainage from the incision. You have severe pain not relieved by Tylenol or ibuprofen.
Leg swelling	The swelling involves only one leg. Your calf is tender and painful. You have shortness of breath or chest pain.
Shortness of breath	You should be evaluated for any ongoing shortness of breath.
Upper abdominal pain	You have a headache and/or visual changes. Your urine is dark or your eyes are yellowish.
Urinary problems	You cannot urinate for more than 6 hours. You have burning with urination, blood in the urine, or fever.
Vomiting	You have had more than one episode of vomiting, especially if you have fever, constipation, or a severe headache.

Resources for Postpartum Patients

Breastfeeding/Lactation

United States Lactation Consultant Association (USLCO)
A nationwide organization/registry of lactation consultants
202 738-1125
www.uslca.com

La Leche League
A non-profit organization with resources to support breastfeeding moms
www.lllny.org

Long Island Lactation Consultant Association (LILCA)
A registry for local Board-certified lactation consultants
www.lilca.org

Lauren Macaluso, M.D.
Pediatrician/Board-certified Lactation Consultant
1575 Hillside Avenue
Suite LLI
New Hyde Park, NY
516 498-2300
www.macalusomedical.com

Karen Walsh, MA, IBCLC, LCCE, LLLL
Lamaze Childbirth Educator & Board-certified Lactation Consultant
North Bellmore
718 869-1377
kwalsh030417@gmail.com

Janice Campbell, MSN, RN, LCCE, IBCLC
Lactation Time
Registered Nurse, Lamaze Childbirth Educator, Board-certified Lactation ConsultantServing Brooklyn, Nassau and West Suffolk
516 442-0563
contact@lactationtime.com

Domestic Violence

Safe Horizon–Domestic Violence Hotline
Hotline for survivors of domestic violence. Provides referrals to domestic violence shelters and other services.
1-800-621-4673
www.safehorizon.org

New York State Domestic Violence Hotline
1 800-942-6906 (in English and Español)

The Safe Center – LI
Local non-profit that offers counseling, housing, advocacy, and referrals
516 542-0404 (24-hour hotline in English and Español)
www.tscli.org

Postpartum Depression/Anxiety

Zucker Hillside Hospital Perinatal Psychiatry
Offers initial telephone assessment, and brief or long-term individual and/or group therapy
270-05 76^th Ave, New Hyde Park 11590
Nassau: 516 470-4666 (470-4MOMS)
Queens: 718 470-4666 (470-4MOMS)

Statewide Postpartum Resource Center of New York
Statewide, on-line perinatal mood disorders resource directory; moms on-call and family telephone support
631 422-2255
Toll free: 855-631-0001.  (English and Español)
www.postpartumny.org