The new mother usually leaves her bed for short periods on the delivery day or the day after, gradually increasing the exercise over the next few days; she may remain in the hospital anywhere from a few hours to a week or more. The first six weeks after labor, the puerperium, is the time when the uterus returns to its nonpregnant state, milk appears in the breasts, and other less obvious changes occur in the body. During those six weeks, the uterus itself diminishes in weight from 2 pounds to 2 ounces, the weight and size of a pear, and can no longer be felt from the outside of the abdomen. This “involution of the uterus” is benefited when the woman nurses her infant.
A vaginal discharge known as lochia appears. It is bright red for the first few days, paling to pinkish and then yellow-white with a tinge of blood. The flow diminishes, usually to disappear entirely by about the third or fourth week after labor. It should not be mistaken for mnenstruation. An ordinary menstrual napkin should be worn; no tampons are permitted sanitary until at leasttwo weeks after delivery.
Menstruation itself may return to the non-nursing mother in about 4 to 8 weeks. In the nursing mother, the variation is great—the period may not occur for 2 to 18 months, averaging about five months. Both groups of mothers find the cycle and flow irregular for some time. Previously painful menstruation is often corrected or notably lessened by childbirth.
Pregnancy is much less likely to occur in the woman who is nursing her child for the first nine months than in one who is not, but the old wives’ tale that conception cannot occur is false. Nor is it true that conception cannot occur in the absence of menstruation. If pregnancy is not desired, it is unwise to rely on nature alone The doctor should be asked for contraceptive advice and materials when sexual relations are resumed. Intercourse should generally be postponed until flow has ceased or after the first examination by the doctor, usually at 4 to 6 weeks after birth.
Lactation. The breasts have been preparing for the arrival of milk thoroughout the pregnancy, but it does not appear until about three days after the birth. It is preceded by the thin, colorless secretion called colostrum. On the third day after delivery, the breasts become engorged—larger, firmer, hot, and painful. The mother may feel fatigue and a low fever. Pale blue-white milk can be pressed from the breast’s nipple. Engorgement passes in a day or so, and the thin fluid secreted by the breasts grows thicker, yellow-white, and plentifull.
There seems to be no reliable way to predict ability to produce an adequate supply of milk. Large or small breasts apparently have nothing to do with this capacity. Most women can produce enough milk to feed their infants successfully. The activity itself generates an increasing milk flow in the early weeks as the feeding schedule is established; nursing intermittently and erratically seems to lessen the flow, as the breasts adjust their supply to the requirement. For this reason, feeding should be started when colostrum appears, about 12 hours after the birth. Tension reduces the milk flow; therefore, regular and adequate rest, a healthy diet, and a reasonably ordered life are necessary conditions for the breast-feeding mother. The addition of some fluids, particularly a quart of milk per day, to an ordinary balanced diet, will supply the child’s needs.
Some drugs and alcohol taken by the mother appear in the milk and affect the child, so the nursing mother should check with her doctor before taking any medications. Onions may flavor the milk harmlessly. The doctor will often advise a lubricant ointment for nipples grown sore during nursing. Watch for any cracks or lesions in the nipple and report them. After pains are common in the first days after delivery, especially with the second or third birth.
These contractions of the uterus are irregular and may last a minute or so; they are frequently set off by the action of suckling. A quickened flow of lochia also may occur. In some mothers, these pains are strong and may require aspirin or even codeine to ease them.
Depression. Many women experience a few days or weeks of slight depression after delivery they may burst into tears or feel low for no reason that they can understand. It may be particularly troubling because it occurs at a time when it seems everything should be delightful, or when the mother feels she needs all her stability to deal with the new situation. If the experience is disturbing, the patient should discuss it with her
Hygiene and Body Care. Since patients customarily get out of bed soon after delivery, many of the problems induced by prolonged bedrest are absent from the postnatal scene nowadays. Ordinary exercise such as walking about and bathing in the hospital, and a sensible return to an ordinary life at home, keeps the body in good condition and hastens the return of firm muscles. This light exercise should of course be accompanied by regular periods of sleep and rest scattered throughout the day.
Showers are permitted at once, but opinion varies on the safety of sitting baths during the first weeks; therefore, the doctor should be consulted. Many doctors do suggest warm shallow baths in plain water to ease discomfort from the healing of the perineal tears or stitches. Other means for treating the painful perineal wounds include ice or alcohol compresses, dry heat from an electric bulb, or medicated pain-relieving ointments. There is no hygienic reason for flushing and bathing of the vulva as long as it is protected by sterile pads or napkins to absorb the lochia flow. The napkins should be changed regularly.
Early post-delivery activity prevents problems with urinary function in most patients. However, there may be some difficulty in women who have had diffcult deliveries, or epidural or caudal anesthesia. When a woman cannot void, a catheter (a flexible tube) may be inserted through the urethra and urinary tract to the bladder for a day or so, and the procedure is usually accompanied by antibiotic therapy to prevent an infection from developing.
Constipation is also far less common than it once was. Where it does occur, a mild cathartic may be recommended. Hemorrhoids may have developed during late pregnancy or labor. Generally, they are managed by frequent sitz baths and analgesic ointments, according to the doctor’s advice. Good supporting brassieres should be worn while the breasts are heavy. Most doctors advise against the regular use of a girdle, since free exercise of the abdominal muscles is helpful in returning their tone.