The “fourth trimester” is an often-overlooked time of major changes, both to your body and to your life! Like each woman’s pregnancy journey, each woman’s postpartum period is unique. Here we will provide for you a wide range of information, some that will pertain to all postpartum patients and some that pertains only in certain situations. We hope you will find it useful as you prepare for and move into this next phase.
- You can expect to have a 1 week visit if you had any blood pressure issues during pregnancy or delivery.
- You can expect to have a 2 week visit if you had a Cesarean delivery or if you have a history of anxiety or depression.
- All patients can expect to have a visit at 6 weeks postpartum.
- Additional visits may be recommended and are welcome if any issues develop.
- We have lactation consultants in our office who are available for appointments if you are experiencing difficulties with breastfeeding.
Your body will go through dramatic changes after delivery. Some will happen quickly, but as it took 9 months for your body to grow your child, it takes months for it to fully return to normal.
- Vaginal delivery: it takes approximately 6 weeks for a vaginal tear to heal. Sutures should dissolve on their own.
- Cesarean section: incision should be closed at 2 weeks. If you have sutures, they will dissolve on their own; if you have staples, they may be removed in the hospital or in the office within a week after delivery. Internal healing takes at least 6 weeks.
- Vaginal bleeding might occur intermittently for up to 6-8 weeks, regardless of the type of delivery.
- Night sweats are common for the first few weeks.
- Leg swelling is common and likely to get worse (usually around 4-7 days postpartum) before it gets better. Contact our office if one side is more swollen or painful compared to the other side.
- Weight loss is often slow in the first week, despite having just delivered a baby plus a placenta! Everyone loses weight at a different rate, but if you eat healthy and exercise when it is safe, the weight will come off in the coming months. Breastfeeding often helps with weight loss.
- Constipation is extremely common and can be quite severe. Staying very well hydrated, walking, and eating fiber can help, but often over-the-counter medications are necessary whether or not you used them during pregnancy. Using Colace (100mg up to three times a day) or Miralax (once a day until you have a bowel movement) can help, and both are safe to use while breastfeeding.
- Milk supply is likely to come in around day 4 postpartum. Breasts will feel very engorged and may be uncomfortable—especially right before your baby is due to eat—but should not be red or painful. Your milk supply will stabilize/adjust in the first few weeks to match the demand of your baby. If you need to stop your milk supply, tight bras, cold compresses, and cabbage leaves in your bra are good ways to decrease milk production.
- Watch for heavy bleeding or signs of infection and call our office if you are concerned.
- Breastfeeding is hard work! But it has the most health benefits for you and your baby, so if you want to do it, stay positive and don’t get discouraged!
- You need 500 extra calories per day while breastfeeding (which is even more than is needed at the end of pregnancy!).
- At first you should be feeding on cue when your baby seems hungry, generally every 2-3 hours. Each session can take approximately 10-30 minutes depending on the baby. This is exhausting and time consuming, but with time, the baby will space out the feedings!
- At the beginning, you might notice that your uterine cramps get worse when breastfeeding. This is normal and your body’s way of returning to its pre-pregnancy state.
- You might leak from one breast when feeding from the other. This is normal and not a sign of oversupply. Conversely, if you do not leak, it does not mean you have an undersupply of breastmilk
- You might feel pain, tiredness/fatigue, or strong emotions (positive or negative) during milk let-down, typically a few seconds to minutes into feeding. This is normal.
- At the beginning, your nipples might be sore. If this is from overuse, it is normal and should get better with time. If it is from a poor latch, you will need to adjust the latch so that it does not cause persistent pain. You should not have pain throughout the feeding session; if you do, seek assistance.
- You can check LactMed (https://www.ncbi.nlm.nih.gov/books/NBK501922/) to see if medications are safe to use when breastfeeding.
- It might be recommended that you pump in addition to breastfeeding your baby directly. This can be helpful for a number of reasons, including trying to increase milk supply or determining how much your baby is eating.
- If you are planning to continue breastfeeding after returning to work, a general rule of thumb is to start pumping halfway through your time at home with the baby to build up a supply. You can pump for an additional 10-20 minutes approximately 10-30 minutes after feeding the baby. You will make the most milk in the morning.
- Check your state and employer rules to determine your rights at work as a breastfeeding mother.
Feelings After Childbirth
- “Baby blues” are very common. They are feelings of sadness, worry, or anxiety that start in the first few days after giving birth.
- You might find yourself crying for no reason or having trouble making decisions. You might question whether you can adequately care for your baby.
- Experiencing the baby blues does not mean you are a bad mother.
- Baby blues should resolve within 2 weeks without any treatment.
- Approximately 1 in 7 women will experience postpartum depression (PPD), which can develop up to a year after giving birth and is more severe than baby blues.
- PPD usually presents as very intense feelings of sadness or worry that impact your ability to perform your daily functions.
- You are at higher risk for PPD if you have a history of depression or anxiety, if your baby is admitted to the NICU, if your delivery is difficult, if you are lacking in support, or if you have trouble breastfeeding.
- Struggling with PPD does not mean you are a bad mother.
- If you, or a family member, think that you have postpartum depression, please contact our office as soon as possible. Do not wait until your next scheduled appointment.
- There are different types of PPD treatment, including therapy and medications.
- In addition to contacting our office, you can also explore these resources:
- Hydration is very important, especially if you are breastfeeding. Try to drink an 8 oz. glass of water with each feeding.
- Regardless of your delivery type, walking is the best form of activity/exercise in the first 6 weeks. The distance and speed can be slowly increased with time depending on how you are feeling. Listen to your body and adjust the activity as you feel comfortable.
- Fit4Mom is a company that offers health, wellness, and fitness programs for new moms. You can learn more about their programs at https://fit4mom.com.
- Sleep is incredibly important and also incredibly difficult to come by. Everyone recommends “sleep when the baby sleeps,” but you might also feel like that is the only time you can get anything else done! This is normal. Try to prioritize taking care of yourself and your baby and leave household chores to other members of your family (or outsource) when possible. Do not be afraid to ask for help or to take a break. Everyone functions much better when they have gotten some sleep, so getting the rest you need is good for both you and your baby.
- If you are going back to work after delivery, be sure to check with your employer as to your maternity benefits and what paperwork needs to be completed. You can bring the forms to any of the front desks at our offices and we will complete the necessary forms for you. Additionally, make sure to familiarize yourself with the lactation laws in your workplace, as you might be entitled to time and space to pump if you desire it.
Sex and Family Planning
- Please wait 6 weeks to have intercourse, regardless of mode of delivery
- Ovulation is less likely if you are breastfeeding a baby less than 6 months old every 4-6 hours, and if your periods have not returned. If any of these criteria are not met, there is a higher chance that you will ovulate. Please note, though, that even if both criteria apply, you could still be ovulating.
- You will ovulate before you have your first period, so it is difficult to know when you will become fertile again.
- We recommend waiting at least 6-12 months before conceiving again, depending on your specific health factors.
- We will review options and, if desired, initiate contraception at your 6 week postpartum visit (though we are also willing to talk about it sooner, as well).
- Postpartum hormone changes, including breastfeeding, can make the vagina drier than prior to delivery. This is normal and not permanent. If you had a vaginal laceration, there might be some additional discomfort as that area heals. Over-the-counter lubrication can help both issues during this time.
All patients are asked to follow up at approximately 6 months postpartum for an annual exam.
Some conditions require additional testing after delivery:
- Gestational diabetes: you will be asked to complete a 2-hour glucose test at your 6-week postpartum visit. Please plan to fast for this appointment and schedule this appointment for an early morning appointment. Additional information about fasting can be provided when scheduling this appointment.
- Abnormal pap smears: a repeat pap smear or colposcopy might be done at your 6-week visit or shortly after.
- Please discuss any diagnosis of diabetes or hypertension with your primary care provider, as these increase your risk of having similar issues in the future outside of pregnancy.
- Book: Nobody Told Me About That: The First 6 Weeks by Ginger Breedlove
- Virginia Hospital Center has different support groups for the postpartum period. Visit
5 Convenient Locations Across Northern Virginia
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