What to Expect in the Hospital
Immediately after the delivery of a baby, the mother is monitored. The hospital staff members make every effort to minimize her pain and the risk of bleeding and infection. After delivery of the placenta (afterbirth), a nurse may periodically massage the mother's abdomen to help the uterus contract. If needed, oxytocin is given to stimulate contraction of the uterus. The drug is given intravenously as a continuous infusion for 1 to 2 hours after delivery. These steps help ensure that the uterus contracts and remains contracted to prevent excessive bleeding.
When a general anesthetic (used rarely) was used during delivery, the mother is monitored for 2 to 3 hours after delivery, usually in a well-equipped recovery room with access to oxygen, blood that matches the mother's, and intravenous fluids.
Within the first 24 hours, the mother's pulse rate drops, her temperature may rise slightly, and the number of white blood cells temporarily increases. A bloody vaginal discharge occurs for 3 or 4 days. During the next 10 to 12 days, the discharge becomes pale brown, then yellowish white. The discharge may continue for up to about 6 weeks after delivery. Sanitary pads, changed frequently, may be used to absorb the discharge. Urine production often increases greatly, but temporarily, after delivery. Because bladder sensation may be decreased after delivery, a new mother should try to urinate regularly, at least every 4 hours. Doing so avoids overfilling the bladder and helps prevent bladder infections. The new mother is also encouraged to defecate before leaving the hospital. She may take laxatives, if needed, to avoid constipation, which can cause or worsen hemorrhoids. Applying warm compresses and a gel containing a local anesthetic to hemorrhoids, if present, can relieve pain.
During the early stages of milk production (lactation), the breasts become engorged with milk. Sometimes they become firm and sore. If a mother is not going to breastfeed, wearing a tight bra, applying ice packs, and taking analgesics such as aspirin or acetaminophen may help relieve the discomfort.
For mothers who are breastfeeding, feeding the baby regularly helps reduce breast engorgement. Wearing a comfortable nursing bra 24 hours a day can help relieve the discomfort. If the breasts are very swollen, the mother may have to express her milk manually just before breastfeeding to enable the baby's mouth to fit around the areola (the pigmented area of skin around the nipple). If the mother is uncomfortable between feedings, she can express milk by hand in a warm shower to relieve the pressure. However, expressing milk between feedings tends to result in continued engorgement and should be done only when necessary for relief.
After the first 24 hours, recovery is rapid. The mother can have a regular diet as soon as she wants it, sometimes shortly after delivery. She should get up and walk as soon as possible. If delivery was vaginal, a new mother can start exercises to strengthen abdominal muscles, often after 1 day. Sit-ups with bent knees, done in bed, are effective. However, most new mothers are too tired to start exercising so soon after delivery.
Before the mother leaves the hospital, she is examined. If she has never had German measles (rubella) or the German measles vaccine, she is vaccinated. If she has Rh-negative blood and the baby has Rh-positive blood, she is given Rh0(D) immune globulin within 3 days of delivery. This drug destroys any of the baby's red blood cells that may have passed to the mother and may trigger the production of antibodies by the mother. Such antibodies may endanger subsequent pregnancies (see Section 22, Chapter 258). The new mother is examined again 6 weeks later. Also before leaving the hospital, she is given information about changes to expect in her body and the type of contraception that can be used as her body recovers from having a baby.
If mother and baby are healthy, they commonly leave the hospital within 48 hours after vaginal delivery and within 96 hours after a cesarean section.
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