What to Expect at Home
The uterus, still enlarged, continues to contract for some time, becoming progressively smaller during the next 2 weeks. These contractions are irregular and often painful. Contractions are intensified by breastfeeding. Breastfeeding triggers the production of the hormone oxytocin. Oxytocin stimulates the flow of milk (called the let-down reflex) and uterine contractions. Normally, after 5 to 7 days, the uterus is firm and no longer tender but is still somewhat enlarged, extending to halfway between the pubic bone and the navel. By 2 weeks after delivery, the uterus returns to its normal size. However, the new mother's abdomen does not become as flat as it was before the pregnancy for several months, even if she exercises. Stretch marks may not lighten for a year.
A new mother may take showers or baths, but she should refrain from vaginal douching for at least 2 weeks after delivery. Washing the area around the vagina with warm water 2 or 3 times a day helps reduce tenderness. Warm sitz baths can relieve pain resulting from an episiotomy or from hemorrhoids. Sitz baths are taken in a sitting position with water covering only the hips and buttocks.
Mothers who are not breastfeeding may take drugs to help them sleep or to relieve pain. For pain, they are usually given acetaminophen or a nonsteroidal anti-inflammatory drug (NSAID). Mothers who are breastfeeding are given limited amounts of such drugs because most drugs appear in breast milk (see Section 22, Chapter 259).
Mothers who are breastfeeding need to learn how to position the baby during feeding (see Section 23, Chapter 263). If the baby is not positioned well, the mother's nipples may become sore. Sometimes the baby draws in its lower lip and sucks it, irritating the nipple. In such cases, the mother can ease the baby's lip out of its mouth with her thumb. After a feeding, she should let the milk dry naturally on the nipples rather than wipe or wash them. If she wishes, she can dry her nipples with a hair dryer set on low. In very dry climates, hypoallergenic lanolin or ointment can be applied to the nipples. Plastic bra liners should be avoided.
As long as a mother is breastfeeding, she needs extra nourishment, especially calcium. Dairy products are an excellent source of calcium. Nuts and green leafy vegetables may be substituted if the mother cannot tolerate dairy products. Or she may take calcium supplements. Vitamin supplements are not necessary if the mother's diet is well balanced, particularly if it includes sufficient amounts of vitamins B6, B12, and C.
A new mother may resume normal daily activities when she feels ready. She may resume sexual intercourse as soon as she desires it and it is comfortable. Use of contraceptives is recommended because pregnancy is possible as soon as the mother begins to release an egg from the ovary (ovulate) again. Mothers who are not breastfeeding usually begin to ovulate again about 4 weeks after delivery, before their first period. However, ovulation can occur earlier. Mothers who are breastfeeding tend to start ovulating and menstruating somewhat later, usually 10 to 12 weeks after delivery. The interval depends on how much food other than breast milk the baby consumes. If more than four fifths of the baby's food is breast milk, ovulation is unlikely to occur. Occasionally, a mother who is breastfeeding ovulates, menstruates, and becomes pregnant as quickly as a mother who is not breastfeeding.
Full recovery after pregnancy takes about 1 to 2 years. So doctors usually advise a new mother to wait before becoming pregnant again (although she may choose not to follow that advice). At her first doctor's appointment after delivery, a new mother can discuss contraceptive options (see Section 22, Chapter 255) with her doctor and choose one that suits her situation. A new mother who has just been vaccinated against German measles (rubella) must wait at least 1 month before becoming pregnant again to avoid endangering the fetus.
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