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Postpartum Guide


Postpartum begins after your delivery of baby and placenta. Some define it as having 3 phases: 1st – Initial or acute phase in the first 6-12 hours. 2nd – The subacute phase which can last 2 – 6 weeks. 3rd – the delayed postpartum phase which can last up to 6 months.

Congratulations on the birth of your baby! Now is the time for you to enjoy your “baby-moon” and learn to know your newest family member. Here are a few reminders about how to care for yourself and when to call your Midwife/Provider


  • Empty your bladder every couple hours in the first postpartum day. You may not feel like you need to go, but try anyway. Please have someone walk with you to the bathroom the first 24 hours.
  • It may sting if you have any abrasions. Do not decrease your intake of liquids is an attempt to avoid having to pee. The more water you drink, the less acidic your urine will be, and the less it will sting.Uterus:
  • Your uterus should feel well-contracted and like a grapefruit either at or below your belly-button. It may feel slightly softer now and then but should basically remain quite firm. If it is soft, gently massage it until it feels firm again. You will feel some cramping when you do this and may feel a small gush of blood. This helps minimize blood loss.
  • It should either stay at the same location or begin contracting down (typical rate of involution, moving downward, is one fingerwidth per day) it should not rise farther up in your belly, or move to the side. If it moves over to the right side, try emptying your bladder.
  • It is normal to have a small gush of blood when you stand up, shift positions, or breastfeed.Bleeding:
  • Normal bleeding should not exceed more than a saturated pad an hour. Watch for heavy bleeding or bleeding that reoccurs after slowing down. If the bleeding seems too heavy, try breastfeeding the baby (you should feel some crampiness), empty your bladder, and gently massage your uterus.
  • Watch for clots : they may be normal, especially after you have been lying down for awhile, but you still need to be aware of them. Call if you pass more than a couple large clots (egg-sized or larger).
  • You will bleed for 2-6 weeks after the birth. This bleeding is called lochia and will change from bright red to brown and will be mixed with mucous. If it becomes red after it has turned brown this is a sign of fresher blood and usually means that you are doing too much and straining your body. However, often women experience an increase in the amount of bleeding at 7-14 days secondary to the sloughing of the eschar on the placental site.Afterpains: By the time you go into labor after 37 weeks gestation, your uterus is about 15 times heavier – not including its contents! – and its capacity is at least 500 times greater than before you conceived. Involution is the process of reduction of the uterus to its normal nonpregnant size and state following childbirth. This does commonly cause some cramping.
  • These pains are caused by the contractions of your uterus as it returns to its normal size. Breastfeeding may make them feel stronger as this is helping your uterus to involute. This cramping will improve daily.
  • You may take ibuprofen or herbal afterpain remedies to ease the discomfort. A warm hot water bottle applied to your abdomen may help, as well as laying on your stomach.Suggestions for care of episiotomy, laceration, and/or hemorrhoids:
  • If you had a laceration or episiotomy, you will need to rest as much as possible. The more you are up and around the longer it will take to heal. Do not sit “Indian style” or with the legs widely spaced apart for at least the first 4 days.
  • If you have alot of swelling or have stitches, cold may feel good on your bottom for the first 24 hours. Intermittently apply cold packs to your perineum. Soak a sanitary pad in calendula mixture of tincture + water. Toss it in the freezer then enjoy….
  • Use a peribottle to squirt warm water onto your perineum while peeing to prevent stinging and to wash away urine and blood (toilet paper will probably not feel very nice). Do this for at least a week. Also can add Calendula , it helps tissues to heal. It has anti-bacterial, anti-viral and anti- inflammatory effects. The Homeopathic preparation dosage for moms : A few drops added to peri bottle in the first few days postpartum.
  • Arnica : This is a homeopathic preparation that aids with swelling, bruising and tissue healing. It will beneneficial to take right after birth and for the first week postpartum. Dosages:Take three times a day or as often as you like. Remember, like all homeopathics, the pellets should dissolve under your tongue and they should be taken away from food or any taste in your mouth (eg. Gum/toothpaste)
  • Daily soak – Add Epsom salt to bath tub or sitz bath as directed (do not have baby in bath with you when using Epsom salt).
  • Sitz Bath soak – An herbal recipe for postpartum perineum healing: 3 cups of dried calendula, 3 cups of dried yarrow flower, 3 cups of dried comfrey, 1 bag sea salt, mesh/cheese cloth or bakers cloth. Cut a big square of the cloth and place 1/4 cup of each of the ingredients on the square. Tie up the corners tightly (so that none can get out). It should look about the size of a softball. Place into a bathtub (it will turn the water slightly yellow) and then get in and soak yourself (it doesnt sting or hurt). It is amazing how fast this works to heal you and keep you from getting an infection. Visible differences have been seen between baths (at morning and at night).
  • General wound healing including perineum: (change daily)1. Clean/rinse with Fresh Breast Milk, an antiinflammatory, antibacterial, antiviral, antibodies, isotonic, and containshuman growth factor substances which encourage new cell growth, not to mention stem cells, active phagocytotic WBC’s and lysosomes that break down bacterial cell walls.2. Apply Raw honey ( Manuka honey if available, its from Australia and New Zealand, the hives are in the tea tree groves, so the honey Also has some properties of Tea Tree Oil, but is edible, and can be used on mucous membranes, etc.)3. Nori strips, helps hold the skin together and has major rapid healing properties. Cut a strip that will cover the area, wet it on one side, pull the skin together, and then apply and
    hold it until it sticks


  • Try to keep Bowel movements regular. – Eat a nutritous diet, including lots of fruits, vegetables, lean protein, dairy products and whole grains. You may try eating prunes, bran cereal, or bran muffins. Drink a minimum of 8 glasses of water daily. A Better guide for healthy water intake should be to drink half your body weight in ounces. Example; if you weight 200 lbs you should try to drink 100 ounces of water. If you weight 160 lbs you should try to 80 ounces of water and so forth. If needed use a gentle stool softener such as Metamucil, or a gentle laxative such as Colace or Milk of Magnesia if desired.
  • Topical preparations such as Tucks (Witch Hazel) or Dermoplast spray.
  • 1% hydrocortisone cream, Preparation H or suppositories such as Anusol HC.
  • Herbal remedy such as Varigone capsule inserted into your rectum 2-3 times daily if persistent (may use olive oil as a lubricant).
  • Another natural remedy – Try placing a small amount of shredded potato (fresh not prepackaged shredded) DIRECTLY next to the hemorrhoid several times per day. It can be messy and feel gross and may help to tuck a Tucks pad or gauze pad on the outer side of the potato. The starch in the potato works wonders to shrink them.Activity:
  • In the first week, plan to care only for yourself and your baby if possible.
  • You will notice that your bleeding becomes heavier and turns bright red if you are doing too much too soon. This is a sign that you need to rest more often.
  • Take lots of naps – try to rest when the baby is sleeping.
  • Stairs: Limit if possible. In the 1st week postpartum (PP) you should try to only go up and down the stairs as many times as you are days postpartum – zero days on the birthday, once the next day, twice on day 2 PP, etc.
  • Avoid excessive lifting.
  • Showers and baths are fine. However , if you had a cesarean section ask your provider when you are able to take a bath.
  • Resume daily activities gradually as you feel able. Remember, If your bleeding begins to increase then you are doing too much too soon.”Baby Blues” (feeling weepy and emotional)
  • 80% of mothers feel some “baby blues” within the first week- this is caused by changes in your hormones. It is ok to cry!
  • Talk with another mother or with your partner.
  • Get more rest if you need to; do something just for yourself, go for a walk, read a book, or relax in a warm bath (preferably with added Epsom salt w/magnesium)
  • Get out of the house for a while.
  • If the “blues” continue, or it feels like you are not able to cope, you may be experiencing postpartum depression, which is more serious, and affects about 10% of mothers. Please call your Midwife/Provider if you feel like you are not able to cope or need more help.
  • Placenta encapsulation has been shown to have wonderful benefits in preventing postpartum depression and numerous other health benefits.When to call your provider:
  • Temperature over 100.4 degrees
  • Heavy bleeding or clots (filling a pad an hour)
  • Foul-smelling vaginal discharge, especially if it is accompanied by a tender uterus and feeling “flu-ey” and achy
  • Increased pain, redness, swelling or drainage from your stitches
  • Hot, red, painful breasts
  • Severe abdominal, chest or leg pain
  • Severe depression, anxiety, sleeplessness, or losing touch with reality.
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