Bleeding Episiotomy C-Section Urination Bowel Movements / Constipation Hemorrhoids Afterpains / Cramping Epidural / Spinal Site Back and Hip Pain Breasts Faintness Swollen Feet or Ankles Night Sweats

Bleeding

Normal:

• Heavy to moderate bleeding, bright red in colour for the first 1 to 3 days
• Light bleeding, pinkish in colour for 3 to 10 days
• Scant bleeding, creamy yellow in colour for 10 days to 6 weeks
• Small clots (size of dime or quarter)
• Earthy smell
• Bleeding may be heavier after activity or breastfeeding or after lying flat for a while
• Regular periods may begin as early as 2 months or as late as 18 months if breastfeeding

What you can do:

• Reduce your activity and rest if bleeding increases - you have done too much
• Stay off your feet as much as possible for 2 weeks:
• Sit rather than stand
• Lay rather than sit
• Avoid stairs
• Don’t lift anything heavier than the baby
• Change sanitary pad at least 5 times per day
• Pour warm water over your perineum (use a squirt bottle) after going to the bathroom, then pat dry
• Do not use tampons until after your 6 week check-up
• Empty bladder frequently

When to call your health care provider:

• If bleeding is heavier than a normal period
• If you are saturating more than 1 to 2 pads in an hour and the flow does not slow or stop with rest
• If you pass clots larger than the size of a dollar coin
• If you are having bright red blood after 3 weeks postpartum
• If you have foul smelling vaginal discharge
• If you have lower abdominal pain 

Episiotomy

Normal:

• Healing should occur in 2 to 3 weeks
• Pain should decrease as time passes
• There may be some bruising, swelling and itchiness
• Stitches will dissolve over time 

What you can do:

• Apply something cold to reduce swelling – e.g., use an ice pack, dampen and freeze a clean maxi pad and put the frozen pad in your underwear
• Take a warm shallow bath with enough water to cover your buttocks and hips (sitz bath) to reduce itchiness
• Use a squirt bottle to clean area. Use cool water as tolerated
• Do Kegel exercises to help the episiotomy heal sooner (see section on exercises after childbirth)
• Reduce your activity and rest if pain or swelling increases
• Check area with a mirror
• Take prescribed pain medication as needed
• Empty bladder frequently
• Prevent constipation (see section on Bowels) 

When to call your health care provider:

• If you have a foul smelling discharge
• If the episiotomy opens up
• If bruising or swelling lasts more than 6 weeks
• If pain increases over time and does not improve with rest
• If you have an oral temperature over 38°C, chills, or lower abdominal pain 

C-Section

Normal:

• Staples or sutures are removed 3 to 5 days after childbirth
• Discomfort from the incision should gradually decrease
• You can shower; don’t worry if the steristrip tapes come off

What you can do:

• Consider taking medication; most pain medications do not interfere with breastfeeding; talk to your health care provider
• Do not lift anything heavy or vacuum for 4 to 6 weeks; your abdominal muscles need time to heal
• Rest – it may take longer to recover from a c-section than a vaginal delivery
• Avoid driving a car for 3 weeks or as advised by your health care provider
• Check incision with a mirror 

When to call your health care provider:

• If you have an oral temperature over 38°C, or chills
• If you have bleeding or discharge from incision
• If your incision opens up or has a red, “hot to touch” area
• If you have increased pain that is not relieved by pain medication and/or rest 

Urination

Normal:

• During pregnancy, your body stores extra fluids; after childbirth, your body gets rid of this extra fluid
• For the first day or two, you may have pain or difficulty urinating; this is more common if you had a catheter, episiotomy, or small tear
• You may have a stinging sensation when you pass urine if you have stitches
• You may be incontinent (leak urine) if you cough or laugh; this will get better over time 

What you can do:

• Empty bladder frequently even if you do not have the urge to void
• Use a squirt bottle to squeeze warm water over your perineum while voiding to help take away the stinging sensation
• Allow sink water to run; the sound of water may help the flow of urine get started
• Drink to thirst – 8 to 10 glasses of liquid per day (limit caffeinated drinks)
• Do Kegel exercises to help reduce incontinence (see section on exercises after child birth)

When to call your health care provider:

• If you have an oral temperature over 38°C, or chills
• If you are passing urine frequently but in small amounts
• If you have a burning pain when passing urine
• If you are unable to pass urine
• If you have difficulty starting or stopping urine
• If you have blood in your urine 

Bowel Movements / Constipation

Normal:

• You may not have a bowel movement for the first 2 to 3 days after childbirth
• Your first bowel movement may be uncomfortable; try not to hold back as this can cause hard stools (constipation)
• Some pain medications can cause constipation

What you can do:

• Drink plenty of fluids and fruit juice, and eat plenty of fruits, vegetables, and whole grain breads and cereals to prevent constipation
• Take stool softeners with phylum or natural fibres; they are available over the counter or can be prescribed by your health care provider; use for one week or as prescribed by physician
• Walking in the house can help to get the bowels moving and eliminate painful gas
• Clean the rectal area with a squirt bottle after each bowel movement; wipe from front to back

When to call your health care provider:

• If you haven't had a bowel movement by 5 days after childbirth
• If your bowel movements are painful and hard
• If you feel you need a bowel movement but can't

Hemorrhoids

Normal:

• Hemorrhoids can occur after childbirth from the pushing and increased pressure during childbirth
• Hemorrhoids can be painful and itchy
• Hemorrhoids usually shrink and become less painful a few days after childbirth 

What you can do:

• Avoid constipation (see above)
• Apply something cold to reduce swelling – use an ice pack or dampen and freeze a clean maxi pad and put the frozen pad in your underwear
• Take a warm shallow bath with enough water to cover your buttocks and hips (sitz bath) to reduce itchiness
• Avoid standing for long periods
• Use medicated pads or creams as advised by your health care provider or pharmacist
• Consider taking a mild pain medication 

When to call your health care provider:

• If your hemorrhoids become more painful or bleed
• If you have a foul smelling discharge
• If you feel your hemorrhoids are preventing you from having a bowel movement 

Afterpains / Cramping

Normal:

• After your baby is born your uterus will continue to contract until it returns to its original shape and size; some women may feel these contractions, while others will not
• Afterpains may increase with each pregnancy
• They should fade after the first few days after childbirth
• You may experience afterpains while breastfeeding 

What you can do:

• Place a warm water bottle on your abdomen
• Consider taking a pain medication
• Try relaxation and deep breathing  

When to call your health care provider:

• If the afterpains get worse
• If your abdomen is tender to touch or rigid
• If you have an oral temperature over 38°C, or chills 

Epidural / Spinal Site

Normal:

• You may have pain and swelling at the epidural / spinal site; it should only last a few weeks
• For the first day or two you may have pain or difficulty urinating if you were catheterized
• You may have temporary weakness or loss of balance while walking  

What you can do:

• Apply icepack to area
• See Urination section above for what you can do if you have difficulty urinating 

When to call your health care provider:

• If you have persistent or increased pain at epidural / spinal site
• If you have persistent difficulty urinating
• If you have persistent weakness or loss of balance
• If you have headaches
• If you have an oral temperature over 38°C, or chills 

Back and Hip Pain

Normal:

• In preparation for childbirth, hormones caused the ligaments and cartilage of your pelvis and back to soften; this may cause some discomfort during pregnancy and after childbirth
• For days or weeks after childbirth, you may have lower back pain from the baby pressing against the tailbone during delivery; if a woman’s tailbone was fractured during delivery, it may take weeks to months for it to heal
• You may also have hip pain from the delivery for a few days or weeks after childbirth

What you can do:

• Consider taking pain medication
• Try sitting on a partially inflated donut shaped pillow
• Apply ice to the area
• Don’t bend over to lift - use legs to lift
• Change position regularly 

When to call your health care provider:

• If the pain interferes with your ability to walk or roll over 

Breasts

Normal:

• Whether you are breastfeeding or not, your breasts will start to produce milk on the 2nd to 4th day after childbirth; they may become very full, sore and hard 

What you can do:

• Wash breasts daily – avoid using soap
•  If you are breastfeeding:
• Feed the baby at least every 2 to 3 hours
• For information on what a good latch looks like and sounds like, click here to link to Dr. Newman’s Video Library
• For more information on breastfeeding click here to link to “Breastfeeding Your Baby”, a resource developed by the City of Toronto 
•  If you have been breastfeeding and need to stop suddenly:
• Apply ice packs or cabbage leaves to your breasts for 20 minutes at a time
• Wear a bra that supports well
• You can express enough milk to feel comfortable several times throughout the day; by expressing milk less and less often, your milk supply will slowly decrease
• Drink to thirst
• Avoid salty foods
• If you plan not to breastfeed at all:
• Try ice packs or cabbage leaves for 20 minutes at a time
• Wear a bra that supports well
• Do not empty or pump your breasts, as this will cause more milk to be produced
• Drink to thirst
• Avoid salty foods 

When to call your health care provider:

• If you have an oral temperature over 38°C, or chills
• If your breast has a localized area that is hard, red or painful for more than 24 hours and is not helped by breastfeeding, pumping, massaging or changing nursing positions 

Faintness / Swollen Feet or Ankles / Night Sweats

Normal:

• During pregnancy, your body stores extra fluids; after childbirth, your body gets rids of this extra fluid; it takes a while for your cardiovascular system to adjust
• You may feel faint for a day or two after childbirth
• You may have swollen feet or ankles or have night sweats for a few weeks  

What you can do:

• Do not restrict fluids, drink to thirst
• For faintness:
• Don’t change your position quickly – e.g., getting out of bed, getting up out of a chair
• For swollen ankles and feet:
• Put your feet up on a stool as often as possible
• Avoid crossing your legs when sitting or standing for long periods
• Avoid ankle or knee socks
• For night sweats:
•  Wear cotton clothing  

When to call your health care provider:

• If the faintness last longer than a few days, you may need to be checked for anemia
• If one foot is swollen more than the other
• If swelling increases and extends up the leg past the ankles
• If you have a red or painful lump in your calf

Reference: 

Murkoff, H., Eisenberg, A., & Sandee, H.  (2002). What to expect when you’re expecting.  New York:  Workman Publishing.

 Lalonde, A. B., and Schuurmans, N.  (2006). Healthy Beginnings: Your handbook for pregnancy and birth, 3rd edition. The Society of Obstetricians and Gynaecologists of Canada and Best Start.

 Calgary Health Region. (2004). From Here Through Maternity. Calgary: Print West Calgary.

 Simkin, P., Whalley, J., Keppler, A. (2001). Pregnancy, Childbirth and the Newborn: The Complete Guide. New York: Meadowbrook Press.