Kristen Gleason

Postpartum Discharge Teaching

Changes in Your Uterus
Your uterus had become greatly enlarged to
your growing baby. Now that your baby
have been delivered, the uterus needs
its normal size. This process is called
and it occurs gradually over about 6-8
the first nine days after your baby has
born, you should be able to feel the
fundus, or the top of your uterus, as it
contracts to a smaller size.
It is important to regularly feel for the
fundus during the first week or so
postpartum. Use your fingertips to
gently press into the center of your
abdomen and locate the fundus. It
should feel firm, somewhat like a
grapefruit. If it feels soft, gently
massage it until you feel it become
again.

accommodate
and placenta
to return to
involution,
weeks. For
been

firm

You will probably experience some afterpains in the days after delivery. These are
cramping pains caused by your uterus contracting as it returns to a smaller size.
Women who have had children previously, or who have had twins or other multiple
births, may feel afterpains even more frequently. If you are breastfeeding, you may
notice afterpains occur more often when your baby has been feeding. This is due to
the release of the hormone oxytocin when your baby suckles, which causes your
uterus to contract. It may be uncomfortable, but it is helping your body return to its
pre-pregnancy state, and protecting you from bleeding heavily.
It may help to lie on your stomach with a small pillow under your lower abdomen
during afterpains. This puts pressure on your uterus and may intensify your pain for
a few minutes, but then will help relieve it greatly. Walking and taking ibuprofen or
acetaminophen will also help with afterpains. Talk to your healthcare provider before
using pain medications.

Lochia

Lochia is the normal discharge from the uterus following childbirth. It can take up to
6 weeks to completely stop, and will gradually progress from a heavier, bright red
flow to a light pink, then white color.
Days 2-3 after delivery: Lochia rubra, discharge is red, may be scant to moderate.
Heavy amounts (see image at right) should be reported as you may be bleeding
more than is desirable.
Days 3-10 after delivery: Lochia serosa, pinkish red or brown discharge, should be
lighter in flow
Days 11-14 up to 3-6 weeks after delivery: Lochia alba, creamy white or yellowish
You may see a few clumps, or clots, in your lochia during the first 2-3 days after
delivery. This is because blood pools in the upper portion of the vagina. Clots are
especially common after you have been lying down for a while. Lochia should not
contain large clots, so any clot approximately the size of a plum should be reported.
Breastfeeding may increase the flow of your lochia because it causes the uterus to
contract more frequently. You may also notice a heavier flow if you increase your
level of activity or overexert yourself.
If you have been having lighter lochia and it becomes heavier and a deeper color
again, please call your health care provider. You may need to decrease your activity
level, or she may need to be checked over.
Lochia should never have a foul odor. It will have a scent to it that may be similar to
that of your period, but with a slightly earthier smell. If you find the odor changes or
is unpleasant, please call your health care provider as this may be a sign of an
infection in your uterus.
Perineal Care
If you had a vaginal birth or pushed prior to a C-section, you will probably
experience some discomfort in your perineal (genital and anus) area in the weeks
following delivery. You may have had some tissue tearing or an episiotomy that
required you to have stitches. These stitches do not need to be removed; they will
gradually dissolve on their own. In the meantime, there are several things you can
do to help yourself heal as quickly as possible and reduce any discomfort you feel
during the healing process.
Use the plastic peri bottle provided to you to cleanse your perineal area each time
you use the bathroom. Fill it with warm water to a comfortable temperature, and
gently squeeze the water directly on your perineal area. You may find it helpful to
use the bottle while you are urinating, as well, but be sure to also use it afterwards.
Then, ensure your skin is dry by gently blotting the area from front to back with
toilet paper or a clean cloth.

Apply a clean, dry pad in your underwear each time you use the bathroom or
whenever you find your pad has become partly saturated. Changing your pad
frequently will help prevent infection.
If your perineal area is painful or swollen from lacerations or an episiotomy,
applying an ice pack may be helpful in reducing swelling and numbing the area. It is
safe to apply an ice pack wrapped in a washcloth directly to your perineal area for
about 20 minutes at a time. Remove the ice for 10 minutes, then reapply it if
desired. Be careful not to apply an uncovered ice pack to the area or leave it in
place for too long, as the cold can burn
your skin.
A sitz bath, pictured at right, may be
helpful to relieve your pain and promote
healing. A sitz bath is like sitting in a gentle
whirlpool for 20 minutes. You can use warm
water, which improves circulation and
promotes healing, or cool water, which
reduces swelling and decreases pain. Ice
can also be added to a cool sitz bath. Your
nurse can help you set up a sitz bath if you would like to try it, and you may choose
to continue sitz baths after discharge.
You can use topical treatments such as Dermoplast spray, Tucks pads, creams, and
foams to help with pain and encourage healing. Dermoplast spray contains lanolin
and aloe to moisturize the skin and help healing, and also contains Benzocaine,
which helps to numb the area. Tucks pads contain witch hazel, which is an
astringent, meaning it helps to shrink swollen tissue.
If you notice your perineal area becoming more swollen, more painful, or if you see
discharge or notice an offensive odor, please notify your healthcare provider. These
are possible signs of infection or poor healing that may require treatment.

Breast Care
If you are breastfeeding, you may
notice your nipples beginning to
become sore. This may be
because your baby is latching onto
only the tip of your nipples. A
proper latch will result in a large
amount of nipple in your baby's
mouth. Visiting with a lactation
consultant again after discharge
may help you and your baby find
breastfeeding success.
If your nipples are sore or cracked,
applying lanolin to them may be
helpful. You can also rub breast
milk over your nipples to help
them heal.
Wear a supportive bra when you are not breastfeeding. If you experience
engorgement (excessive breast fullness), applying a cool compress to your breasts
(20 minutes on, 20 minutes off) can provide some relief. You may also find it helpful
to hand express a small amount of milk between breastfeeding sessions. Avoid
pumping to relieve engorgement, since this will tell your body that the extra milk is
needed to feed baby. If you must pump to relieve the pressure, do so with a manual
pump or with your electric pump on a low setting for no more than ten minutes.
Breast pads or a perineal pad cut in half and inserted into your bra can help prevent
breast milk from leaking through your clothing. You may find it best to wear pads in
your bra at all times for the first few weeks. Keep your breasts clean and dry and
wash them with water only.
If you notice your breasts becoming extremely tender or warm to the touch,
swollen, or if you see a reddened area on your breast, you may be developing
mastitis, which is an infection of the breast tissue. Other signs of mastitis include
feeling sick, developing a fever, and pain while breastfeeding. Please call your
health care provider if any of these symptoms occur.
If you are not breastfeeding, you will also experience engorgement when your milk
"comes in" and until your supply diminishes. Engorgement is usually at its worst by
day four postpartum, and gets better by day 10. During this time, avoid any
stimulation of your breasts and nipples by your baby, yourself, breast pumps, or
your sexual partner. Stimulation will stimulate milk production and delay the
process of suppression of lactation. Also avoid heat; while showering, let the water
flow over your back instead of your breasts. Wear a support bra at all times except

while showering. Cold compresses and cabbage leafs can also help during this time
to promote comfort. Talk to your doctor about use of pain medications
(acetaminophen and ibuprofen) until suppression is complete.

Rest and Activity

After discharge, you can gradually increase your level of activity. Avoid heavy lifting,
excessive stair climbing, and strenuous activity.
It is important that you get as much rest as possible. Do not try to "do it all." Taking
one or two naps a day is essential - nap when baby naps,
and get help from family and friends with housework,
shopping, and meal preparation. You can begin light
housekeeping by the second week you are at home. If
you feel excessively tired or if your lochia flow becomes
heavier, this is a sign that you should increase your rest
and decrease your activity level.
You can return to your normal level of activity by about 4weeks after delivery, when the flow of your lochia has
stopped. If possible, delay returning to work until after
your final postpartum examination with your OB/GYN or
midwife. This will greatly reduce the chance of
complications.

Emotional Changes
Your hormones fluctuate greatly in the postpartum period, so a
wide range of emotions are possible after childbirth. These
emotional changes are normal. You may find that you experience
the "baby blues." This is characterized by periods of irritability,
crying more frequently, and mood swings. The baby blues
typically last about ten days. If symptoms worsen or last longer
than ten days, please contact your physician, as you could be
experiencing postpartum depression. It is also possible to
experience increased anxiety or even psychosis in the postpartum
period, so if you are experiencing significant changes in your
emotions, do not hesitate to call your healthcare provider. If you
find yourself unable to care for yourself or your baby, please seek immediate
medical attention.
Nutrition
You should eat a well-balanced diet to help your body recover and to promote
healing. If you are formula feeding your baby, you should return to your prepregnancy caloric intake. If you are breastfeeding, you should increase your intake
to 500 calories more than you consumed during pregnancy. Continue taking your
prenatal vitamin and your iron supplement until your postpartum checkup. If you
are breastfeeding, you may continue to take these supplements throughout
lactation according to your healthcare provider's direction.

Include foods high in fiber (aim for 20-30 grams of fiber daily) and
increase the amount of fluids you drink (try for two liters daily) to
help prevent constipation.

Sexual Activity
Until your lochia flow stops, you should refrain from vaginal intercourse, as your
cervix is not yet closed and you are prone to developing an infection in your uterus.
It is best to wait until after your 6-week postpartum checkup before having
intercourse. If there is any reason you should wait longer, your healthcare provider
can tell you at this point. You will also be able to use this time to discuss options for
contraception.
The first time you have sex after delivery, you may experience some discomfort due
to the healing process and vaginal dryness from hormonal changes. You may find it
helpful to use extra lubrication. Breastfeeding mothers may notice that arousal
triggers letdown of milk; it may help to feed your baby or pump prior to having sex,
or to wear a bra during intercourse.
Contraception
If you resume sexual intercourse before your postpartum checkup, please review
your options for contraception. It is possible to become pregnant again before your
menstrual period has returned. To avoid pregnancy, it is necessary to use
contraception even before your first menstrual period.

Works Cited
Davidson, M., London, M., & Ladewig, P. (2012).Olds' maternal-newborn nursing and women's
health across the lifespan. Pearson.