1. ACTIVITY-

Basically, if it hurts, don't do it! The ligament relaxing hormones of pregnancy are still active, so avoid heavy lifting the first week or two. If you had a cesarean section, avoid driving; your reflexes will be slowed for 4-6 weeks. REST!! Take naps when the baby sleeps. Recruit any and all persons who are willing to help with household duties. Have only helpful visitors the first week, no "guests".

2. HYGIENE-

Bathing or showering is fine. It is OK to get water on a cesarean incision. Until the 4-6 week check up, no swimming pools or hot tubs, and no douching, as these can lead to infection. Sitz baths are beneficial for episiotomy healing as well as reducing hemorrhoidal discomfort. Tylenol and ice packs are helpful.

3. HEMORRHOIDS

These are quite common in pregnancy and are akin to varicose veins of the legs. They are aggravated by hard stools so have roughage ( fruits, vegetables, bran. etc.) with every meal. Keep well hydrated with 8-10 glasses of water a day. If this doesn't help, call me; I may be able to prescribe something for you.

4. BREAST CARE-

Nursing mothers - Breast enlargement will occur the 3rd or 4th day. Babies love to suck and some will do it all day if you let them. When starting to breast feed, the 1st day limit the time to 4-5 min. per breast and feed more often. Increase 1 min. a day to a maximum of 15 min. per breast. The baby gets the vast majority of the breast's milk in the first 7-8 min. (my wife rarely went beyond 10 min. per breast). It is not a capital offense to give an ounce or two of sterile water between feedings if it satisfies the baby. It can be helpful also to apply a cream to your breast after each feeding to prevent nipple cracking (petroleum jelly is inexpensive and works quite well for many women). Warm packs to breast may help milk flow easier and open the occasional clogged duct. The more fluids you drink the more milk you will produce. I recommend 2-3 quarts a day. You may eat any foods while breastfeeding. Continue your prenatal vitamins and be aware some medications are secreted in breast milk.

Non-nursing mothers- Wear a tight bra until the breast engorgement is gone. Apply ice to breasts. Express only enough milk to relieve pressure.

Flow usually returns within 6-8 weeks if you are not nursing. If you are nursing, menses may return in as early as 2 months, but typically does not resume until the forth month. YOU CAN BECOME PREGNANT AGAIN BEFORE YOU HAVE A PERIOD! Use appropriate precautions.

This is not recommended until your 4-6 week check up to avoid infection and injury to healing pelvic structures. If you are breastfeeding, prolactin, a hormone that is elevated with this process, suppresses estrogen secretion. Without estrogen, the lining of the vagina becomes thin and doesn't secrete lubrication very well. You may need a water soluble lubricant (K-Y) for the first four post-partum months; at that time prolactin returns to lower levels even if you are still breastfeeding. This is also why menses return later in women who are breastfeeding.

You have just been through a remarkable experience. You have a beautiful baby after 9 months of waiting. There is frequently an emotional high following the delivery, but then you may feel a bit of a let down. You are likely tired from being up with the baby. The new responsibilities of motherhood can seem overwhelming. There is a drastic change in your body chemistry, with an abrupt drop in the hormone levels of pregnancy. You may feel a little down, but you feel like you shouldn't be. THIS IS NOT UNCOMMON! It is universally accepted as a normal response to childbirth and usually passes in 2-3 days. If, in the remote possibility, you continue to feel poorly and especially if you are troubled with insomnia call me and we can talk about it.