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Post Partum Instructions
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Birthwise Community Clinic
207-647-5968 x108
 Bleeding
During the first day after the birth, your bleeding will be like a very heavy period. This
bleeding is called lochia. Your lochia will smell fleshy—like a period and you may pass clots,
especially if you have been lying down.
Call us if:
If you saturate more than 1 pad in an hour, try the following:
You fill more than 1
pad an hour.
You pass a clot larger
than the size of an
egg.
You notice a foul
smell.
If you develop a
fever.
You pass tissue into
your pad.
You start bleeding
heavily again after
bleeding has nearly or
completely stopped.
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Empty your bladder to help your uterus contract
Massage your uterus to make it contract
Nurse the baby to stimulate contractions
If the bleeding does not slow down, call us right away
Over time, your lochia will change in color. The color normally transitions from bright red—to
dark red—to brown—then finally, a pink, yellow and/or white color. While it is common for
women to experience bleeding for 2 to 4 weeks, this can vary from woman to woman and with
each birth.
If you suddenly become more active in the first few weeks after your baby is born, you may
notice a return to a heavier, darker, or bright red blood flow. This could be a sign that you are
attempting to be too active too soon.
Pelvic rest: To prevent a possible uterine infection, it is recommended that you do not insert
anything into your vagina, avoid intercourse, or do not immerse yourself in a bathtub until after
your bleeding stops. To monitor for possible infection, we ask that you check your temperature
once each day for 3 days after your baby is born.
Colostrum
 Breasts
Call us if:
Your breasts become
hot, red and or very
tender to the touch.
You feel achy all over
and are running a
fever.
Women produce colostrum during the last weeks of pregnancy and during the first few days
postpartum. Colostrum is produced only in small amounts, is golden in color and is rich in
protein, carbohydrates and antibodies—a substance which supports a healthy immune system. In
fact, colostrum is so rich in antibodies that the World Health Organization (WHO) often refers to
colostrum as “baby’s first immunization.”
Engorgement: Typically, around day 3 postpartum you will begin to produce significantly
more breast milk. When your milk “comes in”, your breasts may feel full, hard, and warm to
the touch. This is engorgement and it is generally relieved in a few days. In the meantime, try
nursing frequently, such as every 2-3 hours, warm showers, or heat to relieve discomfort.
Leaking/ let down: “Let down” occurs when the hormone oxytocin is released in your body and
helps your milk to flow. Some women can barely feel when let down occurs while others may
feel a tingling sensation in their breasts as the let down occurs. During let down, it is common to
have milk leak or drip down from one breast while nursing on the other.
Let down most commonly occurs during breastfeeding as the baby begins to nuzzle at the breast
Call us if:
Sore nipples are
preventing you from
nursing your baby
when you need to.
or suckle. However, some women experience let down when they hear a baby cry or sometimes
even during orgasm.
It can be helpful to wear nursing pads in between breastfeeding sessions to help draw the
moisture from breast leaking away from the skin and protect your nipples.
Sore nipples: Your nipples may become sore. To prevent or reduce soreness, make sure that
the baby is “tummy to tummy” with you while nursing, has his her or her mouth wide open when
latching on, and has most of your areola in his or her mouth. Try different nursing positions to
reduce pressure on any one area, allow your nipples to air dry after nursing, and apply lanolin or
Lansinoh to your nipples. Sore nipples usually improve over the first week or two postpartum.
Mastitis: Milk flows through “ducts” or channels through the breast. If milk does not flow well
or is clogged in a duct in can lead to pain and ultimately, mastitis—a breast infection.
Symptoms of mastitis include feeling achy all over, running a fever, and having one or both
breasts that feel hot, red or very painful to touch. If you have signs of mastitis call your midwife
right away.
 Afterpains
Call us if:
You are having
regular cramping that
seems more severe
than normal
afterpains, or that last
more than 4 days post
partum.
You may experience afterpains. These are usually strongest at 2-3 days postpartum and should
begin to subside after that. If you need relief, try one or more of the following:
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Motherwort tincture
Homeopathic Magnesia Phosphorica pellets
Keeping your bladder empty
Using a heating pad on your abdomen
Lying down on your stomach
If all else fails, take Tylenol (not aspirin).
For perineal soreness and/or hemorrhoids, try the following:
 Your
Perineum
Call us if:
You notice pus or
inflammation around
your perineal tear or
stitches.
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Herbal sitz baths
Apply witch hazel to a pad (these can be prepared ahead of time and frozen)
Rinsing your perineum with water while urinating to prevent stinging
Allow your bottom to be exposed to the air when possible
Stitches: The stitches used to repair a tear in your perineum dissolve on their own. This process
can take up to 4 weeks or longer. Good hygiene is important as the tear heals, so be sure to wipe
from front to back, and rinse your bottom with a peribottle or a sitz bath several times a day.
Activity: If your perineum has a tear that was not stitched, it is important to allow it to heal
properly. You can help this process by limiting your activity, particularly by keeping your legs
together as much as possible. Any activity such as taylor sitting and climbing stairs should be
avoided in the first 1-2 weeks after giving birth.
Infection of lacerations: If your perineum becomes swollen, red, oozes pus from a tear or has
a foul odor, call your midwife right away. These may be signs of an infection.
 Your Mood
Call us if:
You are experiencing
debilitating sadness
that is lasting longer
than 2 weeks.
You are not able to
sleep at night, even
when baby is
sleeping.
 Take Care of
Yourself
Call us if:
You need us to help
you arrange for the
support you need.
It is normal for women to feel sad or weepy for a short time during the postpartum period—
especially around the 3rd to 5th day after the birth. This is known as the baby blues. If this
happens to you, try the following:
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Have some extra help around the house
Take lots of naps
Eat really nutritious foods
Spend some time talking with your partner or a friend
Keep a journal of your thoughts or feelings
Sit outside for a while to enjoy some fresh air and sunshine
Ideally, these feelings would start to lessen day by day after this first week and would disappear
by around 2 weeks postpartum.
However, if these feelings are becoming darker and heavier as the days pass, if you are
experiencing debilitating sadness that is lasting more than 2 weeks, or have thoughts of
harming yourself or others, call your midwife right away. These could be signs of postpartum
depression which affects approximately 20% of women in the U.S.
Sleeping: Sleep is important for supporting your physical and emotional health. The best advice
that your midwives can offer you is to sleep whenever your baby sleeps during the first couple
of weeks.
Eating: Eat nutritious foods, including foods rich in fiber and fruits. This will help you
establish a healthy milk supply and keep your bowel movements soft.
Drinking: Drink lots of water to thirst throughout the day and night. Because it can be easy to
forget to take care of yourself when you are busy taking care of a newborn, try drinking at least 1
glass of water every time you nurse your baby. Drinking lots of water will support a healthy milk
supply and keep your bowel movements soft, as well.
Support: You should have someone with you for the first few days after your baby is born—
especially in the first 24 hours. Wake your partner up during the first 24 hours whenever you get
up to use the bathroom. It can be helpful to get support with meals, light housekeeping, and
errands so you can focus on your recovery and taking care of your baby.