Pullman Regional Hospital

Breast Care

Non-nursing mothers: To avoid engorgement wear a very tight bra (heavy-duty sports bras work well) and avoid any breast stimulation (especially hot shower water pounding on breasts). If you become engorged, ice packs or chilled cabbage leaves in your bra about every 4 hours for 20 minutes at a time may help.

Nursing mothers: Avoid soap on nipples to keep them from drying and cracking. Be sure to wear a well-fitted, supportive bra for the sake of comfort. After nursing, wipe away baby's saliva, express colostrum or breastmilk and rub into nipples, then air dry. Be sure to check your breasts frequently for early signs of infection. Swelling, lumps, or warmth should be reported to your doctor.

Individual consultation with a lactation specialist can be scheduled at our BirthPlace Consultation Office by calling (509) 336-7401. There is a charge for this service. Call the BirthPlace at (509) 336-7401 for urgent problems.

Cesarean Section Care

Be sure to keep your incision clean and dry at all times. If it is in a fold of skin, lie down after your shower and expose it to air, or blow dry on low until dry. Be sure to observe incision daily for signs of infection such as redness, discharge, or separated edges. Notify your doctor immediately if you think an infection may be present. Activity is limited after your surgery so be sure to follow the advisement of your doctor. If you have ongoing feelings of disappointment or depression due to your C-section, be sure to speak with a family member or an on-staff nurse or doctor.

Constipation and Hemorrhoids

You can expect a bowel movement two to three days after delivery. To encourage this, be sure to eat a high fiber diet and drink three to four quarts of fluids each day. Additionally, use a stool softener as directed. Tucks pads (witch hazel compresses) may be soothing against hemorrhoids. Notify your doctor if you have not had a bowel movement by day four.

Diet, Drugs, and Fluid Intake

In order to appropriately feed both you and baby, be sure to eat a balanced diet according to the food pyramid (6-11 servings of grains, 3+ servings of vegetables, 2+ servings of fruits, 4 servings each of milk products and meats/dried beans). Breastfeeding moms need about 500 extra calories each day so eat up! Diets containing less than 1800 calories per day are associated with decreased milk supply.

Drink enough fluids to keep from being thirsty, and to keep your urine pale, not dark yellow (about 2-3 quarts or liters a day). Limit caffeine and any medications, including over-the-counter medicines, unless approved by your doctor. Acetaminophen (Tylenol, non-aspirin) or ibuprofen (Motrin) may be taken if needed. Continue taking prenatal vitamins. Do not drive if taking narcotic pain medicines.

Emotional Adjustments

Expect to be unusually emotional the first 1-2 weeks after your baby is born-especially the day your milk comes in. You may wish to seek the advice of a counselor if you are feeling overwhelmed or are experiencing any of the following symptoms:

• Feelings of anxiety, depression, or inability to cope
• The "baby blues" lasting more than a couple of weeks making you feel very sad, hopeless, and depressed
• Excessive talking, worrying, or crying without being able to stop
• Extreme loss of appetite lasting more than a couple of days
• Inability to rest or sleep despite trying relaxation skills
• Inability to care for your baby or worries about harming your baby

Exercise

Within a day after a vaginal delivery you may begin gentle exercises for regaining your abdominal and pelvic floor muscle tone:

• Abdominal Bracing: Lie on your back with your knees bent up. Take a deep breath in through your nose. As you exhale slowly through your mouth, pull in your lower stomach muscle toward your spine.
• Pelvic Tilting: Lie on your back with your knees bent up. Tighten up your stomach muscles and roll your pelvis backwards, flattening your back against the bed. Hold this for a few seconds.
• Kegels: In any position, gently pull upward with your pelvic floor muscles, as if you were going to stop the flow of urine.

C-section:

• Huffing: Say "Ha, ha, ha..." loudly and briskly with a rapid inward pull of your stomach muscles. You may want to support your incision site with your hands.
• You may perform pelvic tilts and kegel exercises as explained above.

Questions or concerns regarding diastasis (separation of the abdominal muscles), pelvic ring pain, incontinence issues, or regaining abdominal/pelvic floor strength may be addressed by a physical therapist. Call Summit Therapy at (509) 332-5106 with further questions.

Laceration or Episiotomy and Perineal Care

You may want to use a squirt bottle filled with warm water each time you use the toilet until your bleeding has stopped and perineal pain is gone. Spray it over your bottom and pat dry gently from front to back to keep germs from the rectum away from your vagina, and to avoid irritating any stitches.

Look at your stitches daily using a hand mirror, and make sure the edges are together, and there is no redness or discharge. If they are separating or they are causing you have intense, persistent pain, call your doctor. The stitches will dissolve within 2-3 weeks and do not need to be removed.

Tucks pads (witch hazel compresses), warm compresses, or sitz baths in a very clean tub may be used several times a day to decrease discomfort.

Rest and Activity

It is important for you to rest frequently while your body heals. Try napping when baby naps, if possible.

Walking is fine, but avoid strenuous activity and lifting over 15 pounds until okayed by your doctor. Remember, if it hurts, your body isn't ready to do it.

Avoid tampons and sexual intercourse for 3-4 weeks, or until okayed by your doctor, and only when physically comfortable to do so. Talk with your doctor about prevention of pregnancy. Remember, there is a slight chance that you could become pregnant the first time you have intercourse after delivery.

Uterus and Lochia (Bleeding)

Bleeding will be bright red and heavy for the first 12 hours, then lighten up to a discharge similar to a menstrual flow. The first few days, blood will remain bright red then turn watery and pinkish-colored for another few days. By this time you can expect to have subtanitally less bleeding. By the end of the first or second week, the remaining discharge is usually brownish white. This discharge can last up to six weeks.

Flow will increase with activity, but if you notice bright red bleeding after the first few days, clots larger than a quarter, or you're soaking a pad more than every two hours after the second day, you should lie down. Check the firmness of your uterus; it should be firm as a coconut and be shrinking by about one finger width per day. If your uterus is soft, rub it until it becomes and remains hard. If heavy bleeding persists for more than 1-2 hours, report it to your doctor.Your flow should never have a foul odor-if it does you should report it to your doctor. Uterine cramping is normal, especially with second and more babies, or with nursing. Ibuprofen or Tylenol will usually control the pain.

Notify your doctor of the following:

• Temperature over 100.5
• Tender or painful breasts with warm red areas
• Painful area (hot, swollen, or red) in calf or thigh
• Pain or burning on urination, or inability to urinate
• Heavy bleeding (more than 1 pad soaked every 1-2 hours) or passing clots larger than a quarter
• Bad smell to lochia (vaginal bleeding)
• Vaginal discharge with pain or itching
• Increasing tenderness or pain on lower abdomen
• Intense vaginal or pelvic pain