Post Partum Instructions

Congratulations! Please take the time to read over these important instructions to assist you in caring for yourself and your new baby. It's normal to feel a little overwhelmed at this time. If you have additional questions or concerns after reading this pamphlet, call the office at (214) 823-7900.

Upon discharge from the hospital:

Please call the office as soon as you are discharged from the hospital to set up your postpartum exam. If you had a vaginal delivery, please make your appointment for 6 weeks after your delivery.

FOR PATIENTS OF DR. BROTHERS OR DR. FIELDS: If you had a cesarean section with staple closure, please make your first appointment for one week after delivery and then return at six weeks. If you have suture closure, you may come at two weeks and then again at six weeks. You may make the 1^st appointment with the nurse practitioner.

FOR PATIENTS OF DR. CROCHET: If you had a cesarean section with staple closure,please make an appointment for staple removal only, for one week after delivery. You will then make an appointment at four weeks after delivery. Patients with suture closure may call for a four week appointment.

Care of episiotomy or vaginal laceration repair:

You may have stitches to your vaginal or rectal area after your vaginal delivery. Keep this area clean by using a squirt bottle of cool to warm water after each bowel movement or void. You may then gently pat the area dry. The stitches will dissolve on their own. If you have discomfort, you may perform sitz baths (soak in 2-3 inches of warm water only for about 15 minutes up to 3 times daily). Avoid the use of bath oils, lotions or creams. You may use a product such as Dermaplast spray after each pad change. Ibuprofen or Tylenol can be used for pain as well. It is also a good idea to keep your stools soft by eating a fiber filled diet, increasing your fluids, and even using an over-the-counter stool softener (Surfak, Colace) if needed. Try not to sit for long periods of time as this may increase the pressure to your perineal area, causing increased pain and discomfort. If at any time you have a fever (temp greater than 100.5) or increased pain in spite of taking your pain medication, or a foul smelling vaginal discharge, call the office for evaluation.

Care of Cesarean incision:

Keep your incision clean and dry. Regardless of if you have stitches or staples, you may shower and gently cleanse your incision. After showering, you may thoroughly pat the incision dry and then use a hairdryer on the cool setting to ensure that the area is completely dry. You may leave your incision open to air as often as possible. When needed, covering the incision with light gauze is acceptable. You may notice a small amount of clear to slightly bloody discharge from the incision. If at any time you notice a foul smelling or a thick discharge from the incision, or notice swelling or increased redness around the incision (especially if you have a fever), please call the office.

Vaginal Bleeding (lochia):

Bleeding like a heavy period is normal for up to two weeks after delivery (vaginal or cesarean). It usually tapers off to a brownish then yellowish to clear discharge over the course of 6-8 weeks. You may notice increased bleeding after breastfeeding or increased activity. You may also notice some small clots occasionally, especially in the first two weeks. If at any time the clots are combined with heavy flow (enough to soak a pad in less than an hour for greater than 2 consecutive hours), please call to alert the office. Remember to check your uterus for firmness frequently during the first few days. If you note that the uterus feels mushy or soft, massage it until you feel it become firm. This keeps the uterus contracted and helps to keep blood loss to a minimum. You may notice a gush of blood after massaging the uterus (this is normal). The uterus should quickly firm up and the blood flow should decrease.

Other tips and suggestions:

- GET PLENTY OF REST!! Nap when the baby naps. We know that you hear this from everyone (because it really is necessary).

- Keep visits from friends short. If they offer to help, give them a specific job (grocery shopping, laundry, sweeping, watching the baby while you nap) - they really do want to help.

- Get a small amount of exercise daily. A short walk is helpful both physically and emotionally-take care of yourself. Please avoid any strenuous exercise until after your six week postpartum appointment.

- You may drive 1-2 weeks after your baby is born as long as you are no longer taking prescribed pain medication.

- Place nothing inside of the vagina for 6 weeks. Please wait to resume tampon use and sexual intercourse until after your six week exam.

- You may notice some emotional ups and downs for the first few days, but if you can't sleep, or are depressed for more than three days, or feel you can't take care or yourself or the baby, call the office so we can help you.

Breastfeeding:

Newborns usually nurse every 2-3 hours for the first few weeks. Try to alternate the breasts and adjust the baby's position to avoid sore or cracked nipples. Keep the breasts clean and dry between feedings. Allowing the breasts to sit against a wet bra or pad can lead to a painful yeast infection. Remember that it can take a few weeks for both you and the baby to become comfortable with nursing. If you have questions or needs please refer to your list of breastfeeding consultants, or call the office for referrals. Continue your prenatal vitamins while nursing. Your baby should be wetting 6-8 diapers daily by one week of age. If breastfeeding, stools will likely be loose and have a seedy yellow appearance-this is normal. Wear a comfortable and supportive bra at all times. Your milk will likely "come in" by the third day post delivery-this will cause the breasts to feel firm and hard (you may even feel some hardened ducts). Emptying the breast frequently by nursing or pumping will give you comfort (and help to increase your milk supply). If at any time you notice redness or red streaking on your breasts or clogged ducts that will not go away with increased feeding or pumping, especially if accompanied by a fever and pain, please call the office for directions.

Bottle feeding:

If you choose to bottle feed, your breasts may become engorged. To help with this complaint, wear a snug fitting, supportive bra. You may use ice packs to the breasts as needed, or cabbage leaves soaked in cool water may be applied to the breasts throughout the day. Change them as they become wilted. Tylenol or ibuprofen can be helpful as well. Just as with breastfeeding, you should expect your infant to wet 6-8 diapers daily. Formula fed infants will have darker stools with a stronger odor-this is normal. You will also need to be on the watch for signs of mastitis (a painful infection of the breast). Call the office with report of redness to the breasts, fever or increased pain.

Circumcision:

If you have a male newborn and desire him to be circumcised, Dr. Brothers can perform this procedure. Please call as soon as you are discharged from the hospital and set up your appointment. The procedure is done approximately one week after delivery (depending on the weight and size of the infant). Dr. Crochet and Dr. Fields do not perform this procedure, but their patients can have the procedure performed by Dr. Brothers. Patients may speak with their pediatrician as well, as they often perform circumcisions also.