Taking Care of Yourself at Home
In the first few days at home, get lots of rest and take care of yourself. Caring for your body during the grieving process is important for healing. Try to maintain consistent rest patterns and avoid increased work. Return to normal activity should be gradual, leaving non-essential things until you are feeling stronger. Check with your caregiver about when driving will be appropriate.
A full bladder may keep your uterus from contracting properly thereby increasing bleeding. Urinate often, particularly on the first day home. If you have difficulty, try pouring warm water over your perineum or urinating in the shower. If you have stitches, the water will relieve the burning caused by urine running over the stitches.
You may experience a period-like flow of bleeding. It may be relatively heavy and red on the first day but is expected to decrease in amount each day and stop around the tenth day. The flow may be red for two to four days, but usually it becomes brown or pink after the fourth day. If you are consistently saturating (wetting through to the other side) your pads in one to two hours on the first day or any following day, let your caregiver know.
A persistent red flow or sudden gush may be a warning sign that you are doing too much. If you have been lying down for a while, you may experience a heavy release of flow when you change your position to standing or sitting. A slight white or yellow discharge may be noticeable for three to six days afterwards. If a heavy flow persists, you notice a foul odor or your temperature is elevated, let your caregiver know.
Drink plenty of fluids, especially juices. Your bowels should move in a day or two. Prune juice is a natural laxative and may be taken to prevent constipation. After a caesarean birth, abdominal distention and gas (flatus) may be a problem because there is less than normal bowel activity after abdominal surgery. Ambulation and a hot water bottle can help alleviate these problems.
You may expect changes to your breasts in the first several days after delivery. You may experience some mild breast swelling. This swelling (engorgement) will pass in one to three days. During this time, wear a bra that fits well. Ice packs applied to the breasts several times a day for at least 20 minutes will help reduce the inflammation and increase your comfort. Mild pain relievers, such as ibuprofen or Tylenol may also help.
A certain amount of cramping is normal. Severe or persistent cramping in the first 24 hours may indicate that clots have accumulated inside the uterus. This is not uncommon. Sit on the toilet and massage your uterus firmly. This should expel the clots and relieve the cramping. Cramping may increase if you are too active, indicating that you may need to take it easier. Your caregiver may prescribe pain medications such as acetaminophen or ibuprofen to help relieve the cramping. A hot water bottle can also help ease the discomfort. Cramping will gradually decrease in intensity, but may last seven to ten days.
As you are trying to cope with your feelings of loss, you may not feel like eating very much. However, it is important to maintain a healthy diet so that you will have physical energy. Try to eat a balanced diet of protein, dairy, vegetables, fruit and grains at regular intervals, drink eight glasses of water daily and avoid caffeine and alcohol. Any weight reduction you experience should be gradual.
It usually takes four to eight weeks for periods to resume. Ovulation returns before menstruation, so you could become pregnant even if you have not had a period. Usually conception is not recommended until at least two cycles have passed since the delivery. Any plans for conception and contraception can be discussed with your caregiver.
Perform peri care with each pad change or whenever you go to the bathroom. Always wipe yourself from front to back to avoid bringing bacteria from the rectal area forward to the perineum. Peri care involves squirting warm water from a peri bottle over the vaginal opening. This care promotes cleanliness in the perineum, soothes tissues discomfort and helps to prevent infection.
Every individual reacts to loss in a unique way. Some experience intense feelings of grief while others experience feelings of numbness or less intense grief. You may experience many emotional changes during your postpartum period. You may find yourself feeling sad and crying at anything and everything.
Postpartum depression can be concerning after a pregnancy loss because while you are dealing with the normal physical and emotional changes you are also dealing with your grief. Grief includes feelings of depression. It may be a sign of postpartum depression if you experience symptoms that increasingly become more severe such as loss of appetite, insomnia, social withdrawal, lingering irritability/anger, chronic hopelessness, persistent anxiety/panic, overwhelming fatigue and the inability to concentrate and carry out daily activities. It is important that you contact your health care provider if you are experiencing any of these symptoms.
Often times, instructions are given to place nothing in the vagina for two weeks, which would require sexual abstinence as well as refraining from the use of tampons or douches. This two-week time period is usually suggested to allow time for all bleeding to stop and for stitches to heal. It is not unusual to have a decreased sex drive during this time. Reduced vaginal lubrication can be a problem eased by the use of KY Jelly or other water-based jelly. Never use Vaseline as a lubricant for intercourse. Check with your caregiver for more information about resuming sexual relations.
Any stitches you may have required are self-dissolving and no removal is necessary. Most of them are internal so you will not be able to see them. Ice is often applied to the vaginal area in the first 24 hours to decrease swelling. Warm soaks in a clean tub are soothing and promote healing. Be sure to ask your caregiver when tub baths are permitted. Your caregiver may prescribe perineal pads or a spray to soothe any vaginal or rectal discomfort. Witch Hazel compresses may also be applied for relief. If you had a caesarean birth and notice any drainage, swelling or separation at the edges of the incision line, report this to your caregiver.
The uterus can sometimes be felt as a hard size ball, midway between your belly button (umbilicus) and the pubic bone. Each day, it will become smaller and smaller until it can no longer be felt by around the tenth day. It may take approximately six weeks for the uterus to return to its normal size.
The uterus should be firm with moderate bleeding expected. Gentle massage, in a circular motion, over the uterus, should be performed if the uterus is not firm or if bleeding is excessive. Massage causes the uterus to become firm and assists in controlling bleeding. If the top part of the uterus (fundus) is very high or off to one side you may have a full bladder, which can interfere with effective massage.
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