My Doctor Online The Permanente Medical Group

Staying Healthy After Pregnancy

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Avoiding exhaustion

Following the birth of your baby, your emotions might range from joy to sadness and every feeling in between. This roller coaster of emotions could be due to a number of different things: hormonal shifts; fatigue from labor, birth, and the hospital stay; possible anxiety about becoming a mother; and a variety of other factors. These can be different for every mother.

Following the birth of your baby, you will get less sleep and eat at odd hours. You may be at home more than you used to be. Because you will be focused on taking care of yourself and your new family, there are some things you can do to smooth your transition to parenthood:

• Turn off the ringer on your phone.
• Discourage visitors the first couple of days.
• Cook and freeze meals ahead of time.
• Have groceries on hand or find a grocery store that delivers.
• Find healthy take-out restaurants in your neighborhood.
• Arrange for a friend or family member to help with housework.
• Nap when your baby naps.
• Be patient with yourself, your family, and your new baby.

For now, your baby needs you for everything, but with time and patience, your baby will sleep through the night and grow more independent.

Diet

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A sensible, well-balanced diet will allow you to maintain your energy level and recover from childbirth. If you have prenatal vitamins or multivitamins, you may take these. If you are breastfeeding, you can continue taking prenatal vitamins once a day until you stop breastfeeding. Drink 8-oz glasses of water at least 8 times per day to prevent or relieve constipation. This also helps maintain your milk supply.

Many new mothers are eager to regain their pre-pregnancy shape, but it is important not to go on an extreme diet while you are breastfeeding. Eat sensibly. There will be time to lose weight later.

Exercise

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Give yourself some time to recover from childbirth emotionally and physically before you begin exercising. When your stitches from a vaginal birth or your incision from a cesarean birth have healed and you feel your energy coming back, you can begin to exercise again.

You may start exercises to improve the muscle tone of your stomach and abdomen about 2 weeks after a vaginal birth. If you have had a cesarean birth, you may start these exercises when your incision has completely healed and is no longer tender (usually about 6 weeks).

Start Kegel exercises soon after birth to help you regain vaginal and pelvic floor muscle tone. Kegels are performed by tightening your pelvic floor and vaginal wall muscles 100 times a day (10 sets of 10). You can start these exercises while you are still in the hospital.

Selecting an exercise program

Find a local postpartum exercise class that is taught by a certified instructor. Take the time to prepare for class so that you are not too rushed. Let your instructor know how recently you delivered and if you had a cesarean birth. Avoid sit-ups, squats, or any other exercise that strains your incisions or perineum for 6 weeks following delivery.

Some other things to keep in mind when starting an exercise program:

• If possible, keep your baby safely nearby.
• Always warm up and cool down slowly.
• Perform exercises slowly.
• Rest between exercises.
• Do not overdo it.
• Drink water often during exercise.

A Healthy Lifestyle

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If you are breastfeeding, avoid alcohol and other drugs unless they are prescribed. If you or someone in your family has a problem with alcohol or other drugs, please let us know.

If you quit smoking while you were pregnant, congratulations! It is important that you stay smoke-free so that you and your baby get the full benefit of all the hard work you have put in. Children of households with smokers have more ear infections, allergies, asthma, and lung problems. Do not allow others to smoke in the house or car and keep your baby away from all cigarette smoke. Your local Health Education Center has information and classes to help you or your partner quit or stay quit.

Get Your Pertussis Vaccination

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Whooping cough (also called pertussis) is a contagious disease that can spread easily from person to person through coughing. When babies get whooping cough, it can be life-threatening. You can protect your baby by getting a Tdap (tetanus, diphtheria, pertussis) vaccine before you are pregnant, during pregnancy, or after giving birth. Partners and families can be vaccinated at any time, but preferably before the birth of the baby so they don't infect their newborn. It is safe for mothers to get the Tdap vaccine while breastfeeding.

If you are not sure if you and your family members have been properly vaccinated against whooping cough, you can find out by viewing your Preventive Services online through my home page or by contacting my office.

Benefits of Breastfeeding

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Breast milk is the perfect food for your baby. There are many health benefits for you and your baby. According to the American Academy of Pediatrics, breast milk is the only food that your baby will need during the first 6 months of life. We recommend that you continue to breastfeed your baby for up to 1 year if you are able to. Even after you introduce solid foods, you can continue breastfeeding for as long as you wish.

Breastfeeding decreases your baby's risk for many types of infections and allergies. Benefits include:

• Fewer ear infections
• Less risk of respiratory infections and asthma
• Fewer urinary tract infections
• Less diarrhea and constipation
• A lower chance of childhood obesity
• A lower risk of certain childhood cancers
• Improved development of the baby's immune system
• Better digestion
• Improved brain growth

Benefits to you may include:

• More rapid recovery from your delivery
• Decreased blood loss after delivery if you breastfeed immediately after the baby is born
• More rapid loss of pregnancy weight
• Increased sense of well-being
• More opportunity for mother-baby bonding
• No need for preparation, heating, refrigeration, or sterilization of breast milk and a significant cost savings when compared to formula

There are rare medical conditions where breastfeeding is not advised. We can talk further if this applies to you.

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Baby Blues and Postpartum Depression

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It is important to know the difference between the "baby blues" (which pass on their own) and postpartum depression (which is a more serious condition). Almost all mothers experience baby blues, but if you think you may have postpartum depression, please talk to us right away. 

Baby Blues

The baby blues are common during the first 1 to 2 weeks after delivery and affect the majority of new mothers. They are caused, in part, by changes in your hormone levels after delivery. The baby blues usually start 2 to 3 days after delivery and can last up to 2 weeks. You may:

• Experience mood swings.
• Cry for no reason.
• Feel depressed, sad, or lonely.
• Feel anxious or restless.
• Feel irritable or angry for no reason.
• Have trouble sleeping or eating.

Self-help techniques

There are some things you can do to get through the baby blues:

• Get as much rest as much as possible.
• Turn off the phone.
• Put a do-not-disturb sign on the door when you are napping.
• Understand that it is normal for your baby to feed often during the night for the first 2 to 4 weeks at home and once or twice per night for the following months.
• Go outside. Take your baby for a walk.
• Talk with friends and spend time with your partner.
• Go to a support group for new parents.

Postpartum Depression

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Postpartum depression is more serious than the baby blues. It affects approximately 1 in 10 mothers in the first year after giving birth. It can occur after the birth of any child and can begin anytime, but usually symptoms begin 2 or 3 weeks after giving birth.

Women with postpartum depression have stronger feelings of sadness, despair, anxiety, or irritability. If left untreated, symptoms can get worse and may last for as long as a year. However, postpartum depression can be diagnosed and treated.

Risk factors for postpartum depression

Any woman who has had a baby within the past few months, miscarried, or recently stopped breastfeeding a child can suffer from postpartum depression. It can affect you regardless of your age, number of children, socioeconomic status, or educational level.

Postpartum depression is more likely to happen if you have experienced depression prior to pregnancy, or if you have undergone a recent stressful change, such as a change in job or relationship difficulty.

Symptoms of postpartum depression can include:

• Restlessness, irritability, or excessive crying
• An inability to sleep, extreme exhaustion, or both
• Unplanned or unexpected changes in appetite or weight
• Difficulty concentrating, remembering, or making decisions
• Feeling overwhelmed, inadequate, guilty, or worthless
• Excessive anxiety or worry
• A loss of interest or feelings of pleasure in activities
• Thoughts or worries that are difficult to control
• A fear of harming the baby or yourself

If you are experiencing any of these symptoms, please call us right away. We can help.

Treatment for postpartum depression

Postpartum depression can be treated successfully. It is treated much like other types of depression. Treatment options can vary depending on the type and severity of symptoms. The most common treatments for postpartum depression are:

• Psychotherapy/counseling
• Antidepressant/anti-anxiety medication
• Self-care
• A combination of these treatments

There are medications to treat postpartum depression that are safe for mothers who breastfeed. If you are breastfeeding, we can help you decide on the treatment option that is best for you.

Birth Control

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After your pregnancy, choosing the best method of birth control is an important decision. You have lots of options because there are many types of birth control. Your choice may depend on many factors, including whether or not you want to become pregnant again and considerations about sexually transmitted diseases.

Following childbirth, the size of your cervix has likely changed. If you were using a diaphragm or cervical cap before your pregnancy, you should make an appointment to see if your diaphragm still fits, or whether you should use a new size.

What to Expect After a Cesarean Section

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Your recovery

A cesarean section, or C-section, is surgery to deliver your baby through a cut (an incision) that the doctor makes in your lower belly and uterus. You will have some pain in your lower belly, and you may need to take pain medicine for 2 to 4 weeks. You can expect some vaginal bleeding for several weeks. You will probably need about 6 weeks to recover fully.

It is important to take it easy while the incision is healing. While you are recovering, avoid heavy lifting, strenuous activities, or exercises that strain the belly muscles. Ask a family member or friend for help with housework, cooking, and shopping.

Every woman recovers at a different pace. You can follow the steps below to get better as quickly as possible.

Activity

It is best to take it easy when recovering from a C-section, but it is not helpful to stop all activity. Of course, you will spend most of your time caring for your baby, but you will also need to rest when you feel tired and get enough sleep.

Try to walk each day. Start by walking a little more than you did the day before. Bit by bit, increase the amount you walk. Walking boosts blood flow and helps prevent pneumonia, constipation, and blood clots. Avoid lifting heavy objects or engaging in strenuous exercise, including sit-ups, for at least 6 weeks.

Hold a pillow over your incision when you cough, sneeze, or take deep breaths. This will support your belly and decrease your pain.

You may shower as usual. Let the water run over the incision and pat it dry when you are done. You will have some vaginal bleeding. Wear sanitary pads. Do not douche or use tampons until we say it is okay.

You will probably need to take at least 6 weeks off work. This depends on the type of work you do and how you feel.

Diet

You can eat your normal diet. If your stomach is upset, try bland, low-fat foods like plain rice, broiled chicken, toast, and yogurt. Drink plenty of fluids (unless we tell you not to) but avoid alcohol when you are breastfeeding.

You may notice that your bowel movements are not regular right after your surgery. This is common. Try to avoid constipation and straining with bowel movements. You may want to take a fiber supplement every day. If you have not had a bowel movement after a couple of days, ask us about taking a mild laxative.

Medicines

Take pain medicines exactly as directed. If you have a prescription medicine for pain, take it as prescribed. If you are not taking a prescription pain medicine, ask us if you can take an over-the-counter medicine.

Do not take two or more pain medicines at the same time unless your doctor told you to. Many pain medicines have acetaminophen (Tylenol). Too much acetaminophen can be harmful.

If you think your pain medicine is making you sick to your stomach:

• Take your medicine after meals (unless we have told you not to).
• Ask us to prescribe a different pain medicine.

If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.

Incision care

If you have strips of tape on the incision, leave the tape on for a week or until it falls off. Wash the area daily with warm water and pat it dry. Other cleaning products, such as hydrogen peroxide, can make the wound heal more slowly. You can cover the area with a gauze bandage if it weeps or rubs against clothing. Remember to change the bandage every day and keep it clean and dry.

Breastfeeding

If you breastfeed your baby, you may be more comfortable while you are healing if you place the baby so that she is not resting on your belly. Try tucking your baby under your arm, with her body along the side you will be feeding on. This is called the clutch or football hold. Support your baby's upper body with your arm. With that hand, you can control your baby's head to bring her mouth to your breast. Talk to a lactation consultant or your doctor for help with breastfeeding positions.

When to Call for Help

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You need to call 911 if you:

• Pass out (lose consciousness).
• Have severe trouble breathing.
• Have sudden chest pain and shortness of breath or cough up blood.
• Have severe pain in your belly.

Call us now or seek immediate medical care if you have:

• Bright red vaginal bleeding that soaks 1 or more pads each hour for 2 or more hours
• Vaginal bleeding that seems to be getting heavier or is still bright red 4 days after delivery
• Blood clots larger than the size of a golf ball
• Persistent, severe pain
• Loose stitches
• Red streaks leading from the incision
• Pus draining from the incision
• Swollen lymph nodes in your neck, armpits, or groin
• A fever
• Trouble passing urine or stool, especially if you have pain or swelling in your lower belly
• Nausea or vomiting or inability to keep fluids down
• Troubling or dangerous thoughts or sad, tearful, or hopeless feelings for more than a few days

Your Care with Me

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Please call our Appointment and Advice line right away if you have:

• Heavy vaginal bleeding
• Pain not relieved by the medications you’ve been prescribed
• Fever
• Breast redness or an unusual lump in your breast
• Moderate or strong feelings of depression

Your body will need to recover from labor and delivery. You should feel better and stronger each day, but it may take up to 6 weeks from the time you have your baby until you feel fully recovered. We will schedule a follow-up appointment sometime within the first 6 weeks after delivery.

During your first postpartum appointment

I will perform an exam to make sure you are recovering well from your delivery. We can discuss and arrange for birth control at this visit. We can also address any problems you may be having with breastfeeding, postpartum depression, or other issues.

Subscribe to our Healthy Babies newsletter. The newsletter is delivered to your e-mail in box each month, and has information and answers to common questions about newborn care and child development.

Start thinking about birth control. Though breastfeeding can suppress ovulation, it is not a reliable method of birth control. Before you resume sexual activity, consider your birth control options and make a plan that fits your lifestyle.

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Contacting Me

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You can connect with me in a variety of ways, depending on the situation and what is most convenient for you at the time. I am available online, by telephone, or in person.

• For nonurgent questions or concerns, you can e-mail me using this site. You can also book an appointment online to see me in person.
• If your concerns are immediate, or you simply prefer to use the telephone, please call our Appointment and Advice line, which is available 24 hours a day, 7 days a week. Our advice nurses can give you immediate advice, and our telephone staff can send me a message or book an appointment for you. 

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How We Coordinate Your Care

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Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting your care easier for you.

Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your care to stay current on your health status and to collaborate with each other as appropriate.

When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.

If you come to an office visit

• At the beginning of your visit, you will receive information about when you are due for your next test, screening, or immunization. We can discuss and schedule any preventive tests that you need. 
• At the end of your visit, you may receive a document called the “After Visit Summary” that will summarize the issues we discussed during your visit. You can refer to it if you forget what we discussed, or if you just want to recheck your vital signs and weight. You can also view it online under Past Visits.
• To help you prepare for your visit, please see additional details under Office Visit. 

If I prescribe medications

We will work together to monitor and assess how your medications are working and make adjustments as needed. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically in advance of your arrival at the pharmacy.

If refills are needed in the future, you can:

• Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
• Have them delivered to you by mail at no extra cost. Or you can pick up your medications at the pharmacy. If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.

If lab testing or imaging is needed

For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, we will schedule an appointment with the radiology department. When the results are ready, I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.

If I refer you to a specialist

My specialty colleagues are readily available to assist me if I need additional advice about your condition. In some cases, I may contact them during your visit, so we can discuss your care together. If we decide you need a specialty appointment after that discussion, we can often schedule it the same day or soon thereafter.

If you are due for preventive screenings or tests

As part of our commitment to prevention, additional members of our health care team may contact you to come in for a visit or test. We will contact you if you are overdue for cancer screenings or conditions which may require monitoring.

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Convenient Resources for You

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As your personal physician, I have a goal to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.

My Doctor Online is available 24/7 so that you can access and manage your care where and when it is most convenient. From my home page you can:

Manage your care securely

• View and compose secure e-mail messages.
• Manage your prescriptions and schedule appointments.
• View your past visits and test results.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.

Learn more about your condition

• Read about causes, symptoms, treatments, and procedures.
• Find interactive health tools, videos, and podcasts to help you manage your condition.
• View programs to help you decide on or prepare for a surgery or procedure.

Stay healthy

• Locate health education classes and support groups offered at our medical center.
• Explore interactive programs, videos, and podcasts that focus on helping you stay healthy.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.

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