Your baby's descent

The descent may be rapid. Or, especially if this is your first baby, the descent may be gradual.

With each contraction, the force of your uterus – combined with the force of your abdominal muscles if you're actively pushing – exerts pressure on your baby to continue to move down through the birth canal. When a contraction is over and your uterus is relaxed, your baby's head will recede slightly in a "two steps forward, one step back" kind of progression.

Try different positions for pushing until you find one that feels right and is effective for you. It's not unusual to use a variety of positions during the second stage.

The first glimpse

After a time, your perineum (the tissue between your vagina and rectum) will begin to bulge with each push, and before long your baby's scalp will become visible – a very exciting moment and a sign that the end is in sight. You can ask for a mirror to get that first glimpse of your baby, or you may simply want to reach down and touch the top of his head.

Now the urge to push becomes even more compelling. With each contraction, more and more of your baby's head becomes visible. The pressure of his head on your perineum feels very intense, and you may notice a strong burning or stinging sensation as your tissue begins to stretch.

At some point, your caregiver may ask you to push more gently or to stop pushing altogether so your baby's head has a chance to gradually stretch out your vaginal opening and perineum. A slow, controlled delivery can help keep your perineum from tearing. By now, the urge to push may be so overwhelming that you'll be coached to blow or pant during contractions to help counter it.


 

After delivery: Now what?

After you deliver the placenta, your uterus should contract and get very firm. You'll be able to feel the top of it in your belly, around the level of your navel.

Your caregiver, and later your nurse, will periodically check to see that your uterus remains firm, and massage it if it isn't. This is important because the contraction of the uterus helps cut off and collapse the open blood vessels at the site where the placenta was attached. If your uterus doesn't contract properly, you'll continue to bleed profusely from those vessels.

If you're planning to breastfeed, you can do so now if you and your baby are both willing. Not all babies are eager to nurse in the minutes after birth, but try holding your baby's lips close to your breast for a little while. Most babies will eventually begin to nurse in the first hour or so after birth if given the chance.

Early nursing is good for your baby and can be deeply satisfying for you. What's more, nursing triggers the release of oxytocin, the same hormone that causes contractions, which helps your uterus stay firm and contracted.

If you're not going to nurse or your uterus isn't firm, you'll be given oxytocin to help it contract. (Some providers routinely give it to all women at this point). If you're bleeding excessively, you'll be treated for that as well.

Your contractions at this point are relatively mild. By now your focus has shifted to your baby, and you may be oblivious to everything else going on around you.

If this is your first baby, you may feel only a few contractions after you've delivered the placenta. If you've had a baby before, you may continue to feel occasional contractions for the next day or two.

These so-called afterbirth pains can feel like strong menstrual cramps. If they bother you, ask for pain medication. You may also have the chills or feel very shaky. This is perfectly normal and won't last long. Don't hesitate to ask for a warm blanket if you need one.

Your caregiver will examine the placenta to make sure it's all there. Then she'll check you thoroughly to spot any tears in your perineum that need to be stitched.

 

If you tore or had an episiotomy, you'll get an injection of a local anesthetic before being sutured. You may want to hold your newborn while you're getting stitches – it can be a great distraction. If you're feeling too shaky, ask your partner to sit by your side and hold your new arrival while you look at him.

If you had an epidural, an anesthesiologist or nurse anesthetist will come by and remove the catheter from your back. This takes just a second and doesn't hurt.

Unless your baby needs special care, be sure to insist on some quiet time together. The eyedrops and vitamin K can wait a little while. You and your partner will want to share this special time with each other as you get acquainted with your new baby and revel in the miracle of birth.

 

Why would I have a planned c-section?

Sometimes it's clear that a woman will need a cesarean even before she goes into labor. For example, you may require a planned c-section if:

•You've had a previous cesarean with a "classical" vertical uterine incision (this is relatively rare) or more than one previous c-section. Both of these significantly increase the risk that your uterus will rupture during a vaginal delivery.

If you've had only one previous c-section with a horizontal uterine incision, you may be a good candidate for a vaginal birth after cesarean, or VBAC. (Note that the type of scar on your belly may not match the one on your uterus.)

•You've had some other kind of invasive uterine surgery, such as a myomectomy (the surgical removal of fibroids).

•You're carrying more than one baby. (Some twins can be delivered vaginally, but most of the time higher-order multiples require a c-section.)

•Your baby is expected to be very large (a condition known as macrosomia). This is particularly true if you're diabetic or you had a previous baby of the same size or smaller who suffered serious trauma during a vaginal birth.

•Your baby is in a breech (bottom first) or transverse (sideways) position. (In some cases, such as a twin pregnancy in which the first baby is head down but the second baby is breech, the breech baby may be delivered vaginally.)

•You have placenta previa (when the placenta is so low in the uterus that it covers the cervix).

•You have an obstruction, such as a large fibroid, that would make a vaginal delivery difficult or impossible.

•The baby has a known malformation or abnormality that would make a vaginal birth risky, such as some cases of open neural tube defects.

•You're HIV-positive, and blood tests done near the end of pregnancy show that you have a high viral load.


 

C-section recovery: The first few days

What happens right before a c-section?

First, your practitioner will explain why he believes a c-section is necessary, and you'll be asked to sign a consent form. If your prenatal practitioner is a midwife, you'll be assigned an obstetrician for the surgery who will make the final decision and get your consent.

Typically, your husband or partner can be with you during most of the preparation and for the birth. In the rare instance that a c-section is such an emergency that there's no time for your partner to change clothes – or you need general anesthesia, which would knock you out completely – your partner might not be allowed to stay in the operating room with you.

An anesthesiologist will then come by to review various pain-management options. It's rare these days to be given general anesthesia, except in the most extreme emergency situations or if you can't have regional pain relief (like an epidural or spinal block) for some reason.

C-section recovery: The first two months

More likely, you'll be given an epidural or spinal block, which will numb the lower half of your body but leave you awake and alert for the birth of your baby.

If you've already had an epidural for pain relief during labor, it will often be used for your c-section as well. Before the surgery, you'll get extra medication to ensure that you're completely numb. (You may still feel some pressure or a tugging sensation at some point during the surgery.)

A catheter is then inserted into your urethra to drain urine during the procedure, and an IV is started (for fluids and medications) if you don't have one already. The top section of your pubic hair may be shaved, and you're moved into an operating room.

You may be given an antacid medication to drink before the surgery as a precautionary measure. If an emergency arises, you may need general anesthesia, which puts you at risk for vomiting while you're unconscious and inhaling your stomach contents into your lungs. The antacid neutralizes your stomach acid so it won't damage your lung tissue.

You'll probably be given antibiotics through your IV to help prevent infection after the operation. (Some practitioners give antibiotics after the surgery, but the newest recommendations require giving them before the surgery.)

Anesthesia will be administered, and a screen will be raised above your waist so you won't have to see the incision being made. (If you'd like to witness the moment of birth, ask a nurse to lower the screen slightly so you can see the baby but not much else.) Your partner, freshly attired in operating room garb, may take a seat by your head.

C-section recovery: Wound care

In rare circumstances, the doctor will opt for a vertical or "classical" uterine incision. This might be the case if your baby is very premature and the lower part of your uterus is not yet thinned out enough to cut. (If you have a classical incision, it's unlikely that you'll be able to attempt a vaginal delivery with your next pregnancy.)

Then the doctor will reach in and pull out your baby. Once the cord is cut, you'll have a chance to see the baby briefly before he's handed off to a pediatrician or nurse. While the staff is examining your newborn, the doctor will deliver your placenta and then begin the process of closing you up.

After your baby has been examined, the pediatrician or nurse may hand him to your partner, who can hold him right next to you so you can admire, nuzzle, and kiss him while you're being stitched up, layer-by-layer.

The stitches used for your uterus will dissolve in the body. The final layer – the skin – may be closed with stitches or staples, which are usually removed three days to a week later (or your doctor may choose to use stitches that dissolve on their own). Closing your uterus and belly will take a lot longer than opening you up, usually about 30 minutes.

After the surgery is complete, you'll be wheeled into a recovery room, where you'll be closely monitored for a few hours. If your baby is fine, he'll be with you in the recovery room and you can finally hold him. You'll receive fluids through your IV until you can eat and drink.

If you plan to breastfeed, give it a try now. You may find nursing more comfortable if you and your newborn lie on your sides facing each other.

You can expect to stay in the hospital for about three days. Your doctor will talk with you about your pain medication. Most use a patient-controlled anesthesia, through your IV, followed by pain pills as necessary when you're able to eat and drink.

For the full scoop on what happens after a cesarean, see our article on recovering from a c-section.

Baby Delivery Types

 

The delivery of a baby has been called one of life's most treasured events. In reality, while marking the event of a new life in the world, childbirth can also be painful and can bring the possibility of complications for both mother and baby. The delivery of a baby is a process that typically requires intervention from a healthcare professional as a method of guiding the mother through labor and delivery. The baby must also be monitored to ensure a smooth transition through labor, and there are several types of delivery that can take place.

 

Labor and Delivery

 

Labor is the period of time when a mother's body is preparing to deliver a baby. The muscles of the uterus tighten, producing contractions. At the same time, the cervix begins to widen, preparing an opening for the baby to come through. During a vaginal birth, the baby's head is typically down in this birth canal, and the mother pushes the baby out with each contraction. Several positions may be more comfortable for the mother, or give her better capabilities of pushing. A physician or nurse midwife works to guide the baby out as he is being delivered, and assists in delivering the placenta following the birth of the baby.

 

Assisted Vaginal Birth

 

There are times when assistance is needed for a baby to be delivered. The position of the baby as it is coming through the birth canal is not always in the best place for a smooth transition. If a mother has been trying to push the baby out for an extended period of time, or if the baby's head is down but is not facing a direction that will facilitate delivery, a physician may use tools to assist with a vaginal birth.

 Forceps are used to guide the baby's head out of the birth canal and to speed the process of delivery. Forceps have the appearance of large tongs, and a physician places one on either side of the baby's head while she is still in the birth canal. The physician then uses the forceps to pull down while the mother is pushing during labor. This process assists with delivery of the baby's head, allowing the rest of delivery to quickly follow. Forceps can leave bruising on the baby's head and face.

Vacuum extraction is another method of assisted delivery that can be used when a mother has been pushing for a prolonged period. A cap is placed on the baby's head while she is still in the birth canal, and suction is applied. While the mother pushes, the physician pulls with the suctioned cap to bring the baby's head down and out of the birth canal. A vacuum extraction can leave a bruise or swelling on the baby's head after delivery.

 If the vaginal opening is too small for the baby's head to pass through, the physician may perform an episiotomy. An episiotomy is the process of cutting an incision between the vagina and the perineum, thereby making a larger opening for the baby's head to pass. If left unchecked, a vaginal delivery without a large enough opening can lead to tearing of the skin. An episiotomy helps to prevent this from occurring and controls the size of the incision, which can reduce the amount of pain and scarring involved. The episiotomy is sutured closed after the delivery.

 

 

Vaginal Birth after Cesarean


Because a cesarean section involves cutting into the abdominal wall and the uterus, many women who have had previous deliveries with this method choose to have a cesarean section again for successive pregnancies. Another option of delivering a baby vaginally for a subsequent pregnancy is called vaginal birth after cesarean (VBAC).

Many women, after undergoing a long recovery process from a cesarean section, choose to try the VBAC method to ensure a shorter hospitalization and to avoid having surgery again. According to the American Congress of Obstetricians and Gynecologists, 60 to 80 percent of women who try a VBAC procedure are able to successfully deliver a baby vaginally. VBAC does have some risks associated with the method, and it is not a safe choice for all deliveries after a cesarean section. The process of cutting through the uterine wall during a cesarean section can weaken the structure of the uterus. If an attempt is made at a vaginal delivery following a cesarean birth, the act of pushing during labor can cause tearing in the uterine wall at the site of the previous surgery. Women who would like to consider a VBAC should discuss the options available carefully with their physician.


Complications


During labor, if a baby is showing signs of distress, there may be meconium noted in the amniotic fluid. Meconium is the first type of stool that is in the bowel of the baby during development. Meconium-stained fluid will appear dark green and requires assistance at delivery from trained healthcare providers. A baby may need suctioning of the airway immediately following delivery to ensure that none of the meconium is taken into the lungs during an initial breath.

A mother will wear a fetal monitor during labor, which allows a nurse to watch the baby's heart rate. At times, the heart rate of the baby may increase or decrease, especially during contractions. If the baby's heart rate slows considerably with each contraction, it is an indication that the baby may be in distress. The baby may need to be delivered more quickly, or healthcare personnel should be standing by to assist after the birth.

There are potential complications with all types of baby deliveries that can disrupt the health of both mother and baby. Fortunately, healthcare professionals are trained in discerning potential problems and acting quickly during circumstances that require intervention.

 

Caesarean Section

A caesarean section may be performed to deliver your baby if a normal delivery is considered impossible or too dangerous.

The Caesarean Section operation does not take very long (45-60 minutes), but the baby is delivered within the first 5-10 minutes. Small horizontal incisions are made in the mother's abdomen and the baby is removed.

Following delivery of the baby, the placenta is removed and the incision is closed carefully in layers of tissue. If the operation can be planned in advance, it may be possible to arrange for epidural anaesthesia, so that the mother remains awake throughout, but will be shielded by screening curtains from the operation. Where caesarean section is carried out as an emergency procedure, a general anaesthetic is necessary unless the mother is already having epidural anaesthesia.

A 'planned' caesarean means you know in advance that your baby will be delivered this way, and can prepare yourself.

The main reason for acaesarean section is that you or your baby are at risk. These situations include

Fetal distress

Labour is taking a long time

Pre-eclampsia

Cord Prolapse

There are many more reasons for a caesarean section aswell as those listed above

Episiotomy

This is an incision made through the perineum and the vaginal wall. It is done if the vaginal opening isn't stretching enough to let the baby emerge and it is likely to tear. A tear can be ragged and more difficult to repair than a short, straight cut of an episiotomy. A local anaesthetic is given to numb the area, unless the woman has had an epidural. The doctor will stitch the episiotomy and any tears in the cervix or vagina after delivery.

An episiotomy may be required if:

Birth is imminent and your perineum hasn't had time to stretch slowly.

Your baby's head is too large for your vaginal opening.

You cannot control your pushing and push gradually and slowly.

Your baby is in distress

You may require a forceps or vacuum delivery

Your baby is in breech presentation and there is a complication during delivery.

Forceps

Forceps are like metal tongs with two large spoon shaped edges that fit around the baby's head. They are inserted into the vagina to grip the baby's head and speed up delivery. This technique may be used if the baby's heartbeat slows down during a slow delivery of the head, or to ensure its safe delivery during a breech birth.

Forceps can reduce the need for caesarean section. It requires an episiotomy.

Forceps are used when the mother is unable to push because she has had an epidural injection or because labour is not progressing well or if the baby is in distress.

Forceps deliveries are becoming less common, as many doctors prefer the alternative technique of vacuum extraction which works in a similar way. Where delivery is delayed and the baby's head remains high up in the pelvic cavity, Caesarean section is likely to be considered a safer option.

Forceps can bruise your baby's head, and his/her head may appear elongated or an odd shape, but any bruising or swelling will usually subside within a few days and will have disappeared within a couple of weeks.

Ventouse - Vacuum Extraction

Vacuum extraction (ventouse) is a gentler alternative to forceps. It consists of a metal plate or cone-shaped cup of synthetic material. The suction cup is placed over the top of your baby's head and using an attached pump a vacuum is created. This instrument then becomes a handle which the doctor can use to rotate the head and pull while you push. Ventouse can bruise your baby's head, and his head may appear elongated or an odd shape, but any bruising or swelling will usually subside within a few days and will have disappeared within a couple of weeks. After the birth, the doctor or midwife will carefully stitch the episiotomy or any tear.

What if my baby has problems at birth?

If your baby has any problems at birth that require extra observation or a full-fledged resuscitation (or anything in between), your baby will be dried off and the practitioner will cut the cord. Your baby will then be placed on a radiant warmer in your birthing room. The warmer allows him to be left naked without getting cold so his medical team can do whatever is necessary to help him make the transition to life outside the womb.

 

If your baby needs further care after being stabilized, he may be taken to an intensive care nursery. But if he's doing well and needs no more assistance, he'll be swaddled in a warm blanket and brought to you so you can nuzzle, bond, and breastfeed.

What if I've had a c-section?

If you've had a c-section, your baby will be handed to a nurse or pediatrician as soon as she's delivered and taken to a radiant warmer. She'll be dried off, her mouth and nasal passages will be suctioned, an Apgar assessment will be done, and she'll get any other attention she might need.

In many hospitals, if your baby is doing well, she'll be swaddled in a warm blanket and brought to your partner, who'll be sitting by your head. Your partner can hold her while you're being stitched up, and you can admire and kiss your baby while you're still in the operating room.

Afterward, your baby will go to the recovery room with you. If you plan to breastfeed, this is a good time to start.

What tests will be done on my baby?

When your baby is 48 hours old, her heel will be pricked and a few drops of blood taken to test for phenylketonuria (PKU), hypothyroidism, and other disorders. All 50 states require newborn screening tests. Currently, the number and type of genetic and metabolic disorders routinely tested for vary from state to state, though there is a movement afoot to adopt a more uniform national policy.

If you live in a state that doesn't perform a test you'd like, you can pay for additional testing, but you may need to make arrangements ahead of time. (Talk to your caregiver or the provider you've chosen for your baby.) Frequently updated information is available from The National Newborn Screening and Genetics Resource Center.

If you and your baby leave the hospital within 24 hours of birth, you might be asked to return within the week to finish off the necessary testing. (Some signs of the conditions being tested for don't show up until your baby's second day of life or later.)

If you deliver your baby at home, ask your caregiver or pediatrician who will take care of this testing. Your baby's pediatrician might do it in the office or you may need to take your newborn to a local hospital, clinic, or health department. It's best to do this on day two or three, and no later than day seven.

Most hospitals routinely perform newborn hearing tests before your baby is discharged. In many states such testing is required by law. If screening for hearing loss is not done routinely wherever you give birth, request it.

The Centers for Disease Control, the American Academy of Pediatrics, the March of Dimes, and a host of other organizations all recommend that newborns be screened for hearing loss before they're a month old, preferably before hospital discharge. If you give birth at home, make arrangements so your newborn will get her hearing screened shortly after birth, and definitely before she's a month old.

If you need further information about newborn testing, your state's newborn screening program

can help you out.

If your HIV status is unknown, your baby's cord blood may be tested for the virus. (In some states, this is required.)


Will my baby get a hepatitis B shot?

Your baby should get his first dose of the hepatitis B vaccine before being discharged from the hospital. If you're a hepatitis B carrier or your status is unknown, your baby should definitely be vaccinated within 12 hours of birth.

Babies of mothers who are known hepatitis B carriers will also receive an injection of hepatitis B immune globulin (HBIG), which provides short-term protection, within 12 hours of birth. If your hepatitis B status is unknown, your blood will be drawn for testing, and if you're found to be positive, your baby should receive a dose of HBIG as soon as possible.

When are circumcisions done?

If you've decided that you want your baby boy to be circumcised (and aren't planning to have a ritual circumcision performed later), it's usually done a day or two after birth.

General Physiological Condition

The woman in labor goes through a tremendous amount of stress and strain. And it takes some time for her general condition to settle down to a normal state again.

Pulse Rate:

The pulse rate normally rises during the labor. It continues to be variable in the first two days after delivery, then comes back to normal on the third day. However, any pulse rate more than 100 per minute at any time should be investigated for fever or shock.

Temperature:

The temperature often becomes sub-normal immediately after delivery. This low temperature can cause the patient to shiver in an attempt to raise the body temperature again. It comes back to normal within 24 hours. On the third day, there may be a slight rise in temperature because of the letting down reflex of milk with a consequent mild engorgement of the breasts.

Changes in the blood:

Immediately after the delivery, there is a slight decrease in total blood volume due to dehydration and blood loss. This comes back to normal in 7 days. Hemoglobin stabilizes by the 5th day. WBC count which increases during pregnancy comes back to normal in one week. Platelet count and fibrinogen level however increases at around the 4th to the 10th day after delivery and then comes back to normal in about another 2 weeks.

Urinary Tract:

The urinary tract is placed under a lot of stress during labor. The bladder wall becomes edematous and swollen and the muscles of the urethra becomes loose and flabby due to stretching during the delivery. Pressure by the fetal head also tends to decrease the vitality of the bladder and the urethra. As a result there may be some difficulty in passing urine for the first 24 hours after the delivery.

But the muscle tone is regained in 1 - 2 days. There is an increased tendency to pass urine in the first two days to eliminate water retained during pregnancy.

Gastro-intestinal tract:

There may be increased thirst during the first few days after delivery since there is increased fluid loss in the lochia, urine and also in sweating. Constipation can occur as a result of dehydration. Pain from the episiotomy wound and general pain in the vaginal and perineal area can also contribute to constipation.

Weigth Loss:

A weight loss of about 4.0 Kg takes place at the time of delivery of the baby, placenta, membranes and liquor amnii. A further loss of about 3Kg takes place during the puerperium due to the elimination of water and decreased size of the uterus.

So, in a woman with a standard weight gain of 10Kg during pregnancy, there is a weight loss of 7 Kgs after delivery. She will thus have a net weight gain of 3Kg due to pregnancy.

The puerperium or the postpartum period is the period of time following the delivery of the child during which the body tissues, especially the reproductive system reverts back to the pre-pregnant state, both anatomically and physiologically.

The process of reversion of the genital organs is called 'involution'.

The puerperium or the postpartum period lasts for 6 weeks. It is divided into three phases:

Immediate Postpartum

: the 24-hour period immediately following delivery.

Early Postpartum or puerperium: upto 7 days.

Remote postpartum or puerperium: upto 6 weeks.

Anatomy of the Reproductive Organs Immediately after Delivery

The reproductive organs

respond to the end of the process of pregnancy and childbirth by an initial period of rest and then a gradual revert back to their normal pre-pregnancy state.

Uterus:

Immediately after delivery, the uterus becomes a hard, immobile structure located just above the pubic bone. It is about 20 cm in length and, in a woman of average height, will reach up to the umbilicus. It is slightly tender when palpated.

Inside the uterus, the site of attachment of the placenta becomes a small, raised, reddish region of only around 7 - 8 cms in diameter.

Cervix:

The cervix or the mouth of the uterus contracts less slowly than the uterus. Immediately after delivery it becomes an opening of about 2 - 3 cm in diameter with flabby, irregular edges. But at the end of 7 days, the cervical opening becomes much narrower and can admit just the tip of a finger.

Vagina:

After the delivery, the vagina is a loose canal stained with blood. It has flabby walls without much of the rugosity or irregularity normally present. But it heals quite rapidly and by the end of the week almost looks like its pre-pregnant state.

FUNDUS.

The condition of the uterus is assessed by evaluating the height and consistency of the fundus (the part of the uterus that can be palpated abdominally). Immediately after delivery, uterine contractions begin triggering involution. Involution is the process whereby the uterus and other reproductive organs return to their state prior to pregnancy. To properly palpate the uterus, the woman is positioned flat on her back (supine). The health care provider places one hand at the base of the uterus above the symphysis pubis (the interpubic joint of the pelvis) in a cupping manner (to support the lower uterine ligaments). Then, she presses in and downward with the other hand at the umbilicus until she makes contact with a hard, globular mass. If the uterus is not firm, light massaging usually results in tightening. Massaging of the uterus should not be so vigorous as to cause the mother pain. A mother who has had a cesarean delivery should be medicated, if possible, prior to assessment of the fundus; and the health care provider should use the minimal amount of pressure necessary to locate her fundus. The height of the fundus after the first hour following delivery is at the umbilicus or above it. Every day the fundal height decreases by approximately the width of one finger (one cm).


The fundal height may be palpated off of midline because of a distended bladder. If possible, the woman should be encouraged to empty her bladder prior to assessment of the fundus. A full bladder can prevent uterine involution.


A woman sometimes receives the medication oxytocin (Pitocin) after the delivery of the placenta. Oxytocin causes the uterus to contract and can decrease the amount of postpartum bleeding. The health care provider should assess the condition of the uterus frequently, and may need to massage the uterus gently to encourage its clamping down on itself, especially when oxytocin has not been given. If the uterus does not firm to gentle massage, then a clot may be present inside. Gentle pressure on the uterus following massage, and while simultaneously supporting the base of the uterus, may expel the clot.


If massaging the uterus does not result in a firming of the fundus, then the physician or nurse-midwife should be contacted immediately. The existence of severe atony or a retained fragment of placenta may result in excessive loss of blood.


VAGINAL DISCHARGE (LOCHIA).

The color and amount of vaginal discharge (lochia) is assessed by frequently removing the perineal pad and checking the flow of lochia after delivery. An excessive amount could be a sign of a complication such as clot formation or a retained portion of the placenta. The vaginal discharge is red for one to three days following delivery and is called lochia rubra. Between days two and 10, the discharge changes to a pink or brownish color and is called lochia serosa. The last phase occurs when the vaginal discharge turns white. This vaginal discharge is referred to as lochia alba and may occur from 10–14 days postpartum. The spotting can continue for another six weeks. It is common in mothers who breastfeed their babies. A constant trickling of blood or the soaking through of a perineal pad in an hour or less is not normal and should be further evaluated.


 

Postpartum care after hospital discharge

Ideal postpartum care would include several home visits by health care providers in the one to two weeks following delivery to assess the status of the mother and her family. This rarely happens in the United States, but follow-up phone calls by health care providers during the first week and a visit by the mother and baby to her physician or nurse-midwife one to two weeks after the birth are desirable.


Several problems that may arise during the postpartum period do not typically develop until after the new mother is discharged from the hospital. These include mastitis, endometritis, and postpartum depression.


MASTITIS.

Mastitis is an inflammation of the breast, usually caused by streptococcal or staphylococcal infection. It can develop any time a woman is breastfeeding, but usually does not occur before the tenth postpartum day. Symptoms of mastitis often mimic those of the flu, and include body aches and a fever of 101°F (38.6°C) or more. Mastitis is treated with a course of antibiotics, and women should begin to feel better within 24 hours of beginning the antibiotics. If this does not happen, the woman may need to be hospitalized for intravenous antibiotics.


Other measures that may help the mother feel better include bed rest for at least 24 hours, moist heat on the infected breast every two to three hours (when awake), acetaminophen for pain and fever relief, increased fluid intake, and going without a bra for several days. Mastitis does not contaminate the breast milk and the baby should continue to nurse from both breasts. If nursing from the affected breast is too painful, use of a breast pump or manual expression of milk may be needed to prevent engorgement and facilitate continued milk production.


ENDOMETRITIS.

Endometritis is an inflammation of the endometrium, the mucous membrane lining the uterus. It is usually caused by a bacterial infection. Symptoms of this infection include fever, abdominal pain, and foul-smelling vaginal discharge. Physical examination of the patient reveals a tender uterus. Endometritis is treated with a course of antibiotics and other care, including bed rest, acetaminophen for pain and fever relief, and increased fluid intake. Severe cases may require hospitalization.


POSTPARTUM DEPRESSION.

Postpartum depression may appear at any time during the first year after a baby's birth. It ranges in severity from mild, postpartum "blues" that last only a few days shortly after birth, to intense, suicidal, depressive psychosis. Not only does postpartum depression cause distress for the new mother and her partner, but it can also interfere with the new mother's ability to bond with her baby and to relate to any other children she may have.


Symptoms of severe postpartum depression or psychosis include insomnia, hallucinations, agitation, and bizarre feelings or behavior. Any new mother exhibiting signs of postpartum depression should be referred to mental health professionals, support groups, and/or new mother groups. Psychotropic medication is often helpful, as is psychotherapy. About 10% of cases of postpartum depression are caused by postpartum thyroiditis, a temporary inflammation of the thyroid gland that usually clears up spontaneously in one to four months. Whenever postpartum depression occurs, thyroid function should be tested to rule out hyperthyroidism or hypothyroidism as the cause of symptoms.

Sister Teresa, I have a Question, How can you type so much material in reply column, If you don't mind, what technique u will use to post so much material in all forums. It is interesting. U R a good mentor