Postpartum

Life goes on after you’ve had a baby. Here are few things to think about.

Recovering from Birth

Depending on what happened to your bottom during delivery, the recovery time may differ. If you had a spontaneous vaginal delivery and had no tears, the soreness you feel is probably general muscle fatigue and strain of your pelvic floor muscles. This pain should resolve with Tylenol or ibuprofen and a few days’ rest. Many mothers feel sore the first few days after, but by their first visit in the office at week one, they say they feel perfectly fine down there.

If you had a tear during your delivery, this is a different story. Depending on where the tear was and how deep it was, you will have a longer healing period.

  • If the tear was near your urethra, where urine comes out, it may burn while you pee for a few weeks.
  • If the tear was part of your perineum or the posterior portion of the vagina you may have pain with bowel movements for a few weeks.

Any tear and repair that you undergo as a result can take anywhere from two to six weeks to heal. The suture we use to repair that tear will usually dissolve within that time frame as well.

For the most part when women come back for their six week postpartum visit, their symptoms from any tears they had have resolved or are close to resolving. Exceptions to this may be a third or fourth degree tear, which occurs when the tear extends into the anal sphincter or rectum. Talk to your doctor about how extensive your particular tear and repair was for more specific expectations of the healing and recovery process.

Birth Control

We ask about birth control right after you delivered your baby because your uterus needs time to heal after delivery, whether it was a vaginal or Cesarean birth. If you want to get pregnant in the future, we recommend that the uterus has at LEAST a six month period to heal with no pregnancy, with the optimal time frame being 18 months. This waiting period decreases your risk in the following pregnancy of preterm labor, low birth weight, uterine rupture if attempting TOLAC, and a few other outcomes. It also promotes ideal spacing of children so that your first child is independent, becoming potty trained, and less needy by the time the next child arrives.

There are lots of choices for birth control postpartum. For most women, the most appropriate birth control choice is one of the long-acting reversible contraceptives (LARCs). The LARCs include the hormonal IUDs (Mirena, LILETTA, or Kyleena), the copper IUD (ParaGard), and the implant (NEXPLANON). These methods are the most effective, have the highest success rate (as much as 80 times more effective than the pill), have the lowest side-effect profile and lowest complication rate, and the highest patient satisfaction rates. They also don’t interfere with breastfeeding, and they will protect you for 3-10 years depending on which LARC you choose. All of them are immediately reversible if you want to get pregnant, and none of them decrease your chances of pregnancy in the future.

There are lots of choices for birth control postpartum. We talk about birth control choices in three tiers. Tier 1 choices are most effective, while Tier 3 choices are least effective.

Tier 1

  • Intrauterine Devices (Mirena, LILETTA, Kyleena, ParaGard)
  • Implant (NEXPLANON)
  • Sterilization (female and male)

Tier 2

  • Combined oral contraceptive pills (OCPs – “The Pill”)
  • Birth control vaginal ring (NuvaRing)
  • Birth control patch
  • The shot (Depo-Provera)
  • Minipills (progestin-only pill)

Tier 3

  • Condoms
  • Withdrawal method
  • Spermicides
  • Fertility awareness-based methods or natural family planning (NFP)
  • Sponge
  • Diaphragm

When picking a birth control method, ask these questions:

  • How well does the method work?
  • Can I use it while breastfeeding?
  • Will it affect my ability to breastfeed?
  • How soon can I start it?
  • How well do other women like it?

The above chart answers these questions for you. Notice that aside from male sterilization methods, the hormonal IUDs are associated with the highest efficacy and highest patient satisfaction rate. This high rate of patient satisfaction reflects a low rate of complications and side effects. The Tier 1 methods in general are the best choices, with the lowest rates of unintended pregnancies, highest continuation rates, highest patient satisfaction rates, and lowest side-effect rates.

None of the Tier 1 methods interfere with breastfeeding. Though the IUDs and implant can be started immediately after delivery, not all hospitals in the United States don’t offer this choice; most women still get them in the office four to six weeks after delivery.

There is a myth that combination birth control pills can’t be used with breastfeeding because either they will diminish milk volume or because the hormones will pass through the breast milk and affect the baby. Neither of these things are true. However, because the systemic hormones in the pill, patch, and ring can increase your risk of blood clots, they shouldn’t be started immediately postpartum. If you want to take a pill form of birth control, you typically will start that after you are six weeks postpartum. Remember though, the actual failure rate of Tier 2 methods like the pill, patch, and ring is 8.4% per year of use.

For more information and pros and cons of each method, read here for more.

Postpartum Blues/Depression

A lot of women struggle after their baby is born, and that is completely okay! Even though having a new baby is super exciting, it can also be overwhelming, stressful, and tiring! It’s important to distinguish between baby blues and postpartum depression or other mood disorders like anxiety. Baby blues are common and get better without treatment, but postpartum depression (PPD) can be very serious and usually needs treatment of some form.

Before you leave the hospital, your doctor or nurse should discuss your mood with you. It may be that you are doing great before you leave the hospital and when you get home, some mood changes arise. If these mood changes become overwhelming, you should call your doctor or midwife immediately. You’ll be asked about your mood at your one to two weeks and six weeks postpartum visits as well. They can identify whether what you are experiencing is the relatively typical baby blues that should resolve in a few weeks or the more serious condition of postpartum depression that may require medication management or therapy (or both). In rare cases, some women may have postpartum psychosis. This is a serious and treatable condition. If you ever have thoughts of hurting yourself or your baby or if you find yourself hearing or seeing things that aren’t there, call your doctor immediately or call 911.

The management for postpartum depression is similar to general depression. We can try therapy and/or medications. If you discuss medications and decide that you want to try them, it is important that you know there are many medications that are safe for breastfeeding. These medications are usually used for about six months and then reevaluated. Never hesitate to discuss your mood with your doctor or midwife. Together, the two of you and your support system (family, friends, etc.) can come up with a plan to help you get to feeling better.

Planning for the Next Baby.

Here some common postpartum questions: