Tips for the 1st few days post delivery


Shieva Ghofrany: [00:00:00] I haven't done a lot of baby stuff in these last couple weeks, so today I thought I would talk about what happens when you go home. I have done this before, but I just think there's a couple of little nitty gritty details that are valuable to hear over and over. And of course, if I'm not your doctor, ask your doctor. 

They might have different nitty gritty details of their own to tell you were different parameters of things that they are worried about or not. But when I send people home like I just did at the hospital and I did round. After a c-section of a very beautiful big baby with a big head of hair, I, I kind of go through a couple of the same things with almost everyone, with a couple of different changes just based on if you had a C-section or a vaginal delivery one. 

Let's talk physical first. What is very common when you go home is that the otherwise heavy period, like bleeding that you may have had at the hospital with an occasional clot may become heavier. Because you are more mobile, you're walking around more. Your uterus sometimes relaxes in response to you being more active. 

As I joke, you're in a bigger [00:01:00] cocoon. So if you all of a sudden go home, you were a little bit more active, you felt pretty good, and then you notice a big CLO come out alone, not followed by a lot of heavy bleeding, bashing out, the likelihood is you are okay. Now again, ask your doctor if they have different parameters, but I typically tell patients if it's one clot once that's. 

Without gushing blood afterwards, I dunno why I'm whispering. Gushing, then I'm not worried. But if you have repetitive clots or you are soaking through a pad every 30 minutes, that is our index. Four. Too much bleeding. Please call your doctor. And then she may say, come to the officer, go to the emergency room. 

Just depending on what's going on. But again, if it's followed on the heels of having just been very physically active, cuz you felt good, you took a long walk, you did a lot of laundry, things that I would tell you not to do anyway right away. That is sometimes your body's response. Why? We don't know. I think that many of us will surmise that it's because all of the oxygen is going to different parts of your body, like if you're exercising and so there's not as, Of everything going to your uterus. 

And so the ability of your uterus to stay [00:02:00] contracted is less so your uterus relaxes, fills up with the clot and then it squirts it out. So that's one is heavier bleeding. Two your feet, especially if this is your first baby, we'll get far more puffy and swollen than when you're at the hospital. You thought that baby came out, you're gonna lose weight, you're gonna get rid of all your fluid. 

No, no, sorry. Most likely for that first week or so, your feet will get more puffy and swollen. I used to joke that my feet were like, Not cankles cath ankles, but thank ankles, thigh, ankles. Not a great look. The best thing you can do is elevate them and hydrate, hydrate, hydrate, cuz basically all the fluid that was in your system is now seeping out of your blood vessels because your blood vessels are a little bit leaky and they get in, it gets into your tissue, so into your hands, your feet, your ankles. 

And that's what the swelling and edema is, what we call it is. So the best thing you can do is hydrate cuz the more you hydrate with. You will then mobilize the fluid back into your blood supply, which then gets filtered through your kidneys and peed out. That's kind of the easy way to describe it. Now, when would I be worried about swelling? 

I'd be worried if [00:03:00] swelling really doesn't seem to abate over a week or two. Or if it becomes sudden onset, not only your feet and your ankles, but people look at your face and say it's very swollen, or if it's associated with other symptoms of pre-eclampsia, one of which is the third thing that I tell people, which is a. 

It is very common to have a headache postpartum because your hormones have just taken a dip so much like right before your period where your estrogen levels drop and you get that pre period migraine, sometimes your all of a sudden drop in estrogen will potentially push the potato headache, especially if you're nursing. 

We notice that when women are latching again, a low estrogen state, they will sometimes have a terrible headache and almost like a shaking cold shill that will feel terrible, and that is often due to, again, the hormone shifts, especially. Actation Now, am I worried about that headache? Well, I typically tend to tell patients in the absence of having had high blood pressure or pre-eclampsia, I'm less concerned about it, but I would like it to be relieved by ibuprofen, Tylenol, or maybe even caffeine. 

And [00:04:00] if you try those things and it's not better, please call your doctor because it could be a sign of preeclampsia, postpartum even, especially if it's also bad headache not resolved. Also associated with, for example, edema or swelling of your ankles and feet and calves. So, headache, very common, shaking chills, very common. 

Try the ibuprofen, the Tylenol, and make sure you've tried some caffeine. If you're drinking caffeine, and that will often alleviate it. And if not, you call your doctor if that headache does not get better. And if the shaking chills are associated with a fever, a temperature, then you should also call your doctor boobs. 

Your boobs will hurt at some point, either. If you are not breastfeeding, then it will hurt because potential to fill up with milk, in which case you do not wanna shimmy those things around. You don't want any stimulation you want, you wanna basically, Things that will stop stimulation. Tight, tight bra, no touching, no hot shower. 

Some people will say cold cabbage leaves, frozen, cabbage leaves, or ice. If you are nursing, they might get engorged because all the milk is come in or because the baby's latching and the latch can hurt. So again, in those [00:05:00] cases, you want to make sure that you're having ibuprofen and that you are using heat. 

I would say lactation consultants sometimes say heat and cold, so you should listen to them because they have a lot of know-how. Um, but heat tends to soothe it and kind of dilate the blood supply and make things less engorged and less likelihood of mastitis. There's a little controversy in that. Again, should you use ice? 

Should you use heat? There's data on both sides of the map, so the truth is maybe both work. Talk to your lactation consultant or your doctor. What are the other things that happened to me, the emotional part. , you think you're gonna be filled with bliss because you've been waiting for this baby. Either it's your first spontaneous easy delivery. 

You were so happy, this was the best thing in the world. Everything. You went according to plan, or you've had losses, you've had challenges, and even more so than you think. I've wanted nothing more than to hold this little baby. And then you get home and you are filled. With a lay bile up and down where one minute you are on top of the world, this is the best thing ever. 

And two seconds later, you are weeping and crying in a puddle of tears for no apparent reason, and you have no ability to control it. And again, it's your [00:06:00] hormones and it's very natural and it's very normal. And please resist the urge to think that everything you see on Instagram where everyone says is perfect. 

Resist the urge to think that's true. Resist the urge to listen to your friends who might be either unicorns or liars and tell you that every moment postpartum is bliss, especially three in the morning when you are nursing that little angel cherub. It's not always bliss, especially three in the morning, and I'm used to three in the morning with my job, as I always said, at three in the morning. 

Still not a time I want my baby to be awake, but of course your baby's gonna be awake and what can happen and happen to me, Absolut. For me, it was about day 11 or 12, right when my first time came home from the NICU and I was sleep deprived despite him being in the nicu. Cause I would wake up like a crazy person. 

And I remember in that one moment, hating him for a second because he was crying. He had no reason to cry. In my mind. He was already bathed and fed and changed and all the things. And I was like, what can I do to stop this? Why are you crying? And I felt anger, maybe even hatred in that moment towards him, immediately followed by guilt. 

And if you know me, you know how much I [00:07:00] hate. And so of course I call my sister like I'm an ogre. I hated on my innocent baby. And she said, oh, everybody does that. Not a big deal. And I thought, why hasn't anyone told me this? I had only been in practice for a year at that point. I did not know that. And now I try to tell all the moms and any moms, I haven't told first time moms, I am sorry that I haven't told you that day 10 through 12, you might hate your little chair of baby and you think you're the only one on earth and you don't wanna admit it to everyone. 

We all feel it. If you don't feel it, God bless you if you do feel it, it's. You don't really hate your baby. You love that baby, but the sleep will make you crazy when you lack sleep. So the other thing I'd tell patients is anyone that you trust with arms is a good human for you to allow to hold your baby for a couple hours, provided they are masked and or vask baxt during the covid. 

If you're watching this years and from now and you don't know what Covid is, then thank God. But I really think that the best thing you can do for yourself is allow yourself slash force. Slash convince yourself the truth, which [00:08:00] is you need sleep. If you can get a three to four hour chunk, even once a day would be amazing, but once every two or three days till great, then you will feel somewhat human. 

And the best way to do that, in my opinion, is I patch earplugs and that human that you trust who has arms, who might just be your birth partner and you guys tag team on and off, or it might be a parent or an aunt or an uncle or a baby nurse or a doula or someone that you've. and there is no shame in that. 

Back in the day when women did it all, they didn't do all on their own. They did it with a village of people, typically a group of women who are there to help them. And the woman's, the mom's only job made mainly was to feed and nurse and then be nurtured by this village of women. And now we don't have that. 

So women are made to feel bad and guilty and less than if they can. If they're lucky enough to have a mother or a sister or best friends who can come visit, it's wonderful. But when you don't have that, or maybe you have a contentious relationship where you don't want that in your house and you have the privilege of paying for someone to help [00:09:00] you, you should not feel less than. 

Unfortunately, so many women don't have that privilege, and we need to figure out better ways to help them if they don't have that village of even one or two other women to aid them in just the logistics of how you care for a baby, because it's. So now as far as care for your incision, if you had a C-section or your vagina, if you delivered vaginally, let's talk incision First, I tell all my patients, please get a heating pad and drap it over your abdomen because you will potentially have gas and an inability to poop. 

So taking myON, which is the same as GasX can help and it's safer for nursing, making sure you're keeping up with your pain regimen, pain medicine regimen that we'll talk about. And heat. Heat, again, dilates the blood supply even to your bowels if you keep it on your. That will help things move ahead and it's soothing. 

Plus, if you put it on your incision without burning your skin, it will also potentially help it heal. Just like we say, if you have a pimple or a boil, put heat on it to vasodilate and bring in all those co-factors. If you had a vaginal [00:10:00] delivery, you might need ice because that is not where you want the blood supply to be dilated. 

You want the swelling to go down and ice will decrease that swelling. So for that first 24 hours, they'll give you ice at the hospital. When you go home, you might not need. But it might be soothing to put some ice down there and not sitting where you're putting a lot of pressure into your perineum is very valuable because you might also get hemorrhoids from having a C-section or a vaginal delivery. 

And the best way to take care of hemorrhoids, in my opinion, wash with soap and water, especially if they give you that little squirty bottle, pat it dry, and then put a big glove of cortisone on your finger and shove that right up into your rectum. I know I said rectum. Put it right up in there because that hemorrhoid is inflamed. 

And if all you do is take thousands of baby wipes to wash, And wipe it, you're gonna inflame it further. So instead of wiping, wiping, wiping the baby wipes, I want you to wash with soap and water, pad it dry, and a big lop of cortisone cream right up in there. Okay? Now, pain medicine, ideally if you can get on a regimen of Ibuprofen, Tylenol, ibuprofen Tylenol, I should say ibuprofen, acetaminophen. 

[00:11:00] Ibuprofen is Motrin and Advil. Tylenol is acetaminophen. So ibuprofen, acetaminophen, and you switch that so that you're doing every six hours of ibuprofen, 600 to 800 milligrams safe for. and then two extra strength acetaminophen, which is Tylenol also every six hours, so that every three hours you're getting something. 

So you alternate it. That is often enough so that you don't need any other pain medicine or any other narcotic, but especially if it had a C-section or a really challenging vaginal delivery, you might still need some narcotic, like oxycodone, things like. And if you do need a little, that's okay. The downside, besides being addicted, which is rare in our world, we don't see it very often cuz we don't get very much for very long. 

But the downside is that you can get constipated from the oxycodone and you could also feel very dizzy. So those patients who can try to be really ahead of their pain med, re pain medicine regimen by doing ibuprofen, Tylenol alternating, can often only need the narcotic for that couple of days in the hospital maybe, and then go home without it. 

No [00:12:00] shame or harm if you do. It. So do not feel bad. Okay, that's all I got. That's all I can think of for those postpartum post C-section, post vaginal delivery days. The biggest thing is, as I just said to a young mama, give yourself grace. Be kind to yourself. Do not feel the pressure to like do a baby book and get out baby announcements and cook and clean and all that stuff. 

Take help when you can get it. Let yourself sleep because sleep is probably the one thing that will help your mood more than anything. Plus, sleep helps you heal physically and emotion. And just remind yourself, these days will pass. Don't feel bad about it. Resist the urge for people to be like the days you're gonna pass that you're gonna miss them. 

I do not miss them, but I'm glad I went through them and that's okay not to miss them as well. They're little nuggets I missed, but I wouldn't go back to it. And that's okay. It was still beautiful. Okay, have a great day. It is Indigenous People's Day. I am working today. I hope you are not. Bye.