POSTPARTUM CARE AT HOME: YOUR COMPREHENSIVE GUIDE TO THE FIRST FEW WEEKS - PART ONE

Welcome to the postpartum period, the fourth trimester, a period of healing and adjustment, of getting to know and comfort your baby, and mastering breastfeeding. All your baby needs now is love and breast milk. If you are unable or choose not to breastfeed, consider feeding baby pumped breast milk, or donor breast milk from registered milk banks. Breast milk is the ideal food for your baby, although organic goat milk formula is most similar to human milk and you can discuss best alternative options with your pediatrician. And do see the Postpartum Guide to Breastfeeding Postpartum, for initial issues specific to that.

The rest will follow naturally, as you learn on the job, take guidance from wise experienced others, and let Baby be your teacher. As in pregnancy and birth, trust your instincts and your heart. But, do not hesitate to ask for help and support as needed. Hopefully you prepared in your pregnancy so that you are well supported during this sensitive time, as it has always taken a village to raise a baby as well as new parents. A postpartum doula is a must if you do not have family and friends to help you. 

After the first week or so, but before your memory of details fades, it is a wonderful experience to reflect on your pregnancy and birth with heartfelt honesty, and write your pregnancy memories and childbirth story down in a bump to birthday journal. This is something special to share with your child one day, and it is also a wonderful gift to yourself. It can be especially helpful for healing if things were difficult, or your labor and birth did not go as planned or as you hoped. Journaling will help you express, later process, understand, come to terms and make peace with any painful feelings that come up more deeply. 

Below are some helpful hints to make the next few weeks easier and more comfortable, so you are more able to heal, enjoy and reflect upon your extraordinary new miracle. The most important advice is to slow down, stay in the moment, try to resist the temptation to do, do, do...and just be, be, be. Trust that you will heal, as you are perfectly designed to do, given the proper care and support. 

Nutrition for Postpartum Care

Maintain at least the same healthy nutrition as you did in pregnancy, especially now for recovery after birth, and during breastfeeding. This will help you to make good quality milk, and nourish your baby as well as yourself. Make sure to eat at least three whole food varied healthy meals and snacks, and even a little bit more than you would normally consume. And keep well hydrated with at least 64 ounces of water daily. 

Traditional foods for the early postpartum weeks across cultures typically include soups and stews with a lot of vegetables, including the starchy ones like sweet potatoes and winter squash, stew meat or chicken, and whole grains like barley and oats. Also, do eat plenty of eggs, seasonal fruits and vegetables. Much nourishment can be added to fruit/veggie smoothies, soufflés, whole grain hot cereals, and breads/muffins like zucchini-apple, banana-date or carrot-raisin, enhanced with almond flour or chopped nuts and seeds, nut milk, and eggs. 

Herbs and Supplements

Make sure to supplement your diet as in pregnancy, with herbs, vitamins, minerals, omega threes and probiotics to complete nourishment not supplied by diet alone. This will aid in your recovery and help supply all of your and your baby’s nutritional needs. Do increase iron foods and take an herbal iron, especially if you were anemic in pregnancy, have low iron stores, lost a lot of blood at birth, gave birth by cesarean, and/or are still anemic. 

Do continue your nourishing pregnancy herbal infusion to your diet but add alfalfa and red clover. You can have a support person make this by:

1. Blending a handful of dried Nettle leaf, a handful of dried Red Raspberry leaf, a pinch of Alfalfa, large pinch of Red Clover, and several Rose Hips. 

2. Add a pinch of Comfrey to help with healing. (optional) 

3. Brew in a mason quart glass canning jar of boiling water 1-4 hours. The longer the brew, the stronger the taste and effect.

4. Strain, and drink plain or lightly sweetened with Rose Hip infused honey and/or a splash of fresh squeezed lemon or lime juice.

5. Enjoy hot or cold, up to 4 cups per day.

 You can make it in larger quantities and store in the fridge.

Other herbal tonics for new moms to promote general physical and emotional postpartum recovery and healing include Ashwagandha and Gotu Kola (½ -1 tsp each twice daily), and Milky Oats (1/1-1 tsp 1-3 times daily), in addition to herbs mentioned below as appropriate for each specific issue.

To promote healing after birth, take 3-4 pellets of homeopathic Arnica 30 c under your tongue every few hours for the first 3 days, then three times daily for a week. You can also dissolve the pellets in a clean unused bottle of water, shake vigorously a few times, then gargle a mouthful before swallowing, which increases the strength of the remedy.

Treatment for Afterpains

Periodic cramping, known as afterpains, commonly occur as your uterus muscle fibers contract around the blood vessels that supplied the placenta. This is your body’s natural defense in order to minimize excessive bleeding and return to its non-pregnant size. They can be quite painful, and can occur with increasing intensity after each subsequent baby.  

Breastfeeding can temporarily increase the severity of these pains, which is actually helping your body heal and prevent excess blood loss. Afterpains should gradually subside over the next week and lessen significantly over the first 3 days after birth. 

Below are some suggestions to lessen the discomfort.

• Frequently empty your bladder, even though you don’t feel like you need to pee, as is common from the swelling after childbirth.

• Especially during the first 24 hours, check the top of your uterus several times per hour to make sure it is nice and firm like a hard nectarine or knuckle. Massage the top of your uterus gently when it begins to soften or feels boggy.

• Lie on your stomach with a pillow under your lower abdomen.

• Apply warm moist towel compresses, hot water bottles, hot herbal packs or rice packs heated with a few drops of essential oil of Lavender, or a heating pad to your lower abdomen. 

• Practice your breathwork, deep breathing and conscious relaxation exercises during the afterpains, dropping your focus right down into them, relaxing with surrendering to the intense sensations as you did in labor.

• Try soaking in a well-cleaned, warm bath with drops of Lavender or Chamomile.

• For an effective herbal infusion: 

  • Mix a large pinch of Chamomile blossoms and/or Catnip in 1 cup boiling water.

  • Brew covered for 10-20 minutes.

  • Strain in a glass canning jar.

  • Add honey to taste (optional).

  • Drink very warm, 1-4 cups daily.

• Take a dropperful of Motherwort herbal tincture up to 4 times daily. If without relief, try Cramp Bark herbal tincture, 1 dropperful every 30 minutes to 2 hours, then 2-3 times daily. You can add a dropperful of Black Haw tincture 3 times per day. You can make your own cramp bark infusion by steeping a handful of Cramp Bark and Black Haw with a pinch of Hops and generous pinch of Blue Cohosh root in a quart mason jar overnight.

• Take Wish Garden AfterEase herbal tincture as directed

• Take 3-4 pellets homeopathic Chamomilla, Arnica, or Caulophyllum 200 c. Try one remedy under your tongue. If no relief try the other. If the remedy works, repeat daily as needed.

• Try Moxibustion treatments by an acupuncturist.

• Try additional suggestions and remedies mentioned here for aches and pains in pregnancy. They work!

• If the pain is too much for you and interfering with your ability to breastfeed, rest and sleep, you can take ibuprofen (up to 800 mg every six hours) OR acetaminophen (up to 650 mg every four hours) ½ hour before nursing for the first several days only, as needed. But before reaching for these medications, try 1-2 grams of Curcumin (Turmeric), a natural herb studied to be as effective for pain relief than most over the counter synthetic analgesics without their associated potential risk of toxicity. 

Consult your practitioner for severe cramping or cramping that lasts longer than 1-2 weeks, or if accompanied by uterine tenderness, fever or foul smelling discharge.

Home Remedies for Bleeding

During the first two to five days, bleeding is no more than a heavy period with an occasional clot the size of a 50 cent piece or egg, dark red in color with a fleshy smell. It tends to be less after cesarean birth. Clots are simply congealed blood mostly that pools in the vagina when you are reclining, and can occasionally be as long as the vaginal canal. Sometimes bleeding increases with nursing, strenuous activity, heavy lifting and pushing motions, full bladder, and as you rise from a lying down position. 

During the next week or so, the bleeding becomes paler pink or brownish, and it lessens in amount so that you only need to change sanitary pads several times per day. Over the following two to four weeks, discharge becomes creamy white or yellow and even less in amount, but usually returns to red bleeding or spotting for a day or two around the second postpartum week.  

Some women occasionally spot on and off for longer periods of time or throughout breastfeeding. Suggestions for keeping clean and comfortable are:

• Take a daily bath in a well-cleaned tub (add Calendula tincture and Lavender oil to water if desired) or shower.

• Change disposable organic sanitary pads or herbal infused natural pads every four to six hours, and after going to the bathroom. Do not use tampons, menstrual sponges, or menstrual cups. The first day or two, especially at night, consider wearing adult diaper type pads simply because it is just easier, as bleeding can be heavier than common postpartum maxi pads can accommodate, and can leak onto your clothes and sheets. Use them with a smile.

• Wash hands before and after changing pads.

• Remove pad from front to back, squeeze a peri-bottle of warm water over perineum. If you had tearing with or without repair, you can also add 1 tsp Calendula tincture and Lavender oil to the water. Pat dry.

• Do not douche.

• Check the top of your uterus for firmness several times per hour when awake for the first 24 hours, then several times per day for three days. It should feel as firm as a hard nectarine. If it feels soft, massage it firmly so it re-contracts.

• To prevent excessive bleeding, take homeopathic Arnica 30 c as described in the supplement section.

• Take herbal Shepherd’s Purse, 1 dropperful of the tincture three times daily for the first 3-5 days.

• Wear an abdominal binder or Bellefit’s postpartum support girdle. You get a $20 off with code: ANNE20 at checkout.

• Continue your herbal iron dose until your bleeding stops in 4-6 weeks, which may need to be increased per your practitioner if there was hemorrhage. Eat foods high in iron, like red meat, dark turkey meat, eggs, dark leafy green veggies, and dried fruits.

• If bleeding becomes heavy (you are saturating more than a large maxi pad every half hour):

  • Try herbal Shepherd’s Purse tincture (1 dropperful under your tongue), repeat every few minutes as needed)

  • Add 3 dropperfuls tincture of Cotton root, 2 dropperfuls each of Lady’s Mantle, Witch Hazel and Blue Cohosh, and 1 dropperful Yarrow. Take them every 10 minutes under your tongue until the heavy bleeding resolves, but only up to an hour. 

  • If heavy bleeding persists, take 2 dropperfuls of HerbPharm Erigeron/Cinnamon tincture of Erigeron and Cinnamon  under your tongue every 20 minutes for no more than 2 hours, and add 1 dropperful of Angelica if without relief.

Report to your practitioner if you’re saturating more than one pad an hour for more than a few hours not relieved by the other suggestions above, especially if you are starting to feel lightheaded, weak, disoriented, cold and clammy with rapid shallow breathing and heart pounding. Contact them also if you’re experiencing large clots, foul-smelling vaginal discharge, severe lower abdominal pain, temperature over 100.4 after the first few days, and deviation from the described pattern of bleeding.

Perineal and Vaginal Discomfort

After delivery, your perineum and vaginal area may feel sore, swollen and uncomfortable. Any pain or tenderness should gradually lessen over the next several weeks, or longer if you had a large tear. 

Suggestions are:

• Practice good perineal hygiene as previously described in the section on bleeding.

• Don’t forget to take the homeopathic remedy Arnica 30c as directed above, in the first few weeks to support healing after giving birth, which definitely helps your perineal and vaginal areas.

• For a small tear that did not need stitches, using a peri-bottle, squeeze warm water with several drops of Calendula tincture and Lavender oil over the area as you urinate to reduce stinging. Squirt Vitamin E oil a few times daily on the tear to promote healing. Motherlove and Earth Mama make wonderfully soothing and healing herbal combination perineal sprays.

• Apply a perineal ice pack or frozen maxi pads saturated with Witch Hazel for the first 24 hours (with 30 minute respite each hour) or as long as you feel it is soothing.

• Periodically sit in a cool sitz bath during the first 24 hours or as long as you feel it is comforting.

• After the first 24 hours, take a warm sitz bath, or warm shallow bath 2-3 times per day. You can also add tea tree oil, tincture of calendula, garlic, ginger and/or lavender, or try herbal sitz bath combinations with Uva Ursi, Comfrey and Sage or Calendula and Oatmeal (both combos have Witch Hazel, Yarrow and Plantain). You can also try herbs with Epsom and Dead Sea salt or herbal salt soaks and see which feels best for you. You can use any leftover unused liquid for compresses or your peri bottle rinse.

• Use a pillow or cushion when you need to sit.

• Contract your pelvic muscles (Kegels) or even better, engage your mula bandha (all of your pelvic floor muscles) when changing positions.

• Take the homeopathic Arnica 30 c as directed above for general recovery.

Report pain that worsens or does not improve over time, an increased area of redness, swelling or pus-like discharge.

If You Have Difficulty Urinating

During the first four hours after birth, many women have trouble urinating such that they feel no urge, feel the urge but cannot urinate, or feel burning after the urine comes out. It is essential that you urinate within eight hours after birth as difficult as it may be, to prevent infection and excess uterine bleeding.  

Suggestions to help you urinate are:

• Listen to running sink water.

• Squeeze warm water over your perineum with your peri-bottle, infused with a few drops of oil of Peppermint.

• Dabble your fingers in water.

• Apply light pressure to the area above your pubic bone.

• Put oil of Peppermint in the toilet.

• Sit in a sitz bath with several drops of the oil of peppermint.. 

• Take a bath or shower.

• Blow your thumb.

• Concentrate on relaxing and opening your pelvic floor muscles while imagining the urine flowing out.

• Drink eight glasses of water per day.

• Try homeopathic Arsenicum or Causticum both at the 30 c dose.

Report inability to urinate more than eight hours after the birth, burning pain before or as the urine is coming out, feeling the urge to urinate frequently but little urine comes out, fever, or back flank pain.

Cesarean Birth 

If you birthed your baby by c-section, it will take more time to heal physically, and psychologically - especially if unexpected and unplanned, or traumatic. Trust that you will get back to your new mama self. The scar will be there but will eventually fade. Allow for at least 3 months recovery for your body from major abdominal surgery, possibly longer to heal the mind and heart. Homeopathic remedies help tremendously and definitely speed and enhance your recovery safely and naturally.  If your cesarean is planned, start Arnica 200 c three times daily the day before and continue through 3-4 days postpartum. 

Other remedies helpful to have on hand are Aconite 30 c for intense fear and panic before surgery, Bellis Perennis 200 c post cesarean to boost healing after you finish the Arnica, Staphysagria 200 c for incisional pain and healing, and Hypericum 200 c for shooting nerve type pain from the spinal anesthesia (only if needed). Use one remedy at a time and take it three times daily until you feel improvement. Consult your classical homeopath for more personal guidance.

The first week is the hardest in terms of postoperative pain, so take ibuprofen or acetaminophen if absolutely needed, then switch to more natural pain relief remedies like ginger or turmeric that are safe for you and your breastfeeding baby, but still effective. 

Use the skills from breathwork and mindfulness to center and ground yourself, stay present one breath at a time, surrender, lean into and embrace the temporary painful sensations you feel, without the story, with love and compassion towards yourself. Whenever you feel overwhelmed or stressed, take a few minutes to simply breathe, keeping your focus softly on a distant nonmoving object (drishti) or close your eyes and internally gaze between your eyebrows, relaxing deeper with each exhale. Send your love and breath (divine life force) and imagined light to areas of pain. Use visualization to support you as you desire. This is powerfully healing.

While in the hospital, it is important to take deep abdominal breaths also to keep your lungs fully expanding (use the incentive spirometer many hospitals give you), and to get up and walk within 12-24 hours after birth for 10 minutes each waking hour, especially to prevent serious blood clots and painful abdominal gas buildup. The more you walk, the sooner you pass gas and get your bowels moving, and you keep your blood flowing rather than stagnating from immobility.

Ask to be progressed from a clear to regular diet within this time, and choose healthy foods and bottled spring water from the hospital menu (if that even exists!) or have your family and friends bring you more wholesome real food meals and snacks. For gas and bloating, limit:

• Gluten containing foods found in wheat, spelt, rye, barley and some oats

• Some fresh fruits and veggies

• Cow dairy if lactose intolerant

• Carbonated liquids

• Chewing gum. 

Eat slowly, chewing thoroughly and mindfully. Natural remedies for gas and bloating include chewing Fennel seeds, drinking Fennel tea, or taking 2-4 ml of the tincture three times per day, taking Slippery Elm lozenges 3-4 three times daily, and a high quality multi species probiotic twice daily on an empty stomach. Eat and drink more fermented foods like kefir. For bad gas and abdominal pain, take 1 dropperful each of Chamomile and Passionflower, ½ dropperful each of  Hops and Lemon Balm, and ¼ dropperful of Lavender tinctures every four hours.  

The dressing over your incision should be removed within 12-24 hours, so your incision is kept clean and dry to prevent infection. You can apply a clean maxi pad over the incision if your belly is folding over it, so it does not stay warm and moist, inviting bacterial growth. You have been sewn back together in many layers, and the skin is brought together by a glue like substance, absorbable stitches or staples, or removable metal staples. While it takes time to heal, when all is proceeding normally, it is unlikely to open as commonly feared. 

Sometimes they use steri-strips over the incision which will come off eventually or you can remove them in a few days. You can definitely shower, but do not use soap initially on the incision. Dry the area gently. A little oozing of blood is common to see on the dressing, as is a tiny amount of clear, white, or yellowish fluid, as long as it is not pus- like discharge. Look at your incision so you can monitor its healing as well as work on acceptance and appreciation for the journey you and your baby needed, made especially for you both. Once you go home, you can apply herbs for perineal and vaginal tears mentioned above to soothe and enhance healing. Earth Mama makes a lovely herbal balm specific to healing a cesarean scar and there are other organic balms that also help the scar fade. 

Make sure to keep Baby skin to skin in dim quiet as much as you can, bonding and soothing baby with your love, telling Baby all is well, Baby is safe and acknowledge that was a tough journey for both of you. Get help with breastfeeding as soon as possible. Baby may be sleepy from the medications, and it takes longer for the full breast milk to come in, but you will get the breastfeeding going with excellent support and patient perseverance. 

I encourage you to love, be proud and grateful for your cesarean scar. This may take time to cultivate, but is a worthwhile goal. Do not be shy to ask for extra needed help, and get support processing and healing emotionally. For online and local group support and advocacy, there are many wonderful resources like ICAN, but you may want to consider breathwork to release the strong stuck emotions and trauma energy in your body if it is interfering with your well-being. If you are suffering from birth trauma or you suspect your baby has it as well - as is common after cesarean birth - there are resources for healing for you and for your baby.

Consult your practitioner with:

• For fever over 100.6 with general muscle aches and chills

• Persistent or worsening pain

• Area of tenderness/foul smell/pus/redness/swelling by your incision

• Area of leg swelling, redness, warmth and pain worse when you flex your foot

• Unusually frequent, urgent or painful urination

• Heavy or foul smelling vaginal bleeding

• Vision changes, nausea, vomiting, chest pain and/or headache, especially if you had high blood pressure

• Anything unusual you are concerned about. 

Obviously, if you have problems breathing, feel weak, disoriented and faint, call 911.

Constipation and Your First Bowel Movement

It is normal to go a few days after delivery without having a bowel movement. Many have loose stools before labor and pooped during pushing, and those who birthed in hospitals who don’t allow eating in active labor probably did not eat much, if at all, in labor, unless they (hopefully!) respectfully challenged that outdated policy, or simply sneaked it. So you have a few days leeway. Some mothers are afraid that a bowel movement will be painful or open their tear more or stitches if they had them. Other women are too busy and preoccupied with all that is involved postpartum to even think about taking the time. Do rest assured that although the first few bowel movements may be uncomfortable, they will not open your tear or effect the stitches. Even if you had a large tear, it’s extremely rare for them to be torn by a BM.

Suggestions to limit your discomfort and prevent constipation are similar to remedies in pregnancy with some additions:

• Replace refined highly processed foods with whole grains, lots of fresh fruits with the skin, and vegetables (especially green leafy salads).

• Drink at least 64 ounces of fluid each day, preferably filtered, spring or well water, or herbal tea. Consume between meals, at least 20-30 minutes before or 2 hours after eating.

• Do Kegels and abdominal muscle toning exercises.

• Drink warm prune juice or a cup of tea or coffee on an empty stomach.

• Drink Smooth Move Tea, which tastes yummy and works like a charm.

• Mix 2-3 Tbsp oat or wheat bran, or ground flax seed, in your hot cereal or apple sauce. Or, mix with stewed prunes or dried figs. 

• Try raisin bran muffins with black strap molasses (ask someone to make you a batch, with whole grains, or Paleo - gluten, sugar and dairy free).

• You can take these remedies in these doses for preventing and treating constipation which include Magnesium or the powdered liquid equivalent in Natural Calm, herbal Floradix liquid Magnesium, Triphala, Psyllium seed husks, or homemade Dandelion and Yellow Dock root infusion. 

• Use Colace (stool softener) as directed if your bowel movements are getting hard despite these above suggestions, and you are on opioid pain medication after a cesarean birth.

• If you are taking iron, use alternative sources of iron other than ferrous sulfate, such as ferrous fumarate, ferrous gluconate, or herbal iron.

• Do not ignore the urge to have a bowel movement, which usually occurs ½ hour after breakfast.

• Take an interesting book or magazine into the bathroom with you to enjoy some relaxing time on the toilet.

• While on the toilet, rest your feet on a low stool and avoid straining. Support your perineum by applying counter pressure with a folded tissue if needed.

• If it hurts while having the first few bowel movements, do some relaxation and deep breathing exercises, relax into the discomfort instead of fighting it and tensing up, or try splinting the perineum with your hands to provide extra give to the area.

• Avoid relying on enemas and laxatives on a regular basis.

• Ask your classical homeopath, or refer to books like Homeopathy For Pregnancy, Birth and Your Baby’s First Year by Miranda Castro, for a homeopathic remedy specific to your unique symptoms.

Consult your practitioner if there is no bowel movement by the end of the fourth postpartum day, or you experience unusual pain or bleeding.

Treating Hemorrhoids

Hemorrhoids are varicose veins of the rectum, and are a common postpartum occurrence. They resemble a pile of red grapes or marbles just outside the anal area, but they can be internal as well. They can itch, bleed and be quite painful during the first 2-3 days, before gradually becoming smaller. Refer to the suggestions for natural remedies for hemorrhoids in pregnancy as many still apply now.

Suggestions for relief are:

• Herbal sitz baths as mentioned above for your perineum, with Epsom salts, Witch Hazel, and/or Comfrey.

• Use a pillow or cushion when you need to sit on a chair.

• Sleep on your side.

• Lie down several times each day with your hips and legs elevated with pillows.

• Try gently placing the hemorrhoids back inside your rectum with a lubricated finger, and then tightening your rectal muscles around them for 2 minutes.

• Natural remedies with dosing are here for internal and topical use, and include applications of already made Witch Hazel compresses (known as Tucks in the pharmacy) or make your own by pouring Witch Hazel onto round cotton pads, plantain, pure Aloe Vera gel, clove of garlic insert, and homeopathic Hamamelis and herbal combinations in a salve or ointment.

• Shine a red heat lamp on the affected area.

• Avoid constipation and straining.  See above.

Report if pain, swelling or bleeding worsens or becomes severe.

Postpartum Dizziness or Faintness

It is very common to feel dizzy, light-headed or faint the first few times that you get up from a lying or sitting position, especially after a long, hard exhausting labor with a large amount of blood loss.  

Suggestions are:

• Make sure you are eating well and drinking enough water as described in nutrition and constipation sections. 

• Have someone assist you the first couple of times that you have to rise.

• Rise from lying down gradually. First sit, then stand slowly.

• If feeling lightheaded or woozy while standing, lie down with your feet elevated or sit down with your head between your knees. Ask for someone to bring you a few large glasses of juice, as well as a high quality whole carbohydrate, fat and protein meal. For example, a nut butter and jelly sandwich on sprouted multigrain bread, or yogurt with fruit and granola.

• If you feel faint or do faint, sniff ammonia or smelling salts. This is an important first aid item to have, especially if birthing at home.

• Open windows to get fresh air.

• Splash water on your face.

Contact your practitioner with dizziness that lasts longer than the first few days or any actual fainting.

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