Miguel A Jordan, M.D., FACOG

Discharge Instructions

The following guidelines will help you to know what is physically normal between the time of your discharge from the hospital and your return to the doctor’s office of the postpartum visit. To contact us please call 419.424.0180. You may also visit us at

Activity

Upon returning home you should begin to feel better each day. Try to avoid fatigue and rest as much as possible so you are able to handle the demands of the baby. Limit visitors during the first few weeks at home. You may resume driving after two weeks and light exercise after three weeks.

Travel

You may travel after the baby is two weeks of age. Remember not to become too fatigued and to stop at regular intervals on long trips.

Bathing

Showers are permitted and cleansing of the perineum is important, particularly after bowel movements or urinating. Tub baths should be avoided in the first three to four weeks if possible to avoid contaminated bath water entering the uterine cavity. Sitz baths however are advisable for the first two weeks partum to cleanse the affected area. Do not rub the perineum with a towel, but "pat dry" after bathing.

Vaginal Bleeding

Bleeding from the vagina will decrease gradually. There will be some flow for four to six weeks after delivery. This flow will probably vary from bright red to dark brown to light brown. Passage of an occasional blood clot is not unusual. Douching should be avoided and nothing in the vagina for six weeks.

Stitches

Stitches from your episiotomy may cause discomfort for two to three weeks after leaving the hospital. Your stitches will dissolve within several weeks. Sitz baths may be taken for 15-20 minutes, 3-4 times a day to promote healing and alleviate some of the discomfort. Anesthetic spray may be applied to stitches as needed. Rinse perineal area with warm water each time you use the bathroom and "pat dry".

Swelling

Fluid retention in the legs and ankles is common for a week or so subsequent to delivery and will usually clear up if you avoid excess salt in diet, increase fluids and elevated your legs as needed. If swelling is worsening especially in the hands and face or if accompanied by headache, blurry vision or spots before eyes, please call.

Breast feeding

Your breasts may become engorged and full about 72 hours after delivery. This is called milk "let down". The breast will become suddenly very heavy, swollen, painful and hot. This condition is known as breast engorgement and is a combination of blood vessel and glandular congestion from milk production. The breast will become softer and less congested after the first weed or two following delivery. If you are breast feeding, wear a good, firm bra, wash your hands before and after each feedings and talk to our nurses and lactation consultants to get started and for breast care. Continue prenatal vitamins as long as you are nursing. Notify the office if you develop a localized painful area in either breast which feels hot and/ or appears reddened as this may indicate a breast infection. Antibiotics can be prescribed. Continue feeding from the affected breast to help it clear the infection. The infection is caused by the bacteria in the baby’s mouth entering the breast and from cracks in the skin of the nipple that are colonized by bacteria. It is highly unlikely that the baby would be in danger of being infected.

Bottle Feeding

Despite you decision to not breast feed, you may still notice temporary engorgement or evidence of milk production. If you are uncomfortable you may try any or all of the following:

• wear a good support bra
• Avoid stimulation to the nipples for example do not allow the shower beat against your breast.
• Ice packs to the breast 3-4 times a day
• Tylenol or Motrin every 4 hours as needed
• Burp the baby on your lap or knees rather than across the chest

Constipation

Hemorrhoids

Hemorrhoids are varicose veins of the rectum. Pelvic pressure during pregnancy, pressure on the rectum during labor, and constipation following delivery will aggravate them still further. The discomfort of hemorrhoids will gradually subside after the first week postpartum. The following measures may be beneficial:

• Sitz baths
• rectal suppositories (Annusol) or stool softeners (Colace)
• avoid straining at bowel movements and sit on commode for only a brief time
• increase fiber in diet
• 6-8glasses of fluid per day, more if breast feeding

Blues

Many times after delivery you may fell "blue" or "down". This feeling will decrease with additional rest. If you seem severely depressed; thought processes become impaired or if symptoms are not improving or worsening; call the doctor for advice.

Sexual Activity

You may resume your sexual activity 4-6 weeks after delivery. The stitches should be adequately healed by that time, but some discomfort may be experienced because of the associated scarring form the episiotomy repair. This will usually diminish after a few weeks.

Menstrual Cycle

If you are not breastfeeding your periods should return within 4-10 weeks of delivery. If you are breastfeeding your baby, your period may not return for about 6 months, particularly if you are breastfeeding exclusively. For some women, menstruation does not start until they stop breastfeeding. Lack of periods does not guarantee you are protected from pregnancy since you usually ovulate 2 weeks prior to your menstruation.

Call The Doctor

Notify the doctor if you have any of the following symptoms:

• Chills, fever greater than 101 degrees orally
• Frequency, burning and/or pain upon urination
• Heavy or prolonged vaginal bleeding
• Fainting
• Swelling and redness or tender area in the breasts
• Foul odor to the vaginal discharge
• Leg cramps or swollen, reddened and tender areas on the legs

Cesarean Deliveries

Your incision may have been closed using stitches which are underneath the skin or possibly stainless steel staples. If you are released from the hospital with the staples still in place, please call the office for their removal 5-7 days after the surgery. Steri-strips should be left alone for 5-7 days if possible. Pat area dry after you shower. The first two weeks following cesarean section are most crucial for a speedy recovery. During this time, you should limit your activity by avoiding heavy lifting, pushing or pulling for four to six weeks. Climbing stairs will not present a problem, as long as it is not done to excess. After two weeks, you may gradually increase your activity, including a light exercise program excluding lifting and abdominal exercises. You may experience some drainage from the increased activity. Application of hot compresses to the area will speed up the healing. Should the area become red, hot or swollen, please notify the office.

Postpartum Tubal Ligation

If you had a postpartum sterilization procedure done, you will have a small incision under your umbilicus. The incision is closed using suture underneath the skin. The dressing may be removed after 12 hours and does not have to be replaced. The stitches will dissolve on their own. Lifting in moderation will not harm the incision.

The tubal ligation will be near 99% effective immediately, so no additional measures of contraception need to be considered, although, no intercourse is recommended for 4-6 weeks.

Follow Up Office Visit

^{After an uncomplicated vaginal delivery post partum office visit is usually scheduled in 6 weeks. If you delivered by cesarean section with or without a tubal ligation follow up is scheduled in 4 weeks if staples are not in place at the time of discharge. If staples are present, follow up visit is usually 5-7 days after your surgery to have your staples removed and then at 4-weeks for the post-op visit.}