Discharge plan

Postpartum Discharge Instructions

Breastfeeding
Wash your breasts with water daily for cleanliness.
Air dry nipples after each feeding.
If nipples are sore, apply a few drops of breast milk after a feeding and let air dry.
If breasts are engorged, apply warm packs and express milk.
Non-Breastfeeding
Wear a well-fitting bra for support.
Use ice packs to relieve discomfort from engorgement.
Avoid handling your breasts and do not express milk.
Non-breastfeeding engorgement will subside in 24-36 hours.
Uterine Changes
After pains, or cramping, are normal. This cramping means that the uterus is contracting to
return to its non-pregnant size. The uterus takes 5-6 weeks to return to its non-pregnant size.
Vaginal Discharge
Usually lasts about 10 days to 4 weeks. The color will change from bright red to brownish to
tan and will become less in amount and finally disappear.
Menstruation: your period will resume in approximately 6-8 weeks, unless breastfeeding.
Care of Episiotomy
Sitz Bath: sitting in a tub of warm water for 15 minutes, 2-3 times per day, will help relieve the
discomfort.
Local agents, such as Tucks, Witch Hazel and Lanacaine, may be applied to the stitches.
Stitches will dissolve in 1-3 weeks.
Pain Relief
Use a mild analgesic (Tylenol or Advil) for breast engorgement, uterine cramping and
episiotomy discomfort.
Diet & Nutrition
Continue taking your prenatal iron and vitamin pills until your postpartum visit.
It is important to eat a well-balanced diet and drink plenty of fluids. Drink two quarts of fluid
per day if you are breastfeeding.
Emotional Changes
You may get baby blues after delivery. You may feel let down, anxious and cry easily. This
is normal. These feelings can begin 2-3 days after delivery and usually disappear in about a
week or two. Prolonged sadness may indicate Postpartum Depression. Help is available
through the Women & Infants' Day Program.
Activity
Rest! Do not do heavy housework or heavy exercise for two weeks. Avoid driving for 1-2
weeks. Check with your doctor for limitations on activities if you have had a C-Section.
Avoid sexual activity, douching or tampons until your postpartum visit.
Birth Control
Is advisable as soon as you resume sexual intercourse. Foam and condoms are safe and
easy to use. Birth control methods will be discussed further at your postpartum visit.
Postpartum Visit Call your obstetrician's office 2-3 days after discharge to make an appointment for
6 weeks.
When to call your Doctor/Midwife:
Fever greater than 101, with or without chills.
Foul-smelling or irritating vaginal discharge.
Excessive vaginal bleeding.
Recurrence of bright red vaginal bleeding after it has changed to a rust color.
Swollen area, painful area on the leg that is red or hot to the touch.
Burning sensation during urination or an inability to urinate.
Pain in the vaginal or rectal area.
Crying and periods of sadness beyond the two weeks.
Cesarean incision that is red, draining or painful.
Post Partum Teaching and Discharge Planning

Hygiene
You may shower and wash your hair at any time. Change your pads frequently and cleanse your
self with warm water using your peri-bottle at every change. Remember to wipe yourself from
front to back. No douching or internal tampons for 4-6 weeks or as indicated by your physician.
Perineal stitches are absorbable and do not need to be removed. If your stitches or hemorrhoids
are sore and hurt, take a sitz bath three times a day or discuss with your provider and use
perineal wipes on your perineum or hemorrhoids.
Constipation
Avoid constipation by eating a well-balanced diet including fruits and vegetables and drink plenty
of fluids. Stool softeners or mild laxatives may be used.
Family Planning
Your provider may advise that you not have sexual relations for 4-6 weeks. Your period may
return 6-8 weeks after delivery unless you are breastfeeding. Some nursing mothers do not
menstruate until weaning their baby from the breast; others resume menstruation at various times
while nursing. Pregnancy IS possible 4-6 weeks after delivery before you get your period whether
you are breastfeeding or not.
Breast Care
If breastfeeding, refer to breastfeeding handouts. If not breastfeeding, your breasts may still
become full and heavy. Wear a supportive bra. Do not handle your breasts or express milk. If
your breasts feel warm, apply ice packs under arms for 20 minutes to decrease discomfort.
Exercise/ Rest
Take frequent rest periods, especially when your baby is sleeping. Avoid lifting anything heavier
than the baby for 3-4 weeks. DO NOT start vigorous exercises until approved by your provider.
Perineal exercises can be started when you get home.

Discharge Instructions for the Well Newborn
Feeding
Breast-feed on demand every 2 to 4 hours. Bottle-feed on demand every 3 to 4 hours.
Diapers
Bowel movements varysome infants have a bowel movement with each feeding, and others every few days. Stools may be runny, seedy, mushy, pasty,
green, yellow or brown. Babies should be having at least 6 wet diapers in a 24-hour period by day 4 of life.
Care of the Penis
A small amount of spotting from the circumcised penis is normal, and healing usually occurs in 5 to 7 days. Apply a petroleum-based ointment to the site with
every diaper change until the skin looks normal. An uncircumcised penis requires no special care. Do not pull back the foreskin.
Cord Care
No special care is required.
Temperature
Routine temperature taking is not necessary. Check your babys temperature if he or she feels warm, cold or seems sick. Taking the temperature under the
babys arm may be inaccurate, so obtain a rectal temperature.
Jaundice
Check your babys skin from head to toe for a yellow color twice a day under the same lighting conditions.
Sleeping
Place your infant on his or her back to sleep. Most newborns sleep a lot, usually waking up every 2 to 4 hours for feeding. Letting the baby spend a certain
amount of time on his or her tummy while awake and observed is recommended.
Crying
Most newborns will have a few fussy periods. Call your pediatrician if your baby shows any of the following warning signs:
Temperature is less than 97F or greater than 100.4F rectally. Do not give acetaminophen (Tylenol) for fevers during the first 6 to 8 weeks of life.
Breathing is labored or distressed, or the baby is struggling to breathe
Difficulty waking up or refusing to eat for two to three feedings in a row
Excessive crying, irritability or lethargy
Skin is more yellow than at the time of discharge from the hospital, or a blue or gray color
Vomiting for several feedings in a row, or bloody or green vomit
Baby produces fewer than 6 wet diapers in a 24-hour period by 4 days of age
Bloody, black or dark purple stools; large, frequent and watery stools
Redness, bleeding, foul odor or discharge around the umbilical cord
Bleeding or increasing redness of the penis
Postpartum Discharge Instructions for the Mother
New mothers should follow these instructions for themselves after discharge from the hospital:
Medications
Ibuprofen: Take 600 mg of ibuprofen by mouth every 6 to 8 hours as needed for discomfort. Remember: Ibuprofen is preferable to Percocet, as it
does not cause constipation, is nonaddictive, and has no sedative effect on the baby. Percocet side effects may include headache, nausea or
vomiting.
Percocet: Take 1 to 2 tablets by mouth every 3 to 4 hours as needed for moderate to severe pain.
Prenatal vitamins: Take 1 tablet by mouth daily.
Stool softener: Take as needed as directed.
Warning Signs
If any of the following warning signs occur, call your physician or midwife:
Excessive vaginal bleeding (saturating the peripad such that it needs to be changed more than every 2 to 3 hours, or if you are passing large
clots). Remember: It is normal for there to be increased bleeding while breast-feeding and with increased activity.
Foul-smelling vaginal discharge
A red or swollen abdominal incision that is draining or causing increasing discomfort
Increased discomfort or unusual discharge in the area of an episiotomy, or the opening up of the stitches
Fever (temperature greater than 100.6 F for 24 hours or longer)
Burning or difficulty urinating, or if you are not completely emptying your bladder
Pain, redness or increased warmth in the thigh, calf or breast
Prolonged, overwhelming feelings of helplessness or hopelessness, or an inability to cope
Blurry vision or dizziness, with or without a headache