Postpartum Care and Support for New Mamis

by: Alejandra Carrasco, M.D. and Christine Maren, D.O.

by: Alejandra Carrasco, M.D. and Christine Maren, D.O.

Physician founders of Hey mami!

Your beautiful little love nugget has arrived and life will never be the same!

As you snuggle up to baby-loving and ‘round the clock baby-care, you might be surprised to find that your lady parts are very different after delivery.

Your body has entered the alternate universe of puerperium—the time defined as the 6-8 weeks following delivery during which the anatomical and physiological changes of pregnancy regress.

It’s crazy town.

Your vagina is tender, you’re bleeding a lot, you’re taking care of a needy human every minute of the day, your breasts are engorged, you’re peeing like a racehorse, pooping is scary, and there’s no end in sight.

We’ve been there, mami — it’s intense, and we still did it three times…each. And after every single one of our deliveries, we were surprised at how overwhelming the recovery process could be.

Here’s what we learned about taking care of bodies after delivery.

Vaginal soreness/pain after delivery

Lady parts on fire? If you had a vaginal tear (especially one that required stitches) or an episiotomy during delivery, you might hurt for a few weeks. If you had an extensive tear (3rd or 4th degree) healing might take longer.

How to soothe your aching lady parts:

  • Freeze organic cotton maxipads that have been soaked with witch hazel and lavender essential oil and wear, or get these Frida Mom Instant Ice Maxi Pads.
  • Sit on a pillow or donut pillow.
  • Use a perineal bottle (we like this one from FRIDA) to gently spray warm water on your perineum as you’re peeing.
  • Take a sitz bath — sit in a warm bath just deep enough to cover your bum and hips for five minutes. You can also purchase a plastic sitz bath which goes over your toilet and can be more convenient than getting in the tub several times a day.
  • Use numbing spray like Dermoplast spray.
  • Hydrate.

Call your doctor or midwife if:

  • You have excessive bleeding, like enough to soak through a big pad within an hour
  • Severe cramping or pain (like take your breath away pain) that’s not relieved by OTC pain killers
  • A fever
  • A severe headache
  • You feel the pain is too intense or something is not right
  • Painful urination or trouble urinating
  • Any other serious concerns

Involution (AKA Afterpain Hell)

Your uterus weighs about 1000 grams after delivery, but by the end of puerperium, it weighs a mere 50 grams! The shrinking of your uterus is known as involution. And the process of involution involves afterpains.

Afterpains are the painful uterine contractions that occur the first 5-7 days postpartum and intensify when your baby nurses because nursing releases oxytocin.1

Oxytocin, also known as the love hormone, causes those delicious, loving feelings that allow you to bond with your baby AND produce uterine contractions.

Unfortunately, afterpains tend to intensify with each subsequent pregnancy, likely because first-time mothers have better uterine muscle tone than women who have birthed more than one child.

Things that can help with the pain:

  • Cramp bark—used by herbalists as an antispasmodic which has been shown to help ease uterine cramping2,3
  • Yarrow—traditionally used to help ease cramping, tone the uterus, and promote relaxation
  • Heating pad
  • Hot water bottle or a microwavable bean bag
  • Topical magnesium lotion on your abdomen (and not if you had a c-section)
  • Relaxation techniques

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Vaginal bleeding and discharge after birth

Lochia (fondly referred to in our minds as the never-ending period) is the vaginal discharge that occurs for weeks after delivery.

It’s essentially the excretion of the uterine lining that remains on your uterine wall after your placenta has detached. It’s composed of a mixture of blood, maternal uterine tissue, cervical mucus, and cells that will slough off over the coming weeks. 4

You’ll have lochia for weeks, and even if you’ve had a cesarean delivery, you will still have it.

The total duration of lochia ranges from 18 days up to 6 weeks. However, several studies have shown that lochia may even last longer than 6 weeks.5

Many women, particularly women having their first baby, are surprised at the amount and duration of their lochial loss.6 We definitely were!

There are 3 stages of lochia discharge:

  • Lochia Rubra, a red and heavy discharge that may be full of clots, mucous, and tissue that typically lasts up to a week after delivery.
  • Lochia Serosa, a pinkish-brown, watery discharge that lasts up to a few weeks after delivery.
  • Lochia Alba, a yellowish-white vaginal discharge that can last as long as six to eight weeks after the birth of your baby.

Best postpartum pads to prevent rashes and chafing: 

If you’re a first-time mom, chances are you’ve never experienced a “period” this long. Thus, it’s a REALLY good idea to have a stock of breathable organic cotton pads, as they are far less likely to cause redness, rash, or chaffing as pads made with more synthetic materials.

And no, you cannot use tampons during this time, nor will those fabulous reusable period panties cut it…at least for the first few weeks.

Go for super heavy pads for the first week or two, then switch to heavy ones, and downgrade as your flow reduces.

Best postpartum undies:

Do yourself a favor, buy some of these awesome semi-disposable mesh panties and wear them for the first week or two.

Trust us, you won’t have the desire, time, or energy to be de-staining your good underwear while recovering.

Call your doctor or midwife if:

  • You have heavy vaginal bleeding — soaking a pad in less than an hour — especially if it’s accompanied by pelvic pain, fever or uterine tenderness
  • Bright red bleeding that goes on longer than 3 days
  • Passing blood clots larger than a plum
  • Foul-smelling discharge
  • A fever over 100.4 degrees or severe chills
  • Increased swelling, redness, or pain on your perineum
  • Any other serious concerns

If your lochia discharge starts to smell bad, or bleeding or pain increases please let your doctor know because this could be a sign of infection or retained placenta.

Hemorrhoid and Anal Fissure Management

Hemorrhoids and anal fissures are not uncommon after a vaginal birth, especially if you’ve pushed very hard…but boy do they suck!

Let’s start with hemorrhoids, which you can soothe by applying astringent or anesthetic creams topically. Witch hazel pads are great for this, or there are over-the-counter hemorrhoids creams that may reduce swelling.

For anal fissures, which are small tears around the anus, you can use witch hazel pads, take 2-3 sitz baths per day, and put a healing balm around the outside of your anus.

How can you tell if it’s hemorrhoids or anal fissures? Typically, anal fissures are more uncomfortable than hemorrhoids, but the best way to know is to have your doctor or midwife examine you.

It’s also helpful to eat plenty of fruits and vegetables and take magnesium citrate to keep your stool soft and to reduce straining during bowel movements…which brings us to our next point!

We loved stewed prunes and apricots for this, plus they make a nutritious and filling snack.

How to Keep your Bowels Moving

Bowel movements can be a bit harrowing after birth, especially if you have a tear, stitches, hemorrhoids…or all of the above (eep!). The best way to make them comfortable is to keep your stool soft, and the best way to do that is with fruits, vegetables, magnesium citrate supplementation, and plenty of water.

Our favorites for stool softening include stewed prunes and apricots, canned peaches, pears, apples, flaxseeds, and probiotics.

Drinking enough water is also essential as it will keep your bowels moving while helping improve milk production. Aim for 12 – 8 oz glasses per day.

If pooping is still uncomfortable (or just downright scary), you can make it easier on yourself by sitting in one of those sitz baths over the toilet. The warm water will naturally relax your anal sphincter and, voila! The poop will come out easily. Yes, you’ll have to get over emptying it into the toilet and cleaning/sanitizing the plastic bath, but it’s a small price to pay for a comfortable postpartum poop.

If, after trying all of this you’re still having painful bowel movements, call your doctor or midwife as they may recommend a specific stool softener.

Postpartum Pain Management

Every mami will experience different levels of pain and discomfort after giving birth based on the type of birth you had, the duration, and any complications that arose.

Regardless, here are some options for dealing with postpartum pain:

  • Oral analgesics—unless you’ve had a c-section, most doctors will not prescribe strong pain medications. NSAIDs like Ibuprofen have been shown to relieve pain better than placebo, and are generally safe for most women to take short-term.7
  • Drug-free options that are safe to take while breastfeeding
    • We like this AfterEase herbal tincture with Crampbark, Black Haw bark, Yarrow, and Motherwort.
    • Curcumin—is a medicinal component of turmeric, and is one of the most-studied natural remedies for natural pain relief. It works by inhibiting many of the inflammatory cytokines and enzymes which produce pain.8
    • Boswellia—also known as “nature’s steroid”9, this gummy tree resin works in a similar fashion as curcumin, and they work even better together.
    • Homeopathic arnica—helps with overall pain and inflammation, and is also recommended for perineum pain.10
    • Homeopathic hypericum—recommended for pain from stitches/overall perineal pain.11 Can be used topically or by mouth.

And remember, this won’t last forever

When you’re in the throws of postpartum recovery it can be easy to forget that all this will pass. We both found it helpful to rest as much as possible, ask for what you need (this is a profoundly simple but powerful motto), and don’t be afraid to call your healthcare provider if you feel you need to.

And one more thing…find a reason to laugh. This period of time can be so overwhelming and all-consuming, it’s important to blow off some pressure with laughter—-which has also been proven to reduce pain by the way.12 Watch a silly show, read the funnies, or call up a friend and ask them to entertain you with jokes, you’ll feel much better and gain some perspective too.

Happy healthy healing, mami (and BIG congratulations!).



Our Bio

We are doctors Alejandra Carrasco M.D. and Christine Maren D.O. We’re board-certified through the American Board of Family Medicine, and certified in functional medicine through the Institute for Functional Medicine. We’re on a mission to support women as they navigate mamihood—from preconception through pregnancy, postpartum, and beyond. As mamis of 3 (each!), we got you.


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