2-week postpartum visit convo guide
Dr. Michele Torosis
Obstetrician-gynecologist
Obstetricians are increasingly recommending a check-in two weeks after giving birth. This is an important opportunity to address your most pressing concerns and challenges, from physical pain to mood swings to breastfeeding. Here are some questions you might want to come prepared with—and a preview of responses your provider might have for you.
Breastfeeding can be one of the biggest stressors in the first weeks of your baby’s life.
Latch issues can lead to painful nursing, chafed nipples, poor baby weight gain, or engorgement. If the issue is latch, this is something your OB or midwife can work on with you in the clinic—so bring your baby with you! Alternatively, you may be referred to a lactation consultant.
While you were still in the hospital, you may have met with a lactation consultant or been given the contact information for one. The U.S. Lactation Consultant Association is another good resource for finding a local licensed lactation consultant. Bonus: Most health insurance plans cover an in-home consultation!
Sore nipples can be relieved with ice packs, alternating feeding positions, and keeping your nipples as dry as possible between feeding.
By now, your baby has probably visited—and been weighed by—the pediatrician for the first time. After birth, babies typically lose some weight. If your newborn hasn’t re-reached birth weight by the second week, you may have a milk supply or latch issue to address. The best way to improve supply is to increase the frequency of feeds, or to pump between nursing sessions. This is another challenge a lactation consultant can guide you through.
An additional 330 to 440 calories per day is recommended for breastfeeding mothers, compared to the amount they were consuming before pregnancy. The Dietary Reference Intake Calculator can help you calculate your calorie needs based on your age, weight, activity level, and breastfeeding status. I also recommend continuing to take your prenatal vitamin, or comparable prenatal vitamin while breastfeeding.
Breastfeeding women also have an increased need for iodine and choline. Aim for 290 milligrams of iodine and 550 milligrams of choline per day. You can find iodine in dairy products, seafood, or iodized salt. You can find choline in dairy, meats, beans, peas, and lentils.
While sleep-deprived and focusing on feeding your baby, it can be challenging to remember to feed yourself in the first few weeks after delivery. This is a good time for high-protein snacks. Setting some peanut butter crackers next to your nursing chair or pump is a good reminder to eat when your baby eats.
When you nurse, your body produces oxytocin, a hormone that helps contract the uterus and signals for your breast milk to come in. It’s nature’s way of getting your uterus back to its pre-pregnancy size. It also decreases the bleeding. These “afterbirth pains” will naturally dissipate as your uterus heals. They tend to be more intense after having a subsequent (not first) child. You also may notice that your bleeding picks up right after nursing.
The beginning of the bleeding, or lochia discharge, that occurs postpartum should look like a heavy period. After the first 10 days, you won’t likely be passing large clots, and the bleeding should be more like a lighter period.
At this point, you should not be saturating two pads an hour for more than two hours in a row. You should also not have a sudden increase in your bleeding, experience large gushes of blood, or feel dizzy and lightheaded. If you are experiencing any of these things, we need to immediately evaluate you and work to remediate the situation.
If you’ve had a C-section, you likely won’t notice quite as much postpartum bleeding, because the procedure usually involves cleaning out the uterus.
Baby blues are normal for the first couple weeks. About 80 percent of women experience them. They are marked by happiness, followed by inexplicable tearfulness, a feeling of being overwhelmed, or asking yourself questions like, “How am I going to do this?” or “Am I going to love this baby enough?” Hormonal shifts occur as your body tries to readjust.
Over the next week or two, your moods will likely stabilize, as your routine improves. If your symptoms don’t subside or get worse, please let me know, and we will have you evaluated for a perinatal mood or anxiety disorder (PMAD).
If you had a C-section: We will check your incision at this visit and make sure that you are healing well. We will check for drainage from the incision, redness that is spreading, or increased pain. You may have some superficial scabbing at the incision, and the skin edges should be closed. Pain or a pins-and-needles sensation, often on either side of the incision, is common. Nerves run just lateral to your incision, and they are often cut during surgery and need some time to regrow.
If you had a vaginal delivery: Vaginal or perineal pain, particularly if you experienced tearing, should have started to improve. We will check your vagina and make sure that the wound is healing and has not opened up. If you are having increased pain with activity in this area, this is a sign that you may be overexerting yourself. It’s best to use mild soap and water in the shower. You do not need to be doing any special cleaning or douching of this area, but there are ways to relieve discomfort.
Everyone is different. If you had a vaginal delivery, you may be occasionally taking ibuprofen or acetaminophen to relieve pain from cramping or tears. If you had a C-section, you should be off narcotic pain medication by this point, and relying on acetaminophen or ibuprofen for any pain related to your incision. If your pain level is limiting your ability to move, please let me know.
There are two main reasons for perineal and vaginal itching after delivery: vaginal tears or hemorrhoids.
As the sutures in your tear dissolve, and the area heals, it is normal to have some itching. Use a peri bottle filled with warm water after each time you go to the bathroom, and use a benzocaine rectal ointment or spray, such as Dermoplast. You can also take sitz baths a few times a day, or use a toilet-top bidet to keep the area clean. Avoid scratching.
Itching from hemorrhoids is more centered around the rectum. To relieve the itching, gently keep the area clean with soap and water after each bowel movement. You may also use cold compresses or apply over-the-counter creams containing hydrocortisone or lidocaine.
The delivery experience is—and feels—different for every person. Things often move fast with labor and delivery, prompting medical decisions to be made with limited time and discussion. This may leave you feeling like you were not in control of your delivery, or like something went wrong during the delivery process. While we may have discussed this immediately following your delivery, if you are still feeling uneasy, now is a good time to talk about it.
If you had an uncomplicated vaginal delivery, you may resume most of your normal daily activities, including walking, showering, and cooking. Avoid vigorous activities such as running, biking, and weight lifting, until after our six-week postpartum checkup.
If you had a C-section, avoid lifting anything heavier than your baby in the car seat until after our six-week postpartum checkup. Avoid crunches, and don’t drive until you are confident that you can firmly hit the brake (usually around this two-week mark) and are no longer taking narcotic medication.