CHAPTER 259
Postdelivery Period
The postdelivery (postpartum) period is the 6 weeks after delivery of a baby, when the mother’s body returns to its prepregnancy state.
After delivery, the mother can expect to have some symptoms, but they are usually mild and temporary. Complications are rare. Nonetheless, the doctor, hospital staff members, or health care plan usually sets up a program of follow-up office or home visits.
The most common complications are the following:
Excessive bleeding (postpartum hemorrhage— see page 1662)
Infections of the uterus, bladder, kidneys, or breasts
Problems with breastfeeding (see page 1679)
Depression
Postpartum hemorrhage may occur soon after delivery but may occur up to 6 weeks later.
What to Expect at the Hospital
Immediately after delivery of a baby, the mother is monitored. If a general anesthetic was used during delivery, she is monitored for 2 to 3 hours after delivery, usually in a well-equipped recovery room with access to oxygen, intravenous fluids, and resuscitation equipment.
Staff members check the mother’s pulse rate and temperature. Normally, within the first 24 hours, the mother’s pulse rate (which increased during pregnancy) begins to decline toward normal and her temperature may increase slightly, usually returning to normal by the second day. After the first 24 hours, recovery is rapid.
Hospital staff members make every effort to minimize the new mother’s pain and the risk of bleeding and infection.
Bleeding: Minimizing bleeding is the first priority. After delivery of the placenta (afterbirth), a nurse may periodically massage the mother’s abdomen to help the uterus contract and remain contracted, thus preventing excessive bleeding. If needed, oxytocin is given to stimulate contraction of the uterus. The drug is injected into a muscle or given intravenously as a continuous infusion until the uterus is contracted.
Urination and Defecation: Urine production often increases greatly, but temporarily, after delivery. Because bladder sensation may be decreased after delivery, hospital staff members encourage a new mother to try to urinate regularly, at least every 4 hours. Doing so avoids overfilling the bladder and helps prevent bladder infections. Staff members may gently press on the mother’s abdomen to check the bladder and determine whether it is being emptied. Occasionally, if the new mother cannot urinate on her own, a catheter must be inserted into the bladder to empty the urine. Hospital staff members try to avoid using a catheter, which increases the risk of bladder and kidney infections.
AFTER DELIVERY: THE BODY’S RETURN TO NORMAL
| AREA AFFECTED | WHAT HAPPENS |
| Discharge from the vagina | New mothers have a bloody discharge, occasionally with blood clots, for 3 or 4 days. The discharge becomes pale brown for about 10 to 12 days, then yellowish white. The discharge may continue for up to about 6 weeks after delivery. About a week or two after delivery, part of the remaining placenta may separate, causing vaginal bleeding of up to about a cup. |
| Breasts | During the early stages of milk production (lactation), the breasts become engorged with milk, sometimes making them feel tight and sore. |
| Heart rate | The heart rate, which increased during pregnancy, starts to decrease within the first 24 hours and returns to normal soon thereafter. |
| Temperature | Body temperature may increase slightly during the first 24 hours, usually returning to normal by the second day. |
| Uterus | After delivery, the uterus contracts, beginning to return to its prepregnancy size and position. |
| Genital area | The area around the vaginal opening is usually sore. Tears during delivery and repair may also make the area sore. The area may sting when women urinate. |
| Urination | Urine production often increases greatly, but temporarily, after delivery. |
| Bowel movements | The first bowel movement after delivery may be difficult, partly because the abdominal and pelvic muscles have been stretched and stressed. Also, the mother may be concerned about stitches or may have pain due to tearing or hemorrhoids. |
| Hemorrhoids | The pushing required for delivery can lead to or worsen hemorrhoids. |
| Abdomen | Muscle tone is low after delivery but gradually increases. |
| Skin | Stretch marks do not go away, but they may fade, turning from red to silver, but sometimes not for years. Other darkened areas of the skin may also fade. |
| Weight | Most new mothers lose only about 13 pounds after delivery. They at first look as if they are still pregnant. They may lose more during the first week as extra fluids are eliminated. |
| Mood | Many new mothers feel blue or mildly depressed. The sad mood or baby blues usually passes after about 2 weeks. |
The new mother is also encouraged to defecate before leaving the hospital. But because hospital stays are so short, this expectation may not be practical. Doctors may recommend that if she has not defecated within 3 days, she take laxatives to avoid constipation, which can cause or worsen hemorrhoids. If the rectum or muscles around the anus were torn during delivery, doctors may prescribe stool softeners.
Diet and Exercise: A new mother can have a regular diet as soon as she wants it, sometimes shortly after delivery. She should get up and walk as soon as possible.
A new mother can start exercises to strengthen abdominal muscles, often after 1 day if delivery was vaginal and later if it was cesarean. Sit-ups with bent knees, done in bed, are effective. However, most women are too tired to start exercising so soon after delivery. Cesarean delivery is a major surgery and women should not begin exercising until they have had time to fully recover and allow healing, which typically takes about 6 weeks. Women can resume their prepregnancy exercise routine after approval from their doctor at their postpartum visit.
Vaccines and Immune Globulin: Before the mother leaves the hospital, she is given the German measles (rubella) vaccine if she has never had rubella or never been given this vaccine. If the mother has never received the tetanus, diphtheria, and pertussis (Tdap) vaccine and her last tetanus booster was at least 2 years ago, she should be given a Tdap vaccine before she is discharged.
If a new mother has Rh-negative blood and the baby has Rh-positive blood, she is usually given Rh0(D) immune globulin within 3 days of delivery. This drug masks any of the baby’s red blood cells that may have passed to the mother so that they do not trigger the production of antibodies by the mother. Such antibodies may endanger subsequent pregnancies (see page 1650).
Before Discharge: Before a new mother leaves the hospital, she is examined. If mother and baby are healthy, they commonly leave the hospital within 24 to 48 hours after vaginal delivery and within 96 hours after a cesarean delivery. Sometimes discharge is even earlier than 24 hours if no general anesthetic was used and no problems occurred.
The mother is given information about changes to expect in her body and measures to take as her body recovers from having a baby. Regular follow-up visits are scheduled.
Continuing From Hospital to Home
Coping with some changes begins in the hospital, depending on how soon hospital discharge occurs, and continues at home.
Discharge From the Vagina: New mothers have a discharge from the vagina. Staff members give them pads to absorb it. Staff members also check the amount and color of the discharge. Usually, it appears bloody for 3 or 4 days. Then it becomes pale brown for about 10 to 12 days, then yellowish white. The discharge may continue for up to about 6 weeks after delivery.
About a week or two after delivery, part of the remaining placenta may separate, causing vaginal bleeding of up to about a cup. Sanitary pads, changed frequently, may be used to absorb this discharge. Comfortably fitting tampons, changed frequently, can also be used unless they interfere with healing of an episiotomy incision or of tears in the area between the vaginal opening and the anus (perineum).
Drugs: Mothers who are not breastfeeding may safely take drugs to help them sleep or to relieve pain. For women who are breastfeeding, acetaminophen and ibuprofen are relatively safe pain relievers. Many other drugs appear in breast milk (see box on page 1641).
Genital Area: The area around the vaginal opening is usually sore, and the area may sting during urination. Tears in the perineum or episiotomy repairs can contribute to the soreness and cause swelling.
Immediately after delivery and for the first 24 hours, ice or cold packs may be used to relieve the pain and swelling. Anesthetics can be applied to the skin. Washing the area around the vagina with warm water 2 or 3 times a day helps reduce tenderness. Warm sitz baths can help relieve pain. Sitz baths are taken in a sitting position with water covering only the perineum and buttocks. Women should be careful when sitting down and, if sitting is painful, use a doughnut-shaped pillow.
Hemorrhoids: Pushing during delivery can cause or worsen hemorrhoids. Pain caused by hemorrhoids can by relieved by warm sitz baths and applying a gel containing a local anesthetic.
Did You Know…
When breasts are engorged, expressing milk between feedings temporarily relieves the pressure but overall tends to make engorgement worse.
Breast Engorgement: The breasts may be enlarged, tight, and sore because they are engorged with milk. Engorgement occurs during the early stages of milk production (lactation).
For mothers who are not going to breastfeed, the following can help:
Wearing a snug-fitting bra to elevate the breasts and thus help suppress milk production
Applying ice packs and taking analgesics (such as acetaminophen or ibuprofen) to help relieve discomfort until milk production stops on its own
For mothers who are breastfeeding, the following can help until milk production adjusts to the baby’s needs:
Feeding the baby regularly
Wearing a comfortable nursing bra 24 hours a day
If the breasts are swollen and very uncomfortable, expressing milk by hand in a warm shower or using a breast pump between feedings (however, this measure tends to stimulate milk production and prolong engorgement)
If the breasts are very swollen, the mother may have to express her milk just before breastfeeding to enable the baby’s mouth to fit around the areola (the pigmented area of skin around the nipple).
Mood: Sadness is common during the days after delivery. New mothers should not be too concerned unless sadness is extreme or lasts more than 2 weeks.
What to Expect at Home
A new mother may resume normal daily activities when she feels ready. Eating a healthy diet and exercising regularly can help a new mother return to her prepregnancy weight.
She may resume sexual intercourse as soon as she desires it and it is comfortable. If delivery caused tearing or an episiotomy was done, sexual intercourse should be delayed until the area heals. A new mother may take showers or baths shortly after delivery, unless delivery was by cesarean.
If delivery was cesarean, nothing, including tampons and douches, should be put in the vagina for at least 2 weeks. Strenuous activity and heavy lifting should be avoided for about 6 weeks. Intercourse should also be avoided for 6 weeks. The incision site should be cared for in the same way as other surgical incisions. Showering can typically be resumed 24 hours after surgery. Care should be taken not to scrub the incision site. Baths should be avoided until the wound is completely closed and any staples or sutures have been removed. The incision site should be kept clean and dry. Any evidence of increasing redness or drainage from the incision should be brought to the doctor’s attention. Pain around the incision site can last for a few months, and numbness can last even longer.
Abdomen: The uterus, still enlarged, continues to contract for some time, becoming progressively smaller during the next 2 weeks. These contractions are irregular and often painful. Contractions are intensified by breastfeeding. Breastfeeding triggers the production of the hormone oxytocin. Oxytocin stimulates the flow of milk (called the let-down reflex) and uterine contractions.
Did You Know…
Women can become pregnant as early as 2 weeks after having a baby.
Normally, after 5 to 7 days, the uterus is firm and no longer tender but is still somewhat enlarged, extending to halfway between the pubic bone and the navel. By 2 weeks after delivery, the uterus returns close to its normal size. However, the new mother’s abdomen does not become as flat as it was before the pregnancy for several months, even if she exercises.
Stretch marks do not go away, but they may fade, but sometimes not for a year.
Breastfeeding: Doctors recommend breastfeeding for at least 6 months, but some mothers cannot breastfeed or may not want to for various reasons. Bottle-feeding can be done instead (see page 1680).
Mothers who are breastfeeding need to learn how to position the baby during feeding (see art on page 1679). If the baby is not positioned well, the mother’s nipples may become sore and cracked. Sometimes the baby draws in its lower lip and sucks it, irritating the nipple. In such cases, the mother can ease the baby’s lip out of its mouth with her thumb. After a feeding, she should let the milk dry naturally on the nipples rather than wipe or wash them. If she wishes, she can dry her nipples with a hair dryer set on low. In very dry climates, hypoallergenic lanolin or ointment can be applied to the nipples.
When a mother breastfeeds, the breasts may leak milk. Pads can be worn to absorb the milk, but plastic bra liners can irritate the nipples and should be not be used.
While breastfeeding, mothers need to increase their caloric intake by about 500 calories per day. They should also increase their intake of most vitamins and minerals. Usually, eating a well-balanced diet, including enough dairy products and green, leafy vegetables, and continuing to take prenatal vitamins with additional folate (1 milligram) are all mothers need to do. They should drink enough fluids to ensure an adequate milk supply. Mothers on special diets should consult their doctor about the need for other vitamin and mineral supplements, such as vitamin B12 for vegetarians.
Family Planning: Use of contraceptives is recommended when intercourse resumes because pregnancy is possible as soon as the mother begins to release an egg from the ovary (ovulate) again. Mothers who are not breastfeeding usually begin to ovulate again about 4 to 6 weeks after delivery, before their first period. However, ovulation can occur earlier. Mothers who are solely breastfeeding tend to start ovulating and menstruating somewhat later, closer to 6 months after delivery. The interval depends on how much food other than breast milk the baby consumes. If more than four fifths of the baby’s food is breast milk, ovulation is unlikely to occur. Occasionally, a mother who is breastfeeding ovulates, menstruates, and becomes pregnant as quickly as a mother who is not breastfeeding.
Full recovery after pregnancy takes about 1 to 2 years. So doctors usually advise a new mother to wait at least one year and optimally 18 months before becoming pregnant again (although she may choose not to follow that advice). At her first doctor’s appointment after delivery, a new mother can discuss contraceptive options (see page 1593) with her doctor and choose one that suits her situation. Whether a mother is breastfeeding affects the method of contraception used. Oral contraceptives that contain estrogen and progesterone can interfere with milk production and should not be used until milk production is well established. Progesterone-only contraceptives can be used, but methods that do not use drugs (such as barrier contraceptives) are even better. A diaphragm can be fitted only after the uterus has returned to normal, usually after about 6 to 8 weeks. Before that, foams, jellies, and condoms can be used. Intrauterine devices can be inserted about 6 weeks after pregnancy.
AFTER DELIVERY: WHEN TO CALL THE DOCTOR
| AREASYMPTOMS | POSSIBLE CAUSE | |
| Discharge | If blood soaks a sanitary pad every hour for more than 2 hours If the discharge smells foul If the discharge contains very large clots (larger than a golf ball) |
Infection of the uterus |
| Temperature | If the temperature is 100.4° F (38° C) or higher at any time during the first week | Infection |
| Urination | If urination hurts (not just stings) If the bladder cannot be emptied completely If urination occurs much more frequently than usual |
Urinary tract infection |
| Lower abdomen | If pain or discomfort is felt in the lower abdomen (above the pubic area) after the first 5 days | Infection of the uterus or bladder |
| Back | If pain is felt in the back or side just under the rib cage, particularly if fever is also present or urination is painful | Kidney infection |
| Breast | If a firm lump is felt in the breast after engorgement has subsided If the breast is painful, swollen, or red or feels hot or tender |
A blocked milk duct Breast infection |
| Mood | If a very sad mood with fatigue and lack of energy lasts more than 2 weeks | Postpartum depression |
| Incision from a cesarean delivery | If soreness increases If this area turns red or becomes swollen or hard to the touch If there is any discharge from the incision |
Wound infection |
| Leg or chest | If the leg is swollen or painful If a new mother has sudden, sharp chest pain or chest pain that worsens when she inhales If breathing becomes difficult |
A blood clot in a leg or lung |
| General | If a new mother feels light-headed, faints, or feels short of breath | A blood clot in the lungs |
A new mother (or any woman) who has just been vaccinated against German measles (rubella) must wait at least 1 month before becoming pregnant again to avoid endangering the fetus.
Infections
Immediately after delivery, the woman’s temperature often increases. A temperature of 101° F (38.3° C) or higher during the first 12 hours after delivery could indicate an infection but may not. Nonetheless, in such cases, the woman should be evaluated by her doctor or midwife. A postpartum infection is usually diagnosed after 24 hours have passed since delivery and the woman has had a temperature of 100.4° F (38° C) or higher on two occasions at least 6 hours apart. Postpartum infections seldom occur because doctors try to prevent or treat conditions that can lead to infections. However, infections, if they develop, may be serious. Thus, if a woman has a temperature of more than 100.4° F at any time during the first week after delivery, she should call the doctor.
Postpartum infections may be directly related to delivery (occurring in the uterus or the area around the uterus) or indirectly related (occurring in the kidneys, bladder, breasts, or lungs).
INFECTIONS OF THE UTERUS
Bacteria can infect the uterus and surrounding areas soon after delivery.
Such infections commonly cause pain in the lower abdomen, fever, and a foul-smelling discharge.
Diagnosis is usually based on symptoms and results of a physical examination.
Antibiotics usually cure the infection.
Postpartum infections usually begin in the uterus. Such infections may develop if membranes containing the fetus (amniotic sac) are infected and cause a fever during labor. They include infection of the uterine lining (endometritis), uterine muscle (myometritis), or areas around the uterus (parametritis).
Causes
Bacteria that normally live in the healthy vagina can cause an infection after delivery. Conditions that make a woman more likely to develop an infection include the following:
Anemia
Bacterial vaginosis
Repeated vaginal examinations
Internal monitoring of the fetus (which requires rupture of the membranes)
A long delay (often more than 18 hours) between rupture of the membranes and delivery
Prolonged labor
Cesarean delivery
Placental fragments remaining in the uterus after delivery
Excessive bleeding after delivery (postpartum hemorrhage)
Young age
Low socioeconomic group
The chances of developing uterine infection depend mainly on the type of delivery:
Normal vaginal deliveries: 1 to 3%
Caesarean deliveries that have been scheduled and are done before labor starts: 5 to 15%
Caesarean deliveries that are not scheduled and are done after labor starts: 15 to 20%
Symptoms
Symptoms commonly include pain in the lower abdomen or pelvis, fever (usually within 1 to 3 days after delivery), paleness, chills, a general feeling of illness or discomfort, and often headache and loss of appetite. The heart rate is often rapid. The uterus is swollen, tender, and soft. Typically, there is a malodorous discharge from the vagina, which varies in amount. But sometimes the only symptom is a low-grade fever.
When the tissues around the uterus are infected, they swell, causing significant discomfort. Women typically have severe pain and a high fever.
Some severe complications can occur but not often. They include the following:
Inflammation of the membranes that line the abdomen (peritonitis)
Blood clots in the pelvic veins (pelvic thrombophlebitis)
A blood clot that travels to the lung and blocks an artery there (pulmonary embolism)
High blood levels of poisonous substances (toxins) produced by the infecting bacteria, which lead to sepsis or toxic shock
In sepsis and toxic shock, blood pressure falls dramatically and the heart rate is very rapid. Severe kidney damage and even death may result. These complications are rare, especially when postpartum fever is diagnosed and treated promptly.
Diagnosis and Treatment
An infection may be diagnosed based mainly on results of a physical examination. Sometimes an infection is diagnosed when women have a fever and no other cause is identified.
Usually, doctors take a sample of urine and send it to be cultured and checked for bacteria. Occasionally, a blood sample is cultured.
If the uterus is infected, women are usually given antibiotics (usually clindamycin plus gentamicin) intravenously until they have had no fever for 48 hours. Afterward, most women do not need to take antibiotics by mouth.
BLADDER AND KIDNEY INFECTIONS
A bladder infection (cystitis) sometimes develops postpartum. The risk is increased when a catheter is placed in the bladder to relieve a buildup of urine during and after labor. A kidney infection (pyelonephritis) is caused by bacteria spreading from the bladder to the kidney after delivery. Sometimes a bladder or kidney infection develops because bacteria that were in the bladder during pregnancy cause no symptoms until after delivery.
Bladder and often kidney infections cause painful or frequent urination. Kidney and some bladder infections cause fever. Kidney infections may cause pain in the lower back or side, a general feeling of illness or discomfort, and constipation.
Diagnosis and Treatment
The diagnosis is based on examination and analysis of a urine sample. With kidney infections and some bladder infections, the sample may be cultured to identify the bacteria.
Typically, women are given an antibiotic intravenously for a kidney infection or by mouth for a bladder infection. If there is no evidence that the bladder infection has spread to the kidneys, antibiotics may be given for only a few days. If a kidney infection is suspected, antibiotics (such as ceftriaxone alone or ampicillin plus gentamicin) are given until the woman has had no fever for 48 hours. Often, antibiotics are given by mouth for an even longer period of time. After culture results are available, the antibiotic may be changed to one that is more effective against the bacteria present.
Drinking plenty of fluids helps keep the kidneys functioning well and flushes bacteria out of the urinary tract.
Another urine sample is cultured 6 to 8 weeks after delivery to verify that the infection is cured.
BREAST INFECTION
A breast infection (mastitis—see page 1549) can occur after delivery, usually during the first 6 weeks and almost always in women who are breastfeeding. If the baby is not positioned correctly during breastfeeding, cracking (and soreness) can develop. If the skin of or around the nipples becomes cracked, bacteria from the skin can enter the milk ducts and cause an infection.
An infected breast usually appears red and swollen and feels warm and tender. Only part of the breast may be red and sore. Women may have a fever. A fever that develops later than 10 days after delivery is often caused by a breast infection.
Did You Know…
If a breast infection develops after delivery, women should usually continue to breastfeed.
Rarely, breast infections result in a collection of pus (abscess). The area around the abscess swells, and pus may drain from the nipple.
Doctors base the diagnosis on results of a physical examination.
Treatment
Breast infections are treated with antibiotics, such as dicloxacillin or erythromycin. Women are encouraged to drink plenty of fluids. Women who have a breast infection and are breastfeeding should continue to breastfeed because emptying of the breast helps with treatment and decreases the risk of a breast abscess.
Breast abscesses are treated with antibiotics and are usually drained surgically. This procedure can be done using a local anesthetic but may require sedatives given intravenously or a general anesthetic.
Blood Clots
The risk of developing blood clots (thrombophlebitis) is increased after delivery. Typically, blood clots occur in the legs or pelvis (a disorder called deep vein thrombosis—see page 433). Sometimes one of these clots breaks loose and travels through the bloodstream into the lungs, where it lodges in a blood vessel in the lung, blocking blood flow. This blockage is called pulmonary embolism (see page 488).
Symptoms
A fever that develops between 4 and 10 days after delivery may be caused by a blood clot. The affected part of the leg, often the calf, may be painful, tender to the touch, warm, and swollen. The first sign of pulmonary embolism may be shortness of breath.
Diagnosis
Diagnosis of deep vein thrombosis is usually based on results of ultrasonography. Occasionally, a blood test to measure D-dimer (a substance released from blood clots) is helpful. Diagnosis of pulmonary embolism is usually based on computed tomography (CT) of the chest.
Treatment
Treatment of a superficial blood clot in the leg consists of warm compresses (to reduce discomfort), compression bandages applied by a doctor or nurse, and bed rest with the leg elevated (by raising the foot of the bed 6 inches). Women with deep vein thrombosis or pulmonary embolism need to take drugs that make blood less likely to clot (anticoagulants).
Thyroid Disorders
In 4 to 7% of women, the thyroid gland malfunctions during the first 6 months after delivery. Thyroid hormone levels may be high or low, usually temporarily. Women who have a family history of thyroid disorders or diabetes are particularly susceptible. If women already have a thyroid disorder, such as a goiter or Hashimoto’s thyroiditis, the disorder may become worse.
Treatment may be required.
Postpartum Depression
Postpartum depression is a feeling of extreme sadness and related psychologic disturbances during the first few weeks or months after delivery.
Women who have had depression are more likely to develop postpartum depression.
Women feel extremely sad, cry, become irritable and moody, and may lose interest in daily activities and the baby.
A combination of counseling and antidepressants can help.
The baby blues—feeling sad or miserable within 3 days of delivery—is common after delivery. Women should not be overly concerned about these feelings because they usually disappear within 2 weeks. Postpartum depression is a more serious mood change. It lasts weeks or months and interferes with daily activities. About 10 to 15% of women are affected. Very rarely, an even more severe disorder called postpartum psychosis develops.
The causes of sadness or depression after delivery are unclear, but the following may contribute:
Depression or another psychologic disorder that was present before or developed during pregnancy
Close relatives who have depression (family history)
The sudden decrease in levels of hormones (such as estrogen, progesterone, and thyroid hormones)
Stresses of having and caring for a baby (such as difficulties during labor and delivery, lack of sleep, fatigue, loss of freedom, and feelings of isolation and incompetence)
Lack of social support
Marital discord
Other significant life stressors such as financial difficulties or a recent move
If women have had depression before they became pregnant, they should tell their doctor or midwife. Such depression often evolves into postpartum depression. Depression during pregnancy is common and is an important risk factor for postpartum depression.
Symptoms
Symptoms may include frequent crying, mood swings, and irritability as well as feelings of extreme sadness. Less common symptoms include extreme fatigue, difficulty concentrating, sleep problems, loss of interest in sex and other activities, anxiety, appetite changes, and feelings of inadequacy or hopelessness. Women have difficulty functioning. They may have no interest in their baby.
In postpartum psychosis, depression may be combined with suicidal or violent thoughts, hallucinations, or bizarre behavior. Sometimes postpartum psychosis includes a desire to harm the baby.
Fathers may also become depressed, and marital stress may increase.
Without treatment, postpartum depression can last months or years, and women may not bond with their infant. As a result, the child may have emotional, social, and cognitive problems later. About one in three or four women who have had postpartum depression have it again.
Preventing Depression After Delivery
Women can take steps to combat feelings of sadness after having a baby:
Getting as much rest as possible—for example, by napping when the baby naps
Not trying to do everything—for example, by not trying to keep a spotless house and make home-cooked meals all the time
Asking for help from family members and friends
Talking to someone (husband or partner, family members, or friends) about their feelings.
Showering and dressing each day
Getting out of the house frequently—for example, to run an errand, meet with friends, or take a walk
Spending time alone with their husband or partner
Talking with other mothers about common experiences and feelings
Joining a support group for women with depression
Diagnosis
Early diagnosis and treatment are important for women and their baby. Women should see their doctor if they continue to feel sad and have difficulty doing their usual activities for more than 2 weeks after delivery or if they have thoughts about harming themselves or the baby. If family members and friends notice symptoms, they should talk with the woman and encourage her to talk to a doctor.
Doctors may ask women to fill out a questionnaire designed to identify depression. They may also do blood tests to determine whether a disorder, such as a thyroid disorder, is causing the symptoms.
Treatment
If women feel sad, support from family members and friends is usually all that is needed. But if depression is diagnosed, professional help is also needed. Typically, a combination of counseling and antidepressants (see table on page 868) is recommended. Women who have postpartum psychosis may need to be hospitalized, preferably in a supervised unit that allows the baby to remain with them. They may need antipsychotic drugs (see table on page 894) as well as antidepressants.
Women who are breastfeeding should consult with their doctor before taking any of these drugs to determine whether they can continue to breastfeed (see box on page 1641). Many options that allow continuation of breastfeeding are available.