Hesperian Health Guides

Chapter 15: The first weeks after the birth

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HealthWiki > A Book for Midwives > Chapter 15: The first weeks after the birth

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In the first few days and weeks after the birth, the mother's body will start to heal. Her womb should get smaller and stop bleeding. Her milk should come in. The baby should learn to breastfeed normally and start to gain weight.

The mother and baby will still benefit from your care after the birth. Visit them at least 2 times — the day after the birth, and then again at least once in the following week. If you visit even more, you may prevent more problems. Visit every day if there are signs of problems in the mother or baby.

What to do for the mother

Mothers need care after birth just as babies do.

Help the mother care for herself

After birth, the mother's body is tired and her womb is open. It is easy for her to get infected, but she can stay healthy by:

In some cultures, women rest in bed with their babies for 2 weeks or more after a birth. This is a healthy custom because it helps the mother heal, helps her and her baby to be closer, and keeps the mother away from germs outside of her home. If possible, the mother should not do difficult work for about 6 weeks. But she should be sure to walk around a little each day even if she is mostly resting.

Remind the woman and her partner that they should wait until the woman stops bleeding before they have sex. Also be sure to talk to the couple about family planning because the woman can become pregnant again soon.

Watch the mother's womb and bleeding

After the birth, the mother should bleed about the amount of a normal monthly bleeding or less. Her bleeding should stop after 2 or 3 weeks but may last as long as 6 weeks.

Her womb should be firm and get smaller and smaller each day.

6 lines showing the height of the womb, between the bellybutton and  the public bone.
Check this chart to see where the top of the womb should be after the birth.
1 day after birth
2 days
3 days
4 days
5 days
6 days
  • Womb feels soft or large.
  • Mother bleeds a lot.
  • Mother has signs of shock.

The mother's womb

If the womb gets soft, rub it until it is firm. Show the woman's family how they can rub the womb when you are not there. Ask the mother to breastfeed more often, and watch for too much bleeding.

Also, feel the womb to be sure it is going down to its normal size. Just after birth, the womb is about halfway between the pubic bone and the bellybutton. The next day, it grows to the height of the bellybutton, and should shrink every day after that.

The mother's bleeding

If the mother soaks more than 1 pad in an hour, she is probably bleeding too much. Rub the womb to help it contract. Remind the family that the mother needs to rest. Working too much often causes bleeding after a birth.

a man holding a baby and speaking to a woman who lies in bed.
Let me take care of the baby while you get a little more rest.

If these methods do not work, give medicines to stop bleeding. If the bleeding continues, or if the mother has signs of shock, get medical help right away.

Watch the mother for signs of womb infection

normal temperature — around 37°C (98.6°F).

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  • Fever, 38°C (100.4°F) or higher
  • Chills
  • Fast pulse
  • Heavy bleeding
  • Bad-smelling genitals or bleeding
  • Pains in the belly.
  • An ill feeling.

If a woman has any of these signs after a birth, she may have a womb infection. Womb infections are very dangerous — they can quickly kill a woman.

If possible, a woman who may have a womb infection should go to a medical center right away. She can be tested to find out which antibiotic medicines will cure her infection. If you cannot get medical help, treat the woman at home.

Giving antibiotics at home

You cannot be sure which germs are causing a womb infection, so you will need to give 4 antibiotics to kill many different germs. If you do not have all of these antibiotics, it is better to give only 1 or 2 than none at all.

Give the antibiotics until the signs of infection have been gone for 2 days. This may take about 5 days altogether.

To treat womb infection
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  • inject 80 mg gentamicin
in the muscle,
3 times a day for about 5 days
  • give 2 g ampicillin
in the muscle or by mouth for the first dose,
then give 1 g ampicillin 4 times a day for about 5 days
  • give 400 to 500 mg metronidazole
by mouth, 3 times a day for about 5 days
Give these medicines until the woman has had no fever for 2 days (48 hours).

WARNING!    If the woman does not start to feel better within 1 or 2 days, she may have pieces of the placenta still in her womb. These will need to be removed. Keep giving her antibiotics and take her to a hospital.

Watch the mother for signs of vaginal infection

Any tears in the vagina are healing, and the skin is not swollen or hot.

  • Pain in the vagina
  • Pus or a bad smell from the vagina
  • Swelling, redness, or a hard lump in the vagina
An infection of the vagina is not as dangerous as a womb infection
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Wash your hands well, put on gloves, and look at the woman's vagina. If you see any of the warning signs listed here, she probably has an infection. If you see pus, check to be sure the pus is not coming from high inside her vagina. If it is, she probably has a womb infection.

If the pus is coming from a hard lump or tear on the woman's genitals, get medical help, or follow these instructions to drain the pus yourself.

To drain the pus

Warm, wet cloths will usually draw out pus.

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If the tear is open

Hold sterile cloths dipped in boiled warm water on the infected area.

If you know plant medicines that will draw out pus, wrap them in a sterile piece of cloth or gauze, and tie the cloth so the plants cannot fall out. Boil the wrapped plants, let them cool a little, and then press on the infected area.

If you feel a hard lump under the skin

If you feel a hard lump, pus or blood is probably trapped inside.
Watch the lump each day. If it is painful or growing larger, get medical help.

Watch for other warning signs

The mother's legs are red, hard, painful, or swollen

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Very rarely, after a birth, a woman's blood can form a clot in her leg. Signs of a clot are:

  • swelling or heat in one leg or foot.
  • pain in one leg when it is squeezed or during walking.
  • a painful red area on one leg.
  • a hard lump in the leg.
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A clot can move to a
woman's lung and make
breathing impossible.

A blood clot is very dangerous. If the clot breaks free and moves through her blood, it can cause problems in other parts of her body. For example, the clot can go into her lung and make it impossible for her to breathe.

If a woman has a sign of a blood clot, go to a medical center immediately. On the way, have the woman lie down with her legs above her hips and try to stay still. Put warm cloths on the swollen area, but do not rub or massage it. Give aspirin for pain.

Leaking urine or stool

a woman with a wet spot on the back of her dress.
Fistula causes
leaking urine.

When urine or stool leaks freely from a woman, she may have a hole in the skin inside her vagina, called a fistula. This hole is caused during labor by the baby's head pressing hard on the skin between the bladder and the vagina, or sometimes the skin between the rectum and the vagina. The pressure of the head is so great that the skin dies and a hole opens up between 3 and 12 days after the birth.

Fistulas can usually be treated. A small fistula may heal on its own: the woman should drink a lot of fluids and take sitz baths. If she is catheterized for 3 weeks, urine will be kept out of the fistula long enough for it to heal.

A serious fistula needs to be repaired. There are hospitals that can do this surgery — usually about 3 months after the birth. Help the woman get to a medical center for help.

Fistulas can be prevented

A fistula happens when a woman is in labor for a long time. When a woman has been in labor for many hours, do not keep waiting. Get medical help. Learn more about preventing fistulas.

Give emotional support

It is important to give the mother emotional support. Customs and rituals that honor the mother or celebrate the birth are one way to recognize the work she has done in labor.

What to do if the mother feels very upset or sad (depressed)

Most women feel strong emotions after giving birth. This is normal. Some feel sad or worried for a few days, weeks, or months. When this happens, you can help by listening to the woman's feelings and explaining that the feelings are common.

When these sad feelings are very strong, it is called depression. It may be difficult for the woman to care for herself or her baby. She may even act crazy. A woman who is depressed needs help. She needs help caring for her home and family, and she needs help to stop feeling so upset. If possible, someone should stay with the woman to help and to be sure she does not hurt herself or her baby.

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There are also some traditional rituals and remedies, as well as modern medicines, to help a woman feel better. The modern medicines are expensive and can cause other problems, so they should only be taken in extreme cases.

A woman who had feelings like this after a previous birth is more likely to feel them again after this birth.

This page was updated:11 Sep 2019