American Medical Association Family Medical Guide - American Medical Association [303]
Vaginal Soreness
If you had a vaginal delivery, your vaginal area will be sore and swollen because the skin around the vaginal opening (perineum) was stretched and may have torn or been surgically cut (episiotomy; see page 533) during delivery. Urination can be painful for a couple of days after delivery. Your doctor may recommend applying cold packs periodically for the first few hours after delivery to help relieve the pain. Many women find that using a doughnut-shaped pillow can make sitting more comfortable. You will be given instructions for cleaning your vaginal area to reduce the risk of infection.
Breast Conditions
Most breast conditions that develop after pregnancy result from breastfeeding, usually during the first weeks. Most of these problems are temporary, can be treated easily, and do not require you to stop breastfeeding, so don’t be discouraged.
Engorged breasts
As your body begins to produce breast milk (about 2 to 4 days after delivery), your breasts will become engorged with milk and may be swollen and painful. If you are breastfeeding, the best solution for engorgement from the buildup of milk is to feed your baby frequently. However, if your nipples are swollen and difficult for the baby to latch on to, you may need to express some milk with a breast pump before putting the baby to your breast. Hot showers can also help soften the breasts. A good support bra can help relieve some of the discomfort, which usually subsides within a few days.
If you are not breastfeeding, try applying ice packs to your breasts to relieve the pain. Don’t pump your breasts to relieve the engorgement—doing so will produce more milk and cause more engorgement. After about 3 days without stimulation from a nursing infant, your breasts will stop producing milk. If the pain is severe, ask your doctor about taking a pain reliever.
Cracked nipples
When you are breastfeeding, your nipples can become dry and cracked, which you can feel as a sharp pain in a nipple while your baby is nursing. Prevent dry, cracked nipples by using only warm water (no soap) to wash your nipples and by drying your nipples thoroughly after each feeding. Also, make sure the baby has the whole nipple and areola (the surrounding pigmented area) in his or her mouth, not just the nipple (because it puts too much pressure on the nipple). Your doctor may recommend a soothing cream to apply to a sore nipple between feedings. The crack should heal in a few days; feed your baby from the other breast more frequently until the sore nipple heals.
Mastitis
Mastitis is infection of the milk ducts, which is a common problem in women who breastfeed. The infection usually occurs when bacteria from the nursing child’s mouth enter the milk duct. Symptoms include soreness, hardness, redness, and swelling of the breast, and sometimes chills and a fever. See your doctor if you have any of these symptoms; he or she will prescribe an antibiotic if you have an infection. Continue to breastfeed during treatment, because this can help relieve the pain and clear up the infection. Have the baby start feeding on the unaffected breast first because he or she sucks hardest at the beginning, when hungriest. If the baby doesn’t empty the breast completely, pump it after each feeding until it is empty.
Blocked milk duct and abscess
If you feel a small, hard lump in your breast, you may have a blocked milk duct. Try massaging your breast and taking hot showers. If the lump does not disappear in a day or two, see your doctor right away; you could have a breast abscess (see page 855). The doctor will examine your breast and may give you antibiotics to treat the infection. If the abscess is not treated quickly enough, you may need to have it drained