Postpartum Care in Nepal: What Every New Mother Needs to Know

The period immediately following childbirth — the postnatal or postpartum period — is among the most significant and physiologically demanding transitions a woman’s body goes through. Yet in Nepal, postnatal care is often the most under-resourced part of the maternity pathway. Attention shifts to the newborn, and the mother’s recovery is assumed to proceed on its own.

This creates gaps. Postpartum complications — heavy bleeding, wound infection, postpartum depression, breastfeeding difficulty — are common and preventable when recognized and addressed early. At A&B International Hospital in Pokhara, postnatal care is structured, not incidental — beginning before discharge and continuing through planned follow-up visits.

What Physical Recovery Should a Woman Expect After Delivery?

Physical recovery after delivery varies based on whether the birth was vaginal or by cesarean section, but both involve significant bodily change. Understanding what is normal accelerates recovery and helps women recognize when something requires attention.

After normal vaginal delivery:

• Lochia (postpartum bleeding): Normal vaginal bleeding and discharge for 4–6 weeks. Starts red and heavy in the first few days, then pink and brown, then yellow-white by weeks 3–4. Lochia heavier than a period with large clots, or with an offensive smell and fever, requires assessment.
• Perineal pain: If an episiotomy was performed or a perineal tear occurred, pain and swelling in the perineum are expected for 1–2 weeks. Ice packs, sitz baths (warm water sitz twice daily), and paracetamol manage this.
• Uterine cramping (afterpains): The uterus contracts as it returns to its pre-pregnancy size over 4–6 weeks. These cramps are stronger and more pronounced during breastfeeding (due to oxytocin release) and in women who have had previous pregnancies.
• Breast engorgement: When milk comes in (Days 2–4), breasts become full, firm, and tender. Frequent nursing, breast massage, and warm compresses reduce engorgement.

After cesarean section:

• Wound care: The incision should be kept clean and dry. Wound check at 7–10 days. Signs of infection (redness, discharge, opening of the wound, fever) require immediate return to A&B.
• Activity restriction: No heavy lifting (more than the baby’s weight) for 6 weeks. Abdominal muscles are healing.
• Pain management: Regular paracetamol and NSAIDs (where breastfeeding-safe doses are used) in the first 1–2 weeks. Opioid medications should be tapered as quickly as comfort allows.
• Driving: Generally safe after 4–6 weeks when the wound is healed and the patient is not on strong analgesia.

How Does Uterine Involution Happen After Delivery?

Uterine involution is the process by which the uterus returns from its pregnancy size (approximately 1 kg at term) to its pre-pregnancy size (approximately 70 g) over 4–6 weeks postpartum.

Immediately after delivery, the uterus can be felt as a firm, round mass at or just below the navel. Over the first week, it descends by approximately 1 cm per day. By 6 weeks postpartum, it should no longer be palpable above the pubic symphysis.

Factors that support involution: breastfeeding (oxytocin released during nursing stimulates uterine contractions), uterine massage if taught by the midwife team, and avoiding a distended bladder (a full bladder prevents the uterus from contracting properly).

Subinvolution — failure of the uterus to involute — is associated with retained placental fragments or postpartum infection (endometritis) and presents with persistent or returning heavy bleeding. This requires assessment and often treatment.

How Should Breastfeeding Be Managed After Delivery?

Breastfeeding is the optimal nutrition for the newborn for the first six months of life, and has significant health benefits for both baby and mother. A&B International Hospital supports early breastfeeding initiation and provides counseling for common breastfeeding difficulties.

Key breastfeeding guidance:

• Initiation: Breastfeeding should ideally begin within the first hour after birth. Skin-to-skin contact and the rooting reflex guide the baby to the breast naturally.
• Colostrum: The first milk is thick, yellow, and produced in small amounts — this is normal and sufficient for the newborn. Colostrum is rich in antibodies (IgA) that protect the baby against infection.
• Frequency: Feed on demand — typically 8–12 times per 24 hours for newborns. The baby feeds frequently because the stomach is small.
• Latch: A correct latch (baby’s mouth covering the areola, not just the nipple) prevents nipple pain and ensures adequate milk transfer. A&B’s postnatal nursing staff teach and correct latch technique.
• Common problems: Sore and cracked nipples (usually a latch problem), engorgement, blocked ducts, mastitis (breast infection presenting with fever, pain, and redness in one breast — requires antibiotics breastfeeding-safe to use).

What Is Postpartum Depression and How Is It Recognized?

Postpartum depression (PPD) is a clinical depressive illness occurring after childbirth. It affects approximately 10–15% of mothers globally and is underreported in Nepal due to stigma and lack of awareness. It is not “baby blues” — baby blues (tearfulness, mood swings, anxiety in the first week) are a normal hormonal adjustment. PPD is a more serious condition that requires clinical attention.

Signs of postpartum depression:

• Persistent sadness, hopelessness, or feeling empty for more than two weeks
• Inability to enjoy the baby or feel bonded with the newborn
• Severe fatigue beyond what expected for new motherhood
• Inability to sleep even when the baby sleeps
• Loss of appetite or overeating
• Difficulty concentrating, making decisions, or completing daily tasks
• Feeling like a bad mother or guilty for struggling
• Thoughts of harming oneself or, in severe cases, the baby (postpartum psychosis — a psychiatric emergency)

PPD is caused by a combination of rapid hormonal changes after delivery, sleep deprivation, the psychological adjustment to parenthood, and sometimes pre-existing vulnerability. It is not a sign of weakness or failure — it is a medical condition that responds well to treatment.

Treatment: Supportive counseling, structured family support, and antidepressant medication (SSRIs that are breastfeeding-safe) are effective. The A&B postnatal team screens for PPD at postpartum follow-up visits.

When Should a New Mother Call the Doctor After Delivery?

New mothers should return to A&B or call immediately if any of the following develop after discharge:

• Heavy vaginal bleeding: Soaking more than one pad per hour, or passing large clots — may indicate postpartum hemorrhage or retained placental fragments
• Fever above 38.5°C — suggests infection (endometritis, wound infection, mastitis, urinary tract infection)
• C-section wound signs: Redness, warmth, increasing pain, discharge from the wound, or the wound beginning to open
• Perineal wound problems: Signs of infection in the stitches (severe pain, swelling, discharge)
• Difficulty urinating or painful urination — urinary tract infection is common postpartum
• Leg pain, swelling, or redness — deep vein thrombosis (DVT) risk is elevated postpartum
• Chest pain or difficulty breathing — pulmonary embolism, though rare, is most common in the first weeks after delivery
• Severe headache or visual changes — postpartum pre-eclampsia can occur after delivery

When Should a Newborn Have Its First Check-Up?

The newborn should be assessed by a pediatrician within the first 24 hours of life and again before discharge from hospital. The first outpatient check-up is scheduled at 1–2 weeks of age.

A&B International Hospital provides immediate newborn assessment including Apgar scoring, physical examination, birth weight, and initial vaccinations. BCG and hepatitis B vaccines are given within the first 24 hours. The hospital team advises parents on newborn care, cord care, temperature management, and feeding before discharge.

What Family Planning Options Are Available After Delivery?

Return of fertility after delivery varies: breastfeeding delays the return of ovulation, but it is not a reliable contraceptive method. Ovulation can return as early as 3–4 weeks after delivery even in exclusively breastfeeding women.

Family planning counseling is part of the postnatal service at A&B. Options available include:

• Condoms: Suitable from immediately after delivery
• Progestogen-only pill (mini-pill): Safe for breastfeeding; available from 3 weeks postpartum
• Progestogen implant or injectable: Long-acting options; safe for breastfeeding
• Copper IUD: Can be inserted at 4–6 weeks postpartum; highly effective, non-hormonal
• Combined OCP: Delayed until 6 weeks postpartum if breastfeeding (estrogen may reduce milk supply)
• Tubal ligation: Permanent method; can be discussed at A&B — laparoscopic procedure available

The WHO recommends waiting at least 24 months between pregnancies to reduce the risk of preterm birth, low birthweight, and maternal depletion in subsequent pregnancies.

Complete Postpartum Care at A&B International Hospital Pokhara

Your recovery after childbirth matters as much as the delivery itself. A&B International Hospital provides structured postpartum follow-up — wound care, breastfeeding support, mental health screening, and family planning — to ensure every new mother in Pokhara has the support she needs.

A&B International Hospital

Pokhara-02, Bindhyaabasini

Phone: +977 061-412512

Website: abinthospital.com

ECHS-eligible mothers receive cashless postpartum follow-up care. Call or visit to schedule your postnatal check-up. Emergency maternity care available 24 hours a day.