Postpartum

Bleeding and Discharge

After giving birth, women commonly bleed for weeks. The exact duration of postpartum uterine discharge (lochia) varies widely from woman to woman and from birth to birth for a given woman. The median duration of discharge is 36 days, but the discharge toward the end of this time is often not of a niddah color. When the niddah-colored bleeding comes to an end, a woman can undertake the process of becoming tehorah.

(Following the vaginal delivery of a girl, a woman may not immerse until fourteen days have elapsed since the birth. In practice, postpartum bleeding rarely ends soon enough for her to consider immersing earlier.)

It is common for postpartum bleeding to stop and then start again. Often, a woman will get a clean hefsek taharah, but find that bleeding resumes during the shivah neki’im.

One should not hesitate to ask halachic questions during this process. Light browns (the color of coffee with milk or lighter, with no reddish tinge) are acceptable and do not require evaluation. Darker browns, or browns that seem to be reddish, should be evaluated by a halachic authority.

Women often do not to get to the mikveh until at least a month or two after giving birth. If difficulties continue after two months, one should discuss the situation with a halachic authority and physician.

Bedikot

Halachically, the process of becoming tehorah postpartum resembles the process any time a woman becomes niddah. A woman performs a hefsek taharah, counts shivah neki’im, and immerses in the mikveh.

However, the vaginal area is more sensitive postpartum, especially if there are stitches. Therefore, the moch dachuk may be omitted for the first cycle, and one should perform bedikot with extra care. Some women find it helpful to dampen the bedikah cloth slightly with water, or to perform bedikot lying down or in a more shallow fashion.

If bedikot are nevertheless difficult or uncomfortable, there may be room to reduce the number performed.

Timing Immersion and the Postpartum Check Up

Many health care providers instruct couples to delay marital relations until about six weeks postpartum, following a doctor’s visit.

A woman who is able to complete her shivah neki’im before this point may immerse in the mikveh so that the couple can stop keeping the harchakot, which can be important for the couple’s relationship and for baby care, even if relations are off the table.

If a woman has concerns about the safety of bedikot, mikveh preparations, or mikveh immersion, she should discuss them with her healthcare provider.

Contraception

If a couple are considering using contraception, the check-up is a good time to discuss or pursue available options with one’s healthcare provider. We recommend reading about the options in advance of a visit under “Family Planning.”

It is fairly common for nursing women to use progesterone-only pills (also known as mini-pills) postpartum. These pills can be associated with staining and complicate the process of becoming tehorah. A woman may wish to consult her physician about waiting until after her first immersion to begin the pills, and using short-term contraception such as spermicide in the interim.

This article was updated on 14 December, 2021.

Most of us feel sad or miserable at one time or another. Clinical depression is a mood disorder in which feelings of sadness, loss, anger, or frustration persist for an extended time to a degree that they interfere with everyday life. When this condition occurs during pregnancy or within a year of delivery it is called perinatal depression. When it occurs within a year of childbirth, it is also referred to as postpartum depression.

Diagnosis of depression during pregnancy is sometimes difficult as the normal changes of pregnancy often lead to similar complaints – fatigue, difficulty sleeping, and changes in body weight. Similar phenomena can also occur when a woman awakens frequently to care for an infant. But when the symptoms are severe enough to affect the functioning of the woman or her family, and do not improve with simple interventions to assure adequate sleep, a diagnosis of depression should be considered.

It is not uncommon for women to experience extremes in mood during the days after childbirth. Some feel very sad and weepy (“baby blues”), others feel euphoric and as if they could conquer the world, others swing from one extreme to the other. Any of these within the first two weeks, as long as there are no serious thoughts of harming oneself or the baby, are normal and are not a cause for concern. Simple interventions to assist the mother generally help her feel better. These include letting her nap when the baby naps and reducing to the absolute minimum any other household responsibilities of the new mother. Even better than waiting to see if the mother will have trouble is to prepare in advance for help in the house – a gift of household help is of greater use to most families than yet another outfit the infant will soon outgrow.

If the feelings do not subside after two weeks, or if such feelings begin spontaneously during the first year, consultation with a physician should be considered. True clinical depression can be distinguished from simply feeling sad because of the much greater impact on a woman’s well being and functioning.

Treatment of the mother is important for both the mother and her infant; studies have shown impact such as decreased weight gain among infants of depressed mothers. Depending on degree, treatment can include counseling, support groups and/or medication. With help, the condition resolves. In general, if intervention begins sooner, the duration of postpartum depression and the associated suffering can be minimized. Thus it is important not to be embarrassed and to ask for help if one suspects one is depressed.

Information specific to observant Jewish women can be obtained through NITZA – The Israel Center for Maternal Health. NITZA was founded in 1997 as a grassroots organization supporting and financially assisting women across Israel suffering from the devastating effects of Postpartum Depression and its related syndromes.

Phone: (02) 533-2810 (from outside Israel, 972-2-533-2810)
Email: [email protected]
Internet Address: http://www.nitza.org

You can also find out more about depression during and after pregnancy by contacting the National Women’s Health Information Center (NWHIC) at 1-800-994-9662 or the following organizations.

National Institute of Mental Health, NIH, HHS 
Phone: (301) 496-9576
Internet Address: http://www.nimh.nih.gov

National Mental Health Information Center, SAMHSA, HHS
Phone: (800) 789-2647
Internet Address: http://www.mentalhealth.gov

American Psychological Association 
Phone: (800) 374-2721
Internet Address: http://www.apa.org

National Mental Health Association
Phone: (800) 969-NMHA
Internet Address: http://www.nmha.org

Postpartum Education for Parents 
Phone: (805) 564-3888
Internet Address: http://www.sbpep.org

Postpartum Support International
Phone: (800) 944-4773
Internet Address: http://www.postpartum.net