Mothering The Mother: Postpartum Instructions

 

Rest and take care of yourself!

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Now that your baby is here, you will need to take special care of yourself. Stay in bed! You probably feel great, but really allow yourself to be treated like a queen for a few days. Pamper yourself so that you can take care of your baby. During the first two weeks, your activity level can determine how long it will take to heal. Pushing yourself too soon - even if you feel good - can mean that you are still healing at six weeks postpartum. Your body is working hard to make milk and establish a good supply and to heal the site on your uterus where the placenta was. Try to establish limited visiting hours for your family and friends so that you are sure to get enough rest and are able to conserve energy for baby. Your only activities should be caring for yourself and the baby. If you have a lot of energy, take a short walk or sit outside with the baby. Avoid busy public places. You will find that fatigue arrives suddenly. Honor it, and go to bed. Learn the art of napping with your baby.

 

Nutrition

Good nutrition is an essential part of postpartum recovery. You still need to “eat for two”, as your nutritional needs while nursing are comparable to those in pregnancy. You can also continue to take your prenatal vitamins. Eat lots of whole grains, bran and oatmeal cereals, good protein, and plenty of fruits and vegetables. These foods will help keep your bowels moving and to avoid constipation. Drink plenty of water as this will help with your milk supply. A good rule of thumb is to drink a glass of water every time you nurse your baby. To help increase your energy postpartum and to rebuild your blood supply it is important to eat foods high in iron (spinach, kale, red meat, chicken, etc).

Breastfeeding

Your breasts are full of colostrum for the first few days after birth. Colostrum is the perfect first food, containing protein, fat, minerals, and vitamins. Put the baby to breast anytime the baby is awake and making mouthing (“rooting”) movements. Your baby will need to nurse at least every one to three hours- most babies nurse more frequently than that thought. How often your baby wants to nurse is not an indicator of how much milk you’re making. The more often your baby nurses, the sooner your milk will come in. It is normal to have engorgement in your breasts lasting 1-4 days. Frequent nursing will usually give relief. If the fullness makes you too uncomfortable, or makes nursing difficult, try the following:

• Express some milk, by hand or with a pump, to soften the areola before baby nurses. It is unnecessary to pump between feedings (this will just tell your body to make *more* milk, creating more engorgement). You also can try “reverse pressure softening” where you take your two fingers and place the nipple in between them, and place firm pressure down on the breast toward the chest wall. This will also help soften the areola before latching.

• Apply moist heat, a warm shower or a hot water bottle to your breasts before you nurse the baby.

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Bleeding

Postpartum bleeding (lochia) is like a heavy period. It should be intermittent rather than steady. The lochia after birth goes through three stages: bright red blood with clots (some clots can be on the larger side, but please call the midwives if you pass a clot larger than your fist); pinkish brown; and then cream colored. You should notice your bleeding tapering down and essentially gone by six weeks postpartum. Your bleeding should smell like a period. Do not use tampons and change your pads often. You should not be soaking two pads (front and back) in an hour, if you do that you need to call the midwives. Your uterus (found below your bellybutton) should feel firm like a grapefruit. To help keep your uterus firm, nurse your baby “on demand” at least every two to four hours. Empty your bladder frequently (you may not feel a strong urge to go, as the nerve receptors in your bladder are enjoying the extra space). Massage your uterus if it does not feel firm.

 

Afterbirth Pains

Some women, especially after their second or more babies, will experience cramping for the first few days after birth. As your uterus shrinks down to its prepregnant size, you may notice that they feel like menstrual cramps. Here are some options to help alleviate the pain/discomfort:

• Hot water bottle or heating pad

• Extra calcium with magnesium

• Afterease Tincture
• Crampbark tincture / tea

• Ibuprofen every four hours

 

Perineal Care

Use your peribottle during urination and bowel movements to help easy discomfort and clean the area well, and make sure to dry the perineal area well, patting dry is usually most comfortable. It is important to gently keep clean and dry to promote healing. You can utilize frozen pads to help with swelling and discomfort immediately following birth, but remember that after the first 24 hours, warmth helps promote healing better than cold. Squirt witch hazel on a pad or use Tucks pads up against any sutures you may have. Kegels also helps to increase blood flow, ease itching from sutures, and promote healing.

 

Sexual Activity

It is best to wait until all bleeding has stopped and you feel physically and psychologically ready and comfortable. The first time making love can be intimidating after birth so take it slow. Don’t expect to be “back to normal” right away. You may need to use a water-based lubricant or coconut oil (oil only if you’re not using condoms) since your postpartum and breastfeeding hormones may increase vaginal dryness.
It is possible to ovulate within 4-6 weeks after birth - even while breastfeeding - so you may choose to consider some form of birth control. Your midwives will discuss contraceptive options.

 

Sleep

The following approach will help you get as much (or almost as much) sleep as you need. (However, this obviously may not work if you have other children unless you have help to care for them)
• Calculate how many hours of sleep you used to need regularly before pregnancy in order to function. Six hours? Eight hours? That is the amount of sleep you now owe yourself every day
• Since you cannot get this amount of sleep in one stretch because of interruptions for feeding and baby care, you will require more hours in bed to get your allotted amount of sleep
• Plan to stay in bed or keep going back to bed until you have slept your allotted number of hours. This means that with exception of meals and trips to the bathroom, you do not get up. You do not brush your teeth, shower or dress in the early morning. Make a mental note of approximately how many hours you have slept since you went to bed (but try not to obsess about it). You may have to stay in bed from 10pm until noon the next day to get eight hours of sleep! If that’s what it takes, do it. Then, brush your teeth, take a shower, dress, and greet the day
• Many parents find it easier to follow this regimen if their baby sleeps with them or nearby
• As your baby grows and begins to sleep for longer stretches, it will take you less time to get enough sleep.
• Consider hiring a postpartum doula

Questions you don’t see answered here? Call your midwife!

 

WHEN TO CALL YOUR MIDWIFE:

• If you have any red spots or tender areas on your breast(s)
• If you run a fever over 100.6 F
• If you have chills, feel faint or dizzy
• If you soak two pads (front and back) in an hour
• If you pass a clot larger than your fist
• If your bleeding has a foul odor
• If you have any uterine tenderness

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Mothering The Newborn: Postpartum Instructions

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Now that your baby has arrived, you may have some questions about your baby. The following instructions should help guide you through the early days. We provide well baby care for the first six weeks. If you are planning on utilizing pediatrician support during this time, please call your pediatrician to let them know your beautiful baby has arrived. If desired, your midwives will perform your baby’s newborn metabolic screen at your first postpartum appointment. You should make an appointment for your healthy baby within the first six weeks with your pediatrician, but please note that we will refer you more urgently as needed.

 

Newborn Respirations

Newborns breathe faster than adults at rest and their respirations (breaths) are sometimes irregular. Average is 40-60 breaths in a minute when at rest. Your baby may sound congested, snort or sneeze after birth - all is normal.

 

Keeping Baby Warm

Keeping baby skin to skin is the best rule of thumb. Keep baby dressed in one layer more than you are comfortable in. It is normal for a baby’s hands and feet to be blue/ purple - this is not a sign that they are cold.


 

Elimination

Your baby should urinate in the first 24 hours. Until your milk is in, the wet diapers may not be as frequent. After 2-3 days, diapers should be wet every 3 to 4 hours (if it is hard to tell if there is urine in a diaper with all of the moisture wicking options, use a small towel in the diaper). Sometimes uric acid crystals will be found in a wet diaper. These crystals can look orange/red and be mistaken for blood (also known as brick dust, for reference of what it can look like). This can be normal, and usually happens right before your milk comes in. Some female babies will pass a small amount of mucus and blood from their vagina. Your baby’s first bowel movements are a dark, tarry, sticky substance called meconium. The baby should pass some meconium in the first 24 hours. This is easily washed off with warm water and coconut/olive oil. Apply oil after diaper changes to make the clean up easier. Gradually, the meconium changes to a green-brown color, then yellow-green. Babies can have bowel movements after every feeding, or once every 3-4 days. A healthy, breastfed baby will not get constipated.

 

Umbilical Cord Care

You can expect the umbilical cord stump to dry and fall off anywhere from 4-14 days after birth. Keep stump as dry as possible and this will expedite the process. You can utilize Cord Care after most diaper changes, as these herbs help the drying out process safely. Do not use alcohol as this will preserve the cord and delay it falling off. You may notice a slight smell as it dries. Call your midwife if you notice oozing or bleeding from the cord.

 

Jaundice

Healthy breastfed babies will have some yellowing to their skin around 2-5 days after birth. Before birth, babies need more red blood cells for oxygenation. After birth, they get rid of the surplus red blood cells by breaking them down, and part of this process is bilirubin in the blood. This bilirubin is what turns the skin yellow. This is called physiologic, or normal, jaundice. If a baby gets yellow in the first 24 hours after birth, this is NOT normal and called pathological jaundice. You can help the processing of bilirubin by nursing your baby often, putting baby unclothed in indirect sunlight for 20 minutes a day.

 

Skin

The skin of a newborn changes rapidly, coming from a water environment to air. Peeling on a newborn is normal. You can use gentle oils (coconut/olive/jojoba) on baby’s skin. Avoid harsh fragrances. You may see pimple-type rashes on your baby. These are also normal.

 

Eyes

You may notice red spot(s) on the sclera (whites) of your baby’s eyes. These are broken blood vessels from during the birth. These will go away on their own, usually in the first two weeks. Your baby’s tear ducts are immature and do not work fully right after birth. This means that bacteria can easily grow without the flushing of tears. If your baby’s eyes get a yellow-green discharge or become crusty, you can wipe them with a warm, wet cotton ball. Breastmilk is naturally antibacterial and makes handy eyedrops as well.

 

Breasts & Genitalia

Babies of both sexes can have engorged nipples. Some may also have a drop or two of pale white secretions. This is due to the hormones left over from the mother. The same hormones may cause the scrotum to be enlarged, or the labia to be swollen. Some female babies will pass a small amount of mucus and blood from their vagina.

 

Crying

All babies cry at times. While crying can be a sign of boredom, fatigue, loneliness, discomfort, a need to be held, simply communicating, etc- most crying in the early weeks mean hunger or a desire to be close. Most babies tend to have fussy periods during the day or night. Evenings are a common time for babies to get fussy. Your baby may want to be held more, or even nurse more often. If you’ve changed and fed your baby and nothing has soothed him, sometimes a change of scenery (walk outside or a

car ride) can change a baby’s mood. If you feel yourself getting anxious about your baby’s crying, ask another person to hold your baby while you take a break.

 

Bathing your baby

Babies do not need a full bath right away, and too frequent bathing can dry out their sensitive skin. Keep the areas behind the ears and in the neck folds clean, as these are the areas where breastmilk and spit-up can collect. You can bathe your baby in a sink, a baby bath, or in the bath/shower with you, but there is no need to bathe them in the immediate postpartum period.

 

Gas / Stomach issues

Both gas and spitting up are a completely normal part of being a baby. Most of the time breastfed babies do not need to be burped after feeding, but some babies are the exception to this rule. Your baby is more likely to need to be burped if he cried to signal he was hungry. If after a minute or two of patting your baby’s back you have not brought up a burp, feel free to stop and try again later. You will not always be able to get a burp, and it does no harm. Gas is not preventable, although there are some things you can do to help with the discomfort:

1. Gently but firmly massage your baby’s belly in a clockwise, circular motion. This will help gas bubbles move through the intestines.
2. Bicycling or rolling your baby’s legs up to her chest can bring gas out.
3. A warm bath can help relax stomach muscles.

4. A teaspoon of cooled fennel tea (1 Tbs fennel seeds steeped in hot water) can be given every few hours to help with digestion and gas.
5. Infant probiotics can be helpful as well, particularly if baby has been exposed to antibiotics during pregnancy or labor.

 

WHEN TO CALL YOUR MIDWIFE:

• If your baby’s lips or area around their mouth is dusky / purple
• If your baby has respirations faster than described above
• If your baby appears to have trouble breathing
• If your baby has a fever - temperature of 100.4’ or higher
• If your baby has not urinated in more than six hours
• If your baby has not had a bowel movement in 4-5 days
• If your baby has yellow skin in the first 24 hours after birth
• If your baby is too sleepy to wake for frequent feedings
• If your baby does not have at least two bowel movements a day in the first week after birth
• If a pustule (pimple) breaks open
• If you are concerned about any rash