Principles of Postpartum Care

 

After Birth Care for the New Mother

 

After the birth of your baby we will check your uterus for firmness and placental separation. Once the placenta has been born we will check to see that your blood loss is normal and your uterus is firm.

 

There are many variables involved in the amount of bleeding a particular woman might have after birth.  Contractions, nursing, fatigue, lack of fluids, diet and anxiety are all factors that affect the amount of bleeding. Initially, your uterus will feel hard like a grapefruit.  It will begin to relax several hours after birth and tighten only when contractions occur. Check the fundus (uterus) periodically.  If it feels soft, gently massage it.  Do not push down on the top but rather deeply rub the sides to stimulate contractions and good tone. You can place the baby to breast to firm up your uterus.

 

Here are some hints to remember after your birth:

During the first day after your birth, it is normal to change pads every 2-3 hours.  If you are soaking through 2 pads in half an hour, it is a sign that should be checked out. (Please call your midwife).

A few clots are normal; however if you are passing more than two large clots per pad the diameter of an orange, call the midwife.

If discharge has a foul odor, call your midwife.

Vaginal discharge after birth is called lochia.  It goes through three stages normally.

Bloody red clots  for 2-4 days

Pink or brownish for 3-10 days

White with moderate odor with occasional break through red/brown spotting can last for 5 weeks

Take showers to prevent possible uterine infections.  No bathing or swimming until bleeding stops.

Take your temperature 1 time per day for the first 3 days, or if you have body aches or chills If your temperature rises above 100.4, call the midwife.

Stay in bed mostly for the first few days or longer. Skin to skin with your baby helps you both recover from birth and enhances breastfeeding skills and milk production. It is a great time to get to know your baby. Don’t lift anything heavier than your baby. You will recover faster and experience fewer complications, if you rest. Ideally you will have someone help you for the first few days.

Lay on your abdomen with a towel rolled under your hips 3 or 4 times per day. This helps the uterus to tone and return to its original position.

Never stand unassisted in the first 24 hours after birth.  Sometimes fainted can occur. First sit up, massage your uterus then stand slowly.

If is important to keep your bladder empty. A full bladder can displace your uterus and cause it to contract irregularly and can cause increased bleeding.

Drink plenty of fluids.  You will need extra water to help replace body fluids, insure an adequate milk supply and lessen painful urination.

A good tea to drink is equal parts Shepard’s Purse, Comfrey and Red Raspberry.

Postpartum contractions can occur when baby breastfeeds and can be very painful; this is normal. Some things that might help include; Black Haw, Valerian, Cramp Bark in tincture or tea form. Taking ibuprofen 400 mg every 4 hours will not harm baby or interfere with breastfeeding.

No swimming until bleeding stops.

 

Vaginal tears, stitches or a sore bottom

After you’re your baby is born, we will check you for tears in and around your vagina. Most tears are superficial and heal spontaneously.  Some tears are deep and need to be stitched because they are bleeding or may heal poorly if not stitched. Most tears will heal following these guidelines:

Keep your legs together and don’t put unnecessary tension on the perineum, avoid yoga, climbing stairs, stretching and tailor sitting (Indian style sitting) for 2 weeks.

Begin doing Kegal exercises within 24 hours.

Keep area clean and change pads often.

Use peri bottle with warm herbal or Benedine water to rinse after urinating. This is to prevent infection and decrease burning.

Take a sitz bath (vaginal and bottom only) 2 times a day for 2 weeks, using herbal preparation of comfrey leaves, calendula flowers, salt, 1-2 cloves of garlic and lavender oil.

Use Aloe Vera and comfrey compresses

Placing a light bulb close to stitches may help.

No sex for 4-5 weeks.

Ice packs in the first 2 days may help with swelling

Eat natural, high fiber foods to prevent constipation.  Can use CALMS magnesium supplement take as recommended for constipation.

Witch Hazel or tucks pads can be used for hemorrhoids.

Don’t lift heavy items.

 

Resting

We can’t stress enough how important rest is after your baby.  It is very easy in the high after the birth to overdo. Even if you feel great and are anxious to return to your routine, don’t do it. Women who do this are the ones who will most often bleed longer, develop breast infections or come down with whatever illness is around. Remember your resistance is lowered after you have a baby, so take care of yourself. Almost all cultures have a 6 week or 40 day period of rest and recuperation for the new mother who has just given birth…trust their wisdom.

 

If at all possible, spend the first week after your birth just resting and caring for your new baby.  You do not have to stay in bed, but do rest and avoid climbing a lot of stairs. The second week you can start light house work like dishes and cooking.  Please do your best to wait until your bleeding stops before you resume heavier actives like shopping, vacuuming and scrubbing.  If you are doing too much, you will start bleeding again.

 

Use this special 5 week period to get to know your baby.  This is such a special time, one that you can never get back, so honor this period in life. The love that flows between you and your baby will bond the pattern of love for a lifetime. Indulge yourself.  Your baby is much more important than housecleaning. You can also use this time to reaffirm your relationship with your partner and to ease the concerns of your other children.

 

Gone are the days of eight hours of uninterrupted sleep, so sleep when your baby sleeps.  Make a sign to hang on your door that says. “mother and baby are resting…please come another time”. Ask people to call before coming to visit and do not answer your phone while you are resting. When someone asks “Can I help you with anything” say yes and provide them with a task such as run errands of do a load of laundry. Friends enjoy helping and it makes them feel good also.

 

Remember it may take six to nine months for your body to recover completely form the demands of pregnancy and birth. Don’t push it; don’t overdo. Eat well balanced meals, take your vitamins and get lots of fluids. Go by nature’s schedule.  This is when partners may play a protective role by making sure that you do not over do things too quickly. This is the best insurance against common feeling of young partners that can “feel left” out now that the baby is born.  Fathers can mother the mother so that the mothers can mother the babies.

 

Emotions

It is common for emotions to fluctuate after birth. Fear and sadness, as well as joy and relief, are experienced by many women.  The overwhelming magic of your new baby combined with fatigue and hormonal changes, sometimes affects your emotional state. Do not worry about crying as this is normal, just cry if you like. Normal postpartum “blues” usually last no more than a week or two and are helped by adequate rest.

 

If you had a difficult birth, there is sometimes grief to go through.  Even under the best circumstance, the birth and baby are often not exactly what you hoped for and dreamed about. There is inevitability a period of readjustment as you accept how your birth actually happened and the realities of parenting a new child. Transformation Through Birth by Claudia Panuthos is a good book to read about this.

 

Remember you and your partner are still a team, the very essence of your family. With parenthood it is easy to fall into roles such as; you take care of the baby, I pay the bills ect. Parenthood brings challenges to expand and widen the horizons as a loving couple to include your children, but the foundation of the family remains with the couple’s relationship.  If it disintegrates, the relationship with the children will tend to get out of balance and the entire family will suffer.  Tend to you partner, make time to talk, listen and just be together.

 

Remember enjoy your baby’s infancy.  His/her needs though constant, are few and simple and mama is the only one who can fully meet them during the early weeks.  Infancy is so short and time flies…in six to eight months he/she will be crawling away from you to meet the world and you will have to let him/her go more each day.  Enjoy baby while you can.

 

Your Body Size and Shape

At the birth, you lose around 10-15 pounds form the baby, placenta, water, ect.  This leaves another 10-20 pounds above the pre-pregnancy weight.  You will probably think your belly has turned to jello.  Don’t be discouraged if right after birth, you still look like you’re five months pregnant this is normal.  Your will return to normal soon. We affectionately call this the “mama belly”, wear it with pride.

The extra weight form the pregnancy serves as an essential cushion of nutrients and calories that will help insure an adequate supply of milk for breastfeeding. Remember that your body is still serving as your baby’s sole source of nutritional support and the baby is a lot bigger now than while in the womb. Exclusive breastfeeding uses up 1000 extra calories per day.  You need even more protein, calcium and calories than during pregnancy. To avoid problems with excessive fatigue and hypoglycemia, your ideal weight while you are breastfeeding is probably 10 pounds over your pre-pregnant weight.

 

While nursing, most women have a ravenous appetite.  Be sure to trust the wisdom of your body and eat to huger. You will find the demands of nursing and caring for your baby will gradually take off the extra weight in time. Most women lose all the extra weight by 6 and 12 months. Going to an exercise class after 6 weeks can help you tone your belly and facilitate regaining your previous size and shape. Please do not consider dieting at this time…the nutrients you consume are too important for your strength and your baby’s growth.

 

Sex

In order to minimize the chance of uterine infection, it is important not to resume intercourse until all bleeding has stopped and the cervix is closed.  Remember also not to take baths (only showers) and no swimming until your bleeding is over.

 

The first time you have intercourse needs to be particularly gentle and many women find they need extra lubrication. The coconut oil left over from the birth kit can be useful for this. Remember there are other ways to pleasure each other besides intercourse. The most important thing during this time is to communicate.  Be easy and sensitive with each other.  Many women find it takes a little while before sexual desire returns for a number of reasons …lack of sleep, fear of pain, the sensual demands of nursing your baby, wondering how attractive your body is now, how appealing you are as a mother, ect. The father, on the other hand, may be tired from working and taking up the slack around the house and may feel a little left out since he can’t breastfeed the baby.

 

It is important to be sensitive to one another’s needs and moods and to focus on how the baby has enhanced your relationship. Commitment to the relationship is unusually deeper and al life takes on a richer and fuller meaning.

 

Birth Control

The return to regular periods varies a lot from woman to woman and depends to a large extent upon how frequently and how long you breastfeed your baby. Often periods will not resume until you wean your baby. But remember that it is possible to ovulate before the return of your period. Women usually do not ovulate while exclusively breastfeeding on demand without supplementation. Worldwide the World Health Organization recommends the Lactational Amenorrhea Method (LAM) for exclusively breastfeeding women for the first 4 months after birth.  The LAM method is 99% effective if the mother breastfeeds in the night, the baby is frequently at the breast and the mother has not experienced a period by 6 weeks after birth. However there is always a very slim chance of pregnancy.

 

“Natural Birth Control” using the temperature and mucus method is very difficult to use while breastfeeding.  It would be impossible to use this method unless you had a extensive experience with it before becoming pregnant. The combined oral birth control pill is contraindicated during breastfeeding because the hormones pass through the breastmilk and can decrease your milk supply. The mini pill or progesterone only pill is safe for breastfeeding and not associated with decreased milk supply.  It can be taken for the first 4-6 months but should be changed to a combined birth control pill by 6 months after you baby is eating some solid foods.  IUDs are an option, but you should wait until at least 8 weeks after birth to allow your uterus to recover after birth. Please ask us for more information if this sounds like a good option for you.

Most women choose a barrier method and /or spermicide as a birth control method in the early months after birth. The options include spermicidal foams, suppositories, gels or creams, condoms and a combination of these. Some women use the withdrawl method which is only 85% effective with normal use but increasing effective during breastfeeding if performed correctly.  Please ask us more if you have questions.

 

At your final visit, we will check your cervix and bottom, weigh the baby and discuss any questions you may have about parenting, breastfeeding birth control, ect.

 

 

 

Roxanne Estes

Certified Nurse Midwife

Tel: 808 935-0211