Postpartum Instructions

The following article provides basic guidelines for normal postpartum care of both mother and baby. Any other concerns or questions should be addressed directly with your midwife.

Care of the Mother

Bleeding (called lochia)

Lochia will resemble a normal period except with heavier flow in the beginning. At first there may be small clots. These shouldn’t be bigger than a golf ball. Over the course of several days to two weeks, the lochia will turn brown, then yellowish-white or clear and finally end by six weeks. Anytime you bleed as much as to saturate two large pads within a one hour period you should immediately call your midwife.

Uterus

The uterus should feel firm and should feel about the size of a grapefruit for the first few days. The fundus (top portion of the uterus) should be felt at the level of your belly button or lower. You can attempt to feel your fundus by gently pressing on your abdomen. The uterus shrinks at about the rate of one cm. per day. By day 10 it can no longer be felt above the pubic bone. If the uterus is not firm you can massage it. Some women will experience "after-pains" (contractions after the birth). These can be quite painful but can often be alleviated by applying a hot compress. After-pains usually occur after nursing, especially in mothers who have given birth previously. They usually end by the third day. If your fundus is found above your navel, you probably need to pass urine. Call your midwife if your uterus feels soft or is not descending.

Infection

Eating nutritious foods, taking adequate fluids (8 glasses of water daily), and getting adequate rest are all important measures to avoid a postpartum infection. Call your midwife if you develop flu-like symptoms, have a temperature of 38 C /100.4 F or higher, or if you are experiencing night sweating. Please note: it is common for women to have a low grade temperature when their milk comes in but should resolve spontaneously within 12 hours.

Vagina and Perineum

During the first 24 hours after birth you may appreciate applying some ice or cold pads to help reduce swelling and discomfort from any birth trauma. On the second day, taking sitz bath (soaking your bottom end in warm water) twice a day can relieve discomfort, and promote healing. Afterwards, air drying is recommended. Tylenol and Ibuprofen can be taken as needed. Call your midwife if you are experiencing an unreasonable amount of pain.

Urination

Pouring warm water while you void can help dilute the urine if you are experiencing any stinging sensations. Drinking plenty of water will also help dilute your urine. Call your midwife if you are unable to empty your bladder.

Bowel Movements

It may take 2-3 days to resume normal bowel activity. Eating foods that will promote a soft stool is recommended. This includes raw fruits and vegetables, bran, and plenty of fluids. Call your midwife if you have not passed a bowel movement by the fourth day.

Hemorrhoids

Hemorrhoids are protrusion of veins around the vagina and anus. They can be treated with applications of the herb witch hazel, tucks, Annusol, or Preparation H, and by promoting soft bowel movements as discussed above. Apply cold compresses, and avoiding straining on the toilet.

Breasts

Ensure your baby is latching effectively to your breast at each nursing. This will prevent sore nipples and the baby will receive more milk. You can rub the baby’s lips or cheek with your nipple to encourage a wide open mouth before allowing the baby to take the breast. The baby’s mouth should be place behind the nipple onto the areola. The lips should be relaxed and open. After feeding you can express some of your colostrum and apply it to your nipple to keep them healthy. Do not wash your nipples before feedings, or with soap when showering.

On the 2nd to 4th day some women experience very full breasts. This is call breast engorgement. Warm compresses and expressing breast milk just before feedings may be helpful to softening the areola so the baby can latch properly. Cold cabbage leafs in your bra may help relieve this sensation. This is generally a temporary condition lasting 1-2 days. If you develop a lump, massage it during the following feedings but do not ignore it. Lumps should be dealt with immediately through a combination of warm compresses, massage, and keeping the effective side empty. Call your midwife if your nipples are bleeding, sore, or cracked; you cannot get the baby positioned correctly to the breast; you notice a red or hot spot on the breast or if a lump does not resolve with measures listed above.

Self Care

A healthy diet and rest are essential for a speedy recovery. Plan on taking naps during the day while the baby is sleeping. Having friends or family come in to help with laundry, childcare, house cleaning, and meals will help aid in your speedy recovery.

Resumption of Normal Activities

You may find over the next couple weeks your days are full with taking care of your body, and caring for your baby. Listen to your body when considering resuming normal activities. Moderate exercise is fine if you are not straining yourself. You can resume intercourse when you are both ready; however, it is important to consider a method of birth control. Put nothing in your vagina (tampons) for the first six weeks after birth.

Care of the Baby

Breathing

Normal breathing is between 40-60 breaths/minute on the first day. These may be a little irregular, but there should be no gaps in breathing longer than 20 seconds. On the second day the breathing pattern is usually 30-40 breaths/minute unless the baby has been crying. Call your midwife if the baby is breathing more rapidly than 60 times/min (excluding crying episodes); there is flaring of the baby’s nostrils, grunting noises, blue spells, or the baby's chest wall becomes visible on inhalation.

Temperature

Normal under-the-arm temperature for a newborn is between 36.5-37.5 C (97.6-98.6 F). Dress the baby one light layer more than you would wear yourself. Ensure the baby is dressed appropriately if you are worried about the temperature. Call your midwife if the baby’s temperature is unstable (fluctuates from high to low) or is elevated and sustained.

Elimination

The baby should pass both urine and stool at least once in the first 24 hours. On the second day the baby should pass 1-2 of each. Until the milk comes in there may not be much more elimination than that. Sometimes the baby will pass a red colored substance called uric acid crystal. This is normal and may indicate the baby is dry. The first stool is a sticky black tar-like substance called meconium. By the second day this should change to a thinner greenish stool. After the breast milk is in the stool will be yellow and loose. Putting olive oil on the baby’s bottom at diaper changes can help remove the sticky meconium. Once your milk is in, the baby should wet 6-8 cloth diapers (or five disposables) and have 3-5 bowel movements each day. As the baby gets older their bowel routines will vary from several a day to one stool a week. Call your midwife if the baby does not pass urine or stool in the first 24 hours or the baby is passing less than the amounts indicated above.

Care of the Umbilical Cord

The clamp on the baby’s cord will be removed in the first 24 to 48 hours. Allowing the cord to air dry will encourage it to fall off sooner. Folding diapers down to expose it to the air will speed the drying process. The cord may have an unpleasant odor as it decomposes, and there may be a little bleeding when it falls off. Call your midwife if there is substantial bleeding or if there is redness on the skin around the base of the cord.

Hydration

Baby’s mouth and lips should be moist most of the time. The baby's skin should bounce back quickly if pinched together. The anterior fontanels (soft spot on baby’s head) should look normal. The membrane should not be depressed or bulging.

Feedings

Feeding your baby on-demand is a wonderful way to help your baby learn to regulate food intake. When breastfeeding, keep in mind that the more frequently the baby sucks, the more your milk supply will be stimulated. Baby should feed every 2-3 hours with one longer stretch of 4 hours, once in a 24 hour period. Nursing sessions usually last 10-20 minutes once established, but frequently take longer in the beginning as mother and baby learn how to negotiate a proper latch. Call your midwife if your baby is not feeding well.

Burping

Generally the best position for burping is to hold your baby in an upright position while sitting on your lap, or resting the baby on your chest. Rubbing or gently tapping the back may produce a burp. Some babies are more comfortable after a burping; others don’t seem to mind if they aren’t burped. Get to know your baby’s preferences.

Spitting Up

Newborns frequently spit up one ounce or less after feedings. Call your midwife if the baby is vomiting large amounts after feedings, or there is any projectile vomiting.

Sleeping

Babies occasionally need to be awakened for feedings if they are nursing less than described above. It is recommended that newborns are placed on their back on a firm surface. This is for the prevention of SIDS (sudden infant death syndrome). Newborns generally sleep 2-3 hours between feeds, but often cluster-feed (see above under breastfeeding)

Jaundice

About half of all babies will have some jaundice (yellow skin) by day 2-5. This is a normal condition caused by the breakup of excess red blood cells. Nursing the baby frequently, and placing the baby in indirect sunlight for 10 minutes (protecting the eyes) will help the baby through this stage. Call your midwife if your baby is jaundiced in the first 24 hours; is jaundiced and too sleepy to wake up for feedings or the jaundice can be seen in the whites of the eyes, or on the hands and feet. If a baby is having higher levels of jaundice, we often test the levels of bilirubin. The treatment for jaundice usually involves photo therapy (light therapy), and promotion of breast milk.

Newborn Screening Test

A PKU is offered to check for genetic disease that can cause severe long-term problems in the newborn. The advantage of testing is that treatment is available which will prevent the long term complications. The test is done by blood draw taken by heel prick in the first 24-48 hours. See information pamphlet provided for further details.

Birth Certificate

Refer to the forms in your birth package to order a birth certificate.

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