Postpartum care and instructions for mother and baby

This page should be read carefully and completely before your birth.
The midwife will review this information with you along with any other recommendations specific to your birth situation.
This page should be referenced in the postpartum time as you need.

MOTHER

WARNING SIGNS — CALL IMMEDIATELY

Fever  greater than 100.4 F

Localized swelling or tenderness in breasts, especially if accompanied by body aches or fever.

Tender or sore nipples

Discomfort or burning when urinating, or have difficulty

Sharp pains in your abdomen, chest or breast

Blurred vision or dizziness, with or without a headache

Severe headache

Pain in your legs, especially the calf muscle when you extend your foot

A foul smell or unexpected change in your bleeding

Bleeding more than 6 weeks

Any strong sense that something is “wrong” with you or your baby

Crying spells or mood swings that feel out of control or do not get better with more sleep, rest, food

Thoughts of harming yourself or your baby

Small vs big problems

Please contact the midwife with any questions, large or small, especially early in your postpartum time.

Prompt attention to small problems can prevent large problems!

The midwife will request that you call her about 8-12 hours after she leaves from the birth to check in on you and baby.

Rest and visitors

Rest, fluids, and good nutrition are essential to a speedy recovery.  Plan to take naps when baby is sleeping.  Arrange for household help (laundry, cooking, shopping, cleaning, childcare) for a week.  Try to limit your activity for the first three days.  Drink at least 15 glasses of water each day; take a glass with you when you nurse.

LIMIT VISITORS–even if they love us, they are fatiguing to mom and baby and interrupt bonding and breastfeeding.

Bleeding

Expect heavy period-like bleeding in the first 24 hours and then normal period-like bleeding for 1-5 days.  After that, expect minimal bleeding for which you can use a panty liner.

Call the midwife if you fill two pads in one hour or if the discharge becomes foul-smelling.  Clots may be passed especially when getting up after laying down.

Massage your uterus if you are bleeding heavily in first 24 hours and when nursing.  It should feel like a grapefruit below the level of your navel.  If fresh red bleeding persists or returns after the first week, decrease your activity level and call the midwife.

Infection

Expect normal period odor from your bleeding and only slight discomfort when massaging your uterus.  Wash your hands before you change your pad.  Check your temperature if you feel any cold or flu-like symptoms.  Uterine pain and/or foul-smelling discharge with a fever are signs of uterine infection.  A tender breast with body aches and fever indicates mastitis. 

Normal oral temperature is 98.6 F +/- 1 degree.  Fever is >100.4 F orally.  

Call the midwife immediately if you have any of these symptoms.

Perineum

Expect some swelling and tenderness for several days, especially if a tear occurred.  After urinating, pat dry but do not wipe!  Use your peri bottle with the fresh herbal tea or dilute hibiclense to prevent stinging and to clean away urine and feces.  Let your perineum be open to the air for at least 20 minutes each day (preferably after using toilet or showering).

There are several easy treatments to speed healing.  An ice pack can help with swelling: 10 min on, 10 min off, as needed.  A peri soak in a clean tub with 4-5 inches of very warm water and 1 cup sea salt each day helps clean and decreasing swelling.  Start your kegel exercises right away–the muscles were very stretched and are a bit numb so getting the blood flow back to them is very helpful.

Showering and using toilet

You will probably have a shower after birth while the midwife is still in attendance.  This will be quick and not too hot; we want you back to bed with your baby.  If you are bleeding heavily, it is better to wait until the next day to shower.  After that, daily showers are fine.

Expect to have your first bowel movement 2-3 days after birth.  Be sure to drink a lot of water, have two glasses of prune juice daily, and eat fiber to prevent constipation.  Since you will not be getting pain killers that cause constipation, you will probably have little problem with your bowel movements.


Expect to urinate frequently.  Expect burning on the vaginal tissues when urinating for the first 24 hours.  Spraying the peri with the herbal tea or plain water will ease the sting.  Your body is excreting lots of fluids and wastes from tissues and the blood.  Be sure to aid the process by drinking at least 15 glasses of water daily.

Normal activity

Expect whole body fatigue and soreness in first several days after birth.  You just did a whole lot of work!  Expect to rest in bed or on the couch for most of the first days, with frequent trips to the toilet.  Have someone help with the kids, cooking, and housework.  Use common sense when resuming normal activities around the house.  

Kegeling, abdominal exercises, and walking should be your first exercise.  Intercourse often resumes about 6 weeks after birth, once bleeding has stopped, the perineum has healed, and both partners desire it.  It often takes longer depending on how you feel.  Contraceptive options will be discussed at your 6 week visit.

Breastfeeding

This is such as big topic!  Most of this is covered at childbirth education, but refreshers are helpful.  Keep several important things in mind as you start nursing:

1) Sore nipples are almost always caused by a poor latch which can be fixed before cracked nipples develop!  You must have prompt attention to the latch to prevent the painful cracking!!  We review latching with you at the birth, but it is up to you to call the midwife if it doesn’t feel right.

2) Let the baby get a big “bite” of the entire areola, keep his tummy pressed directly up to yours with his back and head in one straight line, and your nipple at the level of the baby’s nose (not chin) before baby latches.

3) Drink a full glass of water at each nursing session.  Get comfortable in a chair or in bed before you start latching.  In the first 24-48 hours, it may be essential to sit up in bed or a chair EACH time you nurse in order to facilitate baby’s latch and your comfort.

4) Treating painful or cracked nipples starts with assessment of latch and possible tongue tie.  The latch and positioning during nursing are the most important part of preventing or fixing cracks.  Sometimes pumping is necessary to help stimulate milk supply, empty the breasts, and heal the nipples.  Use of coconut oil and Lansinoh (lanolin cream) can be helpful.

5) Thrush is a candida (yeast) infection of either or both the baby’s mouth and the mother’s breast.  Catching it early helps prevent it from proliferating.  Treatment may include home remedies, herbal remedies, or medication.

6) All breastfeeding issues cannot be addressed here.  Please look to the La Leche League (main site, Tri-Cities, Yakima) for more information.  Dr. Jack Newman’s site is also full of information.

7) For questions about medications or supplements and breastfeeding, Dr. Thomas Hale is a great resource.

Breastmilk storage guidelines

At Room Temperature

At 60 degrees for 24 hours
At 66-72 degrees for 10 hours
At 79 degrees for 4-6 hours

In the Refrigerator

At 32-39 degrees for up to 8 d

In the Freezer

In a freezer compartment contained within the fridge: up to 2 weeks
In a self-contained freezer: 3-4 months
In a deep freezer: 6 months-1 year

BABY

WARNING SIGNS — CALL IMMEDIATELY

Temperature high or low

Respiratory difficulty: noisy grunting on the exhale, flaring nostrils with each breath, ribs stick out when inhaling

Blue or grey in the torso or head, especially around the lips

Yellow or orange skin in the first 24 hours

Lethargy: can’t wake up even with stimulation, very tired, can’t eat

Seizures: possible signs include eyes rolling upward or fluttering; stiffening of the body; movements of the tongue, lip smacking or excessive sucking; staring spells or periods of unresponsiveness.  They can be very easily missed and are generally rare.

Develops a high-pitched cry

Will not feed

Skin bruising or unusual bleeding

ANY bleeding from a circumcision (a baby can bleed to death by losing just a couple ounces of blood)

Feedings

During the first 24 hours, your baby should nurse well at least every 2 hours.  Some babies sleep for one 5-hour period soon after birth–but he needs to eat before sleeping and right when he wakes up.  Colostrum, the first milk, is small in quantity but extraordinarily nutritious.  It provides all the nutrition your baby needs until your milk comes in.

In the first 24 hours, regular feedings with effective latches means that the baby is regulating his glucose levels well, has a normally functioning GI tract, and is well hydrated.

It is normal for a baby to nurse every 2 hours or more often, for 20-40 minutes each time.  After the first day and if all is normal, nurse your baby when he wants to eat or at least every 2-3 hours.  The latch should feel good, not be painful, and feel effective.

It is NOT NORMAL for a baby who has been eating and nursing well to begin avoiding the nipple, be uninterested in nursing, or be too tired to wake up and feed.  You should call your midwife immediately if this happens.

Respirations

Babies take 30-50 breaths per minute normally.  The time between breaths can vary and be irregular.  However, breathing should NOT be labored or difficult.  It is normal for newborns to cough and sneeze and sound snuffly for a few days as they clear their air passages.  If nursing is going well, the baby is not having breathing difficulties.

Temperature

Take the baby’s temperature every 4-6 hours during the first 48 hours and record it.

Axillary (under the armpit, directly next to skin): normal temp is 97.5-99.0 F.  If the baby’s temp is low, put next to your skin, add warm blankets, and retake temp in 30 minutes.  If the baby’s temp is high, make sure baby is not overdressed or in distress and retake temp in 30 minutes.

Rectal: normal temp is 98.4-100.2 F. This is the most accurate method.  A baby younger than 3 months with a rectal temp of 98.2 or lower, or 100.4 or higher, even if no other signs or symptoms are apparent, should be taken to the pediatrician or hospital immediately for evaluation.

Refer to the AAP website for parents for how to take a child’s temperature.

Cord care

The cord dries and falls off in 4-10 days.  Make sure the cord remains outside the diaper.  Usually you do not need to clean it, but if it is smelly or oozing, wipe with alcohol.  The skin surrounding the umbilicus should not be red, swollen, or streaked.

Urine and stool

Both should happen within 24 hours of birth.

Stools are dark and tarry (meconium) initially and transition in a few days to a greenish then yellow color.  The normal consistency of milk stool ranges from curd-like to runny.  A baby fed 100% breastmilk can have bowel movements with each feeding or one every several days; there is a wide variation.  The addition of formula will change the consistency, frequency, and odor of baby’s stool.

Babies should have 6-8 wet diapers in 24 hours.  Less can mean dehydration and needs to be treated.  This is related to poor breastfeeding.

Jaundice

Jaundice is the yellowing of the skin and whites of the eyes.  It is very common, most often of no clinical importance, and usually develops between 2-7 days after birth.  It is caused by a normal build up of bilirubin in the blood as the baby transitions from fetal red blood cells to adult-type before the bilirubin can be excreted in the stool.  Nursing well and frequently will reduce jaundice.

If jaundice develops in under 24 hours, it is an urgent situation and you should call the midwife immediately.

Weight gain

It is normal for a newborn to lose no more than 10% of his body weight in the week following birth.  Any concerning loss is usually remedied by good, frequent nursing.  By 2 weeks, he should be back to the birth weight or more.  Your baby will be weighed at postpartum visits with the midwife and/or at the pediatrician appointment.

Pediatric care

I recommend that you have pediatric care for your baby lined up as I follow normal, healthy newborns for only two weeks.  You may choose a pediatrician or a family practice doctor, naturopath, or ARNP.  If need for advanced care is anticipated, you should establish care with a pediatrician.

You should interview the potential provider during pregnancy and ask them to care for your baby after birth.  Once the baby is born, I advise you to call and schedule a routine examination for the baby.  I will provide you with a birth summary and explanatory letter for the provider.  I do not provide vaccinations or hearing tests, but I do provide vitamin K injections, eye prophylaxis, and newborn screening.

Birth certificate and SSN

The birth certificate is filled out by you prior to birth.  I will complete it and submit it to the state.  Instructions for how to order it can be found here.  The SSN is mailed to you directly about a month after the birth IF you check the box on the birth certificate.

Insurance

Please make sure you know your policy’s requirements and add the baby to your policy asap.  I can provide you with a Confirmation of Birth if needed.

Newborn assessment

March of Dimes powerpoint on Newborn Assessment may be of interest to you.