Postnatal

After Your Baby Is Born

 

Always remember – there is no one ‘right way’. There are lots of different ways of doing things. As long as it is safe for you and baby it is important to find the way that works for you both. 

After you have given birth in the hospital you may choose to stay for a couple of hours, just to make sure there is no continuing bleeding and baby is able to feed, and then go home. Alternatively, you may choose to stay in the postnatal ward for anything up to 48 hours if everything is normal. If there are problems myself and the midwives on the ward will help you with these. Likewise, if there are problems please don’t worry you will not be asked to leave the ward before these are sorted out.

These first few hours immediately after birth are an amazing time for you, your baby and partner. It is wise not to invite too many family members or friends in too soon. Allow the time for skin to skin contact, bonding and beginning breast-feeding if that is your choice. Plenty of time for visitors later. (If you choose to stay in hospital there is a ‘no visitors’ time between 1pm and 3pm daily – strictly adhered to.)

First Feed : You will need to have made a decision whether to breast feed or not before birth. Your baby will usually want to suckle within about 15- 30 minutes of being born.

Breastmilk is the best food you can offer your baby. Its makeup is just right for your baby’s growth and development. It provides protection against infection, it’s sterile and just the right temperature. And it’s free!!!

Breastfeeding is also great for you because it helps you recover from the pregnancy and birth. It gives you some lovely bonding time with your baby and some research has shown that women who breastfeed are less likely to develop breast cancer.

Whether you choose to breast-feed or bottle feed I will support you in your decision. If you decide to bottle feed please bring sterilised bottles, teats and infant formula with you to the labour ward.

Vitamin K : Please read the brochure on Vitamin K and decide whether you would like your baby to have this. I’ll be happy to answer any questions you might have to allow you to make an informed choice.

Newborn Baby Blood Test : Known as the Guthrie or ‘heel prick test’. We will provide you with a pamphlet which explains what the test is all about. Most parents choose to have this test but it is not compulsory. It has to be carried out after your baby is 48 hours old and is normally done on day 2 or 3. I will let you know in advance when it will be done so you can make sure baby’s feet are nice and warm as this helps the blood flow easily. Sometimes it’s a good idea to incorporate the test with a feed so baby is distracted.

Jaundice : A high percentage of full term babies show symptoms of jaundice. This usually starts around day 2-5 after birth and can last for about a week. Babies are born with an abundance of red blood cells, more than they need, and the excess is broken down and excreted. One of the by-products of this breakdown is called bilirubin. Sometimes baby’s liver is too immature to cope with the excess bilirubin and it can be deposited in the skin which gives it a yellow tinge.

The best treatment is frequent feeds and exposure to sunlight (allowing babe to ‘sunbathe’ in natural light but not in full on sunshine!). Babies can be a bit sleepy so it’s important that they are not left to sleep any longer than around 3-4 hourly while they are jaundiced. The frequent feeding helps them excrete the excess bilirubin.

If the levels of bilirubin are excessively high your baby may need phototherapy with special lights. This involves being in a special cot, usually naked, and continuously exposed to the lights until those levels come down.

 

Babies at Home

 

Feeding and Sleeping : Newborn babies will not usually have any sort of routine until they are around 3-4 months old. Of course, there’s always the exception to prove the rule! Your baby will normally want to feed around 2-4 hourly and when not feeding will more than likely be sleeping. That’s day and night! Newborn babies have very small stomachs, (they hold about 15- 30 mls depending on their birth weight), and breastmilk digests quickly so frequent feeding is normal.

You can’t make your baby go to sleep but it’s important not to miss the signs that he/she is tired and needs a sleep. Constant handling and ‘pass the baby’ from Grandma to Great Aunt Myrtle is lovely for the relatives but really unsettling for the newborn. If they must have a cuddle make it at a time when it fits into a feed time. Perhaps they could give baby a cuddle while you get yourself ready to feed and then be the one winding the baby – another lovely opportunity to cuddle up.

An overtired baby cannot easily relax and fall asleep – seems like it should be the opposite but keeping a newborn baby awake during the day so it sleeps at night does not work! You will have a newborn that does not put on weight as they should and will be a very grumpy baby.

It’s also a good idea for the new Mum to sleep while baby sleeps during the day or night. 

 

While on the subject of sleeping, it is recommended that baby is put to sleep on his/her back rather than side or tummy. More information about this is included in the “Back is Best’ pamphlet.

I will refer your baby to the Well Child Provider of your choice – Plunket or Te Korowai are available in Nelson.

Immunisations : In the back of your Well Child book is a schedule of the recommended/available immunisations. Again, I will send a referral to your GP letting them know you are coming up to six weeks and need an appointment.

 

Well, That’s Baby But What About You?

Some time during the first couple of weeks I will give you and your partner the opportunity to discuss the labour and birth. This is a good time to bring up any questions that you’ve thought of since then or if there’s just something you want to chat about. It’s a really good chance to talk about the things you liked, or found positive, and anything you weren’t so keen on or would want to change next time around.

 

Perineum and Pelvis : Your perineal area may be a bit tender and/or swollen for 24-48 hours following birth – especially if you’ve had stitches or have haemorrhoids. Iced pads can be a great relief to a swollen perineum and witch hazel or prescription cream is available for haemorrhoids.

Physiotherapy is sometimes recommended for bruising and/or haemorrhoids.

Sometimes you can feel a bit achy in the hips and lower back (yes, just when you thought you were done with all that!) because all those ligaments that softened during pregnancy are now firming up again. If discomfort continues discuss it with me because there may be something I can suggest to make you more comfortable.

Tea tree oil and/ or lavender added to your bath water may help with healing. Arnica tablets can help with the bruising. Keep the perineum dry and cotton underwear is preferable. (Warehouse do a very reasonable 3 or 5 pack!).

Uterus : Following birth of baby your uterus will contract back down again quite quickly to about the size of a pear. This is known as involution and sometimes can be accompanied with contraction type pains known as ‘afterpains’. This can be particularly noticeable while breastfeeding. Some women seem to be prone to them and others barely notice it at all so talk to me (or your hospital midwife if you are in there) about it if they are particularly uncomfortable.

 

Heat packs may be helpful, either on your abdomen or back whichever is helpful.

Chamomile tea can also be relaxing and is safe when breastfeeding. Some women find laying on their stomach with a pillow under it helpful – a little pressure on the abdominal area. (This is assuming it is comfortable on the breasts!). Also remember to wear comfortable clothes. I know you want to get straight back into your pre-pregnant jeans but it’s not possible or comfortable. So hang on to those stretch pants for the first few weeks.

Lochia : During your pregnancy the lining of your uterus had thickened to support the growing baby. As your uterus contracts back down again this lining comes away and is passed out through the vagina. This discharge is called lochia and is like a heavy/moderate period. The amount differs for each woman and gradually decreases and becomes lighter in colour until it disappears altogether. This has usually finished by 6 weeks but again it can differ for each woman and may be gone within the first week. Please don’t use tampons during this 6 weeks,  use sanitary pads. You’ll need quite thick ones for the first few days but then panty liners are usually enough after that.

You should consult your midwife if any of the following occur :

Lochia becomes heavier after it has begun to reduce, or afterpains start up again after 2-3 days of having none, or the discharge has an offensive smell 

 

Beyond the Newborn Baby!

Sexuality and Contraception :

It is generally considered safe to resume sex when you no longer have any discharge, your vagina and/or perineum have completely healed from any grazing/tearing/episiotomy, when you have decided on, and are able to use, contraception, and most of all, when you are emotionally ready.

Some women will be fertile again within weeks of giving birth whilst others may not be for months. Remember that many women will ovulate a few weeks before their first menstrual period so don’t be waiting for that to occur and assume you can’t get pregnant! While breastfeeding can be a really good help with contraception please don’t rely on that alone. Once you resume sex it’s a good idea to use some form of reliable contraception if you don’t want to get pregnant.

Options for contraception :

*** Condoms – I can give you a prescription for these

*** Natural Family Planning methods include breastfeeding and fertility monitoring – speak to Family Planning if you’re not sure about this

*** Intrauterine contraceptive devices (IUD) – Independent Nursing Practice or your GP can help you with this

*** Oral contraceptive pill (OCP) – needs to be taken for minimum of two weeks before providing contraception. Mini pill (progesterone only) is usually recommended for breast feeding mums – prescription from your GP or myself

*** Depoprovera injection – GP – suitable while breastfeeding

*** Implant – inserted under skin on arm, GP or midwife would organize this – suitable while breastfeeding

*** Permanent sterilization, ie. tubal ligation for women or vasectomy for men – your midwife or GP can do a referral to a specialist for this.

Baby Blues vs Postnatal Depressionsad

It is really common for women to get a bit tearful, tired, anxious or feeling overwhelmed from time to time, especially around day 2-4, but this passes – usually after you’ve managed to have a decent sleep!

However, if these feelings don’t go away and you constantly feel like that, you may be suffering from postnatal depression.

Symptoms of postnatal depression include –

*** Constantly feeling sad and lacking in energy

*** Feeling unable or unwilling to take care of yourself and/or your baby

*** Lack of interest or perhaps feeling emotionally detached from your baby

*** Feelings of guilt or anxiety about the way you are caring for your baby – feeling like you’re not a ‘good enough’ mum

*** Restless and/or insomnia, even though you’re really tired

*** Extreme exhaustion
*** Irritability, anger or fear that you may harm your baby, your partner or yourself

*** Phobias, panic attacks and nightmares

*** Loss of appetite or compulsive eating

If you are experiencing any of the above symptoms continuously for several days please discuss it with your midwife so she can refer you to the right person and help resolve these feelings.

Being diagnosed with postnatal depression doesn’t always mean having to take medication, sometimes it can be as simple as being heard. Having someone who listens to what you’re saying and understands. It is a very real thing and not something you can make go away by ‘pulling yourself together’! Talk to your midwife or GP.

 

 

Enjoy your newborn baby – that’s the best advice I can pass on to you now!