General Instructions:
Do nothing but rest and take care of your new baby for the first two weeks if not more. Find help for housework, cooking, and
childcare. You need this time to establish breastfeeding, regulate your hormones, allow your uterus to heal and bleeding to
reduce. If you overdo your activity, you can experience increased bleeding, mastitis, excessive fatigue, and emotional
instability.
So rest. Keep baby on your chest, skin-to-skin, with a blanket around both of you. Nurse every 2-3 hours, waking baby up to
nurse if necessary. Use the restroom at least every 2 hours.
Keep the environment quiet, somewhat darkened and calm, especially for the first few days after birth, almost womb-like, to
make the transition calm and peaceful. Keep visitors to a minimum at least for 3 days and rest and privacy to a maximum
For the first 3 days do nothing but rest in bed and nurse your baby, getting up only to shower and use the restroom. For the
next 4 days you can get up and move around, but only to take care of the baby. During the next week, if you need to, slowly
resume normal duties, but no heavy housework for 2 weeks or standing for long periods. Do not lift anything heavier than the
baby for 2-3 weeks. If you feel tired or if your bleeding resumes bright red after tapering off this means that you are over
exerting yourself. Rest!
Drink lots of clear fluids, eat normally, and continue taking your prenatal vitamins and supplements to help milk supply.
Nettle, alfalfa, red raspberry leaf, and oatstraw teas or tinctures will help rebuild iron stores after blood loss at birth.
Breastfeeding: Airing your nipples and applying vitamin E or other oil or Lansinoh (lanolin) after each feeding will help with
any cracking and soreness. If you experience nipple soreness, make sure that baby: 1) has a good latch, 2) is far enough onto
the breast (pull baby closer to you), and 3) is laying on their side with their tummy against your chest and neck not twisted.
Nipple tenderness as the baby latches on and shapes the nipple is a normal sensation. The discomfort should be gone after
the initial 8-10 seconds of breastfeeding. If the pain persists, check the baby’s position carefully and correct as needed. If you
are not able to resolve pain when breastfeeding, contact your midwife immediately.
Colostrum and Milk Supply: The first few days, you will only have colostrum, which is rich in vitamins and nutrients, but small
in quantity. Even if your breasts feel empty, continue to nurse your baby, as there is colostrum present although it isn’t always
noticeable. The more you nurse, the sooner your milk will come in!
Bleeding: You will lose the most blood in the first 24 hours after birth, with it tapering off in the days afterward. Normal
bleeding will soak a large maxi pad in 1- 2 hours. Call me if your bleeding is heavier than this. It is normal to pass some blood
clots, especially when getting up after lying down for a period of time. Anything fist sized or smaller is usually normal. It is
normal to bleed a little more when nursing.
With proper rest, your bleeding should lighten after a few days and stop by 2-3 weeks postpartum. However, if you do not rest
sufficiently, it can continue for up to 12 weeks.
Uterus: Your uterus should feel hard and about the size of a grapefruit. This means the muscles are contracted to control
bleeding. Gentle massage will make it firm back up if it feels soft. To do this, gently push down and in several times a day at
your belly button to make sure it is firm. Do not push hard or massage roughly.
Take your temperature three times a day until your midwife comes back to see you. Your temperature may rise by 1
degree when your milk comes in around the 2nd-4th day, but call your midwife immediately if you develop a fever.
Mother
Temperature: Should be 96-99 F
First 24 hours
Day 2
Day 3
orally
Bleeding: Make for every soaked
pad
Postpartum checkup on: ___________________________I will stay in touch with you by text or phone over the next 2 days to
check up on how you are doing before coming back for a homevisit. Please call anytime, day or night, if you have a concern!
Common Postpartum Discomforts
Sore Perineum & Hemorrhoids: Keep your knees together as much as possible to promote healing of the perineum. Avoid stairs for
the first week. An ice pack, frozen maxi pad, or applying witch hazel astringent (or Tucks pads) will help with swelling and soreness.
Use a peri-(squeeze) bottle filled with warm water (you can add sea salt, lavender oil, or other herbs) to rinse your perineum each
time you use the toilet. Gently pat dry, front to back, instead of wiping.
A sea salt, lavender, and herb bath for 20 minutes daily is very soothing and healing.
If you had stitches, they will dissolve on their own within a few weeks.
It is quite common to have some problems with hemorrhoids after delivery. A hemorrhoid is a swollen vein in the rectum. The best
thing to do if you are having problems with your hemorrhoids, and they are internal hemorrhoids that have fallen out, is to lubricate
your finger and try to push them back inside. This will feel somewhat uncomfortable, but the relief afterwards will be worth it.
Once replaced, make sure you do your kegels to keep them in place and try not to strain when having a bowel movement
Constipation: You will probably have your first bowel movement within three days after delivery. Drink plenty of fluids (8-12 large
glasses each day), and eat a diet high in fiber, raw fruits, and vegetables.
Take large doses of liquid chlorophyll and calcium-magnesium. Sometimes it may be necessary to use a gentle stool softener but you
must be careful not to become dependent on this. Only use stool softeners if necessary, and use for no longer than a few days.
If you haven't had a bowel movement by the third day following the birth, drink a cup of flax tea which acts as an effective stool
softener. Put one tsp. flax seeds in a cup, add boiling water and cover. Let it sit for at least 20-30 minutes. It will take on a
gelatinous consistency but has a mild and pleasant taste -- and it works.
Difficulty passing urine: Try standing in a warm shower or sitting in a tub of warm water. Leave the water running in the tub or spray
warm water over your perineum (front to back) with your squeeze bottle. Try blowing bubbles through a straw into a glass of water
while relaxing your pelvic floor. If the above methods fail and you are still unable to pass urine, call a midwife.
Breast Engorgement: When your breasts begin to feel heavy, you may find comfort in a good supportive bra. The extreme fullness
(due to engorgement of the tissues as the milk comes into the breasts) may be noticed on the second or third day. The discomfort
usually lasts for 12-24 hours.
Place cool, washed, green cabbage leaves directly on and around the breasts and hold in place with a bra. Do not leave in place for
longer than 2 hours. Nurse the baby frequently and apply heat in the form of a shower or warm towels prior to breastfeeding to aid
the letdown reflex. You can stand in a hot shower and massage toward the nipple to hand express some milk and relieve some of
the pressure. In some situations, mothers may need to pump a little to relieve pressure and soften the breast enough to allow baby
to latch properly without damaging the nipples. However, avoid pumping more than absolutely necessary, because pumping will
stimulate your breasts to produce more milk.
After Pains: There is usually little or no cramping pain after your first baby. With second or subsequent babies, the after pains may
be severe for the first few hours after the birth. These contractions will diminish in intensity and are often easy to handle by 24
hours after the birth.
Urinate frequently: every 1-2 hours even if you don’t feel the need. This reduces tension on the uterus.
You can use an herbal tincture called Afterease starting 12 hours after birth
Many women prefer to use acetaminophen (Tylenol) or ibuprofen (Advil). Ibuprofen is particularly effective in reducing the
discomfort of after pains. Take 400-800 mg every 4 hours as needed for the first few days after the baby is born.
Emotions: It is common for emotions to fluctuate wildly after delivery. Many women experience fears and sadness, as well as joy
and relief. The overwhelming magic of your new child and the attendant feelings of responsibility, combined with fatigue and
hormone changes, affect your emotional state. Don't worry about crying. Go ahead and cry if you feel like it. Normal postpartum
"blues" usually last no more than a week or two and are helped by adequate rest and good nutrition. Severe depression that
doesn't improve requires consultation.
Sex: In order to minimize the chance of infection, it is important not to resume intercourse until all the bleeding has stopped and the
cervix is closed. The first time you have intercourse needs to be particularly gentle, and many women find they need extra
lubrication. Remember there are other ways to please each other besides intercourse. The most important thing during this period
is to communicate. Be easy and sensitive with each other and discuss levels of desire. Many women find it takes a little while
before their 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 and how appealing you are as a mother, etc. The father, on the other hand, may be tired
from trying to work and take up all 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 usually deeper, and all of life takes on a richer and fuller meaning.
Breastfeeding:
Frequency: Remember that breastmilk digests rapidly and a newborn’s stomach is TINY—so your baby SHOULD nurse FREQUENTLY.
Normal frequency for the first few weeks should be every 1-2 hours for at least 15-30 minutes each time. If your baby seems to be
to want to sleep all the time, you STILL NEED TO NURSE YOUR BABY. Wake them by undressing them, changing their diaper, moving
them around, massaging their feet and head, and possibly applying a cool washcloth to their legs or back until they have nursed
several minutes every few hours. Babies must eat, and it is your job to get those minutes of nursing accomplished. Some babies are
easy to feed, while others are very difficult, as they only want to sleep.
Latch: Be sure that your baby has a good latch EVERY TIME. Just one feeding with a bad latch can cause days and weeks of pain—it’s
not worth it! Look at the breastfeeding handouts anytime you need to remind yourself what a good latch looks like.
If you are experiencing extended pain during breastfeeding, or if you can’t get your baby to nurse properly or frequently enough, call
your midwife immediately.
Respirations:
It is normal for babies to have slightly irregular respirations. If you are uncertain about your baby’s respirations, count the rise and
fall of their chest for 1 minute – there should be between 35-60 breaths per minute. If you notice your baby pausing for several
seconds between breaths, turning blue, or their breath counts are consistently too fast or too slow, call your midwife immediately.
Diapers:
Baby’s first stools are called meconium—they are black and very sticky. Applying a little coconut or olive oil to their bottom when
putting on a fresh diaper will help the meconium wipe off easily.
Baby should urinate and have a bowel movement within 24 hours, and after that have at least 4-6 wet or messy diapers per day.
To get a feel for what a sufficiently wet diaper feels like, pour 3 teaspoons of water into a clean diaper.
After your milk comes in, baby’s stool will change from the greenish/black meconium to mustard colored and seedy. Sometimes
babies skip a day or two of poopy diapers while transitioning to breast-milk stools. However, still let your midwife know if you’re
baby hasn’t had a messy diaper for more than a day.
Some babies may have orange or red spotting in a few of the early diapers. This is normal and is caused by withdrawal from the
mother’s hormones.
Cord Care:
Normal exposure to air will cause the baby’s cord to dry and fall off in 5-10 days. Keep baby’s cord stump above the diaper to help it
dry out. It’s normal for the cord to get a bit smelly and sticky around the base, but you may clean it with lavender oil or alcohol
cotton swab. Until the cord stump dries and falls off, clean baby with a washcloth only; do not submerse in a bath. If you notice heat
or redness around the cord stump, let your midwife know immediately.
Mucus
Keep your bulb syringe handy in case your baby’s nose or mouth need suctioning. Some babies have more mucus than others and
may occasionally cough it up and need to be suctioned. If you leave your baby to sleep alone, prop them on their side with a rolled
up blanket to prevent them from choking on coughed up mucus while sleeping.
Babies have tiny nasal passages, so they can be noisy breathers. A humidifier can help them breathe more easily. If you need to
remove mucus from their nose, squirting breastmilk into the nose first can help both moisturize and loosen any dried mucus.
Jaundice and Baby Acne
If your baby develops jaundice (turns yellow) BEFORE 24 hours, call your midwife immediately. If your baby begins to turn slightly
yellow AFTER 24 hours, this is normal – simply feed your baby frequently and sunbathe them in a window 15 minutes front and back
to help their system flush out extra red blood cells (which are causing the jaundice).
Babies often develop red (acne) or white (milia) pimples within hours or days after birth. This is not a concern and is a normal
adjustment to their new environment. It will resolve on its own.
Take baby’s temperature three times per day until your midwife comes back for the home visit. Normal temperature taken under
the arm should be 97-98 F. Adjust layers of clothing if temperatures are slightly low or high. Call your midwife immediately if baby
develops a fever, becomes lethargic, or is too cool despite appropriate clothing.
Baby
Temperature: Should be 97-98 F
Diapers: Make for every BM
every wet diaper
First 24 hours
Day 2
Day 3
WARNING SIGNS
Call anytime, day or night, if you experience any of the following:
 Heavy bleeding, soaking a large maxi pad in 20 minutes or less. If this happens, press your hand
firmly down and into your uterus and rub in circular motion until it becomes firm. Call me
immediately.
 You pass a clot larger than your fist.
 Your temperature (taken orally) is higher than 100.4, or baby’s temperature (taken under arm)
is higher than 99.4.
 Uterine tenderness, unusual swelling, foul smelling blood or odor, or belly is warm to the
touch.
 Flu symptoms, such as achiness and chills.
 You look pale or feel like you may pass out.
 Severe headache or pain in the stomach, legs, or chest.
 You cannot urinate.
 Baby’s breathing seems fast, or baby appears to have a hard time breathing, can be shown by
grunting, humming, raspy noises, or flaring nostrils.
 Baby is unusually sleepy, lethargic, hard to wake, will not nurse.
 Baby vomits forcefully, several times, or a large amount. This is different than normal baby
spit-ups.
 Baby’s skin looks yellow.
 Baby’s skin looks blue or gray in color. (Some blue in hands or feet is normal)
 Baby does not urinate or have bowel movement in the first 24 hours after birth.
 Baby’s cord stump is very red, warm, or smelly.