MOM’S POSTPARTUM INFORMATION Activity recommendations for the first 10-­14 days. Sleep, eat, breastfeed and care for your baby, care for yourself, take sitz baths, accept help. Avoid lifting more than the weight of the baby. Bleeding. In the first few days following the birth, bleeding will be similar to a heavy menstrual period, both in color and amount. Clots as large as a plum may be passed, especially when getting up after you have been lying down. Bleeding may increase or be a brighter red if you are over-­‐doing it. If you saturate two pads in one hour, massage your uterus and call the answering service. If the discharge becomes foul smelling, call the answering service. Uterus. In the first few days following the birth your uterus should feel like a firm grapefruit at or below the level of your navel. If it is high or off to one side your bladder may need to be emptied. Many women who have given birth more than twice will experience “after-­‐pains” as the uterus contracts. After-­‐pains are typically worse when the baby is nursing. They usually do not last more than 3-­‐4 days. You may take 600-­‐800 mg (3 or 4 tablets) of Ibuprofen (Advil) for relief every 6-­‐8 hours. Red Raspberry Leaf helps decrease cramping and regulate bleeding, as do the herbs crampbark, black haw, motherwort and yarrow. Infection prevention. Wash your hands each time you change your pad. Check your temperature every 4-­‐6 hours for the first 3 days. There may be a temporary rise in your temperature when your milk comes in (2-­‐5 days after the birth) but this should fall within 24 hours. Uterine pain with a foul-­‐smelling discharge and a fever may be signs of a uterine infection. A tender breast with body aches and a temperature may indicate a breast infection. Please call us if you are experiencing any of these symptoms of infection. Perineum. Place an ice pack on your bottom to minimize swelling. After 12 hours, Tucks (or cotton pads soaked in witch hazel) placed on your bottom may be soothing. Sitting in a clean tub of very warm water (sitz-­‐baths) several times a day will help the healing process. Use the herbal tea bags in your postpartum bag 24 hours after your birth if you have any stitches. Start your kegel exercises right away. Urinating may sting for a few days after the birth. Squirt warm water from the peri-­‐bottle to dilute the urine and to rinse off your bottom. Blot yourself dry from front to back. Bowel Care. Bowel movements often do not resume until 2-­‐3 days after the birth. In order to avoid constipation, make sure you have plenty of fiber (fresh fruits & vegetables) and fluids in your diet. Metamusil, senna and flax may help with constipation. Over-­‐the-­‐counter stool softeners are fine to take while breastfeeding. Rest, fluids, and good nutrition are essential to a speedy recovery. Plan to take naps when the baby is resting. Arrange for help with meals, household chores are childcare. Increase your diet by 500 calories a day (an extra glass of milk and a sandwich) for milk production. The more you rest in the first 10-­14 days, the sooner you will feel totally recovered. 207 W. Washington Street  Boise, ID 83702  phone: (208) 343-­‐2079  fax: (208) 343-­‐6828 www.treasurevalleymidwives.com Nutrition. Avoid or reduce high-­‐sugar foods & caffeine. Eat fresh fruits & veggies. Continue taking prenatal vitamins, Omega-­‐3s & Vitamin D3. Taking Vitamin C 500 mg three times daily can help with wound healing and decrease risk of infection. Probiotics are recommended to decrease the risk of yeast (vaginitis in mom, thrush and diaper rash in baby) to self and baby, especially if you received antibiotics during labor. Resumption of normal activity is mostly a matter of common sense. Moderate exercise, such as walking, is beneficial. Your bleeding is a barometer – if you over-­‐do it, your bleeding & cramping will increase. Intercourse may resume when both partners desire it (we recommend waiting 4-­‐6 weeks). A water-­‐soluble lubrication may be helpful for vaginal dryness. Contraceptive options will be discussed at your 4-­‐week checkup, and should be considered, especially if the baby is not exclusively breastfeeding day and night. If you have used a cervical cap or diaphragm in the past, do not rely on it until it has been refitted. Warning Signs. Page the on-­‐call midwife if you have any of the following:  Fever greater than 100.4°F  Flu-­‐like symptoms, or any sign of localized swelling or tenderness in your breasts  Sharp pains in your abdomen, breast or chest  Pain in your legs, especially in the calf muscle, when you extend your foot (possible blood clot)  Blurred vision or dizziness, with or without a headache  Bleeding more each day, or passing clots larger than a plum more than twice per day  A foul smell or unexpected change in your bleeding (increased bleeding and/or clotting after the first week) especially with uterine pain and fever. These are symptoms of a uterine infection  Perineal wound getting more painful each day, or any sign of swelling or infection around the vagina, especially if you had a tear and/or stitches  Difficulty, discomfort or burning when you urinate  Bleeding that lasts more than 6-­‐7 weeks  Any strong sense that something is “wrong” with you physically  Crying spells or mood swings that feel out of control  Thoughts of harming yourself or your baby Please call the answering service if you have any questions or concerns: (208) 343-­2079 207 W. Washington Street  Boise, ID 83702  phone: (208) 343-­‐2079  fax: (208) 343-­‐6828 www.treasurevalleymidwives.com BABY’S POSTPARTUM INFORMATION General appearance: Babies are very sleepy for their first few days. Wake them to feed every 2-­‐3 hours. Check their color several times per day; baby should be pink on his/her chest and face, but it’s okay if his/her hands and feet are blue for the first few days. Cord care. The base of the cord may be cleaned with a wet cotton ball or Q-­‐tip. The skin around the cord should stay as clean and dry as possible, but it is okay to bathe your baby. Stool (meconium) should be passed at least once within the first 24 hours of birth. Stools are dark and tarry initially; put olive oil or baby balm under the diaper to aid in cleaning. Once breast milk is in, stool will transition to a yellow or brownish color. The normal consistency of the stool ranges from curd-­‐like to runny. Wet diapers. In the first week, the number of wet diapers should equal the days since birth. For example, on day 3, baby should have 3 wet diapers. After your milk is in, the baby should have 6-­‐8 wet diapers in 24 hours and may have a bowel movement as often as every feeding. Girls may have a “pseudo-­‐menstruation” – a small amount of vaginal bleeding, usually noticed during a diaper change. This is normal, as her body processes mom’s hormones. Jaundice is a yellowing of the color of the skin and the whites of the eyes. It is most common between the 3rd and 7th day and usually goes away without treatment. •
Jaundiced babies tend to be sleepy and difficult to wake up but it is very important that they nurse frequently in order to move the bilirubin (which causes the yellowness) out of their system. If your baby is showing signs of jaundice on day 1 or 2, call the answering service and page the on-­‐call midwife right away. Respirations. Newborn breathing patterns are irregular but should not be labored. •
It is normal for newborns to cough and sneeze and sound stuffy, or even vomit clear fluid for a few days as they clear their air passage & belly of amniotic fluid. If a baby is able to nurse well then he/she is probably not having any trouble breathing. Temperature. Take your baby's temperature with a digital thermometer under the arm, on the temple every 4-­‐6 hours for the first 48 hours. Please record the temp on the breastfeeding chart. •
Newborns have difficulty regulating their body temperature. Normal temperature is 97.9 – 99.5°F under the arm. If the baby’s temperature is low, put the baby skin-­‐to-­‐skin with you, cover with warm blankets and retake the temperature in 30 min. If the baby’s temperature is high, make sure that the baby is not overdressed and retake the temperature in 30 min. Call the answering service and page the midwife on call if the temperature is too high or too low after making adjustments. Group Beta Streptococcus (GBS) infection in Newborns. Group B Strep is a serious newborn infection. Call the answering service and page the on call midwife immediately if you notice the following signs. 207 W. Washington Street  Boise, ID 83702  phone: (208) 343-­‐2079  fax: (208) 343-­‐6828 www.treasurevalleymidwives.com Signs of Group B Strep infection include: •
Respiratory distress: Noisy "grunting" on the out-­‐breath, flaring nostrils with each breath, rapid breathing (over 60 breaths/min when baby is sleeping) A baby that is not able to nurse due to difficulty breathing Blue or dusky color in the central part of the baby's body Temperature above 99.5°F or below 97.5°F A baby that will not feed, has significant lethargy, or seizures •
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Vitamin K Deficiency Bleeding. If you chose not to have vitamin K administered to your newborn, we ask that you watch your baby carefully for signs of excessive bleeding that may be caused by vitamin K deficiency. Call the answering service and page the on-­call midwife if any of these signs are present: •
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Skin bruising, more than what was noted during the newborn exam Blood seepage from any body opening (except umbilical cord or circumcised penis or girls having pseudo-­‐menstruation with a small amount of vaginal bleeding) Blood in bowel movements Prolonged jaundice Lethargy or seizures Failure to thrive Follow-­up infant care. We can care for newborns for their first month of life, assuming everything is normal. If not, we will recommend that you contact your chosen healthcare provider for care. We do not do perform circumcision or administer vaccinations, so if you need those done, please contact your healthcare provider to schedule an appointment within the first 2 weeks after the baby is born. Birth Certificate. We will have you sign the birth certificate as soon as you have provided us with all of the necessary information (the baby’s name, etc.). We will then submit the certificate to the Vital Statistics office. They will send you a form for ordering copies of the birth certificate. You will also receive a Social Security Card in the mail for the baby, if you requested it. Insurance. Please make sure to add your baby to your insurance policy. Please call the answering service to have the on-­call midwife paged if you have any questions or concerns (208) 343-­2079 TVM 5/13 207 W. Washington Street  Boise, ID 83702  phone: (208) 343-­‐2079  fax: (208) 343-­‐6828 www.treasurevalleymidwives.com