KENSINGTON MIDWIVES: THE POSTPARTUM PERIOD
Your midwives will be on call for you 24hrs a day in the postpartum period and visit several
times during the first week. Having a new baby is one of life’s most exciting and joyful events. It
can also be overwhelming - juggling the needs of a new baby and adjusting to the increased
demands on you and your family’s time and energy. To help you more easily handle these
lifestyle changes, we have provided some general guidelines for you to follow after giving birth.
Please ask your midwife for any specific instructions.
Activity and Rest
Giving birth to a baby can be physically exhausting. Fatigue and the need to rest should be
expected even if you are in great shape. It may be four to six weeks after giving birth before you
will begin to feel more like yourself.
Although this is an exciting time for you, your family and friends, you are encouraged to limit
your visitors and telephone calls so that you have an opportunity to rest and learn how to care for
yourself and your baby.
In the beginning, tasks that you view as simple may leave you exhausted. Expect to feel this and
give yourself permission to rest. Take the time, especially when your baby sleeps, to nap and
catch up on your own sleep, but this may be difficult if you have other children at home. You
may find that one day you have a lot of energy and the next day you may be too tired to do much
of anything. Try to postpone any unnecessary tasks and ask a friend or family member to help
out at home. Do not be afraid to ask for help with meal preparation, cleaning, laundry, and other
household tasks. This will allow you to care for yourself and to spend
more time with your baby.
If you have other children, they will also need and want your attention
and time. Make sure that you get enough rest, so that you can meet their
needs as well.
Fatigue is a normal part of being a new parent. Gradually increase your
amount of activity, but avoid strenuous work, heavy lifting and excessive
social activity until after your six-week check up. Listen to your body. If
vaginal bleeding increases or if you feel tired, slow down or stop what you are doing.
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Care of Your Breasts
The best way to prevent nipple damage (trauma) is
correct positioning and latching at the breast. When
you begin to breastfeed, your nipples may become
somewhat sore and tender. Expressing
colostrum/breastmilk after each feeding and rubbing it
into your nipples will soothe and condition them and
help with the healing process. Colostrum contains anti-infective properties that will protect your
nipples from bacterial growth. Avoid using soap and washing your nipples between feedings.
Taking a daily shower is all you need to do. If your nipples become cracked and/or are bleeding,
repositioning your baby will prevent further damage. Some women find that ointments such as
pure lanolin can be helpful in the first few weeks.
Preventing breast engorgement:
Two to five days after your baby is born, your milk supply will begin to increase. Some mothers
may experience a condition called engorgement where their breasts become very hard, swollen,
inflamed and painful. It is important to treat engorgement quickly. Excessive fullness may inhibit
the let-down reflex and also flatten your nipples making it difficult to establish a correct latch,
which would then contribute to nipple damage and soreness.
Engorgement can be prevented with early, frequent feedings. Your baby should be breastfeed
eight to 12 times or an average of every 2 - 3 hours in a 24-hour period. Avoid the use of a
pacifier until breast feeding is well established. Use a breast pump to pump your breasts if your
baby cannot breastfeed or, if he or she misses a feeding.
Treatment:
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Take pain-relieving medication. (Acetaminophen and Ibuprofen: alternate 1-2 regular
strength tabs every 3-4hours)
Shower to relax. Gently massage your breasts and hand-express some milk to soften the
areola.
Find a comfortable room with minimal distractions. Play soft music and use calming
images to decrease stress.
Feed your baby for 15-20 minutes or until the breast softens. Using breast massage and
compression during the feeding will enhance milk removal. Offer the second breast. If
your baby does not feed on the second side, pump or hand express that breast for two to
five minutes or until the breast is softer and you are more comfortable. Begin the next
feeding on this breast.
Do not go long periods during the day without either breastfeeding your baby or pumping
your breasts. If your baby is unable to latch effectively and pumping does not facilitate
milk release and breast softening, lie flat on your back, elevate your breasts with towels
and apply ice to your breasts to decrease swelling. Cold cabbage leaves can provide
additional relief and are perfectly shaped to fit in your nursing bra.
Continue cold treatments in between feedings until your milk begins to flow, as well as
for your comfort.
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Wear a well-fitting, supportive bra without an underwire.
Engorgement usually resolves within 24-48 hours. Please contact your midwife if engorgement
continues and you are unable to feed your baby at least eight times in 24 hours. She may refer
you to a lactation consultant.
Help with the pain of engorgement
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Shower or apply warm compresses to your breasts, massage them gently and express
milk to soften the areola.
Find a comfortable chair, relax and begin breastfeeding.
Make sure your baby is properly positioned and latched well onto your breast.
Feed your baby for at least 10 minutes or until your breast softens and your baby is in a
content state.
Gently massage and compress (squeeze) your breasts when your baby pauses between
sucking bursts; this will increase the amount of milk your baby takes during the feeding.
Continue to watch your baby for signs of feeding cues or feed your baby at least every
two to three hours (eight to 12 feedings in 24 hours).
Abdominal Cramps
As your uterus contracts to return to its pre-pregnant size, you may experience “after birth
pains,” which typically disappear three to four days after birth.
Breastfeeding mothers may experience increased abdominal cramps during and after nursing. If
you have had other children, you may have more severe “after birth pains” because the uterus
needs to work harder to get back to its pre-pregnant state. If you need to take pain medication,
take acetaminophen or ibuprofen as directed by your midwife.
Please call your midwife if you experience fever, chills, foul smelling discharge or increased
abdominal tenderness.
Bleeding
Called lochia, the vaginal discharge after birth is a combination of the sloughed uterine lining
and blood. The discharge usually changes in color over several weeks from bright red, to pink
and then to a whitish tone.
If you are soaking through a large pad every hour, if your vaginal bleeding has increased and
does not slow down when you rest or, if you are concerned about the amount, color or duration
of your bleeding, contact your midwife.
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Perineal Care
Until you stop bleeding, continue to use your “peri-bottle” each time after
you urinate or use the toilet. Always wipe from front to back, away from
the vagina. For the first week at home, we recommend you use soft facial
tissue to gently pat dry. Change your pads often.
If your perineum is swollen or painful, apply ice (or a bag of frozen peas)
to the area for the first 24 hours after the birth. Prior to the birth you can
freeze maxi pads soaked with witch hazel to provide additional comfort.
Discomfort usually resolves in 4-6 weeks.
Hemorrhoids
Hemorrhoids are caused in pregnancy by the added pressure of the baby in the uterus.
Protrusions of tissue (varicose veins) through the anal opening, hemorrhoids can be quite
uncomfortable. They can appear for the first time in late pregnancy or following delivery and
usually get better and disappear. In the acute stage, hemorrhoids will respond well to Witch
Hazel compresses, Tucks® or sitz baths. Occasionally, local medication may be needed. Avoid
straining when you have a bowel movement, and do not stay seated in the bathroom for a long
period of time.
Constipation
There is a tendency toward constipation during the first few weeks following birth. This is easily
overcome by establishing proper dietary habits including drinking eight to
10 glasses of water daily, and eating roughage in the diet, such as raw
fruits and vegetables, fruit juices, figs, dates and prunes, whole grain
breads, and bran cereal. If necessary, you may use a mild laxative or stool
softener. If you are breastfeeding you may use psyllium husk (1Tbsp with
lots of water), increase the oil in your diet, add flax seed into a smoothy etc..
Stitches
If you had a tear or episiotomy your stitches may still feel uncomfortable for a while. It takes two
to four weeks for the skin to heal. To alleviate discomfort:
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reduce the amount of physical activity; try to avoid sitting cross legged or with your legs
apart
three times a day, soak your perineal area for 20 minutes in a sitz bath or bath filled with
a small amount of water. Postpartum “teas” or Epsom salts may be added to the water.
expose your perineum to air to promote healing.
adjust your sanitary pad so that it does not rub against your stitches
apply Witch Hazel compresses to your stitches each time you change your pad or
whenever necessary to relieve discomfort.
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Tell your midwife if there is any foul smelling discharge or fever.
Take acetaminophen, ibuprofen, or prescription pain medication as directed.
stitches do not usually need to be removed and will dissolve in about two weeks, if after
that time there are areas where suture material remains, your midwife can remove them.
Itchiness is a normal experience and is usually part of the healing process.
Medications
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You may, as advised, use ordinary medications for colds, headache, constipation,
hemorrhoids, insomnia and other minor ailments. However, if you are breastfeeding,
consider potential effects to your baby. We recommend that you continue taking prenatal
vitamins until you wean your baby. Before taking other medications, please check with
your midwife or “motherrisk”
www.motherrisk.org
Normal Physical Changes to Your Body
You may experience some normal physical and hormonal changes in your body after birth
including:
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hot flashes;
night sweating;
increased urination (for first few days after birth);
dry skin;
temporary hair loss;
vaginal dryness;
mood swings.
These are only temporary and should decrease as your body returns to its pre-pregnant state.
Emotional Health
Having a baby brings plenty of joy, but you may also feel a degree of
anxiety. Mood swings and difficulties concentrating on tasks are common.
Some women experience feelings of depression. Although you may have
planned for all the details of baby care, you still may find it hard to manage
your time. Finding a moment to do something simple, such as taking a
shower, may be challenging.
There may be great joy and celebration at the birth, but sometimes women feel frustration and
disappointment when events do not happen as planned. Remember that the goal of pregnancy
and childbirth is to have a healthy mother and baby, not a perfectly scripted experience. The
labor and birth experience is unique to each mom so it is important to keep your expectations
flexible. Talk to your midwife about how you are adjusting or about concerns you may have.
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Women who plan to return to work may find that they would really like to stay home while
women who decided to leave work may feel a sense of loss from leaving their career. It is
important to find the time to talk with friends and family about your feelings and let them help
you as much as they would like. It is also important to set aside time for you and your partner to
spend together.
Adjusting to being a parent
While childbirth evokes powerful emotions, the bonding process sometimes takes time. Some
parents comment that they feel guilty that they thought their baby was “funny looking” at birth,
that breastfeeding did not happen instantly or that they were “too tired to care.” You may think
you are not normal if you do not instantly love everything about your baby or feel an
overwhelming mothering instinct. Parenting is a learning process,
and not something that happens instantly.
Partners also have mixed feelings about birth and their role. They
frequently are fearful that either mom or baby will suffer, or that
they will not measure up to expectations. Afraid of distressing
moms, partners sometimes avoid discussing their concerns, and are
occasionally repelled by the birthing process and the more mundane
tasks of childcare. Encourage whatever role your partner initiates or
make suggestions.
Your emotions are apt to fluctuate widely after having a baby. The “baby blues” are
a common reaction, appearing usually suddenly in the first few days. As many as 80
percent of all new mothers experience feelings of sadness,(crying for no apparent
reason), loneliness, impatience, irritability and anxiety. Be assured these feelings
usually pass within a few days.
Different from the “baby blues,” postpartum depression can occur in
varying degrees, happening within days of delivery or up to a year
later. Feeling out of control or fearful are common symptoms of PPD. Other
symptoms may include: feelings of inadequacy and inability to cope, despair,
feelings of panic, no feelings for the baby or extreme concern for the baby, fear of
harming the baby or oneself, exaggerated highs and lows, poor concentration or
memory and feelings of guilt or unworthiness. Physical symptoms may include
heart palpitations and panic attacks.
These symptoms are not a sign of weakness or inadequacy. They are temporary and treatable
with support and professional help. Call your midwife or family doctor. Resources for support
groups are included in the binder.
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If you had a Cesarean Birth
You will be encouraged to get out of bed shortly after your cesarean
birth. The Foley catheter will be removed in the morning, and the
IV is usually removed 24 to 48 hours after giving birth. Your
physician/midwife will prescribe pain medication for you on a
“when needed” basis, (i.e. when you tell the nurses you need pain
medicine). On your first day, we recommend you take pain
medication at regular intervals to control the pain. The discomfort
from your incision should subside with each day.
The first few days after surgery can be difficult, from positioning the baby for feeding, to
moving, sleeping and coping with emotions and after-birth pains. To speed your recovery, it is
very important to get plenty of rest. It is also wise to limit your visitors and the length of their
stays, as well as phone calls.
To turn from side to side in bed with the baby, hold the infant close to your chest or under your
arm like you are holding a football (football position), and use the side rails for support. When
you cough, sneeze or laugh, bend your knees and support the abdominal incision with a blanket,
pillow or your hands.
Once the bandage has been taken off - keep your incision dry and
exposed to air. After you shower, dry the area gently and thoroughly.
Usually, your staples or stitches will be removed before you go home
or your midwife will remove them at her first visit to your home. The
staples hold together the top layer of your skin and are not folded
under like the metal staples used on paper, so removal is not a
painful procedure. The incision line may itch and be sensitive to
touch or pressure, so use care when rubbing the area.
Midwifery clients are typically discharged home from St Joseph’s after 48hrs as long as all is
well with baby and mother. Your midwife will visit you in the hospital and plan to see you at
home once you are discharged.
The hospital nurses may offer to perform the newborn hearing screen and/or the Newborn
metabolic screening test. These can also be performed in your home and the clinic if you prefer.
For six weeks or longer, your body will not look the way it did before pregnancy. At first your
balance may be unsteady, so limit stair climbing. Avoid lifting objects any heavier than your
baby, and unnecessary stooping or reaching. Walking is a good beginning exercise. Postpone
more strenuous exercises, such as aerobics, until after your six-week check-up.
Over the next two to three weeks your vaginal bleeding will change from a moderate red flow to
light pink and then to a scant white staining. Overexertion, fatigue or poor nutrition may cause an
increase in the vaginal flow. This is your body telling you to slow down and take it easy. Give
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yourself and your body time to feel better. Notify your midwife if you have bright red bleeding,
redness, swelling or separation of tissue in your incision.
Approximately six weeks after you give birth by cesarean daily massaging of your scar is
recommended to promote healing, break down scar tissue and avoid the formation of adhesions.
Adhesions are bands of scar tissue that bind together body parts that are normally unconnected.
After a cesarean it is common to have adhesions on your colon, ovary or between your bladder
and uterus. If left untreated, adhesions can cause pelvic or back pain, urinary incontinence,
infertility, pain during intercourse or pain during subsequent pregnancies. For a detailed
explanation on cesarean scar tissue massage check out this video on You Tube or speak to your
midwife.
http://www.youtube.com/watch?v=he_YB9e__rQ
Future Childbirth
You should not assume that the next time you have a baby you would deliver the same way.
Under certain circumstances you may be able to have a vaginal birth after cesarean (VBAC).
Midwives are able to care for most women who would like to have a vaginal birth after cesarean.
It is recommended that you allow 24 months between babies. You can chose to have a planned
cesarean or you can choose to have a vaginal birth after cesarean (VBAC). Most women who
attempt a VBAC are successful. Talk to your midwife for more information
Tips for Partners
Following a cesarean section, new mothers need assistance with childcare and other daily tasks.
Here are some ways you can help:
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Encourage her to walk by walking with her.
Make arrangements to minimize stair climbing at home during the first few weeks.
Assist her in lifting or carrying siblings and heavy objects the first few weeks.
Encourage her to take frequent rest breaks. This is especially important for recovery after
surgery.
Bring the baby to her for night time feedings if she is breastfeeding and change the
baby’s diaper.
Assist with household responsibilities.
Minimize your work obligations, if possible, so that you can spend time together and with
the baby.
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