Cambridge Midwives

Complete Pregnancy and Birth Care

Postnatal

The following are guidelines primarily for the first two weeks following an uncomplicated birth. In the case of twins, prolonged or difficult labour, anemia, cesarean section, maternal hemorrhage or severe perineal lacerations, allow extra time for care and recovery.

 

Planning

· Plan for physical help. Hire, bribe or barter the services of a strong, mentally positive person to do household chores. This person should be able to see what needs doing and do it without needing lots of direction. There is to be no guilt involved with having this person in your house.

 

· Inform close friends and family when visiting privileges will begin after birth. Sometimes people assume that if you are strong enough to give birth at home; or to be retuning home so soon after your hospital birth you will be ready for visitors that evening. Think about when you will want visitors, for what length of time, how many at a time, if there is any age cut-off, etc. consider making a poster stating your rules.

 

· Make a list of things your family likes to eat. Post this list on the fridge for all to see. This provides a quick answer for those asking to bring a meal. If you have some last trimester energy, you should freeze meals ahead of time and stock up on non-perishables. Use these after your support person has gone.

 

· Make signs. A favourite is: "Mom and baby are blissfully slumbering. Please come another time." Perhaps you would prefer: "We are unavailable for visits now. We are engaged in (check one): sleeping, bathing, working out gastric difficulties, or being just plain anti-social at the moment."

 

· Simplify your life. Did you know that the less you have, the less there is to keep clean? 300 new born outfits are fun, but alas, impractical. Tell friends to buy a variety of sizes or opt for a non-clothes gift such as a meal, cleaning, childcare, etc. Enjoy a walk in the fresh air every day. It is OK, even in the winter-just bundle up! It invigorates the mind and refreshes the soul. Eat simply. If it is financially feasible, designate a night to order in.

 

· Listen to your body. If it says sleep, sleep. Be selfish it is perfectly acceptable. Don't feel you have to do this or that. Love and take care of your baby and family. People are more important than things. Remember to eat properly. The milk supply and postpartum healing are number one on the agenda so eat well, drink lots of fluids and avoid constipation.

 

· Consider your baby's sibling(s). They go through adjustment too. Plan playtime for them at other homes. Wrap little goodies ahead of time for those "I feel left out" moments. Take ten minutes a day to read books, play a game, etc. with other children. Have a list of simple activities prepared to ease rainy day doldrums.

 

· Communicate. Postpartum can be emotionally high and low all at the same time. Hormones are bouncing around seeking a new level. Talk about the birth, the baby's colic, your disinterest or need concerning sex, body changes, and visitors. There are certain individuals in your surrounding friends who are better suited to listening than others. Talking to such people can be a release. Evaluate your needs and verbalize them.

 

Mothers Special Care

· Vaginal bleeding (lochia) should be like a heavy period. It should smell like your period, not foul. Small blood clots are the normal result of blood pooling in the vagina, when you have been lying down for awhile. The lochia will be bright red for the first few days, then pink, brown, etc. until it has stopped. Women will flow up to four weeks. Plan to have plenty of pads on hand.

 

· Your uterus should feel firm like a grapefruit in the middle of your abdomen. Nursing helps the uterus to contract naturally and these contractions can be bothersome. It helps to press a pillow against your abdomen to support it when they occur. You may not have any uncomfortable Afterpains with your first child. You can take pain medication, (e.g. Tylenol or Ibuprofen) if you need it or you can consider making a herbal 'Afterpains Brew' if you've had several babies and anticipate a problem. After about 10 days, the uterus has involuted to the point of having retreated back into the pelvic area. It takes six weeks for the organs to return to normal.

 

· Let the baby tell you when and how long to nurse. It is by tuning into her/his needs that you learn successful nursing (and parenting). Your baby may want to nurse for hunger, loneliness, sucking satisfaction, to relax, to get to sleep, etc. The breast is nature's pacifier. By using the breast in this natural way and by avoiding early introduction of solids, absences from baby and the use of pacifiers, the menstrual cycle is often suppressed. This can be a side benefit, which promotes natural spacing of babies. For information, read Sheila Kipley's 'Breastfeeding and Natural Child Spacing' or 'A Cooperative Method of Natural Family Planning' by Margaret Nafziger. We highly recommend LaLeche League meetings for encouragement and support, as well as the regular contact with other nursing mothers. Plan to attend several meetings before the baby is born.

 

· Urinating may sting. Try using a peri-bottle to pour some warm water or herbal bath solution over your genitals while you urinate to dilute the flow. Wipe or dab gently from front to back, especially if you have stitches. It is vitally important to keep this area scrupulously clean. Ice packs or comfrey leaf tea bags placed on the perineum will help alleviate swollen tissue and aid in healing. Air and sunshine are also great healers. All of these work for sore nipples, too.

 

· Rest and fluids are essential. Try to sleep when the baby does. Take as much help from others as they are willing to give, but leave the baby to you. Listen to your body's thirst demands while you are nursing.

 

· Bathing is okay. Many women prepare an herbal bath to share with the baby right after the birth. Your midwife will give you a sample of such a healing bath.

 

· Do your Kegel exercises (tightening of the pelvic floor muscles) whenever you think of them. They help in healing and restoring the muscle tone of the pelvic floor. Sit-ups (one in the morning to begin with - gradually do more) and single leg lifts (avoid lifting both legs at once) help in this area, too.      

 

Baby's Special Care

· Cord Stump:  The cord stump doesn't require any special care. Fasten the diaper below it. The midwife will remove the clamp in 24 hours. The cord will smell as though it is rotting, but it should not bleed or have pus oozing from it, and there should not be a red area on the belly the base of the stump.
Stools:  The baby should pass meconium within the first 24 hours. The meconium diapers will last until the milk comes in (from 36 hours to 3 days).

 

· The colostrum in your breasts helps prepare the baby's system for breast milk as well as aids the baby to spit up any mucous.

· Urination:  The baby should urinate within the first 24 hours after birth. There will be little urine thereafter until the milk is in.

· Temperature:  Keep baby warm, especially her/his head.

· Skin:  It is normal for baby's skin to peel and flake during the first week. Babies enjoy being oil and massaged if you wish to do so by lying her/him along your legs as you sit outstretched. You might enjoy Leboyer's book on this subject, 'Loving Hands'.

· Genitalia:  Newborn genitals are normally enlarged. A baby girl may have blood-tinged discharge, like a small period. Babies, especially boys, may also have orange/pink spots on their diapers because of uric acid salts. The foreskin of a baby boys penis needs no special care and SHOULD NOT BE PUSHED BACK.  It is usually quite loose by age three or so.

· Newborn Testing / Screening & Treatments:  We usually do a PKU test at 3-5 days. Phenylketonuria is a rare metabolic disorder causing mental retardation. The test involves pricking the baby's heel to obtain a blood sample. The thyroid function test is done from the same blood sample. This test is not required by law but at the recommendation of the public heath department as routine screening. Other issues you must consider soon after the baby's birth (i.e. during the first hour) include the use of erythromycin (antibiotic ointment) in the eyes for the prevention of infection from gonorrhea or chlamydia which are sexually transmitted diseases. Although this is public health law, many parents in fact decline it, feeling that the existence of such conditions would be extremely unlikely if not impossible in their individual cases. The shot of Vitamin K in the baby's leg is to prevent rare neonatal haemorrhagic disease. This is also a parent's individual choice. We can discuss these issues further at your visits.

· Jaundice:  Jaundice (yellowing of the skin) between 3-7 days is normal unless it is very deep in colour and involves the baby's whole body and extremities and is affecting the baby's alertness to nurse. It should be investigated if it is present within the first 24 hours, as this is abnormal. Normal jaundice occurs because the immature liver is unable to excrete the byproducts of the breakdown of the excess red blood cells the baby needed in intrauterine life. Exposure to sunlight, (e.g. through a sunny window) will help to eliminate the yellow colour. Frequent feedings would also be helpful.

 

Principles of New Baby Care

· You need help with the housework, not the baby. Friends, neighbors, family can help. If necessary, invest in a housekeeper or mother's helper, one or two days a week. Many people can and would like to help. They may even ask. Don't be shy in saying yes, especially to meals. Let your family and friends organize meals to be brought in. It will make the whole day go better.

 

· You should sleep when the baby sleeps. Buy a door sign or make one with "Do Not Disturb" on it. If you have older children who no longer take naps, arrange for them to play in their rooms or visit a kindly neighbor for a couple of hours each day during the first few weeks. You will feel more like coping if you are not continually short of sleep, but you will really have to plan for extra naps to avoid that dragged-out feeling.

 

· For the moment, baby comes first. Be ruthless about this, or you will be overwhelmed with conflicting demands, and feel guilty about the baby being neglected. For every mother who is "too wrapped up" in her baby, there are hundreds of others who are not able to be as wrapped up as they would wish. Don't let society rob you of the full enjoyment of this short time with your baby. You deserve this, you have worked hard to get here.

 

· Take it slowly. It may take six to nine months for your body to recover completely from the pregnancy and birth. Don't push it; don't overdo. If you're tired, rest. Eat well-balanced meals. Drink lots of fluid. Go by nature's schedule, not society's. If you have a husband or partner, that person may play a protective role in making sure that you do not do to much. Your husband or partner can limit visitors at first, assist with family tasks, and generally make sure you are not pushing yourself to hard. Allow yourself to be mothered so that you can mother your baby.

 

· Remember that you, the adult(s), are still the essence of your family. Parenthood brings with it the challenge to expand and widen the horizons of our reality to include children. But the foundation of the family remains the adult(s). If you are parenting alone, find ways to continue to nurture yourself. If you have a husband or partner, nurture that relationship. If it disintegrates, the relationships with the children tend to get out of balance, and the entire family will suffer. Tend to each other; make time to talk, to listen, and just to be together.

 

· Enjoy your baby's infancy. Baby's needs though constant, are few and simple, and often it is only the mother who can meet them in the early weeks. Infancy is so short and time flies - in six to eight months that baby will be crawling away from you to meet a new world and you will have to let go more and more each day. Enjoy those precious early times while you can.

 

 

 

 

 

 

 

 

 

 

 

 

To contact us:

Phone: 519-624-9708

Fax: 519-624-1493

E-mail: cmidwives@bellnet.ca