This is a guide for a normal postpartum recovery period. If you have a concern, please contact your care provider.
Checklist for Mom:
UTERUS- Your uterus should be firm and well contracted. Each day it will get a little smaller in size. You may feel “after pains” in the first few days after birth as it contracts, especially while breastfeeding. If the pains are really bothersome, you can take a pain reliever. You can massage your uterus and nurse your baby to encourage it to firm up if you feel your bleeding is on the heavier side.
BLEEDING- Your blood loss in the first few days after birth will be similar to a heavy period. It will taper off within 1-3 weeks, and you may spot for up to six-eight weeks. Call your midwife if you are soaking more than one pad every ½ -1 hour. Call your midwife if your flow has any bad odor to it. (It should smell like your period). Bleeding will be heavier in the morning and when you first get up after lying down. Call your midwife if you pass a clot bigger than your fist. Keep your bladder empty.
TEMPERATURE- Take your temperature twice a day for at least four days. Call your midwife if temp is elevated. Normal body temperature is 98.6 degrees fahrenheit or 37.0 degrees celsius.
REST- This is one of the most important things you can do for yourself and your baby! Stay in bed or on the couch for the first 5-7 days. Rest is essential to normal recovery and the best prevention of complications. Sleep when baby sleeps. Do not do any housework, lifting, cooking, cleaning, or laundry. This is what friends and family are for. Let them help.
FOOD and DRINK- Nourishing, whole foods are crucial to your recovery and to your body’s ability to make quality breast milk. Your water intake should be around 3 liters a day, even more than in pregnancy. You are feeding two people, so be conscientious.
SUTURES / HEALING – If you have stitches, the first few days after the birth are very important to your recovery. You should remain off your feet, in bed or on the sofa, with your legs together. Limit getting up to just using the bathroom or bathing. Use your irrigation bottle to rinse your perineum with warm water after using the bathroom. Blot the area dry gently. If your have swelling in the area, use an ice pad. You can also do a sitz bath after the first day or two. Limit activities, which involve standing, walking, stairs, lifting, and getting up and down. When you do finally have a BM, use counter pressure with a gauze pad or toilet paper pad to minimize pressure on the sutures.
BREAST CARE- The first milk is called colostrum. It’s thick, rich, orange or yellow colored, and full of antibodies. It’s wonderful stuff. You can put drops of colostrum in your baby’s eyes too. About 72 hours after the birth, your breast will begin filling up with milk. This makes most mother’s breasts feel hard, achy, and sometimes lumpy. This is normal. The key is to nurse. Within a couple of weeks your breasts will figure out how much milk your baby needs and become better regulators. But at first, be ready for milk everywhere!!! Breast pads in the bra and a cloth diaper pressed to the opposite breast than the one you are nursing on is a good way to control overflowing milk. If you get really full and baby is not interested at the moment, you can get into a hot shower and let the water run on your breasts and massage the milk out, you can also pump. Warm compresses (washcloths with warm water on them) are also helpful. Nipple soreness is also a common occurrence in the first few days. It’s important for baby to be correctly latched onto the breast for every feeding. See below for more information. You can use a product made from lanolin to soothe, heal, and protect chapped nipples. If you develop blisters, sores, and pain from nursing that don’t resolve quickly, please contact a Lactation Consultant Get help for breastfeeding problems as soon as possible. It’s always easier to change and correct problems in the beginning by getting immediate help and support.
Checklist for Baby:
NEWBORN BEHAVIOR- Immediately after the baby is born, he or she will usually experience a period of alertness for about an hour followed by a rest. The baby may nurse in that first alert period or upon waking from the first nap. Newborns will eventually settle into a cycle of alertness, nursing, and sleeping after some days, but initially they are still on womb time, which is OKAY. If your baby seems unusually lethargic, call your midwife or emergency care provider.
COLOR/WATCHING FOR JAUNDICE- Newborn babies are often a red color. They should definitely be pink. Jaundice refers to the yellow color some babies get in the first week. This occurs because the newborn liver is still immature and cannot process the old red blood cells fast enough. Jaundice is not usually harmful to baby unless it becomes severe. Your midwife will monitor any jaundice, however if you notice your baby is yellow, call your midwife to let her know. Pathological (associated with a problem) jaundice is present at birth or very soon after and needs to be addressed. Some parents just notice their baby’s eyes have a yellowish tinge to them. The baby is more likely to develop jaundice if there has been some bruising with the delivery, as this creates more red blood cells for the baby’s liver to process.
SIGNS OF RESPIRATORY DISTRESS- Newborns breathe on average 40-60 times per minute. Depending on activity level. Resting the rate goes down and with crying it goes up. Signs that the baby is having trouble breathing are: Rapid respiratory rate, chest retracts inward with breaths, blue color around nose and mouth, flaring of nostrils with breaths, and grunting with breaths. Call your midwife or emergency caregiver if you see any of these signs.
TEMPERATURE-The way to take a baby’s temperature is by placing the thermometer under the baby’s naked armpit. A digital one is best. Vicks brand makes one, which is quite fast and easy to use. The temp should be between 97.5 and 99.5 approx. Take is once or twice a day for the first four days. Remember that newborns sometimes have trouble regulating their temperatures. The best way to help them do this is to be skin to skin with them. Mom, dad, even siblings or grandparents can do this. Babies usually are comfortable wearing the same amount of layers as the people in the same room are comfortable wearing, plus one extra layer.
FEEDING- In the beginning, babies feed on an average of every two to three hours. However, it’s not unusual for mothers to report that their babies want to nurse every hour or can go for four hours in the night. It’s best to offer the breast as often as seems appropriate for your own baby and forget about the time. As your baby grows he or she will probably fall into a routine with nursing. Wearing baby, sleeping with baby, and keeping baby near will allow you to pick up on his or her cues and baby will not have to work so hard to tell you what his or her needs are. You will find what works for you. With regard to proper latch. You will want the baby to have his or her lips flared like a fish, with most of the areola or your breast (the dark part) in baby’s mouth. Breastfeeding should not hurt. Some women report that in the beginning, their nipples hurt for a minute when baby first latches on. Perhaps this is while the nipples are getting a bit desensitized.
CORD CARE-The umbilical cord stump will dry up and fall off. This can happen within a few days or couple weeks. Some care providers recommend washing the cord stump with alcohol. I don’t see that this is generally necessary. I recommend not using anything at all in most cases, or using an herbal powder made from goldenseal or oregon grape root which is made specifically to apply to the cord. When the cord stump does finally fall off, there may be a bit of blood or oozing plasma. Its normal and shouldn’t have a bad odor. In a few more days it will look like a normal baby belly button.
BATHING- Sponge bathing is fine until the cord stump falls off. If you do want to give the baby a bath in water, this is okay too but make sure to allow the cord stump to dry completely after bathing. The cord may take longer to fall off if it gets wet during the drying process. Use a mild baby soap and remember to keep the room warm as baby can loose heat easily. The best time for bath time is when baby is well rested and fed and in a good mood. Keep the bath short. Some parents report that getting into the bath with their babies is a wonderful way to bond.
POOPING & PEEING- Baby should pass meconium (first bowel movement) and urine within the first 24 hours after birth. At first, the baby probably won't urinate a lot at one time, since the colostrum that baby eats is thick and rich and there isn't a lot of volume. Over the next three days, the dark colored, sticky meconium will change to become the seedy, mustard-colored breastmilk poop, and you may notice that baby begins to urinate more often after your milk comes in, as the volume of fluids he or she is taking in is more than that of colostrum. The meconium is staining and messy and you may want to apply some olive or almond oil to baby’s bottom for easier clean up or use disposable diapers just until the poop changes if you plan to use cloth in the future.The amount of poopy and wet diapers varies from baby to baby, but a general rule is at least once in the first 24 hours, and then has one wet and one poopy diaper for each day of life (1 on day one, 2 on day two…). When the breastmilk comes in, expect an average of 3-4 poops and 5-6 wets every 24 hours. In my experience, I've seen a number of situations when after a couple weeks of life, a baby will go a few days without pooping, but not without urinating. This seems to be a variation of normal. However, if the baby is slow to gain weight or the poop hasn't become the yellow, breastmilk yet, consult your pediatrician or speak to your midwife.
WEIGHT GAIN- Most healthy babies can lose up to 10% of their birth weight and it's totally normal. Larger babies can lose more, but usually don't because larger babies are often better and more efficient nursers. Smaller babies sometimes can't afford to lose that much and the care provider may be concerned even before the baby loses much. The general rule is that by two weeks, the baby should have gained back his birth weight, but most of the time, a baby who appears to be eating well will gain his birth weight back within a few days of his mother's milk coming in. If the baby is slow to gain weight, nursing is difficult or painful, and the baby is unhappy, this is a problem and a qualified Lactation Consultant needs to see the mother and baby and rule out problems with the latch, possible tongue tie, or breastmilk supply issues. If problems persist, a visit to the pediatrician is in order.
As with everything else during your childbearing experience, you are encouraged to call your midwife with any questions, enjoy your family, and get acquainted with this wonderful new addition.