August 28th 2006 - POSTPARTUM INSTRUCTIONS
NORMAL POSTPARTUM – MOTHER
Bleeding (lochia) should be similar to a menstrual period at first, both in color and amount. Over the
next few days, it will change from bright red to brown, then over the next few weeks from pink to yellow
and finally to clear. If at any time you saturate two pads in one hour, CALL! Should you have
increased flow, massage your uterus until it is firm, and decrease your activity. Occasionally, clots are
passed in the first few days. If the flow is normal and the uterus firm, there is no cause for alarm
Uterus. In the first few days after birth, your uterus should feel like a grapefruit – at or below the level
of your navel. If it is soft, massage it until it firms up. If it is high and/or off to one side, your bladder may
need to be emptied. Women who have previously given birth may experience “after pains” or uterine
contractions, especially when the baby nurses. These usually do not last more than 2-3 days. You may
take 600-800 mg (3-4 tablets) of Ibuprofen (Advil) or 1000 mgs of Tylenol per day for relief.
Breasts. Your milk will come in 2-5 days after the baby is born. Your breasts may feel full, hard and
shiny. Engorgement is less likely to occur when the baby nurses frequently, 8-12 (or more) times in 24
hours. Nipples will be pinkish from nursing and some may experience breast enlargement following birth.
Urination may be normal, or there may be some difficulty accompanied by slight burning or stinging.
This will pass. Try squirting warm water from the peri-bottle over your pubis as your urinate to help
minimize stinging. If you are unable to empty your bladder at any time, call.
Bowel Movement. With or without stitches, normal bowel movements should return within a few days.
Plenty of fluids, fresh fruits, raw green salads, yogurt, bran, and prune juice will also help. Drink 8-10
glasses of water each day.
Infection. Wash your hands whenever you change your pad. Check your temperature a couple of
times during the first 24 hours. Thereafter, take it once a day for the next three days or any time you
feel like you are running a fever. Let us know if you have constant uterine pain, a foul-smelling
discharge, or any rise in temperature above 100°F. Occasionally, there is a temporary rise in your
temperature when your milk comes in (2-5) days after birth, but this should fall within 24 hours.
Perineum. If you have had stitches or a small tear, you may use ice at first to minimize swelling. After
12 hours, gauze pads soaked in witch hazel and applied directly to the perineum are soothing. Sitz
baths (sitting in a few inches of bath water) will help encourage healing. Herbal sitz baths may be
prepared by using 1cup comfrey, ½ cup chamomile, 1/4 cup yarrow, 1/4 cup lavender and 1/4 cup
rosemary (good for one sitz bath). Steep the mixture for twenty minutes (bring water to a boil, pour over
herbs, turn heat off, cover for twenty minutes). Then, strain and add the liquid to a few inches of water.
Soak in this for twenty minutes. Continue 100 Kegels each day.
Laceration – Peri-Care
After using the toilet, part your labia and squirt warm water from your peri bottle, forcefully and
liberally, into vagina toward the stitches.
Wipe from front to back after toilet use. After bowel movements, gently cleanse with soap/ water.
Take a couple of warm sitz baths per day, then dry well.
Use tucks between pad changes.
Self examine with mirror every day.
OTHER INSTRUCTIONS FOR PARENTS
Rest. For most women, giving birth is both physically and emotionally exhausting. Extra sleep is often
needed during the first few weeks. Sleep as much as you can during the night hours and catnap with
the baby during the day. Keeping the baby close by at night or tucking him/her into bed with you often
helps you get the extra sleep you need.
DO NOT TRY TO CATCH UP ON HOUSEWORK!
WHEN THE BABY SLEEPS, YOU SLEEP TOO!
Exercise. The first week following the baby’s birth should be a lazy week. Staying in your PJ’s reminds
you and everyone else that you should be resting frequently. As much as possible, have a loving friend
or relative help you with household chores while you rest and care for your baby.
Over activity prolongs your recuperation and will often cause more serious problems, like heavy
bleeding. Bright red bleeding is a danger signal! If this occurs, stay off your feet for 24 hours. Pamper
yourself for a good week before resuming light activity.
Nutrition. Good nutrition, which was emphasized during pregnancy, should be continued during
lactation. Follow your high protein pregnancy diet. If your baby appears fussy, you may want to cut
down your milk intake to a pint or less. If you cut down your milk, remember to take 1000 mg. Calcium
supplement. Plenty of fresh fruit, raw salads, and nutritious beverages should be stressed.
Remember that coffee, tea, and carbonated drinks (aside from being non-nutritious) can cause
fussiness in your baby. Some excellent, easy snacks include raw nuts and seeds, fruit, raw veggies,
cheese, yogurt, hard-boiled eggs, dried fruit, and high protein milkshakes.
CONTINUE TAKING PRENATAL VITAMINS OR A COMPREHENSIVE MULTIPLE
Sexual activity. Normal sexual activity may be resumed when it is comfortable for the mother. Women
who have torn will want to wait until they are healed or about 4 weeks postpartum. Breastfeeding
cannot be depended on as a form of contraception, so some method of family planning – such as foam
and condoms - should be used. Vaginal secretions at this time may be insufficient, so extra lubrication
may be necessary for the comfort of both partners. Some nursing mothers continue to need this
lubrication for intercourse throughout the breastfeeding period.
Other children. If there are other children at home, it is normal to experience a brief period of
jealously, misbehavior, and regression when the baby arrives. Mostly, this depends on the age of the
other children – so be patient. Involving them in the care of the infant (according to their capabilities)
and asking everyone to give them some extra attention may help. Small gifts from those who may plan
to bring the baby something special also means a lot to the older children. Remember, the new baby
doesn’t know he’s getting tons of gifts, but the older child is acutely aware of the gifts and attention the
infant gets. A great advantage of breast-feeding is that it gives you an extra arm to hug the other child.
If you are comfortable with tucking the baby into bed with you, it is sometimes fun for mom, baby and
older kids to snuggle up and nap together. Rivalries and jealousies soon disappear when the older
children realize that there is still plenty of love for them, and besides, they soon discover that a baby is
a neat thing to have around.
Respirations should not be labored, but may be irregular and very rapid. Normal rate is 20-60 breaths
per minute. It is normal for newborns to cough, sneeze, hiccup and sound snuffly for a few days. The
baby is trying out his respiratory system and is often getting rid of a little excess mucus. If the baby
sounds very juicy, use a bulb syringe. Depress the syringe and insert into the baby’s mouth, releasing
pressure as you withdraw the syringe. This will suck up extra secretions. Remember that babies are
mandatory nose breathers. If the baby is sucking well during nursing, he/she is probably having no
Color. Baby’s skin color will be pink, rosy, or slightly mottled pink. If your baby has blue or yellow skin,
please call me. Any blue in the trunk of the body or the face is abnormal, but blue in the hands or feet
is nothing to be alarmed about. Sometimes, a baby becomes yellow (jaundiced). Jaundice, is most
common between the 3rd and 7th day and usually goes away by itself. It is important to nurse your
baby frequently to move the bilirubin (which causes the yellowness) out of the body. Jaundiced babies
tend to be sleepy and it may be necessary to wake them up to nurse. Jaundiced babies can be placed
in sunlight for five minutes, three times a day – naked and with the eyes protected. This helps break
down the bilirubin. In a few babies, jaundice becomes extreme and requires treatment.
Skin. Many babies develop transient rashes on their face and diapers areas in particular. Try vitamin E
oil, A & D ointment or Desitin. If the rash is serious, call me. Milia, or tiny white heads, may appear on
the baby’s face, and are normal. These are clogged oil glands and will probably disappear without
problems. Babies will often have dry, flaky skin and peel, particularly on the hands and feet and
around the crease areas. Ordinary vegetable oil rubbed into the areas works well. Avoid using baby oil,
as it robs the skin of fat-soluble vitamins. Babies with long, jagged fingernails often scratch their faces
and bodies. Gently using an emory board to file the nails may help.
Head. Molding or elongation may persist for a while. This will disappear on its own, but placing a baby
on his side with a baby blanket rolled up against his back and against his tummy (to keep him from
rolling over) may help. Most babies will have rounder heads within 24 hours. The soft spot, or anterior
fontanel, need not be a concern unless it is bulging or sunken in. This area is very tough and may be
scrubbed during hair wash. Eyes may have small blood spots in the white area, due to pressure during
birth. This goes away within 10 days or so. Eyes may not focus well in the first week or two. Extra
discharge from the eyes may indicate a clogged tear duct. Massaging below the inner corner of the
affected eye with a clean finger may alleviate this problem. If you notice any yellowing in the baby’s
eyes (jaundice), please call me immediately.
Temperature. Your baby’s temperature will naturally vary throughout the day, typically rising during
periods of activity, hot weather, when overly dressed, or in a hot room. A temperature over 99.5°F
(axillary) or 100.4°F (rectally) in an infant under 3 months old is always a concern. When reporting
your baby’s temperature, be sure to tell the practitioner what method you used
Cord Care. The baby’s umbilical cord should be kept dry and clean. Use 4x4 gauze pads to clean the
cord. Avoid cotton balls, because wisps left behind may cause minor infection or irritation. Clean the
cord with water several times a day. Some mothers prefer to use alcohol around the base of the cord,
though this is no longer considered necessary. In addition to rinsing the cord with water, using herbs
twice a day on the cord speeds healing. Goldenseal powder can be sprinkled on the cord, or a
compress made of comfrey tea can be applied on the cord for five to ten minutes, twice a day. If the
cord stump area is red or if a profuse amount of discharge is noted, please call me. The cord clamp will
be removed within the first few days, during a home visit.. The cord should fall off in a week or so.
Diaper the baby below the cord stump. Be particularly careful of the plastic liner in disposable diapers,
which may stick to the cord. You may give the baby submersion tub baths if you remember to rinse
and dry the cord well after the bath.
Urination. Your baby should urinate within the first 24 hours. A sign that the baby is getting enough
nourishment is 5-6 voidings a day. If you cannot tell how often your baby urinates, put a single
thickness cloth diaper on the baby for the first few days.
Stools. The bowel movements for the first few days will be a greenish/black tarry substance
(meconium). On or about the third day, the baby will have a greenish transitional stool as the result of
colostrum feedings. On the fourth to fifth day, the baby will have a regular, loose, light colored stool
that is yellowish or greenish in color (like mustard). Mucus in the stool is normal for the first few weeks.
Your baby may have several bowel movements each day or one every few days. Remember, the stools
of breastfed babies will always be loose until solids are introduced around six months.
CARE OF THE GENITALS:
Females. The labia may be swollen due to the mother’s hormones. The clitoris of some baby girls will
be exposed for several weeks until the labia matures. Mucus discharge and a small among of vaginal
blood is normal for the first few days. The labia should be parted and gently wiped from front to back
during diaper changes. It is fairly common for fecal matter to be found in this area after bowel
movements. This should be carefully removed.
Males. The scrotum may be enlarged due to birth hormones.
Uncircumcised males: Wash the area well. There is no need to force the foreskin back, as this will
retract naturally as the child begins to handle himself.
Circumcised males: Small amounts of Vaseline should be applied to the head of the penis for the first
few days. Some parents prefer vitamin E. Nursing mothers may take a little extra vitamin C to speed
healing. Within 5-7 days, the plastibell should fall off.
Positions: The cradle hold, in which the baby’s head is held in the crook of the mother’s arm, is
considered the classic, though for most new mothers this position is neither the easiest nor the most
effective for getting the baby well latched on. A good position is the cross-over hold. For now, think
about using your right arm to hold your baby. Lie your baby across you, so that he is on his right side
and facing your left breast. But, instead of placing the baby’s head in the crook of the left arm, nestle
the baby’s bottom and legs under the crook of the right arm – bringing your right hand up around the
back of your baby and gently grasping the baby’s head. You now have a great deal of control over the
direction of your baby’s head. With this hold, your left hand will be free to hold your left breast.
Latching on: Support the breast with one hand, so that your thumb is about 1 ½ inches above the
nipple, at twelve o’clock, and your index finger is the same distance below the nipple, at six o’clock.
Compress your breast with your thumb and index finger so that your hand forms a C-shape. When you
do this, the areola will be more prominent, shaping it to more closely match the shape of your baby’s
mouth. Using the cross-over hold, align your baby so that he is lying on his side, facing you. Then, shift
your baby, so that his nose – not his mouth—is right in line in front of your nipple. In this position he is
more likely to latch on. Stimulate your baby to open his mouth wide, and quickly bring him up to the
breast. You can stimulate your baby by touching the baby’s upper lip to your nipple, and wait until he
opens his mouth wide. When his lower jaw has dropped, quickly bring his mouth to the nipple. His head
should be tipped back slightly, so that his chin reaches the breast first. Don’t lean into the baby. Keep
the areola compressed until he begins sucking. You may need to repeat this process several times
before the baby latches on correctly. Common mistakes include lining up the baby’s mouth rather than
the nose with the nipple, pulling the baby on before his mouth is open, not pulling him on quick enough,
or letting go of the breast before he is well latched on.
Burping: Some breastfed babies never need burping, while others only need it during the early
months. Try a little gentle patting on the back when you switch from one breast to the other or when he
is through nursing. If he falls asleep at the breast, don’t bother burping him…lay him down on his side
with rolled blankets in front and in back of him, for support.
HELPFUL BREASTFEEDING HINTS
Attend La Leche League meetings or call a La Leche League representative.
Try to nurse from each side at each feeding and alternate which breast you start with for each
Ignore the clock – do not limit the time. Feed on demand. Nurse your baby as often as he wants,
for as long as he wants.
There is no such thing as a baby nursing too often or too much.
Most nursing babies will nurse at least every 2-3 hours, if not more often. The baby is getting
plenty of nourishment if he is wetting 5-6 cloth diapers daily. The more you nurse, the more milk
there will be. Most babies enjoy middle of the night feedings. It is safe to tuck the baby into bed
with you, and then fall back to sleep.
No water, juice, solids, or supplements are necessary for the newborn. Breast milk is a perfect
and complete food. Daily use of bottles may cause sucking problems as well as intestinal
Nursing mothers should drink plenty of nutritious fluids. AVOID COFFEE, TEA, ALCOHOLIC
BEVERAGES AND CARBONATED BEVERAGES.
Continue your nutritious prenatal diet and vitamins.
Lots of love and cuddling coupled with frequent nursing increases your milk supply. You can also
try napping with the baby.
Press forearm or flat of hand firmly against the leaking breast.
Don’t’ squeeze out the milk – that just makes it worse.
Not enough milk:
Nurse the baby more often. Nurse longer, if possible.
Giving nothing by bottle.
Give no solids.
Take the baby to bed with you.
Drink plenty of fluids.
Drinking brewer’s yeast drinks or taking tablets, several times a day, will increase your milk.
Cuddle your baby a lot.
Make sure your baby is sucking properly. The areola should be well into the baby’s mouth.
Air and sun the nipples whenever possible.
No plastic liners in bra.
Apply vitamin E oil to the nipples. Take extra vitamin E and C orally.
Nurse the baby more frequently. A less hungry baby is a gentler nurser.
Relax as much as possible.
If soreness persists, apply ice or sit under a heat lamp or a regular lamp for a few minutes, a few
times a day. Direct sunlight is also very good, if possible.
If your breasts become sore, red, warm, hard, and/or you have a fever – apply direct heat (hot
water bottle, heating pad), get into bed taking the baby with you, continue nursing – even on the
sore side, and drink lots of fluids, and call us!
REMEMBER – CONTINUE TO NURSE ON BOTH BREASTS!!
If you have any other difficulties, call: 770-704-7035 or 352-222-1302
Birth in the Tradition/ Mother's Keeper
Atlanta, GA 30349