Postpartum Care in the Early Days at Home: Advice from a Mother Baby Nurse of 20 Years
Questions are unending when you are preparing for a child. To help bring guidance to our mothers, Milkful presents a three part series with Kyle Pfahl, a Mother Baby RN, who has over 20 years of experience in delivering babies and caring for mothers.
Kyle took over Nourisher's Facebook page to answer any and all questions our Nourisher moms might have on the following topics.
Part III: Postpartum Care in The Early Days at Home
Read what our mothers asked during Part III and see Kyle’s responses below.
Preparing for Postpartum Care
Molly: I have all the baby gear ready, but what supplies can I have ready at home for my own comfort/recovery?
Kyle: Yes, babies do seem to require a lot of different supplies. I am sure your living room looks like a baby's R us. But there are a few things you will need for your physical comfort as well. As for your breast, I would have lanolin for your nipples as well as breast pads to prevent leaking on your clothes. If you had a vaginal delivery you will likely have had an episiotomy or tearing, the stitches will heal on their own. As a matter of fact, you may see small stitches appear on your peri pad as you are healing and the stitches are dissolving so don't be alarmed. Your perineum may be very tender, in the first few days it may help to sit on a soft pillow, there is also some topical medication you can use such a dibucaine, or tucks. These are over the counter and they offer some temporary relief. A sitz bath is also another way to soothe your very tender bottom. It is a plastic insert that goes inside your toilet, it has a bag you fill with warm water that will allow you to soak in while flushing with clean warm water.
If you had a c/s you will want to be sure that your incision area stays dry and together. There is no special treatment for the incision area. Do not use any creams or lotion until after your doctor has confirmed it is totally healed.
You may also experience some cramping for a few days. This is really a good thing, it is your uterus slowly contracting and moving down into your pelvis. This process takes 6 weeks but it starts right away. You should talk with your doctor prior to leaving the hospital about taking any pain medicine whether over the counter or prescribed. One additional tip - often mothers find themselves constipated after giving birth. I would recommend in having a mild natural laxative, like senekot, at home.
A little routine I tell my new mothers is before you sit to breast feed your baby, you should take care of you - empty your bladder, change your peri pads and get a nice big glass of water. That way you can relax a little and nurse your baby without hopefully needing to get up (and may get to just snuggle after).
Feeding a Sleepy Newborn
Aimee: Do I have to wake my baby to feed him?
Kyle: We all have heard the saying, “never wake a sleeping baby.” Unfortunately, they were not referring to breastfeeding newborns. Your newborn needs to eat very frequently approximately every 2 – 3 hours. You have probably heard that some babies may sleep for long periods of time. However, this does not mean that they are full and satisfied. Newborns that are allowed to sleep for long periods of time are at risk for having low blood sugar, and a symptom of having low blood sugar is sleepiness, so it becomes a cycle. Often newborns who are allowed to sleep for long periods have parents brag about how much sleep they get, but these newborns are at risk for having failure to thrive or be below the average weight gain. To breastfeed successfully and have an adequate supply frequent nursing is necessary for both you and baby. Remember breast milk does digest approximately every 3 hours making these frequent feedings necessary.
A healthy 2 week old baby will typically let you know when they are hungry, usually 2-3 hours. There will come a time when your baby has regained his birthweight, your milk supply is adequate, that your pediatrician will allow your baby to sleep thru 1 feed in a 24 hour period. As an example, you may put your baby down at 9 PM feed and let your baby sleep longer than 3 hours and possibly skip the 12 AM feed and not wake the baby until 3 AM. However if your newborn wakes at 1 AM then you should always feed. Remember during this time the days and nights might seem long but the years are short. The bottom line is you are giving your baby the healthiest, best start you can by breast feeding.
Boosting Milk Supply Early On
Megan: I am going to try and build up a freezer supply for my son soon after he is born. What is the best way to boost my supply so I can start this process early on? Is there anything wrong with trying to do this soon after delivery?
Kyle: I understand why you are anxious to build up a good supply of breast milk, but it really isn’t recommended to start pumping until you have completely established an adequate supply. This is normally around 3 weeks. It is difficult in the early weeks to find the time to pump, you are just getting familiar with your babies feeding cues and we don’t want to disrupt your supply and demand. A few tips for increasing your milk supply are to be sure that you are drinking enough fluids, breast feed every 2.5-3 hours for at least 15-20 min, or until your baby falls asleep and falls off your breast. Milkful Nursing Bars are a wonderful healthy and nutritious way to increase your milk supply. I would recommend you have at least 1-2 bars starting as soon as your baby is born.
Establishing the Newborn Routine
Sheryl: When will a newborn start to settle into more of a routine? Is there a window of time (2-6 weeks old) where you should start establishing a standard nap time, bed time and feeding time?
Kyle: As much as you would like your newborn to be on a sleep schedule it is really not practical until after 6 weeks. At 6 weeks your baby will start to develop his natural circadian rhythm. This is what regulates his sleep-wake cycle. Once your baby is about 2 weeks old you can start helping him adjust to day vs night. This can be done by interacting with your baby as much as you can, talk and sing to him as you go about your day. Keep the lights on or curtains open, so your rooms remain bright. Be sure to keep your normal noises going like dishwasher, washing machine, radio, while your baby is awake. On the flip side at night keep the room dark, try not to talk with him while you are feeding. And it can help to keep the noises low. All this will hopefully help your baby realize that night time is for sleeping.
It is best if you establish a bed time routine and stick with it. Some mothers will nurse their babies to sleep while others will put your baby down awake to fall asleep on their own. What every your strategy is be consistent.
Back to getting a newborn on a routine, in the first few weeks it is more stressful to try to keep your baby on a routine than it is to let them feed and sleep on demand. The only type of routine I would try to implement at this early age is feed, play, sleep. All the while knowing that you should ALWAYS feed your newborn when they are showing you hunger cues and what works one day will not always work the next. These first few weeks are about listening to your baby and what they need, at this age a schedule can hinder the natural relationship and feeding cues that will develop. Give your baby and yourself time.
Introducing Your Newborn to Other Siblings and Pets
Molly: Any tips for introducing baby to other little family members (siblings, pets) and making that a smooth transition for them?
Kyle: Bringing home a new baby, brings many changes for the family. It takes a lot of time and preparation to get ready for a baby. Once the baby is brought home much of the parent’s attention and energy is focused on the new addition.
All of these changes are hard for the older sibling and it is normal for them to feel some jealousy. This jealousy may result in acting out. However, there are a few things you can do to prepare and make the transition a little smoother.
Once you bring the baby home it helps if you can include the older sibling as much as possible, so they don’t feel left out. Give them “special jobs” I know it can be frustrating for parents because each task may take longer with your little “helpers,” but they need a chance to bond and develop a relationship with the new baby. You should also ask their advice, for example should we put the baby in the blue outfit or pink? If your older child show no interest in helping out, don’t push it, they will come around.
Be sure to take some one on one time with the older child. Spend special time while the baby is napping or someone else is watching him, so you can give the older child your undivided attention. If the older sibling knows that there will be some special time with just you later on in the day it helps ease resentment or anger about the new baby.
It can also help to remind visitors and other family members to pay attention to the older sibling and possibly take them to do something special. Don’t feel guilty about keeping your regular routine like sending your older child to day care or school. Their normal routine is helpful for them.
Encourage your older child to talk about their feelings, they can sometimes regress like talking baby talk or wetting pants. This will pass, they are just looking for more attention. Remember to maintain your rules and discipline, it is important to recognize why your child is acting out, but they need to understand it isn't always appropriate.
As for your dog, rule number 1 – Never leave your dog alone with the new baby. No matter how obedient your dog is, they get jealous too and you never know how they may react. It is recommended that you walk into the house not holding the baby to first say hello to your dog. Prior to that, try to take a blanket or clothing of the babies from the hospital to introduce your dog smell to the babies. Once at home keep your dog on a leash when he first smells your baby. I would do this several times before you allow him to be off the lease near the baby. Obedient training is very important because you need your dog to obey your commands. Your dog also needs a safe place to go to like a bed or cage when told to. Most dogs are very eager to please and will love your new addition but there are dogs that never adjust. It is your job as a parent to provide a safe environment for your child.
Handling the First 24 Hours at Home
Jenny: Do you have any general tips for the first day and first night at home with a newborn?
Kyle: The first night at home with the baby can be stressful. First thing is to relax, you have been preparing for this moment for 9 months. Try to be released from the hospital early in the day so you have plenty of time to fix things up the way you really need them and not the way you thought before you had him. Also try to time your discharge right after a feeding time so you don’t have to rush home with a screaming hungry baby.
For example, his room is beautifully decorated, and you can’t wait to get him in there but, you really need a safe place for him to sleep near you. A bassinet or pack n play in your room might be a great solution for the first few months. You also need to set up a changing area with diapers, wipes, extra clothes etc wherever you are going to be stationed during the day. This is so you don’t have go up and down the stairs in the first few weeks if you are going to be on your first floor or in the family room.
Also keep extra visitors to a minimum, babies can sense the stress and when they get passed around they get sensory overload. Remember that while you are up at night with your fussy baby, your visitors are at home sleeping in their beds. For your care you should have your bathroom set up with the supplies you will need like peri pads, medication and peri bottle to rinse your perineum after you use the bathroom.
Also, it is nice to have someone there who can help you and your partner for a night or two. This allows your partner to be with you and help you with caring for the baby and bonding with the baby. Your helper can be the one to take care of the meals, cleaning, etc. Often times the husbands feel left out if they are busy with chores and don’t get a chance to cuddle. Most importantly you need to rest when the baby sleeps no matter if it is day or night.
Healing After Birth
Molly: How will I know if I’m healing properly? What are some warning signs to look out for with regard to my recovery?
Kyle: Typically, your stitches from an episiotomy or tearing will heal nicely on their own. There is no need to put anything on them to help with healing, only for discomfort. If you notice bright red bleeding or extreme tenderness in your perineum you should call your doctor. If you have increase in vaginal bleeding with bright red blood (saturating a pad an hour) and clots, you should notify your doctor right away as it may be sign of a post-partum hemorrhage. Also, any fever or chills is not normal and should be reported to your doctor.
If you had a c-section, you will want to monitor your incision to be sure that it stays nice and closed and there is no drainage. If there is you will want to report that to your dr. If you had any problems with your blood pressure while you were pregnant it is important to continue to monitor. Any elevation should be reported to your doctor along with headache, epigastric pain or increase in fluid retention. Even though by 6 weeks you are probably feeling pretty good, besides tired, it is important that you go to your post-partum check up with your physician. This visit is when you will be cleared for physical activity, sex and a good time to discuss birth control.
Maggie: How long will my bleeding last after a natural delivery?
Kyle: Maggie after not having any bleeding for 9 months, any bleeding seems like a lot. For the first few days after delivery your bleeding will be bright red and heavy. If you have been lying in bed for awhile you may feel a gush with a few small clots.This is normal as the blood has pooled while you were laying down. After a day or two it will become more scant, watery and pinkish. The discharge, or lochia as it is referred to, is white or yellowish white after about 10 days. This may continue for another 2-4 weeks. If after you leave the hospital you notice bright red bleeding saturating a pad an hour you should notify your doctor immediately. If you have bright red spotting it is a signal that you may have done too much. Be sure to rest and not over exert yourself. If the bleeding continues longer than a few days you should notify your doctor.
In the hospital you will be given large thick peri pads which will help absorb the large amount of blood. Once at home you can use thinner pads or panty liners that are more comfortable. It is not recommended to use tampon until after your six week check up with your OB.
There are a few condition in which you would notify your doctor:
- You have bright red bleeding that continues longer than four days after delivery
- Your discharge has a foul odor
- You develop a fever or chills
- Heavy red bleeding saturating a pad an hour
- Having golf ball size clots.
Do not be too alarmed by the amount of blood, your body increases its blood supply up to 50% during your pregnancy, so that it can handle the normal amount of blood loss during delivery and post-partum.
Pumping Before Returning to Work
Carty: How many times per day do I need to pump when I go back to work for an 8 hour day away from baby?
Kyle: It is possible to continue to breast feed successfully while working. It may take some additional planning but it will be worth it to give your baby the best nutritional start you can. How often you need to pump depends on a few different things. Most importantly how old is your baby? If you baby is 6 weeks and nursing every 2-3 hrs than you will need to pump every 3 hrs. If your child is 6 months and nursing every 3-4 hours and eating solids than you only need to pump every 4 hrs. A double pump works best when you are short on time, but regardless you should pump each breast around 15 minutes. An optimal schedule would be one where you nurse your baby before you leave for work then (depending on age) pump mid morning, late lunchtime, and then again in mid afternoon and nurse as soon as you can once you are reunited. Babies of working mothers often will nurse more frequently at night, this will help if you have trouble pumping during the day. If you are returning back to work it is beneficial if you can begin to stockpile a supply of frozen breast milk. You can pump your breast about 30-60 min after you have nursed or at least 1 hour before you need to breast feed again.
It is important that you are relaxed when you pump. Breast massage may also help with letdown, as can looking at pictures of your baby; this can make the sessions more successful. Be sure that you are keeping up your calorie and liquid intake while at work, water is especially important. I know you can be easily distracted but you don't want it to affect your milk supply. I would recommend having a Milkful Nursing Bar or 2 during the day to assist in your milk supply and daily nutrition.
Starting Solids vs. Exclusive Breastfeeding
Kathy: How long is it recommended to breastfeed exclusively? I see many mixed recommendations around starting solids at 4 months versus 6 months.
Kyle: Officially the AAP (Academy of Pediatrics) recommends that breastfeeding be the sole source of nutrition for your baby for about 6 months. Which means that breast milk has all the nutrients that your baby needs. Some babies seem very interested in food long before they are 6 months, some around 4 months. It is okay to begin feeding solids in small amounts if your baby is ready and you discussed it with your pediatrician. Personally, between my five grandchildren I have had four who were not interested until past 6 months and only one that showed any interest before then. A great sign to look for is if your baby is watching you eat and moving their mouth along. Even when starting feeding it is important to remember that breastfeeding should come first for the first 12 months. After 6 months you can begin introducing foods (avocados are great first foods) but until the baby is 12 months old breast milk should make up 75% of the baby's calories. Food can be fun for you and the baby and can make for some great pictures.
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