Where Families Are Born
We dedicate this book in loving memory of
Mary L. Dickson and Linda Brenneis for their years of caring
and educating new families at Lourdes; and to all those who dedicate
their lives to the nurturing of healthy and happy babies.
Caring for Mom
Perineal Care • After Vaginal Birth • Cesarean Birth/Incision Care • Vaginal Bleeding
Your Uterus • Afterbirth Pains • Kegel Exercise • Sitz Bath • Urination • Your Bowels Rest • Breast Care • Emotional Changes • Post Partum Depression • Breast Self Exam Nutrition • When to Call Your Doctor/Midwife Caring for Baby
Physical Appearance • Reflexes • Urination • Stooling • Cord Care • Diapering Suctioning with a Bulb Syringe • Positioning • Handling • Bathing • Temperature Taking Environment • Dressing • Circumcision • MRSA • When to Call the Baby’s Doctor Fathers and Grandparents
Getting Started • Latching On • Common Positions • Burping • Common Challenges Breast Fullness/Engorgement • Mastitis • Working and Breastfeeding • Hand Expression Breast Pumps • Storing Breast Milk • Breastfeeding Log Formula Feeding
Formula Preparation • Getting Started • Types of Formula • Formula Heating When to Feed • Positioning • Common Questions • Burping • Spitting Common Concerns about Baby
Breathing • Cradle Cap • Hiccups • Colic • Activity • Crying Shaken Baby Syndrome • Newborn Pulse Oximetry Screening For Critical Congenital Heart Disease (CCHD)• Jaundice • Near-Term Infants Safety
Burns • Sunburns • Fire • Falls • Choking • Smoking • Safe Sleeping SIDS: Parents/Caregivers • Shaken Baby Syndrome • Car Seats Vaccinations
Local Resources • Support Groups • Internet Resources • Family Resource Centers Discharge Instructions Glossary of Terms
Parent's Bill of Rights
All health and health-related information contained within this book is intended to be general in nature and an information resource only. It should not be used as a substitute for a visit with a health care professional and is not to be used or relied on for any diagnostic or treatment purposes. The advice is intended to offer a general guide for new parents. Your health care provider should i be consulted regarding matters concerning the medical condition, treatment and needs of you and your family. Inclusion of product information does not imply endorsement of those products.
Caring for Mom Perineal Care After you have a baby, your perineum (the area surrounding your vagina) may be sore due to an episiotomy, tears, or hemorrhoids. Correct perineal care will keep this area clean and help you feel more comfortable and heal faster.
To keep the area clean after urinating, spray warm water onto the area with your peribottle from front to back. Then pat dry with toilet paper from front to back. Clean yourself this way for as long as you have any vaginal discharge. Change your maxipad after using the bathroom or whenever needed.
Any stitches will be absorbed in about two weeks. Your doctor/midwife does not need to take them out.
After Vaginal Birth Ice packs are used during the first 24 hours after birth to reduce swelling and pain.
After 12-24 hours, a sitz bath is recommended for 15 minutes, 3-4 times a day. (See Sitz Bath Instructions.) You can use a portable sitz bath (which may be ordered by your doctor or midwife before you leave the hospital) or sit in a clean tub filled with 4-6 inches of clean, warm water. You also can use an analgesic/antiseptic spray such as Dermoplast. You can buy this at any pharmacy without a prescription. Spray this onto your perineum after you have cleaned it. The ingredients in the spray bother some women. If you feel any burning after using the spray, stop using it. Tucks pads are used for hemorrhoids and stitches. After cleaning your perineum and using the Dermoplast spray, put one Tucks pad on the stitched area and leave it there until you visit the bathroom again.
To ease hemorrhoid pain, place a Tucks pad on your rectal area. When you return home from the hospital, try keeping your Tucks pads in the refrigerator. A cold pad gives you more comfort. You can also use ProctoCream HC to reduce hemorrhoid pain. Use as directed on the package.
After Cesarean Birth/Incision Care If you have a cesarean birth, follow the guidelines above for perineal care. This will help you prevent infection to your uterus. Once your bandage has been removed and you can shower, gently wash your incision every day using non-perfumed soap. Be sure to dry the incision completely by gently patting with a clean towel. Most doctors use stitches that dissolve in about two weeks. If your stitches need to be taken out, or if you have staples, your doctor will take these out before you leave the hospital.
If steri-strips were used on your incision, let them fall off on their own. They peel off easily and may start to come off in the shower. They usually fall off completely within a week.
Vaginal Bleeding Vaginal bleeding (called lochia) begins after the birth of your baby. It continues until the placental site in your uterus heals. The bleeding varies among women and gradually decreases over 2-4 weeks. At first, bleeding is dark red, looks like menstrual bleeding, and lasts 2-3 days. Your flow should be moderate, using 4-8 maxi-pads a day. If you are doing too much, your bleeding might increase. If this happens, reduce your activity and see if the bleeding decreases. Soaking one pad an hour is excessive.
You should call your doctor/midwife if this happens. Passing a few clots is normal as long as they are smaller than a walnut and dark in color. The bleeding will gradually become a pinkish color that will last about 10 days. For 1-2 more weeks, until healing is complete, you may notice a little creamy or whitish discharge.
Like menstrual bleeding, lochia has a musty, stale odor that is not unpleasant. A foul odor can mean you have an infection, especially if you also have a fever. If this happens, call your doctor/midwife.
During this time you can use maxi-pads or pads, not tampons.
Your Uterus Once the placenta is delivered, your uterus will contract, or close up, and become the size of a large grapefruit. Your fundus (the upper ridge of your uterus), should feel round and firm. This firmness or tightening controls bleeding and prevents hemorrhage.
Your nurse will check this frequently during your hospital stay and can help you check it, too. It is usually located at or below your bellybutton. It will decrease by about one finger-width every day until, at two weeks postpartum, you cannot feel it through your abdomen.
If your fundus feels soft, massage it for a few moments until it gets firm. Breastfeeding can also help keep the uterus contracted. This is because oxytocin, a hormone that triggers period-like cramps and milk discharge, is released into your body as your baby breastfeeds. Some women feel afterbirth pains due to these cramps which are normal and healthy during the early days of breastfeeding.
Afterbirth Pains Afterbirth pains are caused by sporadic contractions of your uterus. They feel like menstrual cramps and usually last for 2-3 days after birth. If you have been pregnant before, you are more likely to feel afterbirth pains. If you breastfeed, you may feel these pains when your baby suckles. This is due to the release of oxytocin into your system, which causes your uterus to contract. To help with the pain, you may take a mild analgesic (acetaminophen or ibuprofen) 30 minutes before breastfeeding or at bedtime if the pains make it hard for you to sleep. Placing a warm pack on your abdomen may also reduce the pain.
Kegel Exercise We suggest you do “Kegel” exercises several times a day to encourage healing and tightening of your perineal muscles. When doing the Kegel exercise you are tightening the muscles of your pelvic floor. In a sitting position, lean forward to make it easier to tighten the muscles that surround the vagina. Hold these muscles tight, as if you are trying not to urinate. Hold for a slow count of five and then release. Repeat this several times a day.
Urination Drink 6-8 glasses of liquid a day to help keep your urinary tract healthy. Try to urinate every 2-4 hours. Do your pericare after each visit to the bathroom. Contact your doctor/
• you feel any burning or pain when urinating
• you are urinating more than usual
• you feel like you cannot completely empty your bladder
• you urinate only a few tablespoons at a time Your Bowels It is common for your bowels to move slowly after the birth. This may happen because your hormone levels have dropped, there is less muscle tone in your intestines, and there is less pressure in your abdomen. Pain from an episiotomy, tears, or hemorrhoids and the fear of tearing stitches may make you not want to have a bowel movement. By doing this, you will make your constipation worse and have more pain when you finally go to the bathroom.
Prevent constipation by:
• drinking 6-8 glasses of fluid each day
• eating fiber-rich foods like fresh fruits, vegetables and whole grains
• increasing your activity.
If you become constipated and are uncomfortable, you may take an over-the-counter stool softener as directed by your doctor or midwife. A stool softener will increase the bulk and moisture in your stools.
Once you are home and comfortable in your own bathroom, having a bowel movement should be easier. If you have not had a bowel movement within 4 days, contact your doctor or midwife.
Rest You should rest while your baby sleeps. Do not use this time to do household chores.
Getting enough rest will make it easier for you to adjust to all the changes your new baby will bring. If you are well rested, all the unknown and unexpected issues that come up will be easier for you to handle.
Your doctor/midwife will give you directions about driving and other activities before you leave the hospital. Avoid heavy lifting and exercise until your doctor/midwife approves it. If your legs or ankles swell (called edema), you may be spending too much time on your feet. To reduce the swelling, elevate your legs. You can prop them on a pillow while lying down or prop them on a foot stool while sitting.
If your friends or family offer to help, let them. It is a good idea to give them specific jobs like fixing dinner, running errands, doing laundry, etc.
Breast Care for the Non-Nursing Mother If you are not breastfeeding your baby, your breasts will still fill with milk. To reverse the process, wear a light bra or sports bra, day and night, as long as necessary for comfort. Try not to stimulate your breasts. When you shower, be sure to keep your back to the water spray since the stream of warm water will cause stimulation.
When your breasts fill with milk (called engorgement), place an ice pack or bag of frozen peas or corn on your breasts. This will reduce the pressure and make you more comfortable. When the milk is absorbed into your body after a day or two, the discomfort will go away. If you want, you can take acetaminophen or ibuprofen as directed on the package to relieve some of the discomfort.
Emotional Changes The birth of a baby radically changes your life and your responsibilities. It is a time of physical and emotional stress. You will probably feel overworked, overtired, and overwhelmed.
Postpartum blues is a temporary period of mild depression that affects 50 percent of new mothers. The blues usually begin on the third or fourth day after the birth.
During this time you may have mood swings, feel like crying, have trouble sleeping, or feel let down. Many mothers feel guilty having these feelings because they think they should be thrilled about caring for their new baby. These feelings are normal. It may help you to have a good cry. Don’t be afraid to talk about these feelings with a supportive person (spouse, significant other, family member, etc.).
During the first few weeks after birth, a few new moms (about 15%) experience postpartum depression. Signs include mood swings, lethargy, feelings of inadequacy, and anxiety. For most women, this depression is temporary, resolving within six months. However, for some mothers a more lasting type of depression occurs. These women may have more severe depression that interferes with their ability to function.
Lack of sleep, caring for the new baby, medical complications of childbirth, and other pressures associated with a new baby can worsen the depression. It should be discussed with a doctor/midwife if it interferes with daily activity or lasts more than a few weeks. Hormonal changes are thought to be the major cause of postpartum blues although lack of sleep and discomfort also play a part. The exact cause is not known but there are many things you can do to help yourself feel better.
Here are some ideas to help you manage postpartum depression or blues:
• Admit your feelings and talk about them with someone close to you.
• Cry if you feel like it.
• Get help with chores.
• Get out of the house and spend time with other people. Do not cut yourself off from others.
Take care of yourself by getting enough rest. If friends or family offer help, take it. Try to give them specific jobs to do so you can devote your energies to yourself.
You should feel better when your hormonal levels go back to normal. This happens at about the same time you begin to develop routines and get a sense of control over your life. Please call your doctor or midwife if you still do not feel like yourself after 2-3 weeks. Call them immediately if you have any feelings of harming yourself or your baby.
Fathers can also suffer from baby blues. Although it is usually a much milder condition, it is important for them to talk about their feelings also.