Congratulations on the birth of your baby

Mother Care

Congratulations on the birth of your baby and welcome to parenthood. Parenting is one of life’s most thrilling and most challenging experiences but it is a job, one for which most people receive very little education and training. The information in this booklet was researched and written by the health care professionals at Woman’s Hospital to help you begin to find some answers to the many challenges new parents face. This section of our booklet focuses on care of the mother. Certainly one publication cannot contain all of the information you will need to make the adjustment to parenthood, but gaining experience and knowledge will help lessen the stresses of parenting and will help you appreciate your abilities so you may enjoy this period of your life.

Physical Adjustments

Rest and Activities

All new moms need rest. Not only are the labor and delivery of a baby exhausting, adjusting to parenthood also takes hard work. Caring for a newborn 24 hours a day is both emotionally and physically demanding. You need to rest a lot and let others help you. You should try to sleep when the baby sleeps. It takes at least 2 weeks to recover after delivering a baby vaginally. It will take longer if you have had a cesarean section. Let your family and friends help with cooking, doing laundry, and housework. Climb stairs carefully. Do not lift anything heavier than your baby. You may ride in a car in 1 to 2 weeks and drive a car in 2 to 3 weeks.

The Uterus

During the first 6 weeks after your baby is born, the uterus will become smaller. As the uterus becomes smaller, “afterpains,” or uterine contractions, usually occur. These pains feel stronger during breastfeeding and in women who have had other children. The afterpains usually last 2 or 3 days. Relaxing and breathing slowly can help ease the pain.

Vaginal Flow

After the birth of your baby, you will have a discharge from your vagina. This discharge is called “lochia.” It is heavy and bright red for about 3 days. Over the next 10 to 12 days, the color changes from red to pink to brown and finally to yellow or off-white. The amount of discharge will decrease over the next 2 to 6 weeks. If the lochia becomes bright red again or the amount increases, call your doctor. Usually, the first period after your baby’s birth will have a heavier flow and last longer than usual. Menstrual periods may not be regular for several months.

Episiotomy Care

The area around your vagina may have torn or the doctor may have placed a small cut to help the baby fit through the birth canal during delivery. This tear or cut is called an episiotomy. Your doctor may have placed stitches on the cut or tear to help it close and heal. It is important to keep the area around the episiotomy clean so it does not get infected. Use the plastic “peri” bottle that the hospital gave you to rinse your bottom with clear, warm water after you urinate or have a bowel movement. Change your pads each time you use the bathroom.

Warm tub baths help to decrease pain, clean, and repair the area around the episiotomy. Fill a clean tub with warm water, and sit on a clean towel in the tub for 15 to 20 minutes. Do this 2 or 3 times a day. Hot or cold compresses, which put light pressure on the area, and sprays or ointments prescribed by your doctor can also relieve pain.

If you have stitches in your bottom, they will go away on their own. They do not need to be removed. Your bottom will heal in about 4 weeks. You may have pain for a longer period of time. To help relieve pain when sitting, sit on a soft pillow or an inflated rubber ring.

Urination

The bladder may be weak after birth. Attempt to urinate every 3 to 4 hours. Kegel exercises will help your bladder control become stronger. Until you no longer have a vaginal discharge or flow, use your plastic “peri” bottle to rinse your bottom after urinating. Always wipe your bottom from the front to the back to prevent spreading bacteria from your rectum to your vagina.

You should drink enough fluid to satisfy your thirst. Try to avoid soft drinks and beverages that contain caffeine. Call your doctor if you have any problems urinating. These problems may include pain or burning when you urinate, needing to urinate more often than usual, urinating in small amounts, or having urine that looks cloudy or smells bad.

Bowel Movements

You should have a bowel movement, or stool, within 2 or 3 days after your baby is born. Your doctor may tell you to take a “stool softener” to help stool move through the body more easily. Avoid straining while going to the bathroom. As long as you have a vaginal flow, use your plastic “peri” bottle to rinse your bottom after bowel movements.

After birth, many women have trouble or cannot have a bowel movement. This is called constipation. To prevent constipation, exercise daily and eat right. Your daily diet should include 6 to 8 glasses of fluids, fresh vegetables, fruits, and wholegrain breads and cereals.

Hemorrhoid Relief

To stop hemorrhoids from getting worse, drink a lot of fluid, eat foods that are high in fiber, and exercise every day. This will also help you avoid becoming constipated. To relieve hemorrhoids that are sore or swollen, sit in a warm bath for 15 to 20 minutes. Do this 2 to 3 times a day. The doctor may also prescribe ointments or sprays to help relieve hemorrhoids.

Medications

If you have any questions about your medicine, call your doctor. Discuss all medications with your doctor before you take them. This includes any medicine that has been prescribed by any doctor and medicine you buy off the shelf from the store. Don’t forget to mention your birth control pills. Your doctor also needs to know if you take any diet or nutrition “supplements,” herbs, vitamins, or alternative or complementary medicine. This is especially important if you are breastfeeding. Keep taking your prenatal vitamins until your doctor tells you to stop.

When you are prescribed medicine:

• Always ask the pharmacist, “Is this the medicine my doctor prescribed?” when you pick up your medicine. This will help prevent you from receiving the wrong medicine.
• If you have any questions about the directions on your medicine label, ask the pharmacist or your doctor. Breasts

The breasts generally get bigger or swell soon after birth. This occurs as your body prepares to breastfeed. Wear a good support bra during this time. Some mothers have discomfort as milk “comes in,” or begins to be produced. If this occurs and you are not breastfeeding, do not stimulate your breasts and do not squeeze any milk out. This will cause your breasts to continue to produce milk. Wearing a well-fitting support bra, such as a sports bra, 24 hours a day for about 2 weeks and placing ice packs on breasts and under arms will help stop the milk from being produced and reduce pain. Apply ice packs for 15 to 20 minutes at a time, several times per day. Wrapping each ice pack with a wash cloth will help reduce discomfort. Pain relievers that can be bought over the counter without a prescription may also relieve discomfort. Contact your doctor if pain still occurs after trying these suggestions.

If you are breastfeeding, please refer to the “Breastfeeding Guide” provided by Woman’s Hospital or contact our lactation department at 924-8239.

Sexual Relations

Many doctors recommend that you not have sexual intercourse until after your checkup in 4 to 6 weeks. You may have pain during sexual intercourse for several weeks. **Remember: you can become pregnant anytime after the birth of your baby, even if your menstrual periods have not returned and whether or not you are breastfeeding. You may wish to talk about birth control with your doctor before you begin sexual activity again.

Postpartum Checkup

Your doctor will want to see you for a postpartum checkup within 6 weeks. Call your doctor’s office after you get home to make an appointment.

Helpful Hints After Cesarean Birth

If you gave birth to your baby by cesarean delivery, you will need to recover from both childbirth and surgery. You will need to add at least 1 to 2 more weeks to your recovery time before resuming your normal activities.

Getting Out of Bed and Moving Around

Raise the head of the bed, if possible, before getting out of bed.

Roll onto your side.

Lower your legs over the side of the bed. Breathe normally.

Push to a sitting position with your arms.

Support the incision with your hand or a pillow as you move or cough.

Sit on the side of the bed for a few minutes before you try to stand.

Stand up slowly. Try to stand as tall as you can.

Keeping Your Lungs Clear

It is important to cough and to take deep breaths after surgery to help your lungs. However, coughing can cause your incision to hurt. To lessen discomfort, place a pillow over your belly and lean forward when coughing.

Take deep breaths often throughout the day.

Gas Pain

Gas pain is common after any type of abdominal surgery. You can help to move the gas along and lessen the pain.

1. Walk inside and outside of your room as soon as you are able. Increase the distance you walk gradually each time you walk. The hospital staff will help you as long as you need help.
2. Positions
   • Lie on your left side with your legs bent and a pillow between your knees. A small towel rolled under your stomach may help prevent a pulling sensation on your stitches.
   • Lie on your stomach, on a pillow, 20 to 30 minutes at a time, if able.
3. Eating
   • Drink warm liquids to keep your bowels active.
   • Avoid drinking very cold liquids.
   • Do not use a straw.
   • Avoid carbonated drinks (soda) and gas-producing foods (beans, cabbage, and melon).
   • Drink and eat slowly.

If these techniques do not help, you may want to ask your doctor to approve a physical therapy consultation. The physical therapists at Woman’s Hospital can instruct you on abdominal massage and exercises.

Abdominal Incision Care (Cesarean or Tubal Ligation)

An incision is the cut the surgeon makes when delivering your baby by cesarean or when doing surgery. Your incision may be closed with staples or with stitches. You may have steri-strips placed across the line where the incision was made. The strips will begin to curl up and fall off in 5 to 7 days. If they do not fall off, you may remove them. If your staples were not removed before you left the hospital, you need to make an appointment with your doctor to have them removed. If you had stitches, they will go away on their own. You do not need to get them removed.

Do not soak your incision under water until your doctor gives permission. You may shower, allowing the water to run over your incision. You must keep the incision clean. Use a washcloth with soap and water to clean the incision. You must keep the incision dry. Touch or pat it lightly with a dry towel to soak up the extra moisture. If your incision remains moist, place a pad across it to soak up the moisture. Do not use lotion, powder, or ointment on the incision. Your doctor will tell you when to make your appointment to make sure the incision is healing.

To protect your incision as it heals:

• Use the football hold or the side-lying positions to nurse your baby. (See Woman’s Hospital’s Breastfeeding Guide for examples.)
• Place a pillow on your belly while you feed your baby.
• Place a pad or soft towel over your incision before you strap on your seat belt.
• Support the incision with your hand or a pillow while you move or cough.

Getting Back in Shape

Exercise

Abdominal muscles, often called stomach muscles, are weakened after delivery. Gentle exercises for the stomach, such as pelvic-tilting and abdominal-tightening, should begin 24 hours after you have your baby. Do not do full sit-ups. Avoid exercises that require you to raise or lower both legs at the same time. Each day, try to do 10 to 15 minutes of a mild physical activity to help you get back “in shape.” Ask your doctor if you should avoid any activity. Be careful not to do too much too soon. If you notice any pain in your pelvis or changes in the color or amount of vaginal discharge, stop exercising and call your doctor. Woman’s Fitness Center offers a medically supervised exercise program for women who have recently given birth.

Kegel Exercises After Vaginal and Cesarean Delivery

Kegel exercises tone your pelvic floor muscles. The pelvic floor muscles are stretched from the weight of the baby during pregnancy and even more for those who deliver vaginally. The pelvic floor muscles support the bladder, uterus, and rectum. Strengthening these muscles will help prevent leaking of urine or bowel contents, help the perineum heal, and tighten the vagina which was stretched from giving birth.

• Squeeze the muscles that you use to stop the flow of urine.
• Hold for up to 10 seconds, then release.
• Do this 10-20 times in a row at least 3 times a day.

Studies show that 40% of women do Kegel exercises incorrectly. For more information on how to perform this exercise correctly, register to attend our class, “Bottom Line on Kegels” at the Woman’s Center for Wellness offered by therapy services.

Nutrition

After you return home, eat properly to help your body heal. Eating a variety of different kinds of foods will help you get all of the nutrients your body needs to be healthy and recover after the birth of your baby.

If you are feeding your baby with a bottle, follow the food guide provided below. Adjust the number of servings within each food group to allow for a gradual return to a healthy body weight.

Your daily diet should include:

• 6 to 11 servings of bread, cereal, rice, and pasta
• 2 to 4 servings of fruit
• 3 to 5 servings of vegetables
• 2 to 3 servings of meat, poultry, fish, dry beans, eggs, and nuts
• 2 to 3 servings of milk, yogurt, and cheese
• Eat fats, oils, and sweets sparingly.

If you are breastfeeding, follow the dietary recommendations in the section on nutrition in the Breastfeeding Guide. You may also call Woman’s Hospital’s Nutritional Services for more information.

Other Adjustments

Family Adjustment

Your partner may feel left out because you and your new baby are receiving so much attention. A new father needs attention, too! Include him in the baby’s care and let him have time alone with the baby. Make sure that he knows that you still love him just as much, even though you are having to give most of your attention to the baby. Try to continue doing some of the things that you did together before the baby was born. Find time to be alone as a couple.

If you already have other children, you may be worried about how they will react to the new baby. Your other children may act jealous or may begin to do things that you thought they had outgrown. Be sure to include your other children in the baby’s care and show them that you love them just as much as before the baby was born.

Emotional Changes

Having a baby is a very emotional event. You may have feelings ranging from happiness and excitement to anxiety and helplessness. Hormone changes and the lack of sleep in the first few days after having a baby can cause mood swings in many women. These swings can cause sudden bouts of sadness or crying. These “postpartum blues” are normal and should go away within 2 weeks. If you are still feeling this way after a few weeks or if you feel severely depressed, call your doctor. You may have postpartum depression.

Activities to Prevent Postpartum Depression

• Talk to family and friends about the changes in your mood and problems that may occur after you have your baby.
• Take care of yourself. This means eating a balanced diet, getting regular exercise, and getting adequate sleep. Ask someone to help care for the baby so that you can get a good night’s sleep.
• Share your feelings with someone close to you; don’t isolate yourself at home.
• Don’t try to do everything for everyone. You do not need to be superwoman!
• Don’t expect too much of yourself.
• Don’t be ashamed of having emotional changes after your baby is born. It is very common.
• See “After Baby Comes: Parent Care” brochure.

Rest and activity are very important; plenty of both are needed. Being tired can be a very big problem for a new mother. It can make you lose confidence in yourself and make you resent those you love. As long as the baby still needs to be fed during the night, you should try to rest an extra 2 hours each day, sleep when the baby sleeps, and go to bed early.

Do not be afraid to ask for help before you become overly tired, and do not refuse any help that is offered to you.

If you have good support from your baby’s father, family, and friends, it is easier for you to cope with your new role as a mother. Attending support group meetings with other mothers who are in the same situation is also a way to understand your feelings and share your thoughts. For more information about support groups, call Social Services at 225-924-8456.

• After Baby Comes: ABC Mornings
  Support and information for moms with babies 6 months and younger. Meets each Thursday, 10 AM to 11 AM.
• NICU Parents Support Group
  Meets first and third Monday at noon in the NICU waiting room.

Call your doctor if you experience any of the following symptoms:

• Excessive vaginal bleeding (pad saturated in less than 1 hour).
• Vaginal discharge with foul odor.
• Temperature of 100.4°F or above; severe chills; flushing; flu-like symptoms.
• Drainage, swelling or redness of incision, episiotomy, or breasts.
• Fainting or feeling extremely weak.
• Burning, frequency, urgency of urination, pain in either side of lower back (flank pain), or urine with a foul odor.
• Pain not relieved by medication or an increase in your pain.
• Shortness of breath, persistent and/or productive cough.
• Severe depression or depressed feelings that last over several weeks.
• Hard knot or lumps in breast.
• Severe headache; abdominal pain; blurred vision; dizziness.
• Persistent or worsening edema, or swelling.

If you have any other questions or concerns about your health, do not hesitate to call your doctor.