Guide for New Parents

Having a new baby is one of life’s most exciting and joyful events. It can also be overwhelming - juggling the needs of a new baby and adjusting to the increased demands on you and your family’s time and energy. To help you more easily handle these lifestyle changes, we have provided some general guidelines for you to follow after giving birth. Please ask your obstetric care provider for any specific instructions.

Your Privacy in the Hospital

To protect your privacy, staff cannot give out information to your family or friends. There is a telephone in your room so that you may speak with them yourself. Be sure to let your nurse know if you do not want calls put through to your room. You may use cell phones in the Mary Horrigan Connors Center for Women’s Health, except on CWN-6, the Neonatal Intensive Care Unit (NICU).

Activity and Rest

Giving birth to a baby is physically exhausting. Fatigue and the need to rest should be expected even if you are in great shape. It may be four to six weeks after giving birth before you will begin to feel more like yourself.

Although this is an exciting time for you, your family and friends, you are encouraged to limit your visitors and telephone calls so that you have an opportunity to rest and to learn how to care for yourself and your baby.

In the beginning, tasks that you view as simple may leave you exhausted. Expect to feel this and give yourself permission to rest. Take the time, especially when your baby sleeps, to nap and catch up on your own sleep, but this may be difficult if you have other children at home. You may find that one day you have a lot of energy and the next day you may be too tired to do much of anything. Try to postpone any unnecessary tasks and ask a friend or family member to help out at home. Do not be afraid to ask for help with meal preparation, cleaning, laundry, and other household tasks. This will allow you to care for yourself and to spend more time with your baby.

If you have other children, they will also need and want your attention and time. Make sure that you get enough rest, so that you can meet their needs as well.

Fatigue is a normal part of being a new parent. Gradually increase your amount of activity, but avoid strenuous work, heavy lifting and excessive social activity until after your six-week check up. Listen to your body. If vaginal bleeding increases or if you feel tired, slow down or stop what you are doing.

Care of Your Breasts

All Mothers:

Support your breasts by wearing a well-fitting bra.

For Breastfeeding Mothers:

After feeding, massage your breast milk into your nipples and allow your nipples to air-dry. For detailed instructions on how to manage sore nipples, full breasts, and/or engorgement, see pages 20-21.

For Bottle/Formula-feeding Mothers:

If your breasts are painful or engorged when they are very full with milk, apply an ice pack (a bag of frozen peas or corn works well) under your arms and along the sides of your breasts for 20 to 30 minutes several times a day. Take acetaminophen or ibuprofen as directed by your obstetric care provider. Avoid the direct application of heat. For example, do not face the hot water when taking a shower. Generally, relief of engorgement occurs in 24 to 48 hours. If there are areas on either breast that are red, hot or tender and you have a fever over 100.5 degrees, call your obstetric care provider.

Abdominal Cramps

As your uterus contracts to return to its pre-pregnant size, you may experience “after birth pains,” which typically disappear three to four days after birth.

Breastfeeding mothers may experience increased abdominal cramps during and after nursing. If you have had other children, you may have more severe “after birth pains” because the uterus needs to work harder to get back to its pre-pregnant state. Many women find they can ease the discomfort with the breathing techniques they learned in prenatal classes. If you need to take pain medication, take acetaminophen or ibuprofen as directed by your obstetric care provider.

Please call your obstetric care provider if you experience fever, chills, or increased abdominal tenderness.

Bleeding

Called lochia, the vaginal discharge after birth is a combination of the sloughed uterine lining and blood. The discharge usually changes in color over several weeks from bright red, to pink and then to a whitish tone.

If you are soaking through a large pad every hour, if your vaginal bleeding has increased and does not slow down when you rest, or if you are concerned about the amount, color or duration of your bleeding, contact your obstetric care provider. Do not use tampons or douche before your six-week check-up.

Perineal Care

Until you stop bleeding, continue to use your “peri-bottle,” provided to you by the hospital, each time after you urinate or use the toilet. Always wipe from front to back, away from the vagina. For the first week at home, we recommend you use soft facial tissue to gently pat dry. Change your pads often.

If your perineum is swollen or painful, apply ice to the area for the first 24 hours after the birth, and then use the sitz bath (a special basin filled with warm water in which you sit to soak your perineal area). Your nurse will give you a sitz bath if needed and teach you how to use it.

Hemorrhoids

Hemorrhoids are caused in pregnancy by the added pressure of the baby in the uterus. Protrusions of tissue (varicose veins) through the anal opening, hemorrhoids can be quite uncomfortable. They can appear for the first time in late pregnancy or following delivery and usually get better and disappear. In the acute stage, hemorrhoids will respond well to Witch Hazel compresses, Tucks® or sitz baths. Occasionally, local medication may be needed. Avoid straining when you have a bowel movement, and do not stay seated in the bathroom for a long period of time.

Constipation

There is a tendency toward constipation during the first few weeks following birth. This is easily overcome by establishing proper dietary habits including drinking eight to 10 glasses of water daily, and eating roughage in the diet, such as raw fruits and vegetables, fruit juices, figs, dates and prunes, whole grain breads, and bran cereal. If necessary, you may use a mild laxative or stool softener such as Milk of Magnesia®, Senokot® or Peri-Colace®. If you are breastfeeding, use Metamucil® or Colace® (docusate sodium).

Stitches

If you had an episiotomy, your stitches may still feel uncomfortable when you first go home. It takes two to four weeks for the skin to heal. To alleviate discomfort:

• reduce the amount of physical activity;
• three times a day, soak your perineal area for 20 minutes in a sitz bath;
• adjust your sanitary pad so that it does not rub against your stitches;
• apply Tucks® or Witch Hazel compresses to your stitches each time you change your pad and after each sitz bath or whenever necessary to relieve discomfort;
• take acetaminophen, ibuprofen, or prescription pain medication as directed.

Your stitches do not need to be removed and will dissolve in about two weeks.

Bathing and Swimming

You may shower right away. Wait two weeks before taking a bath to allow for time to heal. Your obstetric care provider may suggest you wait until your six-week check-up before you begin swimming.

Diet and Exercise

Weight loss after childbirth occurs at varying rates for different women. A new mother should expect a slow, gradual weight loss during the first six months after the birth of a baby. Allow your body time to recover from your delivery, continue eating healthy foods and begin a regular schedule of exercise.

If you had a vaginal delivery, you may begin mildm exercise immediately. If you had a cesarean birth, wait until after your six-week exam or until all abdominal tenderness has resolved. You may climb stairs, but avoid lifting anything heavier than your baby. Until your six-week check-up, the best exercise is standing up straight (wearing sensible shoes helps), walking and holding in your abdominal muscles as best you can. If after your six-week exam you weigh more than your pre-pregnant or desired weight, you may consider a reducing diet and exercise program, but only after checking with your obstetric care provider.

Following birth, a nutritious diet is important for proper healing and the added energy you need to care for your new baby. If you are breastfeeding, you will need more calories per day for good milk production, so weight loss should be gradual until your baby is weaned. We recommend that breastfeeding mothers continue taking prenatal vitamins while nursing.

For individual nutrition consultations and weight loss programs at Brigham and Women’s Hospital, call the Nutrition Department at (617) 732-6054.

Emotional Health

Having a baby brings plenty of joy, but you may also feel a degree of anxiety. Mood swings and difficulties concentrating on tasks are common. Some women experience feelings of depression. Although you have planned for all the details of baby care after leaving the hospital, you may find it hard to manage your time. Finding a moment to do something simple, such as taking a shower, may be challenging.

Parents may feel great joy and celebration at the birth, but sometimes feel frustration and disappointment when events do not happen as planned. Remember that the goal of pregnancy and childbirth is to have a healthy mother and baby, not a perfectly scripted experience. The labor and birth experience is unique to each mom so it is important to keep your expectations flexible.

Women who plan to return to work may find that they would really like to stay home while women who decided to leave work may feel a sense of loss from leaving their career. It is important to find the time to talk with friends and family about your feelings and let them help you as much as they would like. It is also important to set aside time for you and your partner to spend together.

Adjusting to being a parent

While childbirth evokes powerful emotions, the bonding process sometimes takes time. Some parents comment that they feel guilty that they thought their baby was “funny looking” at birth, that breastfeeding did not happen instantly or that they were “too tired to care.” You may think you are not normal if you do not instantly love everything about your baby or feel an overwhelming mothering instinct. Parenting is a learning process, and not something that happens instantly.

Partners also have mixed feelings about birth and their role. They frequently are fearful that either mom or baby will suffer, or that they will not measure up to expectations. Afraid of distressing moms, partners sometimes avoid discussing their concerns, and are occasionally repelled by the birthing process and the more mundane tasks of childcare. Encourage whatever role your partner initiates or make suggestions.

Your emotions are apt to fluctuate widely after having a baby. The “baby blues” are a common reaction, appearing usually suddenly in the first few days. As many as 80 percent of all new mothers experience sadness (crying for no apparent reason), loneliness, impatience, irritability and anxiety. Be assured these feelings usually pass within a few days.

Different from the “baby blues,” postpartum depression can occur in varying degrees, happening within days of delivery or up to a year later. Feeling out of control and fearful are common symptoms.

Other symptoms may include: feelings of inadequacy and inability to cope, despair, feelings of panic, no feelings for the baby or extreme concern for the baby, fear of harming the baby or oneself, exaggerated highs and lows, poor concentration or memory and feelings of guilt or unworthiness. Physical symptoms may include heart palpitations and panic attacks.

These symptoms are not a sign of weakness or inadequacy. They are temporary and treatable with support and professional help. Call your obstetric care provider or the National Depression After Delivery hotline at 1-800-944-4PPD. On pages 37-39 of this guide, you will also find a list of organizations that you can call for help with postpartum depression.

Driving and Travel

If you had a cesarean birth, a painful episiotomy or a low blood count, do not drive for three to six weeks. Otherwise, there are no reasons to specifically avoid local travel except the possibility of overexertion and fatigue. On long automobile trips, get out of the car every hour or so and walk for several minutes to help your circulation. If you are planning a long-distance trip in the first six weeks, first speak with your obstetric care provider.

Medications

You may, as advised, use ordinary medications for colds, headache, constipation, hemorrhoids, insomnia and other minor ailments. However, if you are breastfeeding, consider potential effects to your baby. We recommend that you continue taking prenatal vitamins until you wean your baby. Before taking other medications, check with your pediatric care provider or the Drug Information Hotline at Brigham and Women’s Hospital at (617) 732-7166.

Sexual Intercourse

You may resume sexual intercourse whenever you feel physically and emotionally comfortable. A period of time from a few to six weeks may be needed to heal, avoid infection and allow the bleeding to stop. Your obstetric care provider can provide you with his or her recommendations.

It is often suggested that new mothers wait until after the six-week postpartum check-up. If you have had an episiotomy and are worried that you are not healed, use a hand mirror to look at your perineum (your imagination is often worse than the reality). Because of hormonal changes caused by your pregnancy, there will be a temporary decrease in vaginal lubrication. If you are apprehensive about possible discomfort or the temporary lack of lubrication, use a watersoluble vaginal cream or jelly such as K-Y jelly® (NOT Vaseline® or other kinds of petroleum jelly) for extra lubrication. It is possible to become pregnant within six weeks of the birth of your baby. Check with your obstetric care provider about family planning methods (birth control) if you choose to resume sexual activity and prevent pregnancy during this time.

Adjusting to a new role, changing your schedules and being responsible for a new baby can diminish your interest in and energy for sex. Try a massage or a relaxing soak in the tub (if it has been at least two weeks since the birth of your baby). Or, to allow private time for you and your partner, leave your baby with a babysitter.

Normal Physical Changes to Your Body

You may experience some normal physical and hormonal changes in your body after birth including:

• hot flashes;
• night sweating;
• increased urination (for first few days after birth);
• dry skin;
• temporary hair loss;
• vaginal dryness;
• mood swings.

These are only temporary and should decrease as your body returns to its pre-pregnant state.

Medical Care

On your first day home, call your obstetric care provider’s office for an appointment for two to six weeks after the birth, or as suggested by your obstetric care provider. At that time, you will be examined and will have the opportunity to discuss any problems you may have. Following your postpartum check-up, we suggest that you return yearly for a physical examination and Pap test (screening test for abnormal and cancer cells in the cervix). A yearly health examination and Pap test are your best insurance for optimal gynecologic health. We also encourage you to perform a monthly breast self-exam. Please ask for instructions on breast self-exam prior to discharge.

If You had a Cesarean Birth

You will be encouraged to get out of bed shortly after your cesarean birth. The Foley catheter will be removed in the morning, and the IV is usually removed 24 to 48 hours after giving birth. Your physician will prescribe pain medication for you on a “when needed” basis, (i.e. when you tell the nurses you need pain medicine). On your first day, we recommend you take pain medication at regular intervals to control the pain. The discomfort from your incision should subside with each day.

The first few days after surgery can be difficult, from positioning the baby for feeding, to moving, sleeping and coping with emotions and after-birth pains. To speed your recovery, it is very important to get plenty of rest. It is also wise to limit your visitors and the length of their stays, as well as phone calls.

To turn from side to side in bed with the baby, hold the infant close to your chest or under your arm like you are holding a football (football position), and use the side rails for support. When you cough, sneeze or laugh, bend your knees and support the abdominal incision with a blanket, pillow or your hands. Your nurse will help you with these positions. Every few hours you should take a deep breath and hold it five to 10 seconds while tightening your abdominal muscles. Repeat the exercise frequently.

In addition to keeping your lungs clear, this also will help relieve gas pains, which can often be more uncomfortable than the pain from your incision. You may feel some shoulder or neck discomfort, called “referred pain,” that is associated with the build-up of gas. Walking, massaging, and drinking hot tea can help relieve the pain. Avoid ice, carbonated drinks and drinking through straws.

Once the bandage has been taken off, keep your incision dry and exposed to air. After you shower, dry the area gently and thoroughly. Usually, your staples or stitches will be removed before you go home. The staples hold together the top layer of your skin and are not folded under like the metal staples used on paper, so removal is not a painful procedure. The incision line may itch and be sensitive to touch or pressure, so use care when rubbing the area.

For six weeks or longer, your body will not look the way it did before pregnancy. At first your balance may be unsteady, so limit stair climbing. Avoid lifting objects any heavier than your baby, and unnecessary stooping or reaching. Walking is a good beginning exercise. Simple exercises done progressively will help you regain your natural figure. Postpone more strenuous exercises, such as aerobics, until after your six-week check-up.

Over the next two to three weeks your vaginal bleeding will change from a moderate red flow to light pink and then to a scant white staining. Overexertion, fatigue or poor nutrition may cause an increase in the vaginal flow. This is your body telling you to slow down and take it easy. Give yourself and your body time to feel better. Notify your doctor if you have bright red bleeding, redness, swelling or separation of tissue in your incision.

Future Childbirth

You should not assume that the next time you have a baby you would deliver the same way. Under certain circumstances you may be able to have a vaginal birth after cesarean (VBAC). There are doctors experienced with VBAC with whom you can discuss the reason for your surgery and whether you will be able to deliver vaginally the next time. It may be helpful to speak with other women who have had a similar experience. Look into community support groups for mothers who have had cesarean births.

Tips for Partners

Following a cesarean section, new mothers need assistance with childcare and other daily tasks.

Here are some ways you can help:

• Encourage her to walk by walking with her.
• Make arrangements to minimize stair climbing at home during the first few weeks.
• Assist her in lifting or carrying siblings and heavy objects the first few weeks.
• Encourage her to take frequent rest breaks. This is especially important for recovery after surgery.
• Bring the baby to her for nighttime feedings if she is breastfeeding, assist with formula feedings, change the baby’s diaper.
• Assist with household responsibilities.
• Minimize your work obligations, if possible, so that you can spend time together and with the baby.
  

Day of Hospital Discharge

When you return home from the hospital, we recommend you rest for the remainder of the day with no visitors. Then, you can decide when and how many visitors you want. Consider asking that visitors not visit unexpectedly. Also, let family and friends help with daily household chores.

A few points to remember on adjusting to parenthood:

• Remember that rest is important. Increase your activity gradually.
• Do not feel that you must entertain visitors. During the first few weeks it is an important time for your immediate family to get acquainted.
• You and your partner should make arrangements to have some private time together soon after you return home.
• The skills of parenting are learned. Use books, videos, the library or the Internet to get informed.
• Accept and ask for help from dependable friends and relatives.
• Do not be overly concerned with housework and unimportant tasks.
• Do not neglect outside interests, but temporarily scale back on demands and schedules.
• Physical recovery may take you longer than six weeks; emotional adjustment is an ongoing process.

Warning Signs

If you notice unusual changes in your body, please call your obstetric care provider immediately. Some warning signs and symptoms that require immediate attention include:

• Chills or fever of 100.5 degrees for four hours or more;
• Frequent urination or burning with urination;
• No bowel movement for three days;
• Vaginal bleeding heavier than a period (soaking more than one pad an hour), repetitive large clots or foul odor;
• Fainting;
• Swelling, redness, tenderness in any part of your breast accompanied by fever;
• Severe abdominal pains;
• A tender, swollen or red area in the calf or the leg;
• Persistent headache or vision changes;
• Excessive swelling of the face, fingers or feet;
• Cracked and/or bleeding nipples, difficulty with breastfeeding;
• Difficulty coping with the “blues,” feelings that you cannot care for your baby, feelings of deep sadness that appear to be getting worse;
• A great deal of difficulty getting out of bed and facing the day. If you have any concerns about how you are feeling after you have your baby, please speak with your obstetric care provider. We encourage you to address each item with your provider so that you will receive information that is specific to you.
  

When to resume usual activities following your vaginal birth

When to resume usual activities following your cesarean birth