Answers to Mothers’ Common Questions about the First 3 Days Postpartum

In our previous post, we shared a study reporting postpartum mothers’ most common concerns in the first days and weeks postpartum. Their questions varied from concerns about their own post-operative care to those about feeding and caring for their infant. In today’s post, we’ll provide some answers to mothers’ most common questions about the first 3 days postpartum. For more detailed information on any of the topics below, please see the reference section at the end of this post.

Post-Operative Care


Whether you’ve had a C-Section or an episiotomy, it’s important to know what to expect from the procedure itself and how to care for the stitches and wounds afterwards. It’s important to breastfeed in a position that is most comfortable for you and doesn’t put pressure on your incision.

Cesarean Section
Wound care of your incision is monitored for redness and infection by your healthcare team while you are in the hospital. You will be encouraged to shower and get up to walk within 24 hours. You will also be prescribed pain medication. It is important that you feel comfortable asking for adjustments to the dosage if you are experiencing changes in pain. Pain management is important for healing and being able to comfortably care for your newborn. Once you are home, you may need someone to help you monitor your incision (from experience, it was difficult to see the incision myself). One last piece of advice from my own experience: place a pillow over the incision (on top of your clothing) because the area will be very tender, especially while holding your baby or adjusting your position.

Episiotomy
For episiotomies, wound care begins immediately. You will most likely be prescribed pain medication as well as a topical antibacterial cream for the incision itself. An ice pack will help with pain and inflammation. Sitting in a warm bath with Epson salt (“sitz bath”) 2-3 times per day will cleanse the wound and relieve some of the pain.

Uterine Massage
Uterine massage is important to help deliver the placenta and to aid in uterine contractions. This ensures that the uterus expels all of the excess tissue and returns to its normal size. Most nurses will do this for you while you are in the hospital.

Returning to Your ‘Normal’ Figure


I have to admit I was a little surprised to see this was a concern of mothers in the first few days postpartum! There is so much pressure in our society to conform to the ideal body image that we see in the media. Remember, it took you about 40 weeks to carry your baby to term, and most healthcare professionals say that it will take about 40 weeks or up to 1 year to get back to your pre-pregnancy weight. Pregnancy weight gain not only includes weight from your baby but from body fluids and tissues to support the growth of your baby as well. During the first few days postpartum, you should not push yourself too exercise too hard or too soon. Your body needs time to rest, relax, and heal. If you’re jealous of how svelte stars like Angelina Jolie and Reese Witherspoon manage to look red-carpet ready in just a few months after giving birth – consider this – if you had the money to hire a 24/7 personal trainer, nutritionist, chef, nanny, and buy an unlimited supply of Spanx, then you could look like them too!

Physical Activity in the Postpartum Period
How soon you can begin to exercise after giving birth will largely depend on what kind of shape you were in prior to your pregnancy and your fitness during pregnancy. Most people will say that you can resume activity and exercise “when you feel up to it” but moms recovering from a c-section may be asked to wait until their 6-week check-up before restarting an exercise regimen. For all moms, easy walks up to 30 minutes in length can begin a few days postpartum and you can slowly increase exercise intensity as your body regains strength.

Concerns about Your Baby’s 1st 3 Days

Recognizing Infant Illness
Newborn babies will cry, wake, and need to be fed often! Healthy newborns (after they are cleaned up!) will have warm, pink skin and will try to interact with you. If your baby abruptly changes his behavior – i.e. suddenly begins to cry more often than usual and cannot be consoled or becomes lethargic, this may be a sign of illness or injury. Keep in mind that sometimes a baby’s “good” behavior can be misleading. Babies that sleep all of the time, do not wake to feed consistently, or never cry may not be feeding or growing well. Call your pediatrician immediately. If you swaddle your newborn, it is important to un-swaddle them to change diapers and to monitor their skin tone and color. If you are worried that your baby may be sick, call your doctor or advice nurse.

Feeding
Newborns have very tiny stomachs so they can only eat very small amounts at a time. So if it seems like your baby wants to eat “all the time” – You’re right, he needs to eat frequently! During the first 3 days, babies should be fed whenever they show hunger cues -which can be up to 12 times per day! (Do keep in mind that cues may be unreadable or conflicting in the early newborn period. For more information about newborn behavior in the first 72 hours, click here. Twelve feedings per day may seem like a lot, but remember that feeding takes practice, so the more you do it during those first few days, the better you and your baby will become at breastfeeding! For more information about breastfeeding after a cesarean section, click here.

Note: Days 4 and 5 postpartum usually have the most feeds. Many mothers then think that they do not have enough breast milk. This is not true! This sudden increase in feeds helps prevent engorgement (from the rapid increase in milk supply around this time) and gives mom and baby lots of practice feeding, right when they need it most.

We hope the answers to these questions provide information to those of you who are new or prenatal moms with similar concerns! Next time we’ll address mothers’ most common concerns in the weeks and months after giving birth.

References
Cesarean Section:
http://www.mayoclinic.com/health/c-section/MY00214/DSECTION=what-you-can-expect

Uterine Massage: http://apps.who.int/rhl/pregnancy_childbirth/childbirth/3rd_stage/Cd006431_soltanih_com/en/index.html

Episiotomy:
http://www.mayoclinic.com/health/episiotomy/HO00064/NSECTIONGROUP=2

Postpartum Exercise:
http://www.mayoclinic.com/health/exercise-after-pregnancy/MY00477

Breastfeeding comes naturally, right? One story of a not-so-perfect start to breastfeeding

The first feeding: Getting to know you
I thought latching came naturally to newborns. I had this vision of my brand new baby, this little creature I had just birthed, nuzzling up to my breast, latching on and feeding for the first time, with ease. Well, that’s not always how it works! First of all, I wound up having a C-section, and thus, a medicated baby, who, after I got out of the recovery room, was still drowsy from all of the medication. This was not part of my plan! I felt that I needed to get her on the breast quickly because I had been in recovery for awhile and thought she must be starving. The first time I put her to the breast she did latch on, but like a ravaged little animal! She was so drowsy, she would stay on the breast only for a minute or two at a time before falling asleep. I felt a little panicked: would she get enough milk? Was there any milk there? Now I know that the first feeding is more of a “getting to know you” experience between breast and baby, and not a complete meal. She may start by simply licking or mouthing your nipple. She is getting to know you.

Colostrum: The first milk
At first, your body makes a very special type of milk, called colostrum. It is yellowish, thick and sticky. It might seem like colostrum is not enough for your baby because it is produced in very small amounts, but your body is making the perfect amount for your baby, a little goes a very long way. Colostrum is packed with important nutrients and easy to digest. Keep in mind, a newborn baby’s tummy is tiny! My daughter fed every hour or two in the first few days.

After a few days, your milk will "come in" and satisfy your baby’s needs as she (and her tummy) grows. The milk will appear thinner and white (or opaque) in color. This transition is normal, and again, your milk is made to meet your growing baby’s needs perfectly.

Getting help in the hospital
In the hospital, I was lucky enough to have knowledgeable nurses to help me when I had breastfeeding questions. I also had a Lactation Consultant (LC) stop in to check on me a few times. This is not always the case. As part of a study of how women feed their babies in the hospital, we found that most women received help with breastfeeding from the hospital nurses. A smaller number received help from a LC. LC’s are healthcare professionals specially trained to help mothers breastfeed successfully. Before you leave the hospital, I encourage you to ask your nurse if you can see a LC. Their help is invaluable, as my experience below shows.

Welcome home!
When I got home from the hospital, I discovered that I no longer had 24-7 nursing care! That’s when the real fun began. When my daughter latched on at home, something changed. I started having pain when she would latch to my breast. The pain escalated and within a few hours, one of my nipples was bleeding. The pain was overwhelming to the point that I didn’t want to put her to the breast at all. Luckily, I had the phone number of an LC that I knew from a past job; I called her right away. She came over that day and helped me position my daughter so that we were both comfortable. With her help and a new breastfeeding pillow, I was off and nursing again, pain free.

Kerri’s Story
Kerri had a similar experience. She describes her first breastfeeding experience as feeling unnatural and scary. She had problems getting her daughter to latch, but when the nurse would come in to help, she would get her to latch on easily. Then the next feeding would come, and she would try to latch her on by herself and it wouldn’t work. She would get frustrated because it seemed so easy for the nurse. She felt like something had to be wrong with her - women had been breastfeeding for hundreds of years, so why couldn’t she do it?

By the second day, her nipples were cracked and bleeding. Breastfeeding was painful! She thought about giving up because it hurt so badly, but the doctors and nurses kept reassuring her that she and the baby were learning to breastfeed, together. She kept trying and was finally successful. Once she found the breastfeeding position that worked best for them both, breastfeeding became much more natural.

Tips to survive your baby’s first week of breastfeeding...successfully

Get real: latching can be hard work
It is a natural process, but it is a learned process! Both you and your baby will need time to practice breastfeeding. Your baby may not latch on comfortably the first time, especially if she is drowsy from medication during your delivery. To learn more about positioning your baby at the breast and latching her on comfortably, talk to your nurse or a lactation consultant while you are still in the hospital!

If it hurts, get help NOW
The pain might not subside without intervention from a lactation professional (LC, nurse, etc.) Do not wait to call because the pain from an uncomfortable latch could just get worse or you may even develop a breast infection.

Most babies get enough to eat if they just breastfeed frequently
As I said before, the milk your body makes is nutritionally perfect. If you feed your newborn frequently (every 1-2 hours), your body will make just the right amount of milk to satisfy her. The frequent feedings won't last forever! If you are really concerned that you are not making enough milk, talk to a lactation consultant as soon as possible.

Babies cry for many reasons, not just because they are hungry!
Your baby might cry at the end of a feeding; that does not mean she is still hungry or not getting enough milk from you. Babies cry for many reasons. They might cry because they are cold, hot, lonely, tired, over stimulated or having a bowel movement. Keep in mind that even a normal birth is a pretty traumatic experience for a baby. She was warm, safe and comfortable in your womb. Now she is in a bright, cold world with lots of loud sounds and strange new sensations in her body. You might cry too!

Know where to get help before your baby is born
In the hospital, don’t be afraid to ask your nurse for breastfeeding help. Their job is to help you learn to take care of your new baby. Lactation consultants (LCs) are employed by many hospitals to help mothers get breastfeeding off to a good start. USE THEM! They have a wealth of knowledge and experience! Ask your nurse to get you a referral to an LC before you leave the hospital, and be sure to take the LC’s contact information home with you in case you have a breastfeeding problem or question once you take your baby home.

Take a breastfeeding class, prenatally
Breastfeeding classes are helpful for learning the basics of breastfeeding. It is also helpful for your spouse or partner to attend so that they can learn ways to support you while you are breastfeeding. Breastfeeding classes are usually offered at hospitals or at your doctor’s office. Ask your doctor for more information about finding a class.

Fast forward two years My happy ending: the newborn described throughout this post just turned two years old. She is a happy, healthy toddler that still enjoys breastfeeding. The only difference is now she can ask for it!

Next time: One of our moms shares the challenges she experienced when her pregnancy & delivery didn't go according to plan