Postpartum Care

The first six weeks with your baby can be a real roller coaster! Although excited to finally meet your baby, you may also find it challenging. You may have feelings of elation, exhaustion, worry or relief. All of these feelings are completely normal, and your midwifery team is there to guide you through. Regardless of where you give birth, your midwife will provide care at your location within the first one-two days. Visit frequency will be base on your needs and in the first week after delivery, the midwife will come to where you and your baby are. Midwives monitor both your and your baby’s health and provide breastfeeding support. They will ensure that you recovering well, both physically and emotionally.

Physical Recovery

During the postpartum period, there are many physical health changes and recovery that occur. Breast, after pains, bleeding, stitches.

Bleeding

Postpartum bleeding, called lochia, is a normal and necessary part of postpartum recovery. Bleeding after a baby is not menstruation. Postpartum bleeding comes mainly from the area where the placenta used to be attached. Right after you have your baby and when your midwife does postpartum assessments, one common check is to ensure that your uterus is firm (this is called a fundal check). The bleeding process ensures the uterus is completely empty after the pregnancy. There are three stages to postpartum bleeding:

Rubra: dark or bright red blood, flow like a heavy period, some clots are normal, period like cramping
Serosa: pink or brown in colour, more watery, moderate flow, fewer clots
Alba: yellowish or white discharge, spotting, no clots

Each stage of postpartum bleeding varies in length depending on the individual. Although there may be a brief increase in bleeding with activity, in general the bleeding gradually gets lighter and lasts on average for 4-6 weeks.

Page your midwifery team with any of the following symptoms

Filling a postpartum pad (heavy and full) in 30 minutes or less
One clot larger than your fist or many clots together larger than your fist
Lochia that is foul or rotten smelling (not like your usual personal or period smell)
Fever, chills or flu-like symptoms

Wound Care

Perineum Wound

To keep the area as clean and dry as possible use peri-bottle after voiding, pat dry, and avoid rubbing
Witch-hazel products such as TUCKS pads or a clean cloth soaked in a 50% mixture of witch hazel and water can be used for extra cleaning or for a compress
Change sanitary pads frequently
Any stitches will dissolve on their own
Do not apply any lotions or other ointments directly to the wound (unless instructed)
Use “padsicles” to reduce swelling
Herbal bath or Epsom salt baths can be helpful
Acetaminophen and ibuprofen taken as directed can reduce pain and swelling
Open air time is important for quick healing
It is good to shower, only use water on the wound. Don’t put soap or body wash directly on the wound (it is ok to wash the rest of your body regularly), pat dry

C-section Wound

Shower, only use water on the wound. Avoid soap or body wash directly on the wound
Pat dry without rubbing
Any stitches will dissolve on their own
Do not apply any lotions or other ointments directly to the wound (unless instructed)
Acetaminophen and ibuprofen taken as directed can reduce pain and swelling
Open air time is important for quick healing if you have a hair dryer with an “air” setting this can be used for airing

Page your midwifery team with any of the following symptoms

any wound with green or gray discharge
Foul-smelling discharge form any wound
Lochia that is foul or rotten smelling
Fever, chills or flu-like symptoms
Severe perineal pain
Severe pelvic cramping/pain

Breast Care

Breastfeeding will occupy much of your time with a new baby. Breastfeeding exclusive breastfeeding is recommended by the World Health Organization as the best nutrition for your baby for the first six-months of age. On-going breastfeeding with other foods has ongoing benefits for your baby in the first two years of life. Many think that breastfeeding is all natural and automatic. Although some natural reflexes are involved with breastfeeding, much of breastfeeding is learned. There is learning for you and learning for your baby. There is more information on breastfeeding in the Newborn Care section.

Nipple pain

When both you and your baby are learning how to breastfeed, nipple pain may occur. Usually nipple pain comes from latch issues which are further addressed in the Newborn Care section. In your take-home bag you will have been provided an all natural nipple ointment. This can be applied sparingly to your nipples after each feed. Air drying breasts is also beneficial as is rubbing in expressed breast milk. If you are wearing wet breast pads change them frequently. A member of your midwifery team will work with you to get feeding your baby off to a good start and to trouble-shoot issues. Let your midwifery team know if your nipples develop cracking, blistering or bleeding as stronger medication may be needed.

Breast Engorgement

Breast engorgement is a common discomfort on the 3rd or 4th day postpartum. Engorgement happens with both breasts at the same time. Sometimes thee breast firmness makes latching difficult and can lead to nipple pain. To help with this feed your baby regularly from the breast. If breast is still firm and uncomfortable after a good feed, hand expression or pumping until you are more comfortable. (The breasts do not need to be empty, as this will actually increase your milk supply).

Other Issues

Yeast may become an issue on the nipples and areola usually not until after the second week. Symptoms include sudden burning nipple pain and/or deep or sharp pain during and immediately after feeds. When this happens babies usually have yeast in the mount (thrush) so both client and baby are treated at the same time. Yeast likes warm moist environments and can be prevented by frequent changing of breast pads and allowing breasts to air-dry. Make an appointment with your midwifery team if you are concerned you may have this issue.

Mastitis is an inflammation and infection. This develops typically on one breast and often has a tender, red, hot spot on the breast. Mastitis is often accompanies with generally feeling unwell, achy, fever, and chills. If you have symptoms of mastitis please page your midwifery team.

Emotional Care

Baby Blues vs Postpartum Depression

Sometimes a life with as baby is not always what you expect.

Baby Blues

There is a day that your midwifery team likes to refer to as “the wet day”. This day will often start overnight on the second or third night after delivery. Newborns are often very cranky and irritable demanding the milk to come in. There will be a lot of wetness from the hormonal shift that occurs when your milk comes in. Your breasts will become full and often leaky. The sleep deprivation from delivery catches up with you. Often around this day the tears may flow as well as the milk, blood, and sweat. These emotional times are normal (affecting 75% of postpartum clients), but do not take them for granted. If you find yourself teary and emotional do a self-check for self-care. Some aspect of self care (rest, hydration, nutrition) is likely missing. Rely on your supports and your extended support systems.

Postpartum Depression (PPD):

Postpartum depression can present at any time up to 1 year after birth and can affect 10-15% of clients. Symptoms include depressed mood, lack of pleasure or interest (especially in babies), insomnia or hypersomnia, weight loss, loss of energy, agitation, feelings of worthlessness/guilt, diminished concentration, and frequent thoughts of death/suicide. It is important to notice the signs early and seek help. If you have postpartum depression you not notice all the symptoms, so it is crucial for support people (partners, family, friends) to speak up if they have concerns. One scale that can be helpful is called the Edinburgh Postpartum Depression Scale (EPDS). See other mental health resources below:

Page or contact your midwifery team with any of the following:

If you or your family are concerned that you may be suffering from postpartum depression
If you score 10 or more on the EPDS
If you answer “yes” or to question 10 on the EPDS regardless of score
If you are in immediate risk of harming yourself or your baby page your midwifery team and get to nearest emergency department.

Self-Care After Delivery

The first six weeks with your baby can be a real roller coaster! Although excited to finally meet your baby, you may also find it challenging. You may have feelings of elation, exhaustion, worry or relief. All of these feelings are completely normal, and you can discuss all of them with your midwife, who will care for you and your baby for six weeks after the birth (this is called postpartum care). During this time, your midwife will provide guidance around how to care for your baby and yourself during this special time in both of your lives.

While every birth journey is unique, there are some common threads in the needs for the recovery from both vaginal birth and cesarean births. You will need rest, lots and lots of rest. Your body just did a huge amazing thing, and you need to pay attention to what it’s asking of you in return. Think of it as an investment that will pay off greatly as you walk through and beyond the fourth trimester.

Sleep and Rest

Getting enough sleep is one of the most difficult aspects of postpartum recovery. Sleep should be the most prioritized aspect of birthing client care. Clients who get more sleep recover faster physically, have better mental health and have fewer delays in milk supply. You will probably hear it a hundred times but, ‘sleep when the baby sleeps’ really does improve client sleep quantity and quality. It is encouraged to have many small naps in between breastfeeds. Partner/Family/Friend support at this time is crucial, allowing others to settle the baby after feeds while you rest.

There are a wide array of cultural practices around when how much rest to have after a baby and when to get out and about. This seems to range from pressure to get on with life right away and to have everything “perfect” and entertain company. Some of our families, on the other hand, surround new those in the postpartum with plenty of care, good food, rest, and support for the first 40 days! Before your baby your midwifery team talked about the 5-1-1 rule for labour. Try giving yourself a solid two weeks of focused intentional rest. Some find benefit with the 5-5-5 rule:

5 days in the bed
5 days on the bed
5 days near the bed

Create comfortable infant feeding spaces

Many clients create one feeding space in a separate room like a nursery. In reality you will spend many hours of the day and night feeding a baby regardless of your feeding choice. Newborns have very small stomachs that need to be filled frequently in order for growth to happen. It’s very normal for newborns to feed every 1-3 hours, totalling up to 10-12 feedings (or more) every 24 hours. This is physically very demanding and will require lots and lots of time sitting. Prepare comfortable feeding spaces in different locations in your environment.

Make all the food

If you are breastfeeding, you can bank on being very very hungry and will need to consume an extra 300-500 calories a day. When you are stocking up on all the food for your postpartum time, think about having on-hand nutritious foods that you can eat with one hand and that you can quickly grab at all hours of the day and night.

Organize your village

While many people around you will offer help. There are two kinds of guests to consider after having a baby. There are “helpful guests” and “unhelpful guests.” Helpful guests are those you are comfortable enough having around to breastfeed in front of, to go into another room and rest while they are there, and you are comfortable enough around to allow them to take care of tasks that need doing for you (dishes, laundry, meal prep, etc). Unhelpful guests are those you feel you need to entertain and serve. Helpful guests can be encouraged to come. Unhelpful guests need to be limited and managed.

Resuming Activities

There is no set time-frame for when to begin physical activity again. If you feel while rested, try a small outline like a short walk for fresh air. You can gradually increase exercise, but slow down or stop activities if you feel achy, crampy, or sore afterward. Start physical activity when you feel ready. Stop the activity if anything hurts.

Pelvic floor exercises (Kegel exercises)

After pregnancy and delivery, your pelvic floor muscles can become stretched, swollen, and lax. When this happens you may not feel like you have the same amount of control over your bowels and bladder as you did before, and you may feel that your inner organs are not as well supported as they were before pregnancy. Kegel exercises strengthen the pelvic floor muscles, which support the uterus, bladder, small intestine and rectum. Think about doing a few Kegel exercises every time you feed your baby. Do not worry when you initially start doing these exercises that you do not feel much happening. This will improve with time and practice.

Resuming Intimacy

Full physical recovery time will vary. Nevertheless, while bleeding is still present, the pathway from the vagina through the cervix into the uterus is still open. This means that anything put into the vagina could potentially cause infection until which point the bleeding has stopped. Intimacy involves both acts that are both physical and emotional. So when you are ready to resume intimacy will depend on both aspects. Parts of your body that may have been open to intimacy may also feel different to you. For example, you may not desire your breast being touched for intimacy purposes when they are busy feeding a baby and the sensations may not be the same. Give yourself time as a partnership and family to explore new and old ways of expressing intimacy.

Family Planning

Birth spacing on your terms is important to us. While we value and treasure future customers, we do want to see you on your own terms. When you start to be fertile again after having a baby is quite individual. Although menstruation in many cases does not resume for six to eight months when you are exclusively breastfeeding, some clients will become fertile again much sooner. The problem with waiting until you menstruate to begin using birth control is that the way the cycle works is ovulation first and then menstruation. So you likely will not be able to pinpoint the first cycle that you are fertile again. In some circumstances, your care providers may recommend a minimum spacing before getting pregnant again. For example, if you have had a delivery by cesarean section we would recommend at least 18-months to 2-years before delivering another baby. Take some time to discuss with your partner birth control options and what would work with your family. Please note that not all birth control options are recommended when you are breastfeeding. Your midwifery team will discuss and where possible help facilitate options with you.