MemorialCare - Your Guide to Postpartum and Newborn Care

YOUR GUIDE TO Postpartum and Newborn Care

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Postpartum Care All of our spacious postpartum rooms are private or semi-private with large windows. Our highly trained maternity nurses provide education from breastfeeding to baby care, as well as support for feedings and diapering. Birth Parent Couplet Care To enhance bonding, we practice birth parent couplet care. A single nurse cares for both the parent and baby together as one unit. Studies show that infants in their parents presence cry less, have a more stabilized blood sugar, temperature, pulse and respiration rate.

Cherese Mari Laulhere BirthCare Center Our level IV BirthCare Center is designed for your comfort and safety. Your entire birthing experience takes place in a private labor, delivery and recovery (LDR) suite, complete with a bathroom and shower. Each suite is equipped with a state-of-the-art birthing bed that allows you to deliver in the position that makes you most comfortable. These spacious rooms allow the birth parent, partner and/or doula and their family and friends (up to three) to visit and celebrate the birth in bright and airy surroundings. We offer the very latest in technical and developmental care techniques and encourage parental involvement in all aspects of care so you can spend as much time as possible with your baby. Neonatal Intensive Care Units Before birth or immediately after birth, your baby may need specialized medical care. It’s reassuring to know that our level IV Neonatal Intensive Care Unit (NICU) is just footsteps away staffed with specially trained nurses, board-certified neonatologists, respiratory therapists, dietitians and lactation consultants.

YOUR GUIDE TO POSTPARTUM AND NEWBORN CARE

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Educational Videos

Table of Contents

PART 1: Caring for Yourself

PART 2: Caring for Your Newborn IntheHospital.. . . . . . . . . . . 24 Rooming-In.................24 Preventing Infection.. . . . . . . 24 AvoidingFalls.. . . . . . . . . . . . . . 24 Newborn Appearance.. . . . 25 Newborn Screenings.. . . . . 26 Blood........................26 Hearing.....................26 Heart........................26 Jaundice....................26 BloodSugar.................26 Newborn Jaundice.. . . . . . . 27 Circumcision.. . . . . . . . . . . . . 28 Hands-On Care.. . . . . . . . . . 29 Skin-to-Skin Care.. . . . . . . . . . 29 UmbilicalCord.. . . . . . . . . . . . .30 MucusRemoval.. . . . . . . . . . . .30 NailCare....................30 Stools&Urine............... 31 Dehydration................ 31 Changing Diapers.. . . . . . . . . 32 DiaperRash.................33 PenisCare...................33 Bathing Your Baby.. . . . . . . . . 34 Swaddling. . . . . . . . . . . . . . . . . . 35 Taking a Temperature.. . . . . 36 InfantCrying.. . . . . . . . . . . . . .37 Overstimulation .. . . . . . . . . . . 37 Colic.........................37 Calming & Comforting.. . . . . 38 Shaken Baby Syndrome.. . 39 SafeSleep................ 40 The ABCs of Safe Sleep.. . . 40 ReducingRisk.. . . . . . . . . . . . . 41 TummyTime................42 Overheating................42 Rooming-in at Home.. . . . . . 42 Car Safety Seat.. . . . . . . . . . 43 Purchase & Installation.. . . 44 Look Before You Lock.. . . . . 44 Late Preterm Infant.. . . . . . 45 Temperature................45 Angle Tolerance Screening...................46 Continuing Care.. . . . . . . . . . . 46

PART 3: Your Breastfeeding Journey Breastfeeding.. . . . . . . . . . . 48 Importance of Breastfeeding.. . . . . . . . . . . . . 48 Supplementing withFormula.............. 48 MakingMilk................ 48 FeedingCues...............49 Preparing to Breastfeed.. . . 49 Getting into Position .. . . . . . 49 Latching-On................50 Baby-LedLatch.. . . . . . . . . . .50 Burping.....................50 SafetyTips..................50 Newborn Feeding Patterns................... 51 TheFirst5Days.. . . . . . . . . . . . 51 Feeding Variations.. . . . . . . . . 52 How Much NewbornsEat...............53 Common Concerns.. . . . . . 54 Engorgement...............54 Ductal Narrowing.. . . . . . . . . . 54 Mastitis......................55 SoreNipples................55 Expressing Breast Milk.. . 56 Hand Expression.. . . . . . . . . . . 56 BreastPumps...............57 Storage Guidelines .. . . . . . . . 57 Daily Feeding Log.. . . . . . . 58 Lifestyle Decisions.. . . . . . . . 59 Alcohol......................59 Smoking & Vaping.. . . . . . . . . 59 Marijuana (Cannabis).. . . . . . 59 Medications & Drugs .. . . . . . 59 PART 4: Bringing Baby Home Before Discharge.. . . . . . . . . . 60 ComingHome.. . . . . . . . . . . . .60 Big Brothers & Sisters.. . . . . . 60 Accepting Help.. . . . . . . . . . . . 61 Managing Visitors .. . . . . . . . . 61 FamilyPets................. 61 Follow-Up Care.. . . . . . . . . . . 61 Newborn Warning Signs.. . 61 Glossary...................62 Newborn Warning Signs.. . . . . . . . . . . 63 POST-BIRTH Warning Signs.. . . . . . . . . . . 64

Scan the QR Codes throughout this book to watch the helpful educational videos listed below.

Before You Go Home.. . . . . . 4 Rest&Sleep.................. 4 AvoidingFalls................4 Physical Changes.. . . . . . . . . . 5 Uterus........................ 5 Vaginal Bleeding (Lochia).. . 5 Infection (Sepsis). . . . . . . . . . . . .6 Postpartum Hemorrhage.. . 6 Bladder...................... 6 Bowels....................... 7 Hemorrhoids................. 7 PelvicFloor.................. 7 After Vaginal Birth.. . . . . . . . . 8 Perineum .. . . . . . . . . . . . . . . . . . . 8 PerinealCare................. 8 MovingAround.. . . . . . . . . . . . . 8 Showers&Baths.. . . . . . . . . . . . 8 After Cesarean Birth.. . . . . . . 9 WoundClosure.............. 9 Dressing Options.. . . . . . . . . . . 9 IncisionCare................ 10 Showers&Baths.. . . . . . . . . . . 10 GasPain..................... 10 Cesarean Pain. . . . . . . . . . . . . . .10 MovingAround.. . . . . . . . . . . . . 11 Managing Pain.. . . . . . . . . . . 12 Natural Techniques.. . . . . . . . 12 Pain Medication.. . . . . . . . . . . 12 Possible Complications.. . . 13 HeartIssues................. 13 Blood Clot in Leg (DVT).. . . . 13 Postpartum Preeclampsia.. 13 Self-Care...................14 Sleep........................ 14 Skin......................... 14 Hair.......................... 14 Varicose Veins. . . . . . . . . . . . . . .15 Menstrual Cycle.. . . . . . . . . . . . 15 Pregnancy Spacing.. . . . . . . . 15 Sexual Activity.. . . . . . . . . . . . . 15 HealthyHabits.. . . . . . . . . . . . . 16 Physical Activity .. . . . . . . . . . . 16 Follow-Up Care.. . . . . . . . . . . . 16 Emotional Challenges.. . . . 17 Postpartum Blues.. . . . . . . . . 17 Perinatal Mood Disorders.. 18 Related Conditions.. . . . . . . . 19 Treatment & Support.. . . . . . 19 Depression Questionnaire.. 20 Spouses & Partners.. . . . . . . 21 Providing Support.. . . . . . . . . 21 Paternal Perinatal Disorders....................22

FIND: Look for the blue Scan + Play icons throughout this book. SCAN: Use your camera to scan the blue icons. Better Sleep intheHospital................4 Preventing Falls AfterChildbirth.. . . . . . . . . . . . . . 4 UterusChanges.. . . . . . . . . . . . . 5 Hemorrhoids................. 7 Postpartum Perineal Care.. . 8 Cesarean Birth Care.. . . . . . . . . 9 POST-BIRTH Warning Signs. . . . . . . . . . . . . . .13 Postpartum Preeclampsia . . 13 RestandSleep.. . . . . . . . . . . . . 14 Postpartum Emotional Changes.. . . . . . . . 17 Rooming-In.................24 InfantFalls...................24 Newborn Medical Procedures..................26 Jaundice.....................27 Skin-to-Skin.................29 Umbilical Cord Care.. . . . . . . . 30 Diapering a Baby.. . . . . . . . . . . 32 Bathing Your Baby.. . . . . . . . 34 Swaddling a Newborn.. . . . . 35 Taking Your Baby's Temperature................36 Baby Behavior: Overstimulation.. . . . . . . . . . . . 37 Shaken Baby Syndrome.. . . 39 SafeSleep.................. 40 CarSeatSafety.. . . . . . . . . . . . .43 Milk Production.. . . . . . . . . . . 48 FeedingCues.............. 49 Breastfeeding Latch.. . . . . . 50 Burping Your Baby.. . . . . . . . 50 Hand Expression.. . . . . . . . . . . 56 FeedingLog.................58 Baby's Warning Signs.. . . . . . 61

Copyright 2000, 2020 by Customized Communications, Inc. All Rights Reserved Updated: 4/2022, 4/2023, 4/2024, 4/2025, 4/2026

Your Guide to Postpartum and Newborn Care is for general reference purposes only and cannot be relied upon as a substitute for medical care. You and your baby should have regular checkups with your health care provider. You should also consult with your health care provider about any special questions or concerns. All words shown in purple text are defined in the glossary on page 62.

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Arlington, Texas | 800.476.2253 www.baby360.com | info@baby360.com

PART 1

Caring for Yourself The first 6 weeks after your baby’s birth (the postpartum period) will be filled with many changes and challenges. That’s why you need to know what to expect and how to care for yourself after you bring your little one home. Everyone’s birth experience is unique. And it can take anywhere from 6 to 12 weeks before you feel like your “new” self. During this time, get as much rest as you can. Pay attention to how your body is adjusting after giving birth. Above all, make time for plenty of personal care and attention. Self-care will help you feel more comfortable, healthy, and confident as you adapt to life with your new baby.

Before You Go Home

There are lots of things that need to happen before you and your newborn can be discharged from the hospital. In addition to evaluating the health of you and your baby, your nurses and health care provider will need to make sure you can walk around safely and take care of your new baby—and yourself.

SCAN + PLAY

REST & SLEEP Hospitals can be busy places. And it can be a challenge to get enough rest and sleep after going through labor and childbirth.

AVOIDING FALLS Giving birth increases your risk of falling, both in the hospital and after you go home. Falls can happen when you’re in pain or feeling exhausted or dizzy, or your legs feel weak— sometimes all at the same time. Whether you have a vaginal or a cesarean birth , the first few times

What can help • Rest or sleep when your baby sleeps • Ask if other hospital staff can come in during nurse visits • Ask your nurse to visit when you’re already awake for night feedings • Ask for pain medication if you need it so you can rest and sleep comfortably • Ask visitors to give you and your partner private time to bond with your baby • Invite loved ones to connect on a video call or wait to visit after you get home

SCAN + PLAY

you try to get up to use the bathroom may put you at risk of slipping, tripping, or falling. Even worse is the possibility of falling while holding your newborn. The risk of falling is highest in the first few days after childbirth. Your nurse will want to be with you the first time you get out of bed. Ask your nurse to show you how to safely sit up, swing your legs over, stand, and take a couple of steps. If you feel unsteady or unsure at any point, sit back down. Lowering risk • Have someone nearby to help you, especially at night • Remove shoes, cords, or other trip hazards • Turn on a light so you can see where you’re walking • Take pain meds as directed, usually 30 minutes before getting up • Use a shower chair and bathmat to prevent slipping

4 Your Guide to Postpartum and Newborn Care

VAGINAL BLEEDING (LOCHIA) After giving birth, you’ll have a bloody vaginal discharge called “ lochia ” that lasts a week or two or sometimes longer. This is part of the natural healing process for your uterus.

The best way to contain lochia and protect your clothes is with large, super-absorbent pads. Be sure to change pads frequently to prevent infection and irritation. To lower infection risk, avoid tampons, reusable menstrual cups or disks, and douches until your health care provider tells you it’s OK. Appearance At first, lochia appears bright red, is heavy in flow, and may contain small blood clots. It has a distinct smell that people often describe as fleshy, musty, or earthy. You may have less lochia if you had a cesarean birth. What to know • Blood collects in the vagina when you’re sitting or lying down, making lochia heavier after you stand up • Because too much physical activity can increase blood flow, you should slow down and rest often • Lochia decreases and lightens over the first few weeks but may continue for 4 to 6 weeks

Physical Changes

Your body goes through many different changes during pregnancy—some you can see and others you may not notice. After giving birth, you will experience different kinds of changes, including some with the potential to become serious or even life-threatening. Understanding how to manage postpartum physical changes and challenges makes it easier to prevent infection and help your body heal. You’ll also want to pay attention to how your body is working and learn how to recognize the warning signs of a potential complication. UTERUS Over the course of your pregnancy, your uterus enlarged to contain your growing baby. And it will take a few weeks to return to pre-pregnancy size and weight. After you give birth, your health care provider will check your uterus regularly to make sure it is returning to normal size. This is done by pressing on your abdomen. Checking your uterus may cause some discomfort, so be sure to take deep breaths and try to relax before it happens. “Afterbirth pains” are normal belly cramps you may feel as your uterus shrinks back to pre-pregnancy size. They may be stronger during breastfeeding if you had multiples or if this isn’t your first baby. Cramps usually go away on their own by the end of the first week after childbirth. What can help • Empty your bladder frequently SCAN + PLAY

FIRST 1 TO 3 DAYS

• Bright to dark red

• Heavy to medium flow

• May have small clots

• Use relaxation and breathing techniques • Take pain medication as directed by your health care provider

ABOUT DAYS 3 TO 10

• Pink or brown-tinged

• Medium to light flow

• Very few or no small clots

Uterus

ABOUT DAYS 10 TO 14 (MAYBE LONGER)

Bladder

• Yellowish-white (no bright red)

Cervix

• Very light flow

Vagina

• No clots

Pre-Pregnancy

Postpartum

5 Your Guide to Postpartum and Newborn Care

POSTPARTUM HEMORRHAGE Lochia during the postpartum period is normal. If you have a lot of heavy bleeding, you may have postpartum hemorrhage , which can happen any time during the 12 weeks after your baby’s birth. Hemorrhage can be hard to

identify. Pay attention if you experience a constant, steady flow of blood and not just a gush after physical activity or standing up.

Signs & Symptoms

Tell a nurse or your health care provider immediately if you: • Bleed through 1 pad in 1 hour or less • See blood clots egg-size or larger • Have signs of very low blood pressure: blurred vision, feeling faint, dizziness • Feel weak or have clammy skin Call 911 or have someone take you to the closest emergency room if you: ▶ Have a very fast heart rate ▶ Are extremely tired ▶ Feel mentally confused

INFECTION (SEPSIS) Maternal sepsis is a serious and potentially life-threatening condition that arises when the body’s response to infection damages its own tissues and organs. Infectious toxins (usually from bacteria) may be

present in the bloodstream. If bacteria gets into the lining of the uterus during childbirth, it can cause an infection called endometritis . What to know • If not treated quickly, endometritis can lead to sepsis, shock, and organ failure • Endometritis typically happens 2 to 10 days after childbirth • Infection may also develop up to 6 weeks after giving birth Super-absorbent pads are the best choice to protect clothing from vaginal bleeding. To help lower infection risk, follow these guidelines for 6 weeks after giving birth : • Avoid tampons, menstrual cups, or discs • Don’t put anything in your vagina • Stay out of pools and hot tubs • Don’t douche

BLADDER For the first few days after giving birth, try to empty your bladder every 3 to 4 hours. When your bladder is full, it can put pressure on your uterus that may: • Prevent it from returning to normal size • Increase vaginal bleeding (lochia) Because your body is getting rid of the extra fluid it took on during pregnancy, it’s normal to pass large amounts of urine over the first few days. If you had a cesarean birth, you may have a catheter in your bladder after surgery. The goal is to have the catheter removed as soon as possible, typically 6 to 12 hours after giving birth. Urinary tract infection (UTI) It’s not uncommon to develop a urinary tract infection after giving birth, with or without any obvious signs or symptoms.

Signs & Symptoms

Signs & Symptoms

Tell a nurse or your health care provider immediately if you: • Notice lochia has a bad odor • Have severe pain or tenderness in abdomen • Run temperature of 100.4°F or higher or 96.8°F or lower • Experience shaking or chills • Feel warm or have clammy/sweaty skin Call 911 or have someone take you to the closest emergency room if you: ▶ Feel confused or disoriented

Tell a nurse or your health care provider immediately if you have: • Burning during urination • Pain in lower abdomen

• Elevated fever • Blood in urine • More frequent urination

Anytime you have signs and symptoms of complications and you can't reach your health care provider, go to the nearest emergency room .

▶ Have trouble breathing ▶ Experience a skin rash ▶ Are in severe pain or discomfort

6 Your Guide to Postpartum and Newborn Care

BOWELS After giving birth, your first bowel movement may not happen for 2 to 3 days. Hormones , medications, dehydration, the worry about pain, and decreased physical activity can all

HEMORRHOIDS Many people develop hemorrhoids during pregnancy. Hemorrhoids are swollen veins at the opening of the rectum, inside the rectum, or outside on the anus that can be painful, itchy, and even bleed. Although not usually serious, hemorrhoids can be very uncomfortable.

slow down bowel function. When you finally have your next bowel movement, it may be a little uncomfortable or you may feel anxious or fearful. When it’s time • Relax and take some deep breaths • Put your feet on a stool (if you don’t have a severe perineal tear) • Rest your elbows on your knees • Option: Use a sanitary pad for support, holding it from the front as you support the perineum

SCAN + PLAY

What can help • Eat healthy (especially high-fiber) foods • Drink plenty of water to avoid constipation • Avoid straining during bowel movements • Avoid sitting or standing for long periods of time • Use premoistened wipes instead of toilet paper • Apply ice packs or witch hazel pads to the area • Soak in a warm tub several times a day • Use topical creams, suppositories, and pain medication (with provider approval)

WHAT CAN HELP

Signs & Symptoms

Go when you feel the urge

Tell a nurse or your health care provider immediately if you have:

• Pain in your lower abdomen • Severe pain or rectal bleeding • Frequent need to take laxatives

Drink 6-8 glasses of water a day

PELVIC FLOOR Your pelvic floor is the group of muscles that surround your pelvis. Think of it as a hammock

that supports and holds your abdominal organs in place. Your pelvic floor muscles are also important for activities like going to the bathroom and having sex. Pelvic floor physical therapy Following childbirth (vaginal or cesarean) pelvic floor physical therapy can help your body recover more quickly and comfortably, improve muscle strength, and reduce symptoms. Pelvic floor physical therapists typically treat: • Pelvic floor pain • Urinary leakage • Pelvic organ prolapse (feeling of heaviness or bulging) • Pain with intercourse • Diastasis recti (abdominal muscle separation) • Large vaginal tears or stitches • Trouble coordinating or strengthening pelvic muscles • The need for Kegel exercises and how to do them correctly You don’t have to live with symptoms that can be treated! But you may need to be persistent to get the care you need. If your health care provider is not familiar with the benefits of outpatient pelvic floor physical therapy for postpartum patients, ask about it yourself. In most U.S. states you don’t need a medical referral to schedule your first evaluation directly. But your insurance company may require a referral before they will cover the costs.

Eat fiber-rich foods

Walk or do yoga stretches

Take stool softeners

Did You Know? Evidence suggests that chewing gum in the first 24 hours after a cesarean birth may wake up your bowels and get them working faster. Gum chewing can also reduce gas,

help you feel more comfortable, and get you on to solid foods—great reasons to add a pack of gum (or two) to your overnight bag.

7 Your Guide to Postpartum and Newborn Care

After Vaginal Birth

Although every person’s birth experience is a little different, there are physical changes after a vaginal birth that require self-care to enhance healing and prevent infection.

SCAN + PLAY

PERINEUM Your perineum is the area between your vagina and anus. In the first few weeks after giving birth, it will need some extra care. During vaginal birth, this area stretches and may tear. You may have had an episiotomy in your perineum to help the baby be born. If you received stitches, they will dissolve on their own within a few weeks.

PERINEAL CARE Keeping your perineum clean and dry helps prevent infection and promote healing. Gently clean the area using a handheld shower or

squeeze bottle. Then pat the area dry using toilet paper or a moist, disposable wipe. Many hospitals provide a “peri bottle” you can fill with warm water and use to clean your perineum.

MOVING AROUND You should be able to get up and walk soon after a vaginal birth. If you had an epidural, you should wait for it to wear off (1 hour or more) before getting out of bed. Be sure to have your nurse with you to help when you get up for the first time. Get up slowly to prevent falling. After you’re able to get up, continue to be careful and don’t try to do too much too soon. When you get home, avoid housework and heavy lifting. Limit your trips up and down stairs. Taking it easy helps your body rest and heal as the muscles and ligaments that hold your uterus in place regain their strength.

To prevent infection • Wash your hands carefully before and after changing your pad

• Rinse area with warm water 2 to 3 times daily and after urination and bowel movements • Always rinse and wipe the perineal area from front to back Perineal pain If you experience pain and discomfort in the perineal area, here are some things that can help. To reduce pain and swelling • Apply an ice pack in the first 24 hours after giving birth

SHOWERS & BATHS You can usually shower soon after a vaginal birth. If you had an epidural, you will need to wait until it has worn off. You may also want to wait until your IV is removed.

At home • You can shower every day • 3 to 4 daily sitz baths: keeps perineum clean, enhances healing, reduces pain • Ask your health care provider when you can take a full tub bath

• Take a medication like ibuprofen • Lie on your side to rest or sleep To increase circulation and promote healing

• Apply warm compresses 24 hours after giving birth • Soak for 10 to 15 minutes in a warm bathtub or a sitz bath • A sitz bath is a small container filled with water, placed on top of a toilet seat

8 Your Guide to Postpartum and Newborn Care

After Cesarean Birth

After a cesarean birth, it’s important to know how to care for your surgical incision and protection dressing and how to manage other physical changes as your body recovers.

SCAN + PLAY

WOUND CLOSURE After cesarean birth, your abdominal incision will be closed using staples, stitches, sterile strips, or surgical glue.

INCISION CLOSURE OPTIONS

Type

Description

Shower Guidelines

• Removed at hospital or provider’s office • Replaced by wound-closure (sterile) strips

Staples

Pat dry

Stitches

• Dissolve on their own in 10 to 14 days

Pat dry

• Dry up and fall off in 7 to 10 days • Don’t pull off unless very loose in shower

Wound-closure strips

Fully air dry after showering

• Dries up, flakes off in first 2 weeks • Don’t scratch, rub, or pick at glue

Surgical glue

Fully air dry after showering

DRESSING OPTIONS

Sterile

Negative Pressure Wound Therapy

If you are at increased risk of developing an infection, you may be given a negative pressure wound therapy dressing. This special type of wound covering uses a vacuum to create negative pressure on the incision. What to know • Small battery pump in dressing wicks away moisture to keep incision dry • A negative pressure wound therapy dressing typically stays on for about 7 days • Battery pack can be removed to shower, then reattached after it dries

After closing the incision, your care team may cover it with a sterile dressing (bandage) to keep the area clean and dry as it heals. This also protects the incision from contact with your clothing. What to know • Most hospitals use a waterproof, breathable adhesive dressing to create a warm, moist healing environment • Your care team will tell you how long to keep dressing in place • You will be shown how to care for incision after dressing comes off

9 Your Guide to Postpartum and Newborn Care

INCISION CARE If you have a dressing covering your incision, the type of dressing and your health care provider’s preference will determine when it will be removed. This may be before you leave the hospital, at home, or during a follow-up visit to your health care provider’s office. What to do • Always wash your hands before and after touching incision • Check incision daily in a mirror for signs of infection • Use a freshly washed cloth to gently wash incision with warm, soapy water

CESAREAN PAIN It’s normal to feel some pain after a cesarean birth. Your nurse will talk to you about your level of pain and offer pain medication to help you feel more comfortable. In most cases, a combination of medications that act on different parts of your nervous system will be used to reduce the pain signals reaching your brain. Pain medication before surgery • Option to receive small dose of long-acting pain medicine in spinal or epidural • Helps maximize pain relief and minimize side effects like itching or nausea • Lasts up to 24 hours, offering high level of pain relief when pain is most intense

• Lightly pat incision area dry with a clean towel • If belly skin folds over incision, ask about a moisture-wicking fabric dressing

Nonopioid pain medication after surgery • Nonopioid medication options:

Signs & Symptoms

Pain-relieving: acetaminophen Anti-inflammatory: ketorolac Anti-inflammatory: ibuprofen Nerve pain reliever: gabapentin

Tell a nurse or your health care provider immediately if your incision is: • Red • Separated • Swollen • Warm to touch

• Tender or painful • Draining • Not healing • Smelling bad

• Taken as directed (possibly at different times), meds work together to help relieve pain and lower need for opioids • Even if pain-free at the time, consistently take meds every 6 to 8 hours (day and night) as directed by your provider • Missed dose may increase need for stronger drug to relieve “breakthrough” pain

SHOWERS & BATHS You can usually shower in the hospital after your catheter has been removed. Be sure you’re able to stand and walk around without getting dizzy. Tub baths, swimming, and getting into a hot tub are

Opioid pain medication If your nonopioid medications don’t reduce your pain, you may be given a stronger analgesic, typically an opioid like morphine or oxycodone. It’s important to limit the use of opioid medications if possible, as they can cause nausea, drowsiness, or constipation. Most patients can be comfortable without opioid medication, although some with severe discomfort may still need it. If you did not receive long-lasting pain medication during surgery, you may be given a patient-controlled analgesia (PCA) pump. The PCA pump delivers pain medication through your IV line. To receive pain medicine press the button on the PCA device.

not recommended for several weeks after surgery to allow your incision to fully heal. Ask your health care provider how soon you can get back in the water if this is important to you.

GAS PAIN A painful buildup of gas in your intestines

and constipation may occur, especially after a cesarean birth. To keep your bowels moving regularly, walk around as often as you can, eat high-fiber foods, and remember to drink plenty of water. What can help

Signs & Symptoms

• Get in a knees-to-chest position • Walk, rock, or lie on your left side

Tell a nurse or your health care provider immediately if your pain is: • Constant • Unusual • Worse than it was before • Keeping you from doing things you could do before • Located in the right upper area of your abdomen • Located just below your breastbone

• Drink warm fluids often • Avoid carbonated drinks • Don’t eat gassy foods

10

Your Guide to Postpartum and Newborn Care

GETTING OUT OF BED

When you first get out of bed, slowly roll to your side and use your top arm to push yourself up. Sit on the side of the bed for a minute before you get up to make sure you’re not dizzy. Place a pillow over your incision when you cough or move around in bed. If you have stairs at home, try to limit the number of times you walk up and down to only a few times a day.

Lie on back, pillow over belly

MOVING AROUND After a cesarean birth, you can expect to have some abdominal pain when you get up and move around, especially in the first hours and days. The sooner you start moving, the faster you will begin to heal and the better you will feel. Activity can also help improve bowel function and lower the risk of blood clots and pneumonia. In the hospital Always ask for help before getting up until your care team feels you can manage safely on your own. When you’re in bed, you may be encouraged to keep wearing the sequential compression devices (massaging sleeves) that were placed on your legs before surgery. Massaging sleeves help prevent blood clots and improve blood circulation.

Slide knees up one at a time

Lift bottom and move to edge of bed

DAILY ACTIVITY GOALS

• Walk around your room

First 24 hours after surgery

• Sit in the chair

• Walk in the hall several times

Next day and until you go home

• Eat your meals in the chair

Roll onto your side

At home You should be able to do most of your regular activities in about 4 to 8 weeks after cesarean birth. Until that time, it’s important to follow these recommended movement guidelines and restrictions:

DO NOT • Lift anything heavier than your baby

AT SAME TIME: Push up on one elbow while pushing down with other hand

• Do any kind of sit-ups or heavy housecleaning • Jog, exercise, or do anything that makes you breathe hard, strain muscles • Drive a car for at least 2 weeks • Drive if taking narcotic pain medicine or you feel weak or unsafe

DO

Swing bent legs over side, and you’re done!

• Take short walks to increase strength and stamina • Slowly increase your stamina to do light housework • Understand that you will tire easily

• Listen to your body and care for yourself • Wear your seat belt when you ride in a car

11

Your Guide to Postpartum and Newborn Care

NATURAL TECHNIQUES There are natural techniques and activities that may help you manage postpartum pain and feel more comfortable. What to try • Massage and relaxation • Deep breathing • Listening to music • Ice packs on the perineum for the first 24 hours • Warm sitz or herbal bath • Warm pad on abdomen for cramps • Using an abdominal binder

Managing Pain

PAIN MEDICATION In the hospital, don’t hesitate to tell your nurse if you are in pain and need medication. You may be asked for your “pain number” before taking something, then asked again in about an hour to see how well the medication worked. Always ask your nurse or health care provider if you have questions about any medications prescribed for you. It’s important to understand what medications are used for, how often to take them, and any possible side effects. You can try setting a personal goal for pain management or identifying the number at which you feel you need medication. Pain relief options at home • Topical creams or sprays for your perineum • Over-the-counter medications (ibuprofen, acetaminophen) • Prescription medications

Giving birth, vaginally or by cesarean, is often painful. You may experience pain from an episiotomy, lacerations, perineal trauma, incisions, uterine contractions after birth, hemorrhoids, breast engorgement , nipple tenderness, or something else. Keeping your pain level under control is important to your overall recovery. Don’t take too much pain medication as it can slow your recovery and make you too sleepy to function. What to know • Everyone reacts differently to postpartum pain, but there are ways to relieve it • Always speak up and let someone know if you are uncomfortable or in pain • You may need to try different pain-management techniques or medications to find what works best for you

PAIN RATING SCALE

worst imaginable pain

no pain

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Your Guide to Postpartum and Newborn Care

Possible Complications

If you sense that something is wrong with your body or you experience any of the warning signs highlighted throughout this book, you may have a serious or even life-threatening postpartum complication. Always take warning signs seriously and don’t hesitate to reach out for medical care right away. Your symptoms may be nothing. But they could be signs of something serious.

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HEART ISSUES

SIGNS & SYMPTOMS

EXTREME WARNING

POSTPARTUM PREECLAMPSIA Postpartum preeclampsia is a rare but serious condition related to high blood pressure and excess protein in the urine. Most cases appear in the first 48 hours after giving birth but can happen up to 6 weeks after childbirth. Preeclampsia is a very dangerous condition, but it can be treated if caught early. • NEVER ignore any signs or symptoms of preeclampsia • ALWAYS reach out for medical attention immediately Deep vein thrombosis (DVT) is a blood clot in the lower leg. Although uncommon, you are at higher risk for DVT for about 6 to 8 weeks after childbirth. If left untreated, a blood clot can break apart and travel to the lungs (pulmonary embolism) or to the brain and cause a stroke— both potentially life-threatening emergencies. Walking and staying active can help lower the risk of blood clots. But if you experience any blood clot warning signs, immediately reach out for medical attention. During pregnancy, your heart works harder than usual to pump blood to you and your baby. This extra stress can activate underlying heart issues or lead to the development of new heart problems during labor and childbirth and up to 1 year after giving birth. Potential problems • High blood pressure ̵ Preeclampsia Gestational high blood pressure Chronic high blood pressure • Cardiomyopathy (heart failure) • Stroke • Pulmonary embolism (blood clot travels through bloodstream to lung) BLOOD CLOT IN LEG

Call 911 or go to the closest emergency room if you: • Experience chest pain, tightness, or discomfort • Think you might

Tell a nurse or your health care provider immediately if you have: • Severe headache that won’t go away • Vision changes • Swelling in your legs or feet • Heart palpitations (skipping beats) • Blood pressure 140/90 or higher

be having a heart attack

• Shortness of breath • Difficulty breathing

SIGNS & SYMPTOMS

EXTREME WARNING

Call 911 or go to the closest emergency room if you have: • Chest pain

Tell a nurse or your health care provider immediately if you have: • Tender, red, hard, warm area on calf or thigh • Pain or tenderness that feels like a pulled muscle • Unexplained fever • Slight or moderate swelling in one leg • Rapid heartbeat or breathing • Coughed up blood

• Obstructed breathing or shortness of breath • Facial drooping • Arm weakness on one side • Difficulty speaking

SIGNS & SYMPTOMS

EXTREME WARNING

Call 911 or go to the closest emergency room if you are: • Short of breath • Seeing spots • Having a seizure

Tell a nurse or your health care provider immediately if you have: • Blood pressure 140/90 or higher • Severe headache that won’t go away

• Swelling of your hands or face • Vision changes like blurriness, flashing lights, or seeing spots • Upper stomach or shoulder pain under the ribs on the right side

Anytime you have signs and symptoms of complications and you can't reach your health care provider, go to the nearest emergency room .

Postpartum preeclampsia is a very dangerous condition that can be treated if caught early. If you have any symptoms that worry you or something just doesn’t feel right, trust your instincts. Call your health care provider or go to the closest emergency room right away. If you go to the emergency room:

• Tell them you just had a baby (provide the date) • Ask for an obstetrician or gynecologist within 1 hour • Have someone notify your health care provider

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Your Guide to Postpartum and Newborn Care

Self-Care

It can be tempting to focus all your time and attention on caring for your newborn. And this is important. But it’s just as important to take care of your own physical and emotional well-being. That’s what postpartum self-care is all about.

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SLEEP After you bring your new baby home, try to sleep (or rest) as much as you can, even if it’s just short naps during the day. A good rule to remember: When your baby sleeps, you sleep.

SKIN Increased hormone levels during pregnancy may cause some changes to your skin color and texture, including:

• Blotchy brown facial markings • A dark line down your belly • Pimples or acne • Tiny red blood vessels • Red rashes

Even if you can’t fall asleep, you can still do nice things to help your body rest and recover, including:

• Deep breathing • Yoga stretches • Relaxation and visualization exercises Keep it simple

For most people, these changes will go away completely or fade significantly within several months. But about 30% of people can expect them to last longer. Stretch marks will gradually fade to irregular silvery white lines but usually not disappear completely.

During your first weeks at home with your new baby, try to keep things as easy as possible. Focus on caring for your newborn and giving yourself plenty of time and attention as you recover from giving birth. The postpartum period is a perfect time to let friends and family members step in and help with things like shopping, cooking, laundry, cleaning up, and taking care of pets and other people who live in your home. What can help

HAIR Pregnancy can also change your hair’s growth cycle. While you’re pregnant, your hair is in a “resting phase” that minimizes hair loss. Within a couple of months after giving birth, you may

start to lose large amounts of hair. Try not to worry if this happens. Your hair will eventually return to its normal growth cycle, although it may take 6 to 15 months.

• Give visitors a clear message for short visits • Keep meals simple and mealtimes flexible • Postpone any major household projects • Avoid caffeine (coffee, tea, soda) • Stay off social media if it is too stimulating • Ask for what you need, when you need it

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Your Guide to Postpartum and Newborn Care

PREGNANCY SPACING The amount of time between

giving birth to one baby and getting pregnant with your next baby is called

pregnancy spacing . And it’s an important part of planning your family. In addition to affecting how close your children are in age, pregnancy spacing may also impact the health of you and your next baby. The American College of Obstetricians & Gynecologists (ACOG) issued the following guidelines about how long to wait between pregnancies. • Minimum: Wait at least 6 months. Pregnancy sooner than 6 months puts you at highest risk of serious pregnancy and birth complications, including uterine rupture (if you had a prior cesarean). • Best: Wait until 18 months. Waiting this long gives your body time to fully recover. It also lowers your chances of complications in your next pregnancy, including gestational diabetes, preterm (premature) birth, and low birth weight.

VARICOSE VEINS Varicose veins are soft, blue bulges in your legs that can form during pregnancy. They are caused when the vein walls weaken and swell with blood. Varicose veins usually improve without treatment, although there are some things you can do to help relieve discomfort.

What can help • Elevate your legs to improve blood circulation

• Wear compression hose or socks to reduce swelling • Do low-impact exercises like walking and swimming • Take an over-the-counter pain reliever (ibuprofen, naproxen, acetaminophen)

Signs & Symptoms

SEXUAL ACTIVITY Experts agree that couples should be honest about how they’re feeling about having sex after pregnancy and childbirth. Open communication can help minimize the possibility of frustration or misunderstandings. It’s a good idea to talk with your doctor and make sure you have their approval before putting anything in your vagina. If you had a tear, episiotomy, or cesarean incision, you may have concerns about resuming sexual activity. Tears and incisions can take a full 6 weeks to heal, so you’ll want to share this information with your partner. Ongoing pain may be caused by things like tight scar tissue, muscles that stay tense to protect the area, or changes in hormones. Your health care provider can help determine the cause and recommend the right treatment, which may include pelvic floor physical therapy. Challenges to intimacy Pregnancy and breastfeeding hormones may cause vaginal dryness and reduced lubrication for a few weeks after giving birth. This is completely normal and will improve. If this is a problem, a water-based lubricant can help. If you have trouble with sexual intercourse, always discuss it openly with your partner. Make time for each other several days a week to help enhance intimacy and rebuild a satisfying sex life. Sharing your feelings about sexuality is the most effective way to get and stay close, both physically and emotionally.

Tell a nurse or your health care provider immediately if you have: • Worsening pain • Redness or hardness around veins • Ulceration (open sore) around veins

MENSTRUAL CYCLE You will probably have your next menstrual cycle sometime within 7 to 9 weeks after giving birth. If you are breastfeeding, your cycle will usually return between months 2 and 18. But it’s

important to know that your body may begin producing eggs before your next period starts. This means you could become pregnant again before your next menstrual period! Because of this uncertainty, it’s a good idea to talk with your partner and your health care provider about resuming sex and how to manage the possibility of becoming pregnant again. Getting pregnant again sooner than recommended can be risky for you and your next baby. That’s why you’ll want to read and understand the pregnancy spacing section.

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Your Guide to Postpartum and Newborn Care

FOLLOW-UP CARE After you get home, remember to schedule a follow-up appointment with your health care provider. ACOG recommends:

• A phone call, video chat, or in-person checkup with your medical provider (physician or midwife) within 3 weeks after giving birth • An in-person visit with your health care provider no later than 12 weeks after the birth • Ongoing medical care for any health conditions, chronic diseases, or complications present before, during, or after childbirth After your in-person appointment (6 to 12 weeks postpartum), it’s very important that you continue to make your physical and mental health a top priority. What to do • Stay focused on any health issues (diabetes, blood pressure, obesity) • Keep your immunizations (vaccines, shots) up to date • Attend follow-up appointments with all health care providers

HEALTHY HABITS Pregnancy and childbirth can put your body under a great deal of physical stress. One of the best ways to start feeling better is to return to basic activities proven to contribute to a healthy lifestyle.

What can help • 6 to 8 hours of sleep (or resting in bed) nightly • Eating healthy, nutritionally balanced foods • Gradually returning to regular exercise Nutrition

Eating a wide variety of nutrient-rich foods from all food groups supports your physical and mental well-being. To keep your energy level steady, aim for 3 meals a day, plus 1 or 2 healthy snacks. If you’re not already doing it, start drinking plenty of water to stay hydrated. What to eat • Lean proteins • Fruits • Vegetables • High-fiber carbohydrates • Fats (avocados, nuts, seeds) Continue to make healthy eating an important part of your postpartum routine.

PHYSICAL ACTIVITY Another important way to improve your health is to start actively moving again. Talk to your health care provider about how soon you can start exercising and which activities

are safe. Then start slowly and don’t push yourself too hard. Work your way up to walking 20 to 30 minutes per day and start doing simple exercises to strengthen your back and stomach muscles. Benefits of exercise • Increased energy • Better sleep quality • Anxiety and stress relief

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Your Guide to Postpartum and Newborn Care

Emotional CHALLENGES

Becoming a parent is a major life adjustment . With all the changes a new baby brings to the family, it’s no surprise that you may find your emotions changing quickly from up to down to back up again. This is normal and usually levels out as you settle into caring for your new baby at home.

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What to know • New fathers or partners may also experience some emotional highs and lows • Remember to be patient with yourself and with each other when challenges occur • Talk with your health care provider if you would like some support handling your feelings

POSTPARTUM BLUES About 70% to 80% of new parents experience some negative feelings or mood swings, known as “baby blues.” These emotional upsets are common, typically start within a few days after baby’s birth, and usually last from a few days to a few weeks. In most cases, baby blues are related to changing hormones and fatigue. Symptoms • Crying • Impatience • Irritability • Mood changes • Poor concentration If you or your family feel that your symptoms are more severe or have lasted longer than 2 weeks , talk with your health care provider about available treatment and support. What can help • Get plenty of rest and sleep to regain your strength • Ask for help and be specific about what you need • Spend time outdoors, move around, walk, or dance • Spend time with your partner or a support person • Reach out for community or online peer support • Pamper yourself: aromatherapy, massage, warm baths (after approved by your health care provider)

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Your Guide to Postpartum and Newborn Care

The perinatal period begins at conception and concludes at the end of the first year after your baby’s birth. It can also be a time of significant physical and psychological changes for you and sometimes your spouse or partner. This chart provides an overview of 3 psychological conditions associated with the perinatal period . Perinatal MOOD DISORDERS

PERINATAL DEPRESSION (PND)

PERINATAL ANXIETY (PNA)

POSTPARTUM PSYCHOSIS

• 1 in 5 women and 1 in 10 men may experience symptoms

• Very rare condition requiring immediate intervention and medical care • Symptoms can vary, may change quickly, and differ from person to person

• 1 in 5 women and 1 in 10 men may experience symptoms • Significant overlap between anxiety and depression • Can easily be treated and managed

Overview

• Usually 3 to 14 days after childbirth

• Any time during perinatal period

• Can start any time during perinatal period • Significant overlap between anxiety and depression • Constant excessive worry • Fear of something bad happening • Racing thoughts • Sleep and appetite problems • Unable to relax or sit still • Dizziness • Hot flashes • Diarrhea • Nausea

Onset

• Agitation • Confusion • High energy • Racing thoughts • Sleep and visual disturbances • Speaking rapidly or nonsensically • Feeling afraid or like you’re under someone’s control

• Eating and sleeping disturbances • Irritability • Anger • Nervousness • Feeling guilty, worthless or hopeless • Excessive crying • Trouble concentrating • Not enjoying life • Feeling like a bad parent • Lack of interest in baby • Thoughts of harming yourself or your baby

Possible Symptoms

• Imagining something crawling on your skin • Thoughts of harming yourself or your family

• Feelings of anger • Irritability or rage • Frequently nervous or on edge

• Have someone step in to care for your baby • Call 911 or take person to the closest emergency room

• Talk with your health care provider or a mental health professional • Go online to find community resources support • If symptoms become severe, call 911 or go to closest emergency room

What to Do

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Your Guide to Postpartum and Newborn Care