Download The 1 Weeks Guidelines

The 1st Weeks Guidelines
You have had your baby and you are now at home together. You may be feeling tired and uncomfortable, or you
may be feeling wonderful. You may be feeling confident of your parenting abilities or you may be feeling unsure.
Every new parent is different.
This guide has been put together to help you through your first weeks at home with your baby. In it, many
concerns which parents have identified are addressed, lf you take some time now to familiarize yourself with this
booklet, then you will be able to use it as a quick reminder when questions arise. If the answers are not here,
please be sure to call with your questions and concerns.
The Birthday!
During the first hour following the birth, the midwife will be checking your blood pressure, pulse, respirations and
temperature. Your uterus and vaginal flow will be checked and the uterus will be massaged if necessary. The baby
will be observed for color, temperature and respiratory rate. This can be done without separating the two of you.
We will help you get started with breastfeeding as soon as you and the baby are ready.
During the second hour you will be encouraged to empty your bladder and bathe yourself and the baby. The baby
will receive a complete physical exam. You will also be checked periodically. Before you are on your own we make
sure that you are confident in taking your own temperature and the baby's, lf you have chosen to have the baby
receive the erythromycin eye ointment and/or vitamin K., s/he will receive it during the physical exam.
After birth, the baby has a two or three hour alert phase. S/he will look around, respond to your voice and begin to
adjust to "life on the outside." S/he will nurse once or twice, may pass meconium or urine. Within a short time
s/he will have had all the stimulation that s/he can handle and go to sleep. It is not unusual for babies to sleep for 5
or 6 hours during this first period. Hopefully, you will be ready to get into your own bed and take advantage of this
one extended sleep cycle.
After this, you should nurse the baby every 2-3 hours, with only one four hour sleep period every 24 hours during
the first 2-3 weeks. It is nice when this period happens at night, but no matter when it happens you should sleep
too. The key to adequate rest is to sleep when baby sleeps. This is not as easy as it sounds. It takes some planning.
Temperature - Take your own temperature orally. Normal for mother will be between 36 and 37.8 C. if it is 38C or
more that is a fever. Take the baby's temperature under the arm.
Please use a digital thermometer. Normal for baby is 36.5 to 37.5 C. If the baby's temperature is over 37.5 C take
off a layer of clothing and re-check in 30 minutes. If the temperature is below 36.5 C place the baby skin to skin
with you and cover both of you or wrap the baby in a blanket or towel warmed in the dryer. If the temperature
does not return to the normal range within 30 minutes – page the midwife.
Fundus - This is the top of your uterus. Massage your abdomen and feel the firmness and position of the uterus.
This is done more easily when you are lying down. It should be staying firm and below your navel. If your fundus is
above your navel or off to one side, empty your bladder.
Aurora Midwifery – A midwifery practice serving Calgary, Alberta, Canada
Office: (403) 203-5105 Fax: 1-888-697-0574
www.auroramidwifery.ca
1st Week Guidelines - Continued
Flow - You should change your pad every time you go to the bathroom or sooner if necessary. You should not be
saturating a pad in less than one hour. If you find that you are saturating a pad in 30 minutes, front to back, top to
bottom, a big pad, take these actions:
Empty your bladder. A full bladder can prevent the uterus from contracting well.
Lie down with your feet up. Doing too much can result in an increased flow.
Massage your uterus to make it firm. Massage causes the uterus to contract.
Nurse your baby. Nursing releases the hormone oxytocin, which makes the uterus contract.
This should slow your bleeding considerably. If you saturate another pad in 30 minutes after taking these steps,
call the midwife. We may make additional suggestions or refer you to the hospital.
Also notice how your flow smells. If should smell "fleshy" like a normal period, but not fishy or foul. A bad odor
could mean infection.
Vaginal Flow
After birth, your uterus begins to undergo changes that will return it to its non-pregnant condition. Involution is
the term used to describe this process of change. The vaginal discharge you are having is the normal response of
your body to these changes. Right after birth, the discharge (lochia) will be dark red and heavier than your usual
menstrual period but will decrease rapidly in the first week. Over the first few days the discharge will change to
pink or brownish in color and become thinner. Eventually the discharge may turn yellowish or cream colored. This
whole process may take anywhere from 3 to 6 weeks.
Between days 7 and 14 after birth many women have an episode of increased flow. This happens when the blood
that formed a type of wet scab called eschar is passed. This scab covered the area where the placenta was
implanted. This increased discharge should not last more than 1-2 hours before diminishing. There should be no
pain, odor or fever. If it lasts longer than 2 hours, call your midwife.
Often an increase in the amount of discharge is your body's way of telling you to get more rest. Lying down or
relaxing will help to decrease the flow. If your flow increases in quantity, changes back to a previous color, you
begin to pass clots, if you have pain, a foul odor to the flow, a fever or feel ill, call your midwife.
Afterpains
After pains, or afterbirth pains, are caused by contractions of the uterus which shut off the flow of blood from the
blood vessels which fed the placenta. This is one of the ways that bleeding controlled. They are often felt more
strongly during breastfeeding especially by women who have had a baby before. A woman who has had other
babies tends to have a more relaxed uterus which contracts and relaxes. It is the process of contracting that causes
the feeling of pain. Breastfeeding stimulates the release of oxytocin which causes the milk to let down and also
causes the uterus to contract.
Afterpains can be reduced by keeping your bladder empty so remember to urinate frequently. In addition you can
try lying face down with a pillow placed under you abdomen. This creates pressure on the uterus which leads to
one big contraction which stays. If the uterus stays contracted the cramping goes away. Massaging the uterus can
have the same effect.
If these methods are not effective you can take ibuprofen 600 mg every 4 to 6 hours as needed (max 2400mg in
24hrs). If these methods do not work then call the midwife.
Aurora Midwifery – A midwifery practice serving Calgary, Alberta, Canada
Office: (403) 203-5105 Fax: 1-888-697-0574
www.auroramidwifery.ca
1st Week Guidelines – Continued
Care of Your Perineum
Whether or not you have had stitches, your perineum (the area between your vagina and rectum) will need some
TLC. Treat it like an athletic injury (Isn't pushing an Olympic event?). You can use an ice pack on and off during the
first 12 hours. Sanitary napkins dampened with Tincture of Calendula solution and placed in the freezer for several
hours or longer work well. After 24 hours you can take a warm sitz bath several times a day. One half cup of Epsom
salt or an herbal preparation can be added to the sitz bath. Run just enough hot water to soak your bottom. Sit for
15-20 minutes. You may need to add more hot water if it cools quickly
Keep the perineum clean by rinsing it off with warm water every time after using the bathroom. Adding a dropper
full of Tincture of Calendula to the squirt bottle is recommended. Pat the area dry with toilet tissue. Always pat
from front to back and use clean tissue for each pass. Apply a clean pad. Especially important is washing your
hands well before and after using the toilet. Continue to do this for 2 to 3 weeks or until any stitches have healed.
You can shower or bathe as usual with regular bath soap. Do not use bubble bath or bath oil in the water. If you
have any drainage that you think is from the stitches or you have increasing pain from the stitches, call the
midwife. Doing Kegel exercises can also help. Do these especially when you sit down or rise to protect the tender
tissues. If you feel that you need a pain relief medication acetaminophen (Tylenol) or ibuprofen can be taken
according to recommendations on the bottle. Call your midwife if the pain becomes worse.
Bowel Function
It is usual not to move your bowels until 2 or 3 days after birth as your digestive tract has slowed for labour and it
takes time to get back to normal. Sometimes women fear that they will hurt themselves or any stitches by movingtheir bowels. This will not happen. Please follow your urge when it comes, and it will not be as bad as you fear!
You can attempt to avoid discomfort by drinking up to 8 glasses of water and/or juice per day, eating fruits and
other sources of roughage and taking short walks several times during the day. If you are constipated or having
difficulty passing stools, you can try a bulk laxative such as Metamucil or an over the counter stool softener. If you
have not had a bowel movement after the 4th day and you are concerned, call the midwife.
Hemorrhoids
Some women develop hemorrhoids during pregnancy or with birth and other women who already have
hemorrhoids may find they become worse with childbearing. To relieve the pain you can use a warm sitz bath
followed by an application of cold witch Hazel (Tucks) then one of the Hemorrhoid creams such as Preparation H or
Anusol. This can be used as often as necessary.
To speed healing and avoid irritating the hemorrhoids, try to avoid constipation or straining during bowel
movements. This can be done by eating lots of fiber such as fruits, vegetables and whole grains, and drinking lots
of fluids, at least 8 glasses daily. Regular exercise such as walking is also beneficial.
Aurora Midwifery – A midwifery practice serving Calgary, Alberta, Canada
Office: (403) 203-5105 Fax: 1-888-697-0574
www.auroramidwifery.ca
1st Week Guidelines - Continued
Urination
It is important to prevent your bladder from becoming overly full during this postpartum period. Try to urinate at
least every few hours when awake. You may find yourself urinating more often and in very large quantities in the
first few days after birth. This is a way your body uses to get rid of extra fluid built up during pregnancy and is
normal. It is especially important to drink lots of fluids, even if you feel like you are urinating frequently as it is easy
to become dehydrated.
If you feel any discomfort while urinating call the midwife. Burning or pain with urination, difficulty starting to
urinate, a sensation that you have to urinate immediately or cloudy urine with or without a foul odor may all be
signs of a urinary tract infection.
Night Sweats
You may also find that you are perspiring more than usual in the first few days. This is another way your body uses
to get rid of extra fluid built up during pregnancy and is normal.. To cope with sweating, try taking a couple of
showers a day, wearing natural fibers and dressing in layers.
Breasts and Nipples
Your milk will "come in" somewhere between 2 and 4 days after birth. There may be swelling and breast fullness
which may last for up to 48 hours after the milk comes in.
Most women have a certain degree of fullness at this time which is just progressive filling of the breasts. It is not
uncomfortable and the baby can get on the breast to nurse. On the other hand, engorgement is excessive fullness
which makes the breast feel hard and painful. When the breast is engorged it may be difficult for the baby to latch
on. The best way to prevent this condition is to put the bay to the breasts frequently and as long as possible from
birth on in order to drain them.
For the first few days it is common to feel tenderness in the nipples when the baby begins to suck. This should not
last more than a few sucks and should pass within a few days. If there is pain when the baby nurses, check that the
baby is latched on well.
Stimulate the baby to open his/her mouth wide by brushing the nipple against the baby's lips. When the baby's
mouth is wide, pull the baby deeply onto the breast. This should be done quickly. Make sure that the baby gets
most or all of the dark area around the nipple (areola) into his/her mouth. This is important since suckling is
actually a squeezing action by the baby's jaws at the base of the areola. This is more comfortable on the mother's
nipple and results in more effective milk transfer so that the baby gets more milk. If you are still experiencing pain
or the baby does not appear to be latched on deeply, take the baby off the breast and latch on again. To break the
suction, gently place your finger into the baby's mouth so that the suction is broken. Don't pull your breast away
as most babies just suck harder. Encourage the baby to suck as long as he/she is interested. After the baby
spontaneously releases the first breast offer the other breast.
It is good to vary the positions used for nursing as this encourages complete drainage of different areas of the
breast. As a general rule, the area toward which the baby's chin is pointing is the area which is being drained the
most. It is also good practice to drink when your baby drinks. When you sit down, try to have a glass of water or
juice handy.
Aurora Midwifery – A midwifery practice serving Calgary, Alberta, Canada
Office: (403) 203-5105 Fax: 1-888-697-0574
www.auroramidwifery.ca
1st Week Guidelines - Continued
Breastfeeding is a learned skill for both mother and baby. Have patience. If you continue to experience problems,
call the midwife. It is much better to call us sooner so that small problems do not become big problems. If you
have sore or cracked nipples, symptoms may appear anytime in the first week after the birth but are most
common from the third to the fifth day. It is believed that the tremendous physical and hormonal changes that the
mother's body is experiencing as it returns to the non-pregnant state are responsible. Discomfort and fatigue can
also play a part. Reassurance, support and lots of rest are usually all that is needed. If the blue feelings last longer
than the tenth day or make it difficult to look after yourself or your baby, call the midwife.
Family Adjustment
Adding a new baby to the family requires adjustments on the part of all family members. Many women are
surprised at the time and energy required to care for a new baby. It may be necessary to remind yourself that
being a super housekeeper is not as important as spending time with your family. Many tasks can be left for later
or done by others. Including fathers and siblings (if present) in baby care is one way of integrating the baby into
the family relationships and sharing the load. It is also beneficial for the father, or another special person, to spend
extra time with older siblings.
Sexuality
The excitement and attention focused on the new baby, together with new responsibilities and the fatigue that
comes from night time awakenings may leave little time or energy for couples to give to each other. Couples will
find it beneficial to arrange for time together. Relaxation and time together provide the opportunity to
communicate and maintain the relationship. Family, friends or other reliable persons can be enlisted as baby
sitters as the parents wish.
Although sexual activity can safely be resumed when the perineum is healed and the bleeding has mostly stopped,
the desire to resume sexual activity varies greatly among women and their partners. It may be affected by pain or
tenderness from any stitches, concerns regarding milk letdown during sexual activity, lack of privacy or
interruptions. The vagina may be dry. This is due to a decrease in hormone levels, especially if you are
breastfeeding. Use of a water soluble lubricant or contraceptive foam can increase comfort. If the milk let down
reflex is bothersome, a bra can be worn during sexual activity or the baby can be fed immediately before. Good
communicate on, a sense of humor and patience go a long way towards smoothing over the rough spots.
Periods and Contraception
The return of menstruation varies according to the individual woman's pattern and whether or not she is
breastfeeding. Most non-breastfeeding mothers resume menstruating between six and ten weeks after the birth.
The return of periods for breastfeeding mothers is associated with the length of time she continues breastfeeding
and whether or not supplemental formula is used for infant feeding. The longer the woman breastfeeds, the
longer the delay in the return of periods tends to be. Remember, OVULATION PRECEDES menstruation. The
woman who wishes to control future conception cannot wait until her periods resume, so the woman needs to be
using a birth control method when she resumes sexual activity. There are many different types of birth control
methods available to meet the varied needs of women, including those who are breastfeeding. You should contact
your midwife for assistance in deciding which method is right for you.
Aurora Midwifery – A midwifery practice serving Calgary, Alberta, Canada
Office: (403) 203-5105 Fax: 1-888-697-0574
www.auroramidwifery.ca
1st Week Guidelines - Continued
Baby Care
Breathing - Irregular, shallow breathing is normal for a newborn. Count your baby's respirations for a full minute to
get a good idea of the rate. Normal ranges are 40-70 per minute on the first day and 30-60 thereafter.
Baby's make all kinds of faces and noises, most of which are endearing and normal. Watch for flaring nostrils,
grunting with expiration, or gasping. These are signs that the baby is having to work hard to breathe and should be
reported to your midwife. Also report if the baby's chest pulls in between the ribs when he breathes.
Colour - Regardless of race or national heritage, all newborns are pink. It is not uncommon for the baby's hands
and feet to be blue during the first day. If it happens after the first day it may mean that he is cold. Observe the
color around his mouth and nose. A blue tinge can mean a problem. -Call us and report it as soon as possible.
Umbilical Cord Care
Turn the diaper top down to allow air to reach the stump and help it to dry. It is not necessary to clean it. If you
wish to clean it, you may use Tincture of Calendula on a q-tip around the outside. When the cord is nearly ready to
fall off, you may clean it instead with hydrogen peroxide. The solutions are cold, but the cleaning is not painful.
Urine and Stools
The baby should pass his first urine and his first stool within 24 hours. The first stool is sticky, greenish-black. It is
helpful to coat the baby's bottom with olive oil or Vaseline whenever you change her to increase the ease of
cleaning it up. You may see a small streak of orange in the baby's diapers. These are called "brick dust spots" or
uric acid crystals. They are harmless and will disappear.
The birth of a baby is a wonderful and exciting time for everyone. Take time to nourish and pamper yourself.
Treasure these special moments. We are here for you 24 hours a day to assist you along this incredible journey
into parenthood. If you have concerns – please call your midwife.
Aurora Midwifery – A midwifery practice serving Calgary, Alberta, Canada
Office: (403) 203-5105 Fax: 1-888-697-0574
www.auroramidwifery.ca