These discharge instructions are included in your postpartum folder, we have included the files to download as well.
Postpartum Discharge Instructions for Mom
Please take your temperature and blood pressure twice a day until we see you for your first postpartum visit.
Bleeding: Postpartum bleeding (lochia) is like a heavy period. It should be intermittent rather than steady. The lochia after birth goes through three stages: bright red blood with clots (like a heavy period); pinkish brown (like the end of a period); and then a heavy cream colored discharge.
You should notice your bleeding tapering down and essentially gone by six weeks postpartum. Your bleeding should smell like a period. Do not use tampons, and change your pads often.
Your uterus (found below your bellybutton) should feel firm like a grapefruit. To help keep your uterus firm, nurse your baby “on demand” at least every two to four hours. Empty your bladder frequently (you may not feel a strong urge to go, as the nerve receptors in your bladder are enjoying the extra space). Massage your uterus if it does not feel firm.
***CALL THE ON CALL MIDWIFE LINE AT (817) 477-6551***
If you soak two pads (front and back) in an hour
If you pass a clot LARGER than a large egg (take a photo)
If you have a fever over 100.4 (if you have been nursing or doing skin to skin take baby off of you and re-check in 15 minutes)
Uterine tenderness (not cramping/after birth contractions)
If your bleeding has a strong foul odor
If your blood pressure is 140/90 or higher
If you are not feeling yourself: dizziness, headache that won’t resolve, swelling, nausea, or vision disturbances
Afterbirth Pains: Some women, especially after their second or more babies, will experience cramping for the first few days after birth. As your uterus shrinks down to its pre-pregnancy size, you may notice that they feel like menstrual cramps. Here are some options to help alleviate the pain/discomfort:
Empty your bladder often
Hot water bottle or heating pad
Extra calcium with magnesium
Afterease tincture
Ibuprofen every 6-8 hours
Acetaminophen every 4-6 hours
Perineal Care: Use your postpartum herbs for a sitz bath, you can even put a small amount in your peri bottle diluted with warm water. Use your peri bottle every time after using the restroom for a few days. It’s important to gently pat dry to promote healing.
Padsicles are great that first day but after the first 24 hours warmth helps promote healing better than cold. Witch hazel on a pad or use Tucks pads on your pads will allow for a cooling sensation up against any sutures you may have while still allowing the skin to heal. Kegels also helps to increase blood flow, ease itching from sutures and promote healing.
Rest & Sleep: Now that you are home with your baby, you will need to take special care of yourself.
Stay in bed! You probably feel great, but really allow yourself to be treated like a queen for a few days. Pamper yourself so that you can take care of your baby. During the first two weeks, your activity level can determine how long it will take to heal. Pushing yourself too soon - even if you feel good, can prolong your healing. Your body is working hard to make milk and establish a good supply and to heal the site on your uterus where the placenta was.
Try to establish limited visiting hours for your family and friends so that you are sure to get enough rest and are able to conserve energy for baby.
Activity: Your only activities should be caring for yourself and the baby. If you have a lot of energy, take a short walk or sit outside with the baby. Avoid busy public places. You will find that fatigue arrives suddenly, honor it and go to bed. Learn the art of napping with your baby. The goal is 8 hours of sleep collectively in a 24 hour period.
Nutrition & Hydration: Good nutrition is an essential part of postpartum recovery. You still need to “eat for two”, as your nutritional needs while nursing are comparable to those in pregnancy. You should also continue to take your prenatal vitamins including fish oil, probiotics and additional vitamin D (6400IU).
Eat lots of whole grains, bran and oatmeal cereals, good protein and plenty of fruits and vegetables. These foods will help keep you bowels moving and to avoid constipation. Drink plenty of water as this will help with your milk supply. A good rule of thumb is to drink a glass of water every time you nurse your baby. To help increase your energy postpartum and to rebuild your blood supply it is important to eat foods high in iron (spinach, kale, red meat, chicken, etc).
Hygiene: When you take a shower for the first time make sure you have someone in the bathroom with you in case you feel light headed. Mild soap only and pat your perineum dry after. Warm water, not hot - hot water can increase dizziness, so aim for a comfortably warm shower. Keep it short - a quick shower might be easier on your energy, especially the first few days.
Bowels: Your first bowel movement after birth may not happen for 2-3 days. Many things can make bowel function sluggish during this time. Hormones, dehydration, fear and decreased physical activity can slow things down. When the time comes, it may be a little uncomfortable and you may feel anxious about it. Consider adding in chlorophyll (3x the recommended dose) and magnesium to act as natural stool softeners. Go when you feel the urge. Drink at least 8 glasses of water a day. Eat fiber rich foods. Use a stool or squatty potty.
Emotional Wellbeing: You will feel better emotionally if you are resting and nourishing your body with good foods. “Baby Blues” typically occurs 2-4 days after birth and is common. This is caused by rapid hormone changes - sleep deprivation doesn't help. Here is what you might expect:
Mood Swings: feeling happy one minute, then tearful or anxious the next
Irritability and frustration
Feeling overwhelmed or even guilty for not enjoying this season
Trouble sleeping (even when the baby sleeps)
Difficult concentrating
Crying more easily
While “normal” the above should only be happening for short periods of time. If rest and support is not helping and you are feeling like this around the clock we want to know. If you are hearing things, seeing things, or having intrusive thoughts please call the on-call line immediately. Don’t be embarrassed as this is not your fault and we are here to help. If you are noticing depression, anxiety, rage or just not feeling yourself please reach out as well so we can see you sooner and come up with a plan to get you feeling back to normal.
Breastfeeding & Nipple Care: Read the Breastfeeding message in your portal. Your breasts are full of colostrum for the first few days after birth. Colostrum is the perfect first food, containing protein, fat, minerals, and vitamins. Put the baby to breast anytime the baby is awake and making mouthing (“rooting”) movements. Skin to skin is going to help recognize feeding cues. Your baby will need to nurse at least every one to three hours. Your baby should nurse as long as they want on one breast and then they may or may not nurse on your other breast, you will want to start with that one next. Many babies nurse frequently in the first few weeks. Your baby may cluster feed, so how often your baby wants to nurse is not an indicator of how much milk you’re making. Babies are soothed with non-nutritive sucking and this helps you both. Remember those first few days the more often your baby nurses, the sooner your milk will come in.
It is normal to have have fullness/slight engorgement of your breasts lasting 1-4 days. Some experience a low grade fever as well. Frequent nursing will usually give relief. If you’re too uncomfortable or it makes nursing difficult try the following:
Warmth and massage before you feed your baby. You can hand express some milk just enough to soften the areola before baby nurses. You want to avoid pumping as you will continue to make more milk than you need.
Ice in-between feeds with a cloth or washcloth in-between.
***CALL YOUR MIDWIFE*** Remember we often do NOT hear texts!
If you have red streaks or red spots with tender areas on your breast(s) that do not go away accompanied by a fever of 101 after a fever reducer or flu like symptoms
Sexual Activity: It is best to wait until all bleeding has stopped and you feel physically and psychologically ready and comfortable. The first time can be intimidating after birth so take it slow. Don’t expect to be “back to normal” right away. You may need to use a water-based lubricant or coconut oil (only if you’re not using condoms) since your postpartum and breastfeeding hormones may increase vaginal dryness. It is possible to ovulate within 4-6 weeks after birth - even while breastfeeding - so you may choose to consider some form of birth control. Your midwives will discuss contraceptive options during your postpartum care.
Discharge Instructions for Baby
Please take your baby’s temperature twice a day (every 4 hours if mom was GBS+) and keep track of their output until we see you for your first postpartum visit.
Congratulations! Now that you’re home you may have some questions about your baby. The following instructions should help guide you through the early days. We provide well baby care for the first six weeks of life. Please plan on calling your pediatrician or family physician to let them know your baby has arrived and make their first appointment. Remember midwives can only provide normal - low risk care, so if you call with something abnormal we will most likely refer you to your pediatrician. Although, we have been known to save families from unnecessary middle of the night ER trips. So when in doubt if you cannot reach your pediatrician call the on call line. Your midwives will preform your baby’s first and second newborn screen for $75 each if you are not planning on doing it with your pediatrician. We will do their CCHD screen after 24 hours and test bilirubin levels if needed. It is also recommended that your baby have a hearing screen, if your pediatrician does not offer this there are local resources in your portal.
Newborn Respirations: Newborns breathe faster than adults at rest and their respirations (breaths) are sometimes irregular. Average is 30-60 breaths in a minute when at rest. Your baby may sound congested, snort or sneeze after birth - all is normal.
CALL 9-1-1 then your Midwife if your baby’s lips are dusky/ purple or they appear to be struggling to breathe
***CALL THE ON CALL MIDWIFE LINE AT (817) 477-6551***
If you baby has respirations faster than described
Your baby is having retractions or wheezing
Temperature: Keeping baby skin to skin is the best rule of thumb. Keep baby dressed in one layer more than you are comfortable in. It is normal for a baby’s hands and feet to be blue/purple - this is not a sign that they are cold. If your baby has a temperature 100.4 or over take a layer of clothing off of them or take them off of you if they have been skin to skin or nursing then retake in 15 minutes. If 100.4 or higher please CALL THE MIDWIFE LINE
Output: Your baby should urinate in the first 24 hours. Until your milk is in, the wet diapers may not be frequent. After 2-3 days, diapers should be wet every 3 to 4 hours (disposable diapers are very absorbent so you can place a small piece of toilet paper inside. Sometimes uric acid crystals will be found in a wet diaper. These crystals can look orange/red and be mistaken for blood if this is happening past day 4 please reach out to a lactation consultant or your midwife. Some female babies will pass a small amount of mucus and blood from their vagina (this is caused by maternal hormones), this is normal.
Your baby’s first bowel movements are a dark, tarry, sticky substance called meconium. The baby should pass some meconium in the first 24 hours. This is easily washed off with warm water and coconut/olive oil. Apply oil after diaper change to make the clean up easier. Gradually, the meconium changes to a green-brown color, then yellow-green almost mustard like that is loose and seedy or curdy. Babies can have bowel movements after every feed, we expect at least one per day for the first 6 weeks.
CALL YOUR MIDWIFE IF YOU ARE NOT GETTING THE MINIMUM DIAPERS BELOW
Day 1 = 1 Wet Diaper
Day 2 = 2 Wet Diapers
Day 3 = 3 Wet Diapers
Day 4 = 4-6 Wet Diapers
Day 5 = 6-8 Wet Diapers
Minimum 1 Bowel Movement per day
Umbilical Cord Care: Your midwife will remove the plastic cord clamp at your first visit. You can expect the umbilical cord stump to dry and fall off anywhere from 4-14 days after birth. Keep the stump as dry as possible and this will expedite the process. We recommend using a blow dryer or the cool setting after each diaper change. Do not use alcohol as this will preserve the cord and delay it from falling off. You may notice a slight smell as it dries, if it’s a foul odor please call your midwife. Call your midwife if you notice active oozing or bleeding. Some wetness and a scab that has some spots of blood from being pulled by clothing or a diaper irritation is normal. Call your midwife if the skin around your baby’s belly button is red and swollen.
Jaundice: Healthy breastfed babies will have some yellowing to their skin around 2-5 days after birth. Before birth, babies need more red blood cells for oxygenation. After birth, they get rid of the surplus red blood cells by breaking them down, and part of this process is bilirubin in the blood. This bilirubin is what turns the skin yellow. This is called physiologic, or normal jaundice. It’s important to nurse your baby often, the more baby feeds the more output they have and bilirubin is removed with baby’s stool. You can also put baby indirect sunlight for 15 minutes at least 3 times a day.
WHEN TO CALL YOUR MIDWIFE:
If your baby has yellow skin or on the whites of their eyes in the first 24 hours. This is NOT normal and called pathological jaundice. This is typically caused by ABO incompatibility and phototherapy is most likely needed.
If your baby is lethargic
If your baby is not meeting the minimum output requirements
Skin: The skin of a newborn changes rapidly, coming from a water environment to air. Peeling on a newborn is normal. Calendula is a gentle and soothing oil for sensitive skin. Avoid lotions and washes with harsh fragrances. You may see pimple-type rashes above and below the skin on your baby or red patches. These are considered normal newborn rash.
CALL YOUR MIDWIFE IF A PIMPLE OPENS OR BABY APPEARS TO HAVE OPEN SORES OR LESIONS
Eyes: You may notice red spot(s) on the sclera (whites) of your baby’s eyes. These are broken blood vessels from during the birth. These will go away on their own, usually in the first two weeks.
Your baby’s tear ducts are immature and do not work fully right after birth. This means that bacteria can easily grow without flushing of the tears. If your baby’s eyes get a yellowish-green discharge or become crusty, you can wipe them with a warm, wet washcloth or cotton ball. Breastmilk is naturally antibacterial and makes a handy eyewash.
Breasts & Genitalia: Babies of both sexes can have engored nipples. Some may also have a drop of two of pale white secretions. This is due to the hormones left over from the mother. Do not try to squeeze the milk out, apply warm compresses or massage as this can promote more and could lead to infant mastitis. The same hormones may cause the scrotum to be enlarged, or the labia to be swollen. Some female babies will pass a small amount of mucus and blood from their vagina.
Crying: All babies cry at times. While crying can be a sign of boredom, fatigue, loneliness, discomfort or a need to be held, most crying in the early weeks means hunger. So when in doubt try nursing.
Most babies tend to have fussy periods during the day or night. Evenings are a common time for babies to get fussy. Your baby may want to be held more, or even nurse more often.
If you’ve changed and fed your baby and nothing has soothed him, sometimes a change of scenery (walk outside of a car ride) can change baby’s mood. If you feel yourself getting anxious about your baby’s crying, ask another person to hold your baby while you take a break.
CALL YOUR PEDIATRICIAN OR TAKE YOUR BABY TO THE CLOSEST ER/CHILDREN’S HOSPITAL IF YOUR BABY IS INCONSOLABLE AND CRYING IN PAIN, THEY MAY NEED A HIGHER LEVEL OF CARE
Bathing your baby: Until your baby’s umbilical cord stump falls off you will want to avoid a full bath, you can use a warm wet washcloths and give them a “sponge bath”. When you begin bathing your baby keep in mind frequent bathing can dry out their sensitive skin. Keep the areas behind the ears and in the neck folds clean, as these are the areas where breastmilk and spit-up can collect. You can bathe your baby in the sink, a baby bath, or in the bath/shower with you.
Gas / Stomach issues: Both gas and spitting up are a completely normal part of being a baby. Baby’s are born with an immature GI tract which is why colostrum is the perfect first food, shown to strengthen their gut and intestinal lining.
Most of the time breastfed babies do not need to be burped after feeding, but some babies are the exception to this rule. Your baby is more likely to need to be burped if he cried to signal he was hungry. If after a minute of two of patting your baby’s back you have not brought up a burp, feel free to stop and try again later. You will not always be able to get a burp, and it does no harm.
Gas is not preventable, although there are some things you can do to help with the discomfort:
Burping before feeding and half way through the feed.
Research different burping techniques. What works for one baby may not work for another!
Gently but firmly massage your baby’s belly in a clockwise, circular motion. This will help gas bubbles move through the intestines.
Bicycling or rolling your baby’s legs up to her chest can bring gas out.
A warm bath can help relax stomach muscles.
Baby wearing provides light pressure on their belly
Some find gripe water or OTC gas drops to be beneficial - be sure and talk to your pediatrician