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By day three, the difficulties of integrating newborn care with daily life have become evident, and emotional outbursts are common. This coincides with hormone surges that initiate lactation. It is both common and appropriate for the mother's tears to flow just as her milk begins to come in. And since the baby must also make an adjustment to taking breastmilk, the baby may experience some fussiness or crying spells. This usually evokes emotional distress in the parents, which is made worse by fatigue. If the mother's partner has been frantically trying to handle everything -- house, shopping, laundry, food preparation -- the partner may be at the point of exhaustion and collapse. This may leave the mother somewhat stranded. The midwife needs to see that the mother's postpartum support system is fully activated.
The midwife needs to make sure that the mother is well nourished and has been receiving plenty of fluids to drink. It is good to make sure she has a fresh container of water by her bed and a freshly made jug of herbal tea in the refrigerator.
2 Parts Red Raspberry Leaf
1 Part Nettle Leaf
1 Part Alfalfa Leaf
1 Part Peppermint Leaf
Mix dried herbs thoroughly and use a portion to make up a half gallon to a gallon of tea. This blend makes a nice sun tea that can them be refrigerated for a refreshing iced tea to be consumed throughout the day. It provides red raspberry leaf for hormonal balance and uterine toning, Nettle and Alfalfa are high in blood building vitamins and minerals, and the peppermint leaf is good for soothing the digestive system and getting it back to normal as well as giving the tea a nice minty flavor. It tastes fine unsweetened, but if the mom would like a little sweetener, use honey. Honey is high in nutrients and digests easily. A great tea blend for not only pregnancy, but postpartum recovery. It makes a great tea blend for adding recovery tinctures to, if needed, since the flavor of the tea will help "hide" some of the flavors of the tinctures (not all of them taste good). Bulk herbs are available through Mountain Rose Herbs (see banner ads at the bottom of the page or click on the herb above. They have a nice selection of organic bulk herbs for a reasonable price).
Discussions of the birth may either begin or resume, but tend to be more emotionally involved than on day one. To best facilitate the parents' honest disclosure regarding the midwife's care during labor, she should pose the question, "Is there anything you wish I had done differently?" Of course, the midwife must be entirely relaxed and receptive if she expects them to be fully honest with her. Don't press, though -- there will be plenty of time later on to talk things through.
Be sure to check:1. The breasts - Check for engorgement by feeling for lumps along the sides of the breasts and under the arms, and looking for reddened areas. If engorgement is a problem, have the mother soak her breasts or her whole body in warm water, as this will stimulate the release of any backed-up milk. Then show her how to express milk.
Many women find this easiest if they oil the entire breast, and using long strokes toward the nipple, work down from the collar bone with one hand and up from the base of the breast with the other. If specific lumps are noted, have her work from behind these areas. This may hurt a bit at first and she may need to work slowly, but make sure she applies enough firmness to bring the milk out. Up to 10 sweeps may be necessary before milk appears at the nipple. Also demonstrate the proper way to grasp the areola, and how to squeeze it to get the flow started.
Check the nipples carefully for cracks, and ask her how it feels to nurse (if the nipples are cracked, it will not feel good). Make sure she is positioning the baby properly on the breast, and recommend vitamin E oil on the nipples between nursings, if needed. Cold cabbage leaves tucked against the nipples also provide a lot of relief. And for lingering engorgement, hot ginger compresses under the arms or in the upper, outer quadrants of the breasts do a lot of good.
2. The uterus, the lochia, the perineum. - Recheck the perineum thoroughly, using guidelines from day one. Ask the mother if her flow has been consistent -- any clots, heavy bleeding, dark red blood? By day three, her flow should be a bit lighter than before, beginning to change from rubra to lochia serosa (more pink than red). Palpate the uterus for enlargement, and note the tenderness that might indicate infection. And check the odor on her pad to be sure it is normal. Ask how she feels when she's out of bed -- any vaginal pressure, or dragging sensation? It is never too early to begin vaginal toning exercises (kegels), as long as they are started slowly.
3. The mother's temperature. - Elevation of temperature to 101°F is normal at the time the milk comes in. Nevertheless, rule out uterine infection by checking for symptoms.
UTERINE & PELVIC INFECTION
Symptoms of uterine infection include fever over 101°F, pelvic pain, elevated pulse, and subinvolution of the uterus. Risk factors include PROM, prolonged labor with numerous vaginal exams, manual rotation or other manipulations of the fetus during labor, maternal exhaustion, delayed delivery of the placenta, hemorrhage, uterine exploration (as for manual removal of the placenta or sequestered clots), postpartum dehydration, or improper perineal hygiene.
A prime cause of uterine infection is over-activity and exhaustion in the first few days postpartum. Most women do not resume care for other children and immediately resume normal activity after the birth unless there has been a totally uncomplicated delivery, with none of the precipitating factors cited above. Even then, the mothers should use common sense and take care of themselves completely, if they do feel good and can be up and about. The midwife should warn mothers having easy deliveries that bed rest is necessary postpartum not just to recover from birth, but from the entire pregnancy. Adequate rest permits oxytocin to involute the uterus, tone the vagina, and facilitate breastfeeding, whereas stress and over-activity cause counter-effects of adrenaline to slow recuperation.
Sepsis may not only affect the uterus, but pelvic ligaments, connective tissue, and/or the peritoneal cavity. These become infected only if uterine sepsis is untreated, and cause more severe symptoms of vomiting, chills, and extreme pain. Rarely, the tubes and ovaries may also be affected, usually be a preexisting gonorrhea infection which has flared up again.
4. The baby's cord stump. - If the midwife has used cord clamps, this is definitely the time to remove it.
5. The baby's skin color, inspecting for jaundice. - A bit of yellow tinge is normal in the face and down to the nipple line, but unusual in the extremities. Generally, excess bilirubin in the bloodstream is diluted and flushed from the system by breastmilk (isn't it amazing that nature has the mother's milk come it at the same time the baby needs to have the breastmilk to flush out bilirubin from the baby's body!). Encourage the mother to breastfeed often. This will not only help rid the baby of jaundice, but it will also help her with any engorgement problems. If the baby is very yellow, speak to the pediatrician, and certainly check again the following day.
MoonDragon's Pediatric Information: Neonatal Jaundice
6. The baby, for dehydration. - This is particularly important if noted earlier. Encourage the mother to breastfeed her baby often and on demand, not by a clock or schedule.
7. The baby's behavior, nursing pattern, crying pattern, etc.
8. Mom's relationship to nursing. - This is crucial. Make sure she is not trying to impose a schedule on the baby, or limit the amount of time it nurses. Replace any out-dated puritanical beliefs about structured breastfeeding with those of a loving approach based on the baby's needs and instincts. The sensation of let-down varies from mild tingling to a sexual sort of release, and some women occasionally experience orgasm while nursing. Hormones released while breastfeeding also helps to reinforce the mother's "maternal nurturing instinct" creating a mother-infant bond. This is nature's way of making the breastfeeding experience pleasurable for the mother (as well as the baby) and helps to ensure the survival of the infant. Try to promote a positive feeling around letting go.
9. Sleeping arrangements. - Check to see what has evolved. If the baby is in bed with the couple, how does the partner feel about this? If the baby is in a basket or crib, how does the mother feel about getting up to nurse? Is her partner willing to get up and bring the baby to her?
There are often phone call ramifications of this visit, especially regarding the last three points. This is a time when concerns about discipline arise, and conflicts may develop between partners. Amazing as it seems, fear of spoiling the baby may actually become an issue this early! Men particularly tend to worry that the baby will be spoiled by too much attention, too much contact, too much love. Some respond by setting limits on how much time the mother spends with the baby, or by insisting that the baby be left to "cry it out" when it is fussy, which only intensifies and makes the problem worse. Whether due to cultural conditioning or simple jealousy, this reactionary approach should be set aside as soon as possible.
Explain to parents that the baby has literally been enveloped by the mother for nine months, it's every need immediately met. It has no experience of waiting to be fed or held, and cannot know when it is upset that its mother or father is close by in the next room. Babies need all the security they can get. There is no such thing as too much love for a newborn. If parents can surrender to the sensitivity and vulnerability engendered by love, they will be stronger and wiser in the end, and their baby will grow to be a loving, secure child. Encourage them to relax and get to know the baby through touch, play, and gentle massage. (Infant massage is also an important antidote for colic.)
Check in on parents for the next few days on the basis of findings at this visit. As with the day-one checkup, anything unusual is best followed up by a house call, rather than by phone. Otherwise, if everything is normal, a phone chat each day is sufficient.
HELPFUL POSTPARTUM CARE SUPPLIES
MoonDragon's Client Handouts about nutrition and diet for pregnant and breastfeeding mothers are available at the links below. Examples of sample diets and menus are given, including some holistic suggestions. Nutritional analysis for various foods and nutritional therapy information is also available.
POSTPARTUM CARE INFORMATION
Postpartum Care: Index
Postpartum Care: Weight
Postpartum Care: Diet
Postpartum Care: Bowel Movements & Urination
Postpartum Care: Bathing
Postpartum Care: Breasts & Breastfeeding
Postpartum Care: Perineal Care
Postpartum Care: Vaginal Bleeding (Lochia) & Menstruation
Postpartum Care: Exercise & Back Care
Postpartum Care: Sexual Intercourse
Postpartum Care: Contraception
POSTPARTUM VISITS
PostPartum Visit: Day One
PostPartum Visit: Day Three
PostPartum Visit: Day Seven
PostPartum Visit: 4 to 6 Week Visit
POSTPARTUM CONCERNS
Baby Care & Concerns
Fatigue & Exhaustion
Postpartum Depression (The "Baby Blues")
NOTIFY YOUR MIDWIFE OR HEALTH CARE PROVIDER IF...
You or your family member has questions about postpartum care.
You or a family member develops any unexpected and/or unusual symptoms.
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