POST NATAL CARE GUIDE

CONGRATULATIONS!! AND WELCOME TO BEAUTIFUL JOURNEY OF

PARENTHOOD. WE HAVE BEEN THERE WITH YOU THROUGH YOUR
PREGNANCY AND WE STAND THERE WITH YOU NOW.

BEING A PARENT IS AS EXCITING AS IT MAY GET OVERWHELMING AND

EXHAUSTING. DO NOT WORRY WE ARE THERE FOR YOU TO MAKE YOUR
JOURNEY EASY.

HOPING THIS INFORMATION IS USEFUL AND CLEARS YOUR WHIMS AND

DOUBTS ABOUT POSTPARTUM PERIOD.

PLAN OF DISCHARGE FROM HOSPITAL

After a normal vaginal delivery we may discharge you around 24-48 hrs
post delivery depending on contition of both mother and baby.

After a caesarean section discharge from hospital is after 48-72 hrs of

delivery.

Prolonged stay is required if only mother or baby needs any futher

special care.

CARE OF STITCH LINE POST CAESAREAN SECTION

We send you home after discharge most likely with a waterproof

dressing . We change or remove the dressing after your visit in OPD.
once the dressing is removed you can clean the stitch line with soap
and water and apply antiseptic cream/ointment as prescribed for a
week or so. After that no specific care of stitch line is required as such.

CARE OF EPISIOTOMY STITCH POST VAGINAL DELIVERY

You can change your sanitary pad every 6-8 hours to prevent any
infections. Take sitz bath with warm water twice daily followed by
application of antiseptic cream as advised for atleast 7-10 days.

Avoid sitting in crossed legged position.

Avoid constipation and starining while passing motion. Ask us for stool
softeners if any such problem arises.

We will check the stitch lines on your further visits to OPD.

BREASTFEEDING
In the first few days, you and your baby will be getting to know each
other. It may take time for both of you to get the hang of breastfeeding.

This happens faster for some women than others. But nearly all women
produce enough milk for their baby.

The fluid your breasts produce in the first few days after birth is called
colostrum. It's thick and usually a golden yellow colour. It's a very
concentrated food, so your baby will only need a small amount, about a
teaspoonful, at each feed.

Your baby may want to feed quite often, perhaps every hour to begin
with. They'll begin to have fewer, but longer feeds once your breasts
start to produce more "mature" milk after a few days.

The more you breastfeed, the more your baby's sucking will stimulate
your supply and the more milk you'll make.

How often should i breastfeed ?

Feed your baby as often as they want and for as long as they want.
They'll begin to have fewer, but longer feeds after a few days.

Generally newborns should be fed atleast every 2-3 hrs or on demand.

As a very rough guide, your baby should feed at least 8 to 12 times, or

more, every 24 hours during the first few weeks.

It's fine to feed your baby whenever they are hungry, when your breasts
feel full or if you just want to have a cuddle.

Around 2 to 4 days after birth you may notice that your breasts become
fuller. This is often referred to as your milk "coming in".

Your milk will vary according to your baby's needs. Each time your baby
feeds, your body knows to make more milk for the next feed. The
amount of milk you make will increase or decrease depending on how
often your baby feeds

In the beginning, it can feel like you're doing nothing but feeding. But
gradually you and your baby will get into a pattern and the amount of
milk you produce will settle down.

How to know if baby is hungry?

When your baby is hungry they may:

-get restless

-suck their fist or fingers

-make murmuring sounds

-turn their head and open their mouth

It's best to try and feed your baby during these early feeding cues as a
crying baby is difficult to feed.

Signs your baby is well attached

Your baby has a wide mouth and a large mouthful of breast.

Your baby's chin is touching your breast, their lower lip is rolled down
(you can't always see this) and their nose isn't squashed against your
breast.

You don't feel any pain in your breasts or nipples when your baby is
feeding, although the first few sucks may feel strong.

You can see more of the dark skin around your nipple (areola) above
your baby's top lip than below their bottom lip.

Signs your baby is getting enough milk

Your baby starts feeds with a few rapid sucks followed by long, rhythmic
sucks and swallows with occasional pauses.

You can hear and see your baby swallowing.

Your baby's cheeks stay rounded, not hollow, during sucking.

They seem calm and relaxed during feeds.

Your baby comes off the breast on their own at the end of feeds.

Their mouth looks moist after feeds.

Your baby appears content and satisfied after most feeds.

Your breasts feel softer after feeds.

You may feel sleepy and relaxed after feeds.

Your baby gains weight steadily after the first 2 weeks – it's normal for
babies to lose some of their birth weight in the first 2 weeks.

From day 5 onwards, wet nappies should start to become more

frequent, with at least 6 heavy, wet nappies every 24 hours. In the first
48 hours, your baby is likely to have only 2 or 3 wet nappies.

BATH AND HYGEINE

You can take a bath from head to toe from as soon as day 2 of delivery.
Bathing daily with soap and water is necessary in postpatum period to
maintain your hygeine. You can change the sanitary pads every 6-8hrly
or as soon as they are full.

Even with caesarean sections the dressing which is done is

waterproof ,so you can take a bath over it and will not affect the
dressing.

MASSAGE

You can take a gentle massage from head to toe except for your belly as
soon as you go back home.

EXCERCISE

Returning to exercise after vaginal birth

You can start doing gentle pelvic floor and abdominal exercises the first
day or two after the birth. If you feel any pain, stop.

When you feel like it, start with a gentle walk, perhaps while pushing
the pram. Then, at your own pace, gradually increase the time and pace
of your walks. Build up to a 30-minute walk every day if you can.

Avoid swimming until the bleeding has stopped for 7 days and you've
had your postnatal check with the doctor or obstetrician (6 to 8 weeks
after the birth).

Wait until your 6-week postnatal check-up before you go back to the
gym or start a group exercise program. It's best not to return to your
previous level of physical activity until 16 weeks after the baby is born.

Returning to exercise after caesarean

A caesarean is a major operation and it will take you at least 6 weeks to

heal. However, you can still do pelvic floor exercises from the first day
after the birth. You can start to exercise your abdominal muscles as
soon as you feel able to. Avoid sit ups, crunches or abdominal curls, as
these put pressure on the scar.
Avoid lifting heavy weights. Tighten your tummy and keep your back
straight if you need to lift something around the house.

After 6 to 8 weeks, you will still be healing inside. It is OK to start

walking, do low-impact aerobics or cycle. Stop if there is any discomfort,
pain or a pulling sensation on your scar and try again a couple of weeks
later.

You should avoid high-impact exercise for 3 to 4 months after your

caesarean. Don't go swimming until the bleeding has stopped for 7 days
and you've had your postnatal check with the doctor or obstetrician (6
to 8 weeks after the birth).

Low-risk exercise for mums

The following exercises are suitable in the days after you have your
baby:

Abdominal exercises, or 'abdominal bracing' Choose one of these

positions: sitting, standing, lying on your side, lying on your back, or
kneeling on all fours. Pull in your lower tummy towards your spine. Hold
for 5 to 10 seconds and breathe normally. Repeat 8 to 12 times, 4 times
a day.

Pelvic floor exercises Sit and lean slightly forward with a straight back.
Squeeze and lift the muscles around your vagina as if you are trying to
stop a wee. Hold as you count to 8; relax for 8 seconds. If you can't hold
for 8, just hold as long as you can. Repeat about 8 to 12 times.

Other exercises that are safe after pregnancy include:

· walking
 · swimming and aqua aerobics (once the bleeding has stopped)

· yoga

· Pilates

· low-impact aerobics

· light weight training

· cycling

DIET

Eat a variety of foods. Try to eat a balanced diet of fruit, vegetables,

grains, protein foods and diary each day.Drink plenty of liquids. Your
body needs lot of fluid (about 6-10 glasses a day) especially if you are
breastfeeding your baby. Drink mostly water, milk, and fruit juice.

Eat foods that have protein such as milk, cheese, yogurt, meat, fish and
beans. Protein rich foods are important to help you recover from
childbirth and keep your body strong. If you are under 18, or were
underweight prior to pregnancy, you need to eat more protein.

Eat your fruits and vegetables. Try to make half your plate fruits and
vegetables. Fruits and vegetables have vitamins and minerals that keep
you healthy. They also have fiber, which helps prevent constipation.

Lose weight safely. Losing weight too quickly can affect your breast milk
supply. Do not take diet pills. They contain harmful drugs that can be
passed to your baby through breast milk.Take prescribed vitamins. If
you are breastfeeding, it is a good idea to continue to take your
vitamins.

Limit junk foods. Soda pop, cookies, donuts, potato chips and french
fries are okay sometimes, but don’t let them take the place of healthy
foods!

Avoid these Foods when Breastfeeding

Alcohol

Caffeine

Highly processed/junk food

Fish high in mercury

RED FLAGS WHEN TO SEE A DOCTOR

Excessive pain abdomen

fever (>100 degree F. for more than 2 days )

excessive headache

blurring of vision

vomiting

redness,pain and fullness in breasts not releiving after expressing milk

CONRACEPTION

It is advisable to maintain abstinence for atleast 6 weeks after birth

both in vaginal delivery or caesarean section.
After 6 weeks couple can opt various methods of contraception.
Maintaining a gap of 2-3 years between two pregnancies is advisable.

Various methods available are barrier method(condoms), hormonal

pills, intrauterine contraceptive devices etc.

Of these hormonal pills and intrauterine devices have highest efficacy.

you can discuss with your doctor which method is preferable for you.

POSTPARTUM BLUES AND POSTPARTUM DEPRESSION

Many women feel a bit down, tearful or anxious in the first week after
giving birth.

This is often called the "baby blues" and is so common that it's
considered normal.

The "baby blues" do not last for more than 2 weeks after giving birth.

If your symptoms last longer or start later, you could have postnatal
depression.

Postnatal depression can start any time in the first year after giving
birth.

Signs that you or someone you know might be depressed include:

· a persistent feeling of sadness and low mood

· lack of enjoyment and loss of interest in the wider world

· lack of energy and feeling tired all the time

· trouble sleeping at night and feeling sleepy during the day

 · difficulty bonding with your baby

· withdrawing from contact with other people

· problems concentrating and making decisions

· frightening thoughts – for example, about hurting your baby

Many women do not realise they have postnatal depression, because it

can develop gradually.

If you fear you may have postpartum depression you must seek help
from your doctor.

What are afterbirth pains?

Afterbirth pains are belly cramps you feel as your uterus (womb) shrinks
back to its regular size after pregnancy. The cramps should go away in a
few days. Right after you give birth, your uterus is round and hard and
weighs about 2½ pounds. By about 6 weeks after birth, it weighs only 2
ounces.

DO's and Don'ts

· Don’t lift from a squatting position. Don’t lift anything heavier

than your baby.

· Support your belly with pillows when you’re breastfeeding.

· Drink plenty of water to help replace fluids in your body.

What is vaginal discharge?

After your baby is born, your body gets rid of the blood and tissue that
was inside your uterus. This is called vaginal discharge or lochia. For the
first few days, it’s heavy, bright red and may contain blood clots. Over
time, the flow gets less and lighter in color. You may have discharge for
a few weeks or even for 2 months.

What you can do:

Use sanitary pads until the discharge stops.

What is breast engorgement?

This is when your breasts swell as they fill with milk. It usually happens
a few days after giving birth. Your breasts may feel tender and sore. The
discomfort usually goes away once you start breastfeeding regularly. If
you’re not breastfeeding, it may last until your breasts stop making milk,
usually within a few days.

What you can do:

Breastfeed your baby. Try not to miss a feeding or go a long time

between feedings. Don’t skip night feedings.

Before you breastfeed your baby, express a small amount of milk from
your breast with a breast pump or by hand.

Take a warm shower or lay warm towels on your breasts to help your
milk flow. If your engorgement is really painful, put cold packs on your
breasts.

If your breasts are leaking between feedings, wear nursing pads in your
bra so your clothes don’t get wet.

Tell your doctor if your breasts stay swollen and are painful.
If you’re not planning to breastfeed, wear a firm, supportive bra (like a
sports bra).

What is nipple pain?

If you’re breastfeeding, you may have nipple plain during the first few
days, especially if your nipples crack.

What you can do:

Talk to your doctor or a lactation consultant to be sure your baby is

latching on to your breast the right way. A lactation consultant is a
person trained to help women breastfeed, even women who have
breastfeeding problems. Latching on is when your baby’s mouth is
securely attached to (placed around) your nipple.

Ask your doctor about cream to put on your nipples.

After breastfeeding, massage some breast milk onto your nipples. Let
your breasts air dry.

What is swelling?

Lots of women have swelling in their hands, feet and face during
pregnancy. It’s caused by extra fluids in your body. It may take time for
the swelling to go away after you have your baby.

What you can do:

· Lie on your left side when resting or sleeping.

· Put your feet up.

· Try to stay cool and wear loose clothes.

· Drink plenty of water.

What is constipation?

Constipation is when you don’t have bowel movements, you don’t have
them often or your stools (poop) are hard to pass. You also may have
painful gas. This may happen for a few days after you give birth.

What you can do:

· Eat foods that are high in fiber.

· Drink lots of water.

· Ask your doctor about medicine to take.

What urinary problems can happen after giving birth?

In the first few days after giving birth, you may feel pain or burning
when you urinate (pee). Or you may try to urinate but find that you
can’t. Sometimes you may not be able to stop urinating. This is called
incontinence. It usually goes away as your pelvic muscles become
stronger again.

What you can do for pain, burning or if you have trouble urinating:

· Drink lots of water.

· Run water in the sink when you go to the bathroom.

· Soak in a warm bath.

· If the pain continues, tell your doctor.

· What you can do for incontinence: Do Kegel exercises to

strengthen your pelvic muscles.

Why do you feel tired after giving birth?

You may have lost blood during labor and birth. This can make your
body tired. And your baby probably doesn’t let you sleep all night!

What you can do:

· Sleep when your baby sleeps, even when he naps during the day.

· Eat healthy foods, like fruits, vegetables, whole-grain breads and

pasta, and lean meat and chicken. Limit sweets and foods with a
lot of fat.

· Ask your partner, family and friends for help with the baby and
around the house.

· Limit visitors. You’ll have plenty of time for family and friends to
meet your new baby when you’re feeling rested.