Your Best Postpartum: A Doctor's Tips For New Parents

Childbirth evokes overwhelming joy, but comes with the challenging demands of motherhood.  That’s why guidance should begin during pregnancy. The development of a postpartum care plan can address the transition to parenthood and well-woman care.  I wrote down and unpacked 9 things I hear new moms saying the first few moments to days after childbirth. I hope that by thinking about these beforehand helps set you up for a more informed Fourth Trimester!

Dr. Falzon in action, delivering a baby in 1992

Dr. Falzon in action, delivering a baby in 1992

Dr. Falzon in action, delivering a baby in 1992

“Finally. I get to hold my baby!”

Holding your baby is exactly what you should be doing immediately after giving birth if you and the baby are deemed healthy. In fact, healthy, term infants should be placed in direct skin-to-skin contact with the mother immediately after birth and remain there for the first hour. Skin-to-skin contact has been proven to help stabilize baby's temperature, breathing, heart rate, and blood sugar while also promoting healing for mom.

“My baby is healthy. Wait, am I?”

How you are monitored postpartum depends in part by the events of the delivery process and the type of anesthesia or analgesia used, guided by protocols established by the anesthesiologist and obstetrician in concert. So this will vary for each individual patient.

Your vital signs -- blood pressure, pulse, temperature -- will be checked frequently. The nursing staff will also be checking the height of your uterine fundus (the top of the uterus) and watch for any excessive vaginal bleeding.

“I’m ok, but exhausted.”

In your postpartum period, the staff should help your learn how to take care of your general needs as a new mom, along with those of your newborn.

It’s important that you sleep, regain strength, and recover from the effects of any analgesic or anesthetic agents that you may have received during labour.

You will likely be strongly encouraged to sleep at the hospital while you can.

You may also be asked to walk around as soon as you’re able to do so. Early ambulation has been shown to decrease the incidence of deep vein thrombosis.  But remember, you should not attempt to get out of bed the first time without assistance.

“It still hurts down there.”

Application of ice packs to the perineum (area between the anus and vulva) during the first 24 hours after delivery may help reduce your pain and swelling resulting from the pressure of your baby’s head. 

Orally-administered analgesics often are required and usually sufficient for relief of discomfort from episiotomy or repaired lacerations. Beginning 24 hours after delivery, moist heat in the form of sitz baths may also reduce local discomfort.

“Breastfeeding?”

Breastfeeding is greatly encouraged. There are diverse and important advantages to infants, mothers, families and society for breastfeeding and the use of human milk for infant feeding. These include nutritional, immunologic, developmental, psychologic, social, economic, and environmental benefits.

During the newborn hospitalization, formal evaluation of breastfeeding, including observation of position, latch, and milk transfer is done by trained caregivers. If the breasts get engorged, ice packs and pumping help. If there is infection in the breast, or the mother has painful, red breasts and fever, she should call her caregiver right away.

If you choose not to breastfeed, rest reassured that milk production will slow down over the course of the first few days after delivery. During the stage of engorgement, the breasts may become painful and should be supported with a well fitting brassiere. Ice packs and analgesics can help relieve the discomfort during this period.

“I’m so happy. Why do I feel so sad?”

For many women, the postpartum period can be a stressful time and may lead to the onset of some degree of postpartum “blues” which normally occur within 2 to 4 days postpartum. This is very common.

Your mood might be unstable. You may feel happy or excited, only to be sad, depressed, anxious and irritable hours later. Symptoms are usually mild. Supportive care and reassurance are helpful in ensuring that the postpartum “blues” are time limited.

However, severe postpartum depression should receive immediate treatment. 

“How will the hospital know when it’s time for us to go home?”

The hospital stay of the mother and the newborn should be long enough to allow identification of any problems and ensure that you are sufficiently recovered and prepared to take care of yourself and your newborn at home.

Some big items the staff is checking for:

• Before discharge you should have no fever, and your blood pressure, pulse and respiration should all be within normal range. 
• The amount and colour of lochia (vaginal postpartum bleeding) should be normal. 
• Your uterine fundus should be firm and urine output should be adequate. 
• Any surgical repair or wound should have no evidence of infection and should be healing without complications. 
• You should be able to walk around with ease and have adequate pain control. 
• Arrangements should be made for postpartum follow-up care. Family members or other support persons should be available to help for the first few weeks after discharge.

“We’re home. Is it normal to feel overwhelmed?” 

It is! During this period you are quickly adapting to multiple physical, social and psychological changes. You are recovering from childbirth and adjusting to changing hormones. Your “Fourth Trimester” comes with considerable challenges, including lack of sleep, fatigue, pain, breastfeeding difficulties, stress, and the new onset of mental health disorders. 

The World Health Organization’s guidelines for postnatal care include postpartum evaluation of all women and infants at 3 days, 1-2 weeks, and 6 weeks. 

A comprehensive doctor’s visit done about 6 weeks postpartum should include full assessment of physical, social and psychological well being, including: 

• Mood and emotional well being
• Infant care and feeding
• Sexuality
• Contraception
• Birth spacing
• Sleep and fatigue
• Discussing pregnancy complications, if any, and their implication for future childbearing and long term maternal health
• Reviewing vaccination history
• Performing well woman screening, including pap smear and pelvic exam as indicated 

Women with medical conditions such as hypertensive disorders, obesity, diabetes, thyroid disorders, kidney disease, and mood disorders are counseled regarding the importance of timely follow up with their obstetrician/gynecologist or primary care provider for ongoing coordination of care. Each individual patient should be followed and advised by her obstetric care giver.

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These are some of the guidelines recommended by The American College of Obstetricians and Gynecologists in their Journal Opinion “ACOG Committee Opinion” Number 436 in May 2018, and from the “Guidelines for perinatal care” from the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists’ Women’s Health Care Physicians.

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