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*Fever greater than 100.3 F
*Burning with urination or inability to urinate
*Red area on breast accompanied by fever and flu-like symptoms
*Bleeding heavy enough to soak through a large perineal pad in an hour or less and/or passing a clot larger than a lemon
*Putrid odor of vaginal discharge (usually accompanied with tenderness upon palpation of fundus and fever), vaginal itchiness or soreness
*Increase of pain at perineal laceration site or episiotomy - often mother notices burning over stitches with urination that had not occurred before
*Any opening of caesarean incision accompanied by bleeding or purulent discharge
*Swollen, red, painful area on leg (especially the calf) that is hot and tender to the touch
*Feeling depressed, uncontrollable crying, inability to sleep or eat, extreme anxiety or agitation
*Trust your gut instincts and the mother you are caring for - if you need reassurance about a concern, call the care provider
BLEEDING.
Bleeding following the baby's birth (called lochia) can continue for up to six weeks. Most commonly, however, it continues for three to four weeks. It is heaviest during the first week and may even contain clots during the first three days. The clots are usually just a result of pooled blood which drops out when you change from a lying to a standing position. Although the bleeding starts out a deep red, it will change color to brown or pinkish brown as the weeks pass.
RETURN OF REGULAR MENSTRUATION.
The postpartum bleeding the mothers experience for weeks after birth is not a period. It is lochia, the discharge from your uterus following birth. The mother's regular period, however, will eventually return. The timing depends on whether or not she is breast-feeding her infant. If she does not nurse, her period will resume within eight to twelve weeks. If she is breast feeding, her period will take much longer to return, sometimes eight months or more, depending on when the baby is weaned and how often the mother is breast feeding. Sometimes her period will return while she is still breast-feeding. The mother can continue to nurse during her period.
AFTER PAINS
If this is the mother's second or third child, she may notice that her uterus contracts painfully while breast feeding. These are called after pains. They are felt during breast-feeding because breast feeding releases the hormone oxytocin into your system, which is responsible for uterine contractions. The pains usually disappear within the first day or two.
SWEATING
A not-often-mentioned postpartum discomfort, sweating is actually fairly common. The mothers' body has a lot of excess water weight left over from the pregnancy. One of the ways it gets rid of this water is through perspiration. Make sure the mother drinks plenty of water, especially if she breast feeding. You don't want her to become dehydrated.
HEALING EPISIOTOMY OR TEAR
Immediately after an episiotomy or tear, it is very helpful to put an ice pack on the area to reduce swelling. As the first few postpartum days pass, be sure to keep the area clean, using a squeeze bottle (filled with warm water) to direct a flow of warm water over the perineum after using the toilet. Have the mother take warm showers and lean over so that the water can run down the affected area. Always pat the area dry after cleaning. If possible, have the mother spend time letting the area air-dry. Have the mother lie on her bed with a disposable pad underneath her.
A sitz bath, a small plastic basin that fits on your toilet, can be used to increase circulation to the perineal area. The water is warm and circulates, which will help healing.
It is possible that the new mother won't feel herself for many weeks. She may have trouble walking or sitting due to discomfort from an espisiotomy or tear. It can take up to a month for complete healing.
FREQUENT URINATION
The new mother is not pregnant anymore, so why does she still have to go to the bathroom so often? Her body needs to get rid of a lot of retained fluid during the early weeks, and besides sweating, it does this through more frequent urination. Make sure the new mom drinks plenty of water. This will help to dilute the strength of her urine so it is less likely to burn the tender perineal area on the way out.
The muscles of the pelvic floor have really been stretched by childbirth. The new mother will need to do the KEGEL exercises to help get them back in shape. By toning up these muscles, she can reduce her chance of urinary "accidents" and feeling of urgency.
KEGEL exercises are relatively easy method of keeping the muscles of the pelvic floor strong and flexible. If the mom exercises these muscles faithfully, some people think she may be able to have a delivery with a greater chance of an intact perineum (no tearing or cut needed), as well as faster recovery from any physical trauma to the area. Kegel exercises can lessen the likelihood of urinary incontinence, and even, some say, promote a better sex life.
Firmly tense the muscles around your vagina and anus, hold for as long as you can, up to eight or ten seconds, then slowly release the muscles and relax for several seconds. Repeat. Do at least 25 repetitions at various times during the day, while sitting, standing, lying on your back, or urinating.
HEMORRHOIDS
Hemorrhoids, also called piles (they resemble a pile of marbles or grapes), are actually varicose veins of the rectum or anus. They may be painful, itchy, and/or burn, and they sometimes bleed. Internal hemorrhoids are found far up in the rectum, external ones right on the skin just beyond the anal sphincter.
Hemorrhoids often develop during pregnancy, particularly during the last trimester. Childbirth, because of the extreme pressure exerted on the rectum and anus during pushing, may make them worse or can even make them a problem for the first time. In new mothers who didn't have hemorrhoids before pregnancy, the bothersome symptoms usually lessen or disappear after the immediate postpartum period. In the meantime, taking the following steps can help minimize discomfort and may hasten that departure:
1. Apply heat or cold, whichever offers more
relief. Warm sitz baths of about twenty minutes duration are usually
recommended, but some women find ice packs or chilled witch hazel
soaks more soothing. Or she might try alternating hot and cold
treatments.
2. Keep the perinatal area clean. At first, rinse the area with
warm water after each bowel movement, using a squeeze bottle (filled
with warm water), for keeping the perineal area clean.
3. Have the mom sleep on her side, not on her back, and avoid
long periods of standing or sitting.
4. Do KEGEL exercises to improve circulation to the area.
CHEST PAIN
You would not expect to do three hours of pushups and not feel sore. And the new mother can't expect to do three hours of baby pushing without feeling the effects of her hard work. Which muscles will be sorest will depend on which ones tensed and released most as the mother pushed; the aches and pains might be in the area of the rib cage, in the back, the legs or even in the shoulders.
Of course, such pain can occasionally indicate
a more serious problem- such as a blood clot or
internal breeding- so the mother should report it to her doctor.
If the pain is indeed muscular, it should gradually diminish over
the next several days. Heat (in the form of a heating pad) may
help to relieve the discomfort.
BROKEN TAILBONE
You have probably never heard of a broken tailbone, or coccyx, because such an occurrence is very rare. But it does happen. More common is injury to the muscles of the pelvic floor, which can result in muscular spasm and tenderness in the area. Either can cause what is medically termed coccy-godynia, or pain in the region of the coccyx at the base of the spine. Most women find the pain is most severe when they are sitting on a hard surface or straining (not just sitting) at the toilet. Lying down or sitting on a cushion or a rubber ring "donut" usually offers relief.
Treatment may include heat applications and massage of the buttocks to relax the area, and, possibly, intrapelvic massage. With treatment, the pain gradually lessens and is usually gone in a month or two.
HAIR LOSS
About three to six months after the mother has a baby, her hair tends to fall out. This is normal. During pregnancy, her hair did not shed as it normally does. Instead, it went into a resting phase. Now all that hair is shedding. It will not make any noticeable difference in the amount of hair on her head even though it looks like hair is falling out in clumps.
ENGORGED BREASTS
If painfully tender, granite-hard breasts were what mothers had to look forward to for the duration of the breast feeding experience, most babies would be weaned before they entered their second week of life. The engorgement that arrives with a mother's milk can temporarily make nursing agonizing for her and, because the nipples are flattened by the swelling, frustrating for the baby. The condition may be more severe when a baby isn't put to the breast immediately after birth.
Engorgement occurs rather suddenly, usually over a few hours, most often on the third or fourth postpartum day, but it can occur as early as the second day or as late as the seventh. It's more uncomfortable for some women than for others, is more severe with the first babies than with subsequent ones. Some lucky women get their milk without experiencing any discomfort or noticeable engorgement at all especially if they are nursing regularly.
Happily, engorgement and its distressing effects disappear within a matter of days. Until then, you can use heat or cold (some women find ice packs helpful, others hot showers or soaks). A breast pump or manual expression of milk can help to get the flow started and ease engorgement enough to allow your baby to grasp the nipple for suckling. Or applying warm soaks just before nursing encourage milk let-down may also bring some relief.
The mother should not be tempted to skip or skimp on feedings because of pain; the less her baby sucks, the more engorged she will become. The more she nurses her newborn, on the other hand, the more quickly engorgement will subside. If the baby doesn't nurse vigorously enough to relieve the engorgement in both breasts at each feeding, have the mother use a breast pump to do this herself.
It's comon for the breasts to engorge less with the second and subsequent pregnancies. Perhaps the breasts, having gone through all this before, have less difficulty adjusting to the influx of milk, or perhaps the experienced mother can get her baby started nursing more easily and more quickly, resulting in more efficient emptying of engorged breast.
SORE NIPPLES
The early weeks of breast feeding can be hard on the new mothers nipples. They may feel sore or even crack slightly. Having the mother continue nursing will toughen them up within a week or two. Let the nipples air-dry when possible. A little bit of breast milk left on the nipples can actually aid healing. Make sure the baby is latching on correctly, with the whole nipple well in his mouth and most of the areola as well.
BREAST INFECTION
If a tender lump develops in one of the mothers' breasts, try to massage it out. Stroke downward toward the nipples in an attempt to get the milk moving out the blocked duct. Use moist heat on the breast- warm shower or hot washcloths work well. Change breast feeding positions so that the baby's chin is close to the hard lump. This gets his tongue into the quadrant of the breast that needs draining.
If ducts remain blocked, the mother may get a breast infection, known as mastitis. She can usually continue to breast feed in spite of this infection but it will need treatment. Symptoms can include redness, swelling, pain in the breast, fever, chills, and headache. Treatment may include analgesics like Tylenol, warm compresses on the breast, plenty of fluids, more frequent nursing, and antibiotics. In almost all cases, she would be able to continue breast feeding. In fact, frequent nursing is part of the cure. Contact her doctor at the first sign of fever.
DURING
THE FIRST SIX WEEKS POSTPARTUM
During the first six weeks postpartum the mother will be recovering
from childbirth and delivery. She will probably experience many
of the following to some degree at one time or another.
PHYSICALLY:
- Continuing vaginal discharge (lochia), turning pink then brownish, then yellowish white
- Fatigue sometimes bordering on exhaustion
- Some pain, discomfort, and numbness in the perineum, if she had a vaginal delivery (especially if she had stitches)
- Diminishing incisional pain, continuing numbness, if she had a caesarean section (especially if it was her first)
- Continuing bouts of constipation (although it should be easing up). Gradual flattening of her abdomen as her uterus returns to pre-pregnancy location in the pelvis
- Gradual loss of weight
- Breast discomfort and nipple soreness, if she is nursing, until breast feeding is well established
- Achiness in arms and neck; backache (from carrying and feeding baby). Noticeable hair loss
- Swollen neck glands; throat dryness and constriction
EMOTIONALLY:
- Elation, depression, or both alternately
- Either a sense of being overwhelmed or a growing feeling of confidence, or both alternately
- Decreased sexual desire
DEPRESSION
Roughly one-half (some estimates go as high as 90%) of all new mothers complain of weepiness, unhappiness, anxiety, and mood swings, during the first week or so after delivery. This bout of "baby blues" is probably related to the progesterone after childbirth, and usually clears up within a few days, though some women find it comes and goes over the first six weeks.
Less common (it probably affects 25% of first-time mothers and 20% in subsequent pregnancies) and lasting (it often begins during the first six weeks and can persist for months) is true postpartum depression. Hormone variations offer one explanation for this depression. The fact that sensitivity to hormonal fluctuations varies from women to women is believed to explain, at least partially, why it is that although all women experience the same shift in hormonal levels after delivery, not all suffer mood changes.
Depression can also be triggered by the hormonal changes related to weaning. But, there are a host of other factors that are believed to contribute to postpartum depression. Some of these non-hormonal factors may explain why fathers and adoptive mothers, who have no postpartum hormone changes to blame, are also subject to such depression.
THE END OF THE PREGNANCY
For women who passed the nine months in relative misery-with morning sickness, varicose veins, backaches, and indigestion the end of pregnancy is something to celebrate. But if you thoroughly enjoyed pregnancy, its conclusion may be something to mourn, particularly if more children are not on your agenda. The mother may feel a sense of loss and emptiness, and miss the uniquely intimate sensation of carrying her baby inside her.
A FEELING OF ANTICLIMAX
Childbirth- the big event the mother has trained for and anticipated for so long- is over.
GOING HOME
It's not unusual for the new mother to feel overwhelmed and overworked by the responsibilities that await her, especially if she has no help and if dishes, dust, and dirty clothes have been allowed to pile up while she has been away.
EXHAUSTION
Fatigue following childbirth, compounded by the rigors of caring for a newborn, can make the women feel unable to meet the challenges she faces.
LACK OF SLEEP
People deprived of sleep can experience mood changes. New mothers are no exception.
PHYSICAL DISCOMFORT OR PAIN
The new mother's episiotomy or caesarean incision burns, her breasts
are uncomfortably engorged, her hemorrhoids are excruciating,
and she is in pain from after-pains. It is not easy to be cheerful
when you hurt so much.
FEELINGS OF GUILT
New mothers often feel guilty about having to go back to work in the near future, or not bringing in income if she plans on staying home. Guilt can be very depressing.
UNHAPPINESS OVER HER APPEARANCE
Before she was fat and pregnant; now to her over-critical eyes, she is fat. She can not stand wearing maternity clothes anymore, but nothing else fits.
LACK OF SUPPORT
If she does not have enough support-from family and friends, but especially from her spouse, facing the job of new mother may be overwhelming and depressing.
NON-BABY RELATED STRESS
Problems- family, job, financial- that aren't related to her baby can nevertheless induce postpartum depression.
RECOVERY FROM A CAESARIAN SECTION
Recovery from a caesarean section is similar to recovery from any major abdominal surgery. In addition to recovering from the surgery itself, the mother will also be recovering from childbirth. Except for a neatly intact perineum, she'll experience all the same postpartum discomforts she would have if she delivered vaginally- after-pains, lochia, breast engorgement, fatigue, hair loss, excessive perspiration, the baby blues, and, if she had a long period of labor, the exhaustion and other after-effects of that as well.
As for her surgical recovery, she can expect the following in the recovery room:
1. CAREFUL MONITORING UNTIL ANESTHESIA WEARS OFF. If she had general anesthesia, her memory of the time in the recovery room may be fuzzy or totally absent. Since everyone responds differently to drugs and each drug is different, whether she is clear-headed and alert in a few hours for a day or two will depend upon her body and the medications that were given.
2. INCISIONAL PAIN. Once the anesthesia wears off, the incision is going to hurt tough just how much depends on many factors, including the mothers personal pain threshold and whether or not she has had a previous caesarean (subsequent recoveries are less uncomfortable than the first one). The mother will probably be given pain medication as needed, which may leave her with a woozy or drugged feeling. She need not be concerned if she is nursing: the medication won't pass into her colostrum in any meaningful amount, and by the time her milk comes in she probably won't need any more pain relief medication.
3. NAUSEA. If the new mother experiences nausea, she may be given an antiemetic preparation to try to prevent vomiting.
4. ENCOURAGEMENT TO DO BREATHING AND COUGHING EXERCISES. These help rid her system of any leftover general anesthetic, and help to expand her lungs and keep them clear to prevent the complication of pnewmonia. Done correctly, they may cause discomfort, but she may be able to minimize it by holding a pillow against her incision while performing them.
5. REGULAR EVALUATION OF THE MOTHER'S CONDITION. Her vital signs, dressing, urinary output and vaginal discharge, and her uterus, as well as her IV and catheter (while they remain in place), will be checked regularly.
6. REMOVAL OF THE CATHETER AFTER 24 HOURS. Urinating on her own may be difficult. If she can not urinate on her own, the catheter may be reinserted.
AFTER PAINS
Like the women who is gone through a vaginal delivery, she can expect to begin feeling after-pains about 12 to 24 hours after delivery.
A GRADUAL RETURN TO A NORMAL DIET
About 24 hours after surgery, or soon, her bowels begin to show signs of activity (by moving or passing gas), her IV will be discontinued and she will be allowed fluids by mouth. Over the next few days, she will gradually return to her usual diet. Take it slow getting back to her usual fare, or she may find herself with unnecessary digestive discomfort. If she is breast feeding, be sure she gets plenty of fluids.
REFERRED SHOULDER PAIN
Irritation of the diaphragm from air in the abdomen following surgery can cause a few hours of sharp pain referred to the shoulder.
POSSIBLE CONSTIPATION
Like the mom who went through a vaginal delivery, she may have difficulty having a bowl movement for a few days. That's not a reason for concern, especially since she has not eaten very much that can come out.
WEARING ELASTIC STOCKINGS
These improve circulation and are intended to prevent blood clots in the legs.
GAS PAIN
As her digestive tract begins to function again, trapped gas can cause considerable pain especially if it presses against her incision line. Discomfort may be worse when she laughs, coughs, or sneezes.
MOTHERS CAN EXPECT TO GO HOME FROM A CAESARIAN SECTION IN THREE OR FOUR DAYS.
A baby who sleeps all the time and doesn't cry much is often called a "good" baby. If you have one of those good babies, you'll realize that people who have babies that are not so good are lucky.
How to encourage a sleepy baby to nurse?
Make sure your baby is healthy
20 Ways to Calm a Cranky Baby: Win the Crying Game with these Parent-Tested Soothing Tactics.
Hal Mayfourth, Child First-Year Planner 1998
All babies cry- it's their only way of communicating. And in most cases they are trying to say they are hungry, tired, or uncomfortable from a wet or soiled diaper. As you and your baby become more familiar with each other, you'll recognize her special language.
Some infants- about one in five- cry more in the early months, developing a condition known as colic. No one knows what causes colic, but most experts believe that the young baby's systems may simply be too immature and sensitive to regulate their eating, sleeping, and other behaviors. Your baby would be considered colicy if he cries for more than three hours a day, three or more days a week, for at least three weeks. Happily most cases of colic disappear by about 3 months of age.
Whether your baby is a prolonged crier or just going thorough a cranky spell, try these soothing tactics.
1. Offer the breast or bottle. Hunger is the most common cause of distress.
2. Rock together in a rocking chair. Babies love the rhythmic feel.
3. Hold baby close to your heart. The sound of your heartbeat is calming because it is familiar from the womb.
4. Check the diaper. She may need changing, have an irritating rash, or is about to make a bowel movement.
5. Soothe diaper rash by letting baby go bottomless for a little while. You'll remove the source of the chafing and the fresh air will help the rash to heal.
6. Watch your diet. If you're breast feeding, a certain food you've eaten- broccoli and chocolate are common culprits- may be upsetting your baby's delicate digestive system.
7. Ask your baby's healthcare provider about switching formulas if you are bottle-feeding. Your little one might be able to digest soy based formula better than cow's milk variety, or he may simply prefer the taste of one particular brand.
8. Check the temperature of your baby's bottle- it may be too cold or too hot. Room temperature is best.
9. Wear your baby in a front carrier or sling. The gentle rocking motion coupled with the closeness and sound of your heartbeat is very soothing.
10. Position baby near a window. The change in scenery may perk him up.
11. Offer your little one a pacifier. Some babies really need the extra comfort sucking provides.
12. To relieve gas pain, lay your baby on his back and pump his legs slowly, as if he's pedaling a bike.
13. Put your little one in a car seat and take her for a lulling ride.
14. Turn on a lullaby tape and slow dance together. Many babies respond positively to the sound of music.
15. Try a warm bath. Water can be very relaxing to infants because it feels like the womb environment. Follow it up with a gentle massage.
16. Go for a walk outdoors. The motion, fresh air, and new scenery might bring about a change of mood.
17. Switch on the vacuum cleaner or hair dryer, or put the television on a "fuzzy" channel. This sort of "white noise" is calming to many infants.
18. Swaddle baby. Place her on a soft blanket with her head at one corner and her feet pointed toward the other. Fold the corner near her head under it, and bring the opposite corner up to her chest. Then fold in the side corners.
19. Put baby in his crib. Continue to check on him every 10 minutes. Some infants need to be left alone in a quiet room when they are over stimulated.
20. Don't feel guilty! All babies cry, and if you've got a colicy one on your hands, there's nothing much you can do. Remember, this stage will pass.