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Congratulations on Your Baby Sunnybrook Health Sciences Centre, Perinatal Program supports Family Centred Care and respects the pivotal role of families in our patients lives. Family Centred Care respects family lifestyles, beliefs, values and culture. We respect individual choices and would like to provide information and resources that will help you to make informed decisions. Your questions are important and should be directed to the nursing staff on the unit. This booklet will provide you with a written record of what you have been taught by your nurses and a reminder of what you already know.
Updated: January 2007
Sunnybrook Health Sciences Centre ______________________________________________________________________________________
TAKING CARE OF YOURSELF Your nurse will be checking on your condition every 4 hours for the first 24 hours. After that, they will be checking you twice a day or as necessary. Here are some suggestions that can help you during your recovery from labour and delivery.
Getting Up •
Please call your nurse the first time you wish to get out of bed. It is important to have your nurse there as many women often feel faint the first time they get up.
Your Uterus Gradually over the next few weeks your uterus will contract back to its normal size and position. After delivery you can feel it just under your belly button as a firm mass about the size of a grapefruit. The uterus contracts firmly to prevent it from filling with blood and clots, which can cause heavy blood loss. Breastfeeding releases oxytocin naturally, helping your uterus to contract.
Vaginal discharge After delivery, the contracting of your uterus expels blood and tissue. This vaginal flow is called lochia. Lochia continues for a period of 2 to 6 weeks after birth. The first day after delivery bleeding can be heavy and bright to dark red in colour. Small clots the sizes of a plum are normal. A slight increase in lochia is normal with a full bladder during increased activity and breastfeeding.
Notify your nurse if you soak a pad in an hour or less and pass clots larger than a plum. Laceration / Tear / Episiotomy As your baby is born, your perineum, the area between your vagina and rectum, stretches and occasionally tears. If the tear is small you may experience swelling and stinging. If the tear is large you will have had stitches and may experience increased pain. Occasionally, an episiotomy (a surgical incision that enlarges the perineum) is performed to ease the birth of your baby. The swelling and bruising of the tissue surrounding the tear or episiotomy causes pain that can vary from woman to woman. Swelling and discomfort usually peak on the second or third day after delivery. __________________________________________________________________________________ Taking Care of Yourself
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Sunnybrook Health Sciences Centre ______________________________________________________________________________________
PERICARE The following suggestions will help to increase your comfort, prevent infection, and promote healing: •
Each time you use the toilet, rinse your perineum with warm water using the plastic pericare bottle. Pat dry with toilet paper from front to back.
•
To decrease stinging when voiding, use the plastic pericare bottle to spray water over your perineum while you are urinating.
•
Take care not to touch the inside surface of the sanitary pad with your fingers. • Change your pad every time you use the toilet.
•
Use ice packs on your perineum for the first 24 hours. This will help to decrease the swelling. • Your nurse will be able to show you where to get ice.
BLADDER Urinating is sometimes difficult because of swelling and decreased muscle tone. Helpful Hints: •
Drink to thirst.
•
Sit comfortably on the toilet.
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Pour warm water over your perineum with the pericare bottle to help start a stream of urine.
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Try to empty your bladder every 3 – 4 hours.
•
Passing large amounts of urine in the first week after delivery is normal.
Notify your nurse if any of the following occur: •
You are unable to urinate.
•
You have burning when urinating.
•
You are going to the bathroom frequently and only urinating in small amounts.
These symptoms, in addition to a fever, may indicate an infection. __________________________________________________________________________________ Taking Care of Yourself
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Sunnybrook Health Sciences Centre ______________________________________________________________________________________
BOWEL MOVEMENTS You should have a bowel movement within 4 days after the birth of your baby. It may be difficult to have a bowel movement because of decreased muscle tone, decreased activity of the intestines and discomfort. Helpful Hints: •
Take the stool softener that is provided in the self-medication package.
•
Eat fresh vegetables, fruit and whole grains to provide fibre and bulk.
•
Drink to thirst, approximately 6–8 glasses of fluids a day.
•
Walking and gentle exercise may help.
• Support your perineum with toilet paper/sanitary pad to support the tissues and relieve the fear of hurting yourself while attempting to have a bowel movement.
Hemorrhoids Hemorrhoids are swollen veins around the rectum. They can be sore after delivery due to pressure on the rectum from pushing out your baby. To increase comfort and promote healing you can: •
Use ice packs for the first 24 hours.
•
Use witch hazel compresses such as TUCKS
•
Avoid sitting for prolonged periods. Use a side lying position as much as possible.
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Eat a diet high in fibre and drink 6-8 glasses of fluids/day. This will help to keep your bowel movements soft.
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Use a hemorrhoid cream or suppository as ordered by your care provider.
•
Rubber rings are not recommended to ease hemorrhoid pain.
Sitz Baths A sitz bath is a portable basin that rests in the toilet bowl. It allows you to bathe your stitches and hemorrhoids with warm water. The bath helps to clean, heal, and soothe your stitches.
Sitz baths can be purchased from the hospital gift shop. An alternative source to a sitz bath is frequent use of the pericare bottle that will be given to you. __________________________________________________________________________________ Taking Care of Yourself
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Afterpains Afterpains are caused from your uterus contracting and cramping after birth. While afterpains keep your uterus firm and decrease bleeding, they can be very uncomfortable. Afterpains are particularly noticeable in the first 2-3 days after birth and tend to be worse with each pregnancy. They are more noticeable and increase in discomfort when you are breastfeeding. To ease the discomfort of afterpains, try: •
Relaxation breathing techniques that you used while in labour.
•
Walking slowly after delivery.
•
Keeping your bladder empty.
•
Use the medication in the self medication pack before breastfeeding and activity such as walking.
Self Medication Package Managing your pain has many benefits. Pain relief helps your body heal, quickens your recovery, helps you relax and increases your comfort while breastfeeding. You will be provided with a self-medication package containing IBUPROFEN (also known as ADVIL) and ACETAMINOPHEN (also known as TYLENOL). Both medications are used to relieve pain and are safe to use when breastfeeding. Ibuprofen is especially helpful for pain related to inflammation (swelling), which is common after delivery or surgery. Acetaminophen is a pain reliever. Although they work differently, they can be used together with the goal of providing better pain relief. Your nurse will explain the contents of the self-medication package and its use.
__________________________________________________________________________________ Taking Care of Yourself
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Sunnybrook Health Sciences Centre ______________________________________________________________________________________
CAESAREAN BIRTH MOMS Your stay in the hospital will be 3 - 4 days. During this time, pace yourself and try not to do too much too soon. Your body needs a lot of rest to recover. It is a good idea to rest when your baby is quiet. During your postpartum stay you will experience the following: •
A nurse will be checking on your condition every hour for the first 24 hours and after that twice a day or as necessary.
•
An intravenous (IV) for at least 18 hours after your caesarean section.
•
Pain from your incision. • The anaesthetist gave you pain medication through the epidural or spinal at the time of your caesarean section. •
You will be provided with a self-medication package containing IBUPROFEN (also known as ADVIL) and ACETAMINOPHEN (also known as TYLENOL). Both medications are used to relieve pain and are safe to use when breastfeeding.
•
Should you need additional pain relief, medication has been ordered. It is important to take this additional pain medication when you begin to feel discomfort because the medication takes 15-20 minutes to work.
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If the pain medication you are taking is not relieving your pain let your nurse know.
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A tube in your bladder to drain urine is called a catheter. This is removed approximately 18-24 hours after delivery.
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Getting out of bed and moving around will help you to feel better. Ask for a nurse to assist you the first time you get up.
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Gradually increase from a fluid diet to a regular diet once you have started to pass gas.
•
Laughing and coughing may strain your incision. Supporting your incision with a pillow will increase your comfort.
__________________________________________________________________________________ Taking Care of Yourself - Caesarean Birth
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YOUR INCISION Your nurse will check your dressing and incision daily. On the second day after your caesarean section, the dressing will be removed and you may have a shower. Leaving your incision uncovered will promote healing. Your incision is closed with metal clips called staples or stitches. Your nurse will remove the staples before you are discharged to go home. Stitches will dissolve.
Report any of the following to your nurse or care provider: •
Fever
•
Increased redness or swelling around the incision
•
Bleeding or discharge from the incision
•
Separation of the incision
GAS During the second to third day you may experience discomfort from gas that has collected in your bowels after surgery. To manage the discomfort and promote passage of gas: •
Walk in the halls
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Lie on your left side.
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Drink a lot of fluids.
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Avoid carbonated, very hot or very cold beverages
•
Avoid using straws
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Sunnybrook Health Sciences Centre ______________________________________________________________________________________
NEWBORN CARE Understanding Your Newborn While each baby is unique, there are certain characteristics and behaviours that are common to all newborns. This section will provide some information on physical and behavioural traits you may notice in your baby during the first few weeks of life.
Mucous In the first few days of life your baby may have excess mucous causing them to gag or vomit. This may be more noticeable with feedings as the milk tends to loosen any mucous in the stomach. If your baby begins to gag or spit up mucous, turn your baby on their side and gently rub their back as if to burp them.
Spitting Up or Vomiting Almost all babies spit up during the first week. The spit up will usually be a teaspoon of breast milk or formula. If it has been a while since their last feeding, the food spit up may look partially digested and curdled. The reason your baby may be spitting up is because of air trapped in the stomach, which is now coming out with part of the feeding. Tip
Burp your baby prior to feeding if they have been crying as babies swallow air when they cry.
Head shape The process of coming through the vagina during birth may temporarily alter the shape of your baby’s head. This is a normal process with the ‘round’ shape of their head returning by the end of the first week. Head shape does not usually change in babies born by caesarean section.
Soft Spot Your baby has two soft spots or fontanelles on their head. One is on the top of the head and closes by 18 months of age. The other is near the back of their head and closes by 2 to 6 months of age. A tough layer of skin covers both of these soft spots.
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Tip
Normal handling and care such as shampooing, brushing or stroking will not damage the fontanelles. Diapering The most effective diaper care is to change diapers frequently. At each diaper change wash the skin with warm water or diaper wipe, then pat or air dry. Ask your nurse or paediatrician to check the rash if you have any concerns. Tip Exposing the buttocks to air can help dry diaper rash. Uncircumcised Infant: There may be a whitish discharge around the tip of the penis— this is called smegma. Gently clean and wash as usual. Do not forcibly retract your son’s foreskin as it will naturally retract by the time he is 3 to 4 years old. More information is available on the Canadian Pediatric website www.careforkids.cps.ca/babies/Circumcision Cord Care • • • • •
At birth the cord is clamped. When the cord is dry (approx. 24 hours) your nurse will remove the clamp. The cord usually falls off in 7 – 10 days. There may be some slight bleeding at this time. It is important to keep the cord clean and dry until it falls off, as this will prevent infection. To help the cord dry and prevent infection, wash your hands with soap and water before and after touching the cord. Continue to keep the umbilical cord clean and dry until the area has completely healed.
Tip Keep the cord dry and exposed to air by folding the diaper down and loosely covering it with clean clothes. .
If you notice a foul or bad smell, yellow discharge or redness and swelling around the cord or the skin around the cord feels warm, notify your physician.
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Keeping your baby safe While in hospital do not leave your baby unattended. Leave your baby only with hospital personnel with proper Sunnybrook Health Sciences Centre photo identification. You may accompany your baby with hospital staff for any procedures that need to be done outside of your room.
Knitted Mittens & Booties Knitted mittens and booties are not recommended for babies. Loose threads may become tightly tangled around fingers and toes causing poor circulation and permanent damage.
Back to Sleep The Canadian Pediatric Society recommends that babies under 1 year of age sleep on their back. When your baby can roll over on his/her own there is no need to force your baby to sleep on its back. Wedges or rolls to keep your baby on their side should not be used. To prevent flattening of the back or side of the baby’s head supervised tummy time while awake is recommended. For more information www.hc-sc.gc.ca/hppb/childhood-youth
Car Seats Canadian law states that all passengers in cars should be safely secured. Seat belts have been shown to reduce the risk of injury in the event of a car accident. It is important that infants and children are also safely secured by the proper use of car seats. Infants should not be transported in a vehicle in someone’s arms, or a seat that has not been approved for use in a motor vehicle. Transport Canada reported in 1997 that in Ontario only 73 % of people used appropriate restraints properly for children under the age of one.
Babies should be placed in an approved infant car seat, which faces "backward" (toward the rear) in the back seat.
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Beginning Breastfeeding First Feeding Breastfeeding should begin as soon after birth as you and your baby are ready. It is common practice to initiate breastfeeding in Delivery Suite before you are transferred to your postpartum room. Your nurse will help you with positioning and latching for the first feed. Some babies will snuggle, sniff and lick the breast during the first feed. Others will latch and suck eagerly. All these behaviours are normal. Don’t forget that you have plenty of time to get the breastfeeding relationship off the ground. Spending lots of time skin-to-skin with your baby is important. So are the following: •
Offer your baby your breast at least eight times every 24 hours
•
Take time to achieve a good latch with your baby’s mouth open and the bottom jaw well under the areola (the darker skinned area around your nipple)
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If your baby is sleepy, encourage his interest in feeding by undressing your baby down to his diaper and gently stroking your baby’s back or head
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Let your baby “finish the first breast first”. This means you should let your baby feed for as long as he wants on the first breast. After changing the diaper and burping, you can offer the second breast. Some babies will feed on the second side, some will not.
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Crying is a late sign of hunger. Watch instead for early signs such as wiggling or eyelids moving during sleep.
Colostrum is the name given to the first milk. It is all your baby needs as long as you feed your baby at least 8 times a day. It is normal for babies to have times when they feed several times in a 4-5 hour period. This “cluster feeding” behaviour does not mean your baby isn’t getting enough. It is a natural way to increase your milk supply. It is more important for your baby to breastfeed frequently during these times and not be given formula or water. Any other food offered to your baby would decrease your milk supply.
Latching and Positioning As you will be feeding your baby 8 to 12 times each day, it is important to be comfortable. Here are a few tips on how to begin: •
Breastfeeding may be easier if you can sit in a chair with your back well supported, feet flat on the floor or raised on a stool. Another option is to pull down the bed rail
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of your bed and rest your feet on it. •
Unwrap your baby so that you can position him more easily.
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If your baby is having trouble breastfeeding, you can try undressing him down to a diaper since skin-to-skin contact can help your baby figure out what they need to do.
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Turn your newborn totally on their side, your breast and his tummy to you.
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To help support your baby, bring him up to breast level, put a pillow or two on your lap.
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You can support your breast in a U-hold (cross cradle position) and C-hold (football position) with your thumb well above and fingers well below the areola, so that your baby can take a large mouthful of breast.
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Your baby needs to open wide to breastfeed well. To encourage this, lightly tickle your baby’s lower lip with your nipple. It’s important to be patient until your baby opens their mouth and then bring them very close onto the breast.
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A baby who is latched well will have his chin and nose lightly touching your breast.
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Babies are primarily nose breathers and are able to flare out their nostrils so that you do not worry about him not being able to breathe.
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You can tell your baby is latched well when his mouth is wide and both top and bottom lips are flanged out. With each feeding baby should: • Gape his mouth widely • Take a large mouthful of breast
Sucks should be mostly strong and rhythmic, with pauses between each episode of sucking.
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Burping Some babies swallow a little air when they breastfeed, while others swallow more. After your baby has fed on one breast you can burp them by: • •
Placing your baby over one shoulder and gently patting or stroking the back. OR Holding your baby in a sitting position on the lap, then leaning them forward against one hand, with the index finger and thumb supporting the head.
Burping – Sitting position YOUR BABY IS DOING WELL IF: • • • •
By day 3-4 you see deep rhythmic sucking and regular swallowing at the beginning of feeding. Your baby breastfeeds well 8-12 times/day. Your baby has adequate wet and dirty diapers (see chart below) Your baby is satisfied and sleepy after feedings. MINIMUM
Day: 0-24 hours Day: 25-48 hours Day: 48-72 hours Day: 4 to week 6 Sleepy Day: 5 Babies
Wet diapers Dirty Diapers 1 1 (loonie-sized) 2 1 3 1 6 2 stool should be turning golden, liquid and seedy
Many babies are sleepy in the first 24 hours after birth.
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•
Full-term, healthy newborns are born with adequate fluid stores, so supplementation with water or formula is not recommended unless there is a medical problem.
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It is a good idea to wake your sleepy baby and attempt to nurse every 3 hours. Some babies will easily awaken with gentle stimulation such as, unwrapping blankets from around the baby or changing their diaper.
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When attempting to breastfeed, try holding your baby skin to skin against your body and express a drop(s) of colostrum into their mouth. If your baby does not wake after 10 to 15 minutes of trying, simply take a break and try again in an hour or two.
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You may need to continue with some "gentle" stimulation to keep your baby feeding. Try lifting the baby's upper arm, stroking legs, feet and head and blowing on baby's face.
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After long periods of sleep, some babies go through a "marathon nursing phase" where they want to nurse "all the time" and can't be put down. This is the way your baby stimulates your body to establish a good milk supply. Allowing your baby to eat as often as they want is best. If your baby does finally fall asleep during this frequent feeding phase, your baby may settle if they are held and cuddled. If you put your baby down, she may soon awaken and want to nurse again. Remember, the more you nurse, the sooner your milk will come in and your milk supply will increase.
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Do all soothing at the breast. Avoid pacifiers or bottle nipples until your baby is breastfeeding effectively. Pacifiers and bottles can lead to breastfeeding problems while you and your baby are still learning how to breastfeed.
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Keep a record of your baby's feedings, wet diapers and bowel movements. You can use the form at the end of this section. Adequate bowel movements are the best indication that your baby is getting enough to eat.
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You no longer need to record this information after the first week unless asked to do so by your baby’s physician or the Breastfeeding Clinic.
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RECORD OF FEEDINGS, WET DIAPERS & BOWEL MOVEMENTS
DAY
TIME 1 AM
0-24 hrs FEEDING PEE POO 25-48 hrs FEEDING PEE POO 48-72 hrs FEEDING PEE POO DAY 4 FEEDING PEE POO DAY 5 FEEDING PEE POO DAY 6 FEEDING PEE POO DAY 7 FEEDING PEE POO
2 AM
3 AM
4 AM
5 AM
6 AM
7 AM
8 AM
9 AM
10 AM
11 AM
12 PM
1 PM
2 PM
3 PM
4 PM
5 PM
6 PM
7 PM
8 PM
9 PM
10 PM
11 PM
12 PM
Printed with permission from Best Start
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