Postpartum, Breastfeeding & Newborn Care

New baby, new mama

Whether this is your first or fourth child, each birth brings change, adjustment and transition. We believe that the more support you get in the early days, the less you will need weeks down the road. This is why we do homevisits nearly every other day in the first week or so. We will be checking in on you and your baby to see how you are both recovering from birth, help with breastfeeding and see what other physical or emotional changes you may be experiencing. We will basically sit on your bed or couch with you and check in on how you’re doing.

FAQ

New Mama Care

Postpartum Panic Prevention

New Mama Care

Congratulations!!! You had your baby! You may be feeling tired, sore and uncomfortable, or you may be feeling wonderful. You may be feeling confident of your parenting abilities or you may be feeling unsure. This pamphlet has been put together to help guide you through your first days and weeks postpartum.

Birthday!

Alert phase: After birth, the baby has a two or three hour alert phase. S/he will look around, respond to your voices and begin to adjust to “life on the outside”. This includes coordinating her/his breathing, feeding once or twice and possibly passing meconium and/or urine.

Sleep phase: After this initial alert period, baby will go to sleep. It is not unusual for babies to have an extended sleep on the first day, anywhere from 2-12 hours. Make sure you take advantage of this by sleeping yourselves.

Feeding phase: After this first sleep, you should nurse the baby every 2-3 hours, with only one 4-hour sleep period every 24 hours until your baby is over its birthweight. It is nice when this sleep period happens at night, but no matter when it happens you should sleep too.

Breasts and nipples

2013appleblossomfamilies0013 cropBreastfeeding is a learned skill for both mother and baby. Have patience. Use lots of nipple cream to prevent or deal with nipple damage.

Latch

For the first few days it is common to feel tenderness in the nipples when the baby begins to suck. This should not last more than 5 or 6 sucks and should pass within a few days. If there is pain when the baby nurses, double check that the baby is latched on well. Do NOT tolerate a bad latch, as this can cause damage in as little as five minutes, which then will take days to heal.

Milk & engorgement

Your milk will “come in” somewhere between 2 and 4 days after birth. Most women have a certain degree of fullness at this time which is just progressive filling of the breasts. It is only mildly uncomfortable and the baby should be able get on the breast to nurse. It may last for up to 48 hours after the milk comes in.

On the other hand, engorgement is excessive fullness which makes the breast completely hard and painful. When the breast is engorged it may be difficult for the baby to latch on, leading to nipple damage. The best way to prevent this condition is to feed frequently and as long as possible from birth on, in order to drain the breasts. If you become engorged, some strategies for dealing with it are:

  • Feed frequently
  • Before feedings, apply wet heat (shower, bath, wet face cloth) to your breasts, and then express some milk to soften the areola. This helps baby get a good latch.
  • After feedings, use cold cloths or frozen cabbage leaves to minimize any pain. It is best to use green cabbage, since purple will stain your breasts and clothes!

Once breastfeeding is well established, it is good to vary the positions used for nursing as this encourages complete drainage of different areas of the breast. As a general rule, the area toward which the baby’s chin is pointing is the area which is being drained the most. It is also good practice to drink when your baby drinks. When you sit down, try to have a glass of water or juice handy.

Contact your midwife if you have:
  • A red or tender area on the breast
  • A fever or flu-like symptoms

Vaginal flow

After birth, your uterus begins to undergo changes that will return it to its nonpregnant condition. Involution is the term used to describe this process of change. This whole process may take anywhere from 2 to 6 weeks. The vaginal discharge you are having is the normal response of your body to these changes.

  • Right after birth, the discharge (lochia) will be red and heavier than your usual menstrual period but will decrease rapidly in the first week. It is normal to pass clots, which form from pooled blood in your vagina while sitting or lying down.
  • Over the first few weeks the discharge will change to pink or brownish in color and become thinner.
  • Eventually the discharge may turn yellowish or cream colored.
  • Between days 7 and 14 many women have an episode of increased flow. This happens when the blood that formed a type of wet scab called eschar is passed. This scab covered the area where the placenta was implanted. This increased discharge should not last more than 1-2 hours before diminishing.
  • Often an increase in the amount of discharge is your body’s way of telling you to get more rest. Lying down or relaxing will help to decrease the flow.
  • If you find that you are saturating a pad in 30 minutes, take these actions:
    1. Empty your bladder
    2. Lie down with your feet up
    3. Massage your uterus to make it firm
    4. Nurse your baby
    5. If you saturate another pad in 30 minutes after taking these steps, call the midwife.

Call your midwife if:

  • There is an extremely foul or fish-like odor to the discharge
  • You are completely soaking 2 pads in an hour or less
  • You pass a clot larger than a lemon

Afterpains

Afterpains, or afterbirth pains, are caused by contractions of the uterus which shut off the flow of blood from the blood vessels which fed the placenta. This is one of the ways that bleeding is controlled. They are often felt more strongly during breastfeeding, especially by women who have had a baby before, because breastfeeding stimulates the release of the hormone oxytocin, which in turn causes both the milk to let down and the uterus to contract intermittently. Various things will lead the uterus to have one big contraction that stays. If the uterus stays contracted the cramping goes away.

Some ideas to reduce afterpains:

  • Massage your uterus
  • Keep your bladder empty
  • Use a hot water bottle or heating pad
  • Drink raspberry leaf tea
  • Try lying face down with a pillow placed under your abdomen
  • If these methods are not effective you can take ibuprofen 600mg every 4 to 6 hours as needed.

Care of your perineum

Whether or not you have had stitches, your perineum (the area between your vagina and rectum) will need some TLC. Treat it like an athletic injury (isn’t pushing an Olympic event?).

First days:
  • Use frozen pads or apply ice to your perineum (like any injury – ice for the first 48 hours). It sounds uncomfortable now, but will feel great in the moment!
  • Wash your hands before (as well as after) using the toilet until your stitches are healed
  • Pee in the shower/bath if urination causes stinging
  • Use a peri bottle after using the toilet – add herbs/lavender/tea tree oil for their antibiotic and healing properties
  • Take Homeopathic Arnica 30C every 4 hours while awake (minimizes any swelling or bruising)
  • If you feel you need pain relief medication, ibuprofen or acetaminophen can be taken according to the recommendations on the bottle
  • Plan to not go outside for 7 days. Stay in bed and cuddle with your baby, minimizing activity as much as possible. Aim to only walk up/down stairs once or twice a day max.
  • Sit with your legs together, i.e. don’t sit cross legged.
  • Sitz bath twice a day – add herbs/lavender/tea tree oil.
  • Full bath x 10-20 minutes once a day (in addition or instead of sitz bath) – add 2 cups Epsom salts, perineal wash herbs – avoid bubble bath
  • Do NOT sit on a hemorrhoid or “donut” pillow which can cause stitches to tear out
  • Eat healthy, drink lots of water
  • It is normal to feel “heaviness” in your pelvis at the end of the day if you have had increased your activity. This is the pelvic floor muscles getting fatigued. Try to balance days of activity causing fatigue, with days of rest.
  • Prolonged use of maxi pads can be very drying – occasionally try sitting on a blue pad while nursing, or use cloth pads. After a sitz bath, dry out your perineum well, then sit on a blue pad or towel and let your perineum fully dry and breathe for 1-2hours.
  • You will not have the same strength when doing kegels. Be patient, it will return.

Inform your midwife if:

  • You have increasing amounts of pain in your perineum, not associated with increased activity or decreased use of painkillers
  • You have discharge that is abnormal in color or foul smelling
  • You continue to have serious urinary incontinence past the first few weeks
  • Use lots of lube when you have sex, as postpartum hormones cause dryness.
  • See a pelvic floor physiotherapist if you have any concerns or just want to improve your pelvic floor strength. You do not have to have serious incontinence before seeking physiotherapy. If your problem is assessed to need further medical intervention, they can provide a gynecological referral.
  • BC Women’s Continence Clinic 604-875-3137 (self-referral)
  • Various private physiotherapists specialize in the pelvic floor
  • Check out pomegranate-midwives.com/Resources under Health for further referrals
In the first year:

Urination

It is important to prevent your bladder from becoming overly full during this postpartum period. Try to urinate at least every few hours when awake. You may find yourself urinating more often and in very large quantities in the first few days after birth. This is a way your body uses to get rid of extra fluid built up during pregnancy and is normal. It is especially important to drink lots of fluids, even if you feel like you are urinating frequently as it is easy to become dehydrated when trying to produce breastmilk. It may take a few days for the nerves of the bladder to return to normal, so you may need to pee by the clock if your body isn’t warning you when your bladder is full.

Signs of a urinary tract infection (if you feel any of these, call your midwife):

  • Burning or pain with urination
  • Difficulty starting to urinate
  • A sensation that you have to urinate immediately
  • Cloudy urine with or without a foul odor

Bowel function

It is usual not to have a bowel movement until 2 or 3 days after birth, as your digestive tract has slowed for labor and it takes time to get back to normal. Sometimes women fear that they will hurt themselves or any stitches by moving their bowels. This will not happen! Please follow your urge when it comes, and it will not be as bad as you fear.

To minimize discomfort:

  • Drink at least 8 glasses of water a day
  • Eat foods that will keep you from getting constipated: lots of fruits, vegetables and whole grains
  • Drinking prune juice or eating prunes, figs and bran can be helpful, but beware of overdoing it and getting diarrhea!
  • If other methods haven’t worked, you can try a bulk laxative such as Metamucil or an over-the-counter stool softener.
  • If you have not had a bowel movement after the 4th day and are concerned, call your midwife.

Hemorrhoids

Some women develop hemorrhoids during pregnancy or with birth. Other women who already have hemorrhoids may find they become worse with childbearing.

To relieve pain, speed healing and avoid irritating the hemorrhoids, use any combination of the following:

  • Apply an ice pack (bags of frozen peas work well)
  • Use a warm sitz bath
  • Apply a cotton ball soaked in cold witch hazel
  • Use a hemorrhoid cream or suppository – there are various herbal preparations, as well as over-the-counter preparations.
  • Do Kegel exercises to increase circulation in the area
  • Try to avoid constipation
  • Don’t strain during bowel movements
  • Lie on your side whenever possible
  • Regular exercise such as walking is also beneficial after the first week
  • Do NOT Sit on a donut pillow as this may tear out your stitches

Sleep/rest/activity

It is very important to get plenty of rest and sleep and to not become stressed with too much activity. Your job as a new mother is to take care of yourself and your baby. Mothers need to spend the early weeks recovering and getting to know their new baby. Recovering from the birth and caring for a newborn can be very tiring. Sleep deprivation can result from frequent night feedings and the demands of baby care. It has been shown that being overly sleep deprived can push susceptible women from normal baby blues into postpartum depression.

Plan on having a “babymoon”, which includes not going out of the house for the first seven days, and being pampered for at least two weeks. This is not as easy as it sounds. It takes advanced preparation, but it is vitally important for your long term health. Your efforts now will be well spent:

  • Beware of the “week one high”, which fools women into thinking they are fine, when in fact they are still on an adrenaline high from the birth and the excitement of having a new baby.
  • The key to adequate rest is to sleep when baby sleeps.
  • Turn the phone off when you are sleeping, and change the answering machine message to let people know that you are both resting but will phone when you can.
  • Plan meals ahead. Prepare extra portions when you cook and bake now, and put them in the freezer.
  • If friends offer to have baby showers, request a “casserole shower”, with guests bringing a frozen (hopefully homemade) entrée. When you are recovering someone can just add a salad or veggie, and dinner is served.
  • Consider hiring a postpartum doula.
  • If you have other children, it is a good idea to plan some babysitting, quiet activities, and general household help to allow you to rest whenever you get the opportunity. At the very least, arrange time for naps during the day and go to bed as early as possible.
  • Minimize visitors. Have a list ready of things that need to be done, for friends and family who do come over.

Mood

Baby blues or postpartum blues occur in many new mothers. This is different from postpartum depression or anxiety. These blues can include

  • Feeling mildly down
  • Being easily upset or irritable
  • Feeling unexplainably sad or tearful
  • Feeling restless
  • Having difficulty sleeping
  • Having little or no appetite
  • Headaches
  • Feeling “flat” or unable to fully experience emotions.

One or more of these symptoms may appear anytime in the first week after the birth, but are most common from the third to fifth day (as the milk comes in – part of the same hormonal process). It is believed that the tremendous physical and hormonal changes that the mother’s body is experiencing as it returns to the nonpregnant state are responsible. Discomfort and fatigue can also play a part. Reassurance, support and lots of rest are usually all that is needed.

If the blue feelings last longer than the tenth day or make it difficult to look after yourself or your baby, call your midwife.

Nutrition

During the postpartum period, it is important to maintain the same amount of nutritious food and fluids that you ate during pregnancy. Your body needs 500 extra calories per day to produce enough breastmilk. You should focus on eating a well-balanced variety of high-quality, nutritious foods. Fluid intake needs to be maintained to help replace fluids lost during labor, aid in the elimination process and provide a good supply of milk. A beneficial practice is to have a snack and fluids during the night if you are awake to feed the baby.

Weight loss should not be a concern at this time. Due to the extra calories required by milk production, most women find that they can continue to eat 2500 to 2700 calories per day and still lose the extra weight gained during pregnancy. Rapid weight loss is never healthy. With breastfeeding, the weight will come off gradually over 6 to 9 months in much the same way that it was gained.

Night sweats

You may find that you are perspiring more than usual in the first few days. This is another way your body uses to get rid of extra fluid built up during pregnancy and is normal. To cope with sweating:

  • Wearing natural fibers
  • Dress in layers.
  • Try taking a couple of showers a day

Sexuality

Although sexual activity can safely be resumed when the perineum is healed and the bleeding has mostly stopped, the desire to resume sexual activity varies greatly among women and their partners. It may be affected by pain or tenderness from any tears, tiredness, concerns regarding milk letdown during sexual activity, lack of privacy or interruptions. Emotional recovery from the birth and adjustment to the parenting role is important as well, for both partners.

The vagina may be dry, due to a decrease in hormone levels. Use of a water soluble lubricant can increase comfort. If the milk letdown reflex is bothersome, a bra can be worn during sexual activity or the baby can be fed immediately before. Good communication, a sense of humor and patience go a long way towards smoothing over the rough spots.

Menstruation

The return of menstruation varies according to the individual woman’s pattern and whether or not she is breastfeeding. Most nonbreastfeeding mothers resume menstruating between 6 and 8 weeks after the birth.

The longer the woman exclusively breastfeeds, the longer the delay in the return of periods tends to be. The return of periods for breastfeeding mothers is associated with the length of time she continues breastfeeding and whether or not supplements – formula or solid foods – are used for infant feeding. It also depends on length of time between feedings. The sooner baby “sleeps through the night”, the sooner your period will return.

Contraception

Remember, ovulation usually precedes menstruation, so it is possible to get pregnant before having a period. Even if you think now that you will never be interested in sex again, it will happen! It’s wise to plan a method of contraception and have it available before the mood hits.

Postpartum exercises

You can begin simple exercises such as Kegels shortly after birth. Be aware that increased vaginal flow and pain means that you should re-evaluate the type and amount of exercise that you are doing. If this occurs you should decrease or modify your activities. Listen to what your body is telling you, gradually increase your exercise and don’t overdo it.

Phase 1: First Week
Deep breathing and abdominal wall tightening

Lie on your back, knees bent. Place hands on abdomen. Take a deep breath in through your nose. Keeps ribs still and let abdominal wall expand upward. Part lips slightly and slowly but forcibly blow air out through the mouth, pulling in your abdominal muscles until you feel you have completely emptied your lungs. This exercise works the transverse muscles, which compress the abdominal contents and prevent the abdominal wall from bulging.

Pelvic Tilt

Rock the pelvis back by flattening the lower back down onto the floor or bed. On exhale tighten the abdominal muscles and buttocks. Hold the position for 3 seconds. Concentrate on flattening the hollow in the small of the back while also contracting the abdominal wall muscles. This should feel good.

Kegels

Consists of alternately contracting and relaxing the pelvic floor muscles. Contract the muscles surround the urethra, vagina and rectum, all at the same time. Imagine you are on an elevator going up five floors. Tighten these muscles slowly as you go up each floor, 1-2-3-4-5. Hold for the count of five, then slowly relax. To check if you are doing the exercise correctly, begin to urinate then stop the flow. Do this only to check the exercise; do not interrupt the flow on a regular basis. Do a minimum of 20 Kegels per day.

Phase 2: One to two weeks after birth
Leg Sliding

Lie on back, knees bent, pelvis tilted backward and lumbar spine flattened. Breathe normally throughout. Slowly slide heels down until legs are straightened. If the abdominal muscles won’t stay flat, draw knees up again, one at a time, to the point where the spine began to arch. Work in the range until abdominal muscles maintain a straightened back with the legs outstretched.

Bridging

Lie on back, knees bent. Raise the hips so the knees and chest form a straight line. The closer the feet are to the buttocks, the more leverage you achieve. Do not arch the back. You can strain ligaments and stretch the abdominal muscles. Contract both abdominal muscles and buttocks together. Progress by moving the feet farther away from the buttocks.

Abdominal Tightening

Lie on back, knees bent. Cross hands over abdomen so you can pull toward the midline as you raise your head. Breathe out and raise your head at the same time, then relax.

New Baby Care

Postpartum Panic Prevention

New Baby Care

Congratulations on your new baby! Even though some baby books will state that they are “manuals”, babies don’t actually come with them! There are some great books out there you can use as reference guides and as you learn more about your baby you will grow to recognize changes. We are there to help you in the early days at postpartum home visits and then at our clinic check-ups. We can answer your questions and help you as you transition into becoming parents.

  Normal
Behavior
  • Deep sleep, light sleep, drowsy, quiet alert, active alert, crying
  • Sleeps about 16 hrs/day, 2-3 hrs at a time
Feeding
  • Every 2-4 hrs: 8-12 times per day
  • Usually, at least 20 minutes is advised
  • Cluster feeding, followed by longer interval
Elimination
  • Until milk comes in: One wet diaper for every day postpartum (e.g. day 2, two wet diapers); meconium stools.
  • After milk comes in: 6-8 wet diapers/day; liquid yellow, green or brown stools, with curds
  • Bottlefeeding: 6-8 wet diapers; poops are more formed, smelly and fewer
Skin color
  • Acrocyanosis (blue feet and hands) on first day
  • May mottle with cold, crying
  • Vernix and lanugo may be present
  • Milia (white spots)
  • Baby “acne”
  • Birthmarks may appear within first week
  • Mild jaundice after 24hrs
Respiratory patterns
  • Rate 30-60/min
  • Obligate nose breathers
  • May be irregular or periodic
  • Apnea up to 20 seconds
Weight gain/loss
  • Loss of 5-8% considered average
  • Regained birth weight by 14-21 days
  • Average weight gain of ½ – 2 oz per week after milk in
Temperature
  • 3 to 37.5

AppleBlossomFamilies-12Temperature

Between 36.3 to 37.5C is normal. If the baby’s temperature is over 37.5, take off a layer of clothing and re-check in 30 minutes.

If the temperature is less than 36.3, place the baby skin-to-skin with you and cover both of you, or wrap the baby in a blanket warmed in the dryer, and re-check in 30 minutes.

Respirations

Irregular, shallow breathing is normal for a newborn. They will even stop breathing for up to 20 seconds at a time. Normal ranges are 40-70 per minute for the first 24 hours, and 30-60 thereafter.

Babies make all kinds of faces and noises, most of which are endearing and normal. They may blow bubbles or cough up mucous for the first few days. If you see flaring nostrils, grunting with each expiration, or the baby’s chest pulls in sharply between the ribs when s/he breathes: these are signs that the baby is having to work hard to breathe and should be reported to your midwife.

Colour

Regardless of ethnicity, all newborns are pink. It is not uncommon for the baby’s hands and feet to be blue during the first day. If it happens after the first day it may mean that s/he is cold.

Skin care

Sponge baths or tub baths are okay, although not necessary, right from birth. Research has shown that babies who are not bathed for the first 2-3 days find the breast easier which makes breastfeeding more successful. When you do start bathing, it may be easiest for mom (or anyone) to get in the tub, then have someone hand her the baby.

  • Use water to clean eyes and face
  • Use mild soap to wash hair and body
  • Use non-petroleum-based oil or lotion (olive oil works well) daily for dry or peeling baby, or if the environment is very dry

Babies’ is influenced for several weeks by the maternal hormones passed through the placenta. This can caused small red “acne”  which usually is on the face or trunk, and disappears quickly.

Cord care

The cord usually falls off within the first few days or weeks.

  • Keep the cord dry and clean, placing the diaper, diaper wrap and plastic pants below the cord
  • If desired, clean the cord daily, or when it is soiled, with warm water, then let it dry thoroughly. This will delay the cord falling, since it washes off the necrotizing bacteria, but will cut down on odor (for the same reason).

Problems to report include a large halo of redness around the cord area (some redness is normal due to irritation from diapers, etc), or excessive bleeding when the cord falls off (enough that it stains the blanket the baby is lying on).

Elimination

Healthy, term babies are built to lose some weight after birth before the milk comes in. This allows them time to take in the highly concentrated antibodies in the mother’s colostrum before they get the higher volume and hydration of breastmilk. Sometimes they get dehydrated enough that their urine forms crystals. These are called urate crystals and are pinky orange. More common in boys, they are often mistaken for blood in the diaper.

Problems to report

Temperature >37.5C

Temperature <36.3

Skin color changes to pale, grey or bluish

Difficulty breathing: nasal flaring, grunting, retraction of sternum

Apnea >20 seconds

Lethargic or difficult to arouse

Extremely irritable

Excessive, high-pitched crying

Blisters, boils, pustules or other unusual rash

Red halo or bleeding cord area

Urate crystals after first 48 hrs

Jaundice that appears in first 24 hours, extends into extremities, or rapidly increases

If circumcised: if there is discharge or the penis becomes increasingly red or swollen

Perineal Care & Healing

Care of your perineum

Whether or not you have had stitches, your perineum (the area between your vagina and rectum) will need some TLC. Treat it like an athletic injury (isn’t pushing an Olympic event?).

First days:
  • Use frozen pads or apply ice to your perineum (like any injury – ice for the first 48 hours). It sounds uncomfortable now, but will feel great in the moment!
  • Wash your hands before (as well as after) using the toilet until your stitches are healed
  • Pee in the shower/bath if urination causes stinging
  • Use a peri bottle after using the toilet – add herbs/lavender/tea tree oil for their antibiotic and healing properties
  • Take Homeopathic Arnica 30C every 4 hours while awake (minimizes any swelling or bruising)
  • If you feel you need pain relief medication, ibuprofen or acetaminophen can be taken according to the recommendations on the bottle
  • Plan to not go outside for 7 days. Stay in bed and cuddle with your baby, minimizing activity as much as possible. Aim to only walk up/down stairs once or twice a day max.
  • Sit with your legs together, i.e. don’t sit cross legged.
  • Sitz bath twice a day – add herbs/lavender/tea tree oil.
  • Full bath x 10-20 minutes once a day (in addition or instead of sitz bath) – add 2 cups Epsom salts, perineal wash herbs – avoid bubble bath
  • Do NOT sit on a hemorrhoid or “donut” pillow which can cause stitches to tear out
  • Eat healthy, drink lots of water
  • It is normal to feel “heaviness” in your pelvis at the end of the day if you have had increased your activity. This is the pelvic floor muscles getting fatigued. Try to balance days of activity causing fatigue, with days of rest.
  • Prolonged use of maxi pads can be very drying – occasionally try sitting on a blue pad while nursing, or use cloth pads. After a sitz bath, dry out your perineum well, then sit on a blue pad or towel and let your perineum fully dry and breathe for 1-2hours.
  • You will not have the same strength when doing kegels. Be patient, it will return.

Inform your midwife if:

  • You have increasing amounts of pain in your perineum, not associated with increased activity or decreased use of painkillers
  • You have discharge that is abnormal in color or foul smelling
  • You continue to have serious urinary incontinence past the first few weeks
  • Use lots of lube when you have sex, as postpartum hormones cause dryness.
  • See a pelvic floor physiotherapist if you have any concerns or just want to improve your pelvic floor strength. You do not have to have serious incontinence before seeking physiotherapy. If your problem is assessed to need further medical intervention, they can provide a gynecological referral.
  • BC Women’s Continence Clinic 604-875-3137 (self-referral)
  • Various private physiotherapists specialize in the pelvic floor

Recovery from Cesarean Birth

Cesearean Recovery

Now what?

You may have many questions after your caesarean. Hopefully this fact sheet will help provide some answers. If you have any other questions, please feel free to contact us..

What can I expect the first few days?

You will be in the hospital 2 to 3 days after a caesarean. The trend is toward a shorter stay for those with a normal recovery. During this time your dressings will be changed, IV and catheter removed, vital signs taken, uterus massaged to keep it firm, and urine output measured. Like vaginally born babies, unless your baby has any signs of respiratory problems, infection or other problems, you can have him/her room-in with you.

How long will my stitches stay in?

Your internal stitches will start to dissolve within a couple of days after the birth. They do not need to be removed.

If you have external staples, they are usually removed on day 3. If you would like to go home on day 2, your midwife can remove them during a home visit.

Should I be resting in bed the whole time?

Following any major abdominal surgery it is important that you rest. However, it is also important that you spend some time each day up and walking around. The sooner you do this, the better you will feel. As you stand up, you may be afraid that your insides are going to fall out, but don’t worry, you have been stitched securely in separate layers. You may have a gush of blood from your vagina, since the lochia (blood and tissue from the uterine lining) pools in the vagina while you are lying down. Your instinct will be to slump forward and do the “caesarean shuffle”. Stand as tall as possible from the very beginning, because it becomes more difficult later.

Walk about as much as you can, as it will help prevent or relieve gas pains. Try to walk to the toilet rather than using the bedpan. Remember to regularly do circles with your ankles and feet since this helps reduce risks of complications after abdominal surgery. If you have any odd pains in your legs, be sure to let the nurses know. Once you have passed gas, make sure you are keeping well nourished. It will be very difficult to establish breastfeeding and keep up your own energy if you do not eat properly.

What can I eat?

Most physicians require a liquid diet to begin with while your digestion returns to normal. When you progress to solid foods, eat a balanced diet, which includes lots of fiber. Drink at least 8 glasses of water a day. To help reduce gas, which can be very painful, avoid very hot or very cold or bubbly drinks and use this exercise.

I am in pain a lot of the time. What can I do about it?

Ask for painkillers. You cannot effectively rest or take care of your baby if you are in pain. Over the first week or so you will find you need fewer painkillers each day.

Is there anything I can take to help the physical healing process?

Yes. Many herbs and natural remedies help the body’s healing process without any harmful side effects for you or your baby. You can take the following herbs, made up as tinctures (available from health stores) and take them three times a day for up to a month after your birth: Comfrey, Echinacea, Raspberry Leaf and Marshmallow.

Homeopathic Arnica can be of enormous benefit in preventing infection and promoting tissue healing. The recommended dosage is one dose of 200C, followed by 30C each day of Bellis Perennis for 5 days. If your wound seems slow to heal or you still have a lot of discomfort after several weeks, homeopathic Staphysagria can help – one dose of 200C is usually enough.

A compress made from adding a few drops of lavender, tea tree and myrrh oils to warm water can be placed over the wound for healing and soothing inflammation. Once the wound has closed, comfrey ointment can be massaged in each day to reduce scarring.

Will my cesarean affect breastfeeding success?

It can be more difficult to establish breastfeeding after a caesarean but not impossible. You may need some extra support from someone to help you lift the baby into your arms for each feed over the first few days. It may take a few extra days for your milk to come in but this should not be a problem – your baby can get all of her/his nutrition from colostrum. Make sure you are eating and drinking enough to help your milk supply become established (you can eat once you have passed wind after the operation).

Is there anything I should be careful of?

A caesarean is major abdominal surgery. You must take care of yourself, making sure you are resting enough and eating a healthy balanced diet. Try to find someone else to take over all the household chores in the first few weeks as well as prepare your food, so you are able to concentrate on your baby and yourself. Don’t lift anything heavy like a toddler or a baby bath full of water, until at least six weeks after your birth.

How long will my scar feel uncomfortable?

Your scar will itch, feel numb or have sharp pains for a while. Most women find the scar becomes less uncomfortable by about six weeks postpartum. However, for some women the scar can be still uncomfortable for several months. If you are concerned about the way your scar feels or looks discuss this with your midwife. Of course, if you notice anything unusual, such as swelling, oozing or a bad smell, report it to your doctor immediately.

Will I always be able to see my scar?

The scar will fade over time and once your pubic hair begins regrowing it will be difficult to see.

Who can I talk to about the reasons for my cesarean?

For many women it is important to understand the reasons for their caesarean – especially if they had hoped for a vaginal birth. Your midwife will have a copy of your labour notes, which she can talk through with you. This may help answer some of your questions.

I’m feeling very emotional. Is this normal?

Many feelings accompany a caesarean birth – from wonder, gratefulness and joy, to anger, disappointment and despair. This is normal. A caesarean often means the loss of a dream of a natural birth or a perfect outcome. You may have positive and negative feelings at the same time. You might feel tremendous gratitude and love for your healthy baby while at the same time feel very disappointed that you had to have a caesarean. Caesarean mothers often experience feelings that come and go: anger, sadness, relief, guilt, fear, disappointment, depression, inadequacy, jealousy of mothers who had natural births, powerlessness, confusion and hopelessness. Negative feelings are stronger if your labor had been traumatic, if you feel you were misled by your caregivers or unprepared by your childbirth educator. It doesn’t help that a common reaction by caring but misinformed people is to feel that if you have a healthy baby that you should be happy and satisfied. In reality the issue is much more complicated. Resolving your feelings and healing take time.

Certain things make the emotional recovery easier. Cry if you need to – tears are very healing. Talk about your feelings. Join a caesarean support group. Find a knowledgeable counselor. Write in a diary or journal. Write letters to those involved and tell them exactly how you feel (you don’t have to send the letters.)  Write the story of the birth experience and what you have learned from it. Acknowledge your incredible courage: you were willing to undergo major surgery for the sake of your baby! Educate yourself about caesareans and when you are ready, reach out to another caesarean mother and help her with your experience and knowledge. There are many good books available, as well as information and support on the internet.

Will I ever be able to have a vaginal birth?

Many women go on to have subsequent children vaginally – called VBAC, Vaginal Birth After Caesarean. Research now shows that vaginal birth, even after caesarean, is usually safer, except in rare cases. Women having VBAC births have their own special needs: while many are eager for the opportunity of a vaginal birth, others find it difficult to convince themselves to go through labor again and try to have their baby vaginally. It is good to do lots of research and find lots of support.

International Cesearean Awareness Network   www.ican-online.org

Will I be able to have midwifery care with my next pregnancy?

Midwives often take care of women who have had a previous cesarean section. Many of these women go on to have wonderful vaginal births. Ideally you will have had 24 months between pregnancies to give your uterus time to fully heal and form a strong scar.

Safe sleeping with your baby

Safe Sleeping for You and Your Baby

You have held your baby safely inside you for many months. Your baby has been comforted by the sound of your heartbeat, and the rhythm of your movements.  So it is not surprising that almost all babies like to be held and kept close after they are born – even when they are asleep!  It’s up to you to decide what sleeping arrangement is best for you and your baby: in your bed with you, in a cot beside your bed, or in a crib nearby.  All of these options can be safe, and have been used for centuries by families all around the world.

While you are in hospital

“Rooming-in” (keeping baby in your room with you) is highly recommended, however hospital beds are not designed for co-sleeping.  They are narrow, and have open sides which mean that pillows must be used to keep the baby from falling out.  Also, many mothers are very tired from a long labour, or have received medications that may make them groggy or sleepy.  For these reasons, the bedside cot in your room is the safest spot for your baby to sleep in hospital.

When you get home

To reduce the risk of SIDS (Sudden Infant Death Syndrome) and to make sure that your baby is as safe as possible when sleeping:

  • Keep your baby IN THE SAME ROOM AS YOU, especially at night, for the first six months of the baby’s life.
  • Put your baby on his BACK to sleep, not on his side or stomach.
  • Make sure that no one smokes in your home, or around the baby.
  • The baby’s sleeping surface (mattress) should be FIRM, FLAT and CLEAN. The baby should not be able to fall out of the bed, or get stuck between the mattress and the wall.  Water beds, sheepskins, bean bags, recliner chairs and saggy mattresses are not suitable sleeping surfaces for babies.
  • The room should not be too warm (the best temperature is 16-18° C), and your baby should not be dressed too warmly.  Put the same number of layers of clothing or bedding on your baby as you do on yourself, and make sure your baby’s head is not covered.  Check your baby’s temperature by feeling just behind her neck.  She should not be sweating.
  • Use sheets and blankets, rather than duvets and quilts, which can settle around the baby’s face. If you are using a crib, don’t use bumper pads, which can reduce air flow around the baby.  Avoid having soft, fluffy things like pillows and stuffed toys near your sleeping baby.
  • Don’t swaddle your baby for sleep. Leave her hands and arms free so she can push herself away from anything that is too close to her face.
  • Make sure that pets cannot get into or onto your baby’s bed.

Sharing a bed with your baby…

Bedsharing with a newborn baby has been practiced for centuries (long before cribs were invented!), and is still common in most parts of the world.  In the early days and weeks, many breastfeeding mothers prefer to keep their baby in bed with them because it makes breastfeeding easier.  The baby can feed when it’s hungry, and the mother doesn’t have to get up every time the baby wants to feed! Bedsharing not only promotes more successful breastfeeding, but is also associated with longer and more restful sleeps for both mother and baby.* Quite apart from these practical benefits, many parents simply enjoy the added closeness of sharing a bed with their baby.

 

Most mothers will sleep facing their babies. Your baby may lie on his side to breastfeed. When he is finished, gently put him on his back to sleep, taking care to remove any pillows or extra covers away from his head and face.

Points to Remember ifyou are sharing a bed with your baby:

  • If not everyone goes to bed at the same time, make sure that everyone knows that the baby is in the bed.
  • If older children are also sharing your bed, an adult should sleep between the older children and the baby.

Bedsharing is NOT Recommended if… you or anyone else in the bed:

  • is excessively tired, and might not respond to the baby
  • is a restless sleeper who frequently flails about in their sleep
  • is sick or has a condition that may make it more difficult to respond to the baby
  • is a smoker
  • has drunk alcohol or taken any drug or medication which may make them less aware of the baby

* S. Mosko et al, “Infant Arousals during Mother Infant Bed Sharing: Implications for Infant Sleep and Sudden Infant Death Syndrome Research,” Pediatrics 100, No.5 (1997): 841-850.

Newborn Screening Test

What is the Newborn Screening Test ?

Newborn Screening is actually a battery of tests done at the same time. Here are some of the tests done:

  • Congenital Hypothyroidism: 1 in 3000

A baby born with hypothyroidism cannot make enough thyroid hormone. Thyroid hormone keeps a baby’s body growing strong and health. Without it, delayed growth and brain damage occur. With early detection and thyroid hormone treatment, these children have normal growth and intelligence.

  • Phenylketonuria (PKU): 1 in 12,000

A baby with PKU is missing an enzyme that is needed to process the essential amino acid phenylalanine, found in certain foods. Without treatment, phenylalanine builds up in the baby’s blood and causes mental retardation. If PKU is found early, the baby is fed a special formula that is low in phenylalanine. Most children with PKU who are treated early have normal intelligence.

  • Galactosemia: 1 in 50,000

A baby with this condition cannot process galactose, a sugar found in milk. If Galactosemia is not treated, it can cause damage to the baby’s eyes, liver, and brain. These problems are prevented with a special diet.

  • Medium Chain Acel-CoA (MCAD): 1 in 12,000

A baby born with MCAD may have problems using fats stored in their body as an energy source. The baby is healthy when eating well. If the baby has a cold or the flu, they may not be able to use the stored fatty acids for energy. There is a risk of sudden unexpected death which can be prevented by using a special diet and avoiding fasting.

  • Long Chain 3 Hydroxyacyl-CoA Dehydrogenase (LCHAD): 1 detected in BC/Yukon every 2 years

Very similar to MCAD, a baby born with may have problems using fats stored in their body as an energy source. Treatment is also through special diet and avoidance of fasting.

  • Glutaric aciduria type I (GA-I): 1 detected in BC/Yukon every 5 years

A baby born with GA-I is missing the enzyme needed to breakdown several types of amino acids (lysine, tryptophan and others). This block in metabolism leads to a build up of substances such as glutaric acid which causes health problems or can even be fatal. Treatment is with a special diet, avoidance of fasting and supplementation with carnitine and riboflavin.

How is the test done?

A few drops of blood are collected from the heel of your baby’s foot. The same blood sample is used for all tests. We are happy to do the test when you are feeding in order to minimize the pain to the baby.

When is the test done?

Hypothyroidism and Galactosemia can be detected anytime after the birth, but the other tests will not be accurate before the baby has had a chance to try to digest food, i.e. there is a high chance of a false negative if done before the first 24 hours. Therefore the Newborn Screen is usually it is done between 24 and 72 hours.

What if the test is positive?

If the test comes back positive, more in-depth testing will be done. If further testing shows that your baby has one of the disorders, you will be referred to a specialist and treatment will start in a few days.

Why does NB Screening in other provinces include more than 6 tests?

It’s true that some provinces and states have screening programs that involve more tests. The BC Government has announced that further screening tests will soon be added to those currently being done.

Jaundice

What is jaundice?

A common condition in newborns, jaundice refers to the yellow color of the skin and eyes caused by excess bilirubin in the blood. Bilirubin is produced by the normal breakdown of red blood cells.

Normally bilirubin passes through the liver and is excreted as bile through the intestines. Jaundice occurs when bilirubin builds up faster than it is cleared from the body. Reasons for this include:

  • Bilirubin is being made faster than the liver can clear it from the body.
  • Too large an amount of bilirubin is reabsorbed from the intestines before the body gets rid of it in the stool.

What causes jaundice?

There are several types of newborn jaundice. The following are the most common:

  • Physiological (normal) jaundice: occurring in more than 50% of term newborns, this jaundice is due to the immaturity of the baby’s liver, which leads to a slow processing of bilirubin. It generally appears at 2 to 4 days of age and disappears by 1 to 2 weeks of age.
  • Jaundice of prematurity: this occurs in 75% of premature babies since they take longer to adjust to excreting bilirubin effectively.
  • Breast milk jaundice: in 1-2% of breastfed babies, jaundice can be caused by substances produced in their mother’s breast milk that can cause the bilirubin level to rise. These substances can prevent the excretion of bilirubin through the intestines. It starts at 4 to 7 days and normally lasts from 3 to 10 weeks.
  • Blood group incompatibility (Rh or ABO problems): if a baby has a different blood type than the mother, the mother might produce antibodies that quickly destroy the infant’s red blood cells. This creates a sudden buildup of bilirubin in the baby’s blood. Incompatibility jaundice usually begins during the first 24 hours of life.

Are there risk factors for jaundice?

There are a number of risk factors for jaundice. These include:

  • Prematurity
  • Infection
  • Vacuum/forceps birth
  • Resuscitation
  • Bruising
  • Delayed feeding
  • Birth weight <2500g
  • Rh incompatibility

How can it affect my baby?

Newborn jaundice usually appears around the second or third day of life. It begins at the head and progresses downward. A jaundiced baby’s skin will appear yellow first on the face, followed by the chest and stomach, and finally, the legs. It can also cause the whites of an infant’s eyes to appear yellow.

Jaundice can make babies sleepy, which in turn can lead to feeding problems (a sleepy baby may not wake itself to feed and/or maintain a strong latch). This in turn can lead to significant weight loss (>10% of body weight). Because of this, it is recommended that jaundiced babies be fed frequently, even if it means waking them.

Extremely high levels of bilirubin – usually above 20 mg – can cause deafness, cerebral palsy, or brain damage in some babies. In rare cases, jaundice may indicate the presence of hepatitis.

Newborn jaundice usually appears around the second or third day of life. It begins at the head and progresses downward. A jaundiced baby’s skin will appear yellow first on the face, followed by the chest and stomach, and finally, the legs. It can also cause the whites of an infant’s eyes to appear yellow.

How is jaundice diagnosed?

A simple test for jaundice is to gently press your fingertip on the tip of your child’s nose or forehead. If the skin shows white, there is no jaundice; if it shows a yellowish color, your baby has jaundice. It is most accurate to do this while holding your baby in natural light. It should be noted that this is a subjective test, resulting in over-diagnosis of jaundice in babies of Asian descent.

The most accurate test for jaundice involves taking a small sample of your baby’s blood with a heel-prick to measure the bilirubin level.

How is jaundice treated?

  • Mild increases in bilirubin level usually don’t require treatment.
  • Frequent feedings (at least 10 to 12 times in 24 hours) can speed up the rate that stool passes through the intestine. This can reduce the amount of bilirubin that is reabsorbed from the bowel.
  • Moderate jaundice can be treated with at-home phototherapy. The baby is exposed, with as little clothing as possible, to sunlight through a sunny window (never direct sun), making sure to not let him/her get chilled.
  • Higher bilirubin levels can be treated with in-hospital phototherapy. This is where the baby is placed, with as little clothing as possible, under a special type of light (often called a bili-lamp). This light causes a chemical change to occur in the bilirubin molecules in the tissues under the skin. Once this chemical change occurs, the bilirubin can be excreted by the liver without the liver having to convert (conjugate) it. During the treatment, the baby will be placed in an isolette to keep him/her warm and the his/her eyes will be protected from the bright light with eye patches.

If your baby needs this type of phototherapy, you may be eligible for the Home Phototherapy Program. Ask your midwife.

  • Dangerously high bilirubin levels, can also be treated by performing exchange blood transfusions (replacing the blood high in bilirubin with blood that is lower in bilirubin).

When to call your midwife

You should call your midwife if jaundice is noted during the first 24 hours of life, the jaundice can be seen in the arms or legs, your baby develops a fever over 38 degrees Celsius (100.4 degrees Fahrenheit), or if your child starts to look or act sick.

Breastfeeding Record

Please print this out and have on hand in the first week of breastfeeding. What you record here can help us support you during your home visits postpartum so we can refer to your notes and help solve any mysteries or troubleshoot any challenges. Keeping this record is also a great way to reassure yourself that you are feeding your baby enough, that your baby is peeing/poop enough and that you are on the right track!

Breastfeeding Chart

Yeast & Thrush

What is yeast?

We all have both yeast (aka Candida) and bacteria in our gastrointestinal and vaginal tracks. In a healthy state they are in balance, and are essential for optimal health.

However with a yeast overgrowth, the yeast overpopulates our system and we have what we call a “yeast infection”. This overgrowth can be on your nipples and in your milk ducts, as well as in your baby’s mouth and gastrointestinal track. It causes sore nipples and can cause intraductal pain in your breasts (burning, shooting pain during and after feedings). In your baby, it may have no symptoms or it may cause a sore mouth and tongue, and sometimes red, sore skin in the diaper area, or even irritability and excessive gas.

It is important to remember that the yeast overgrowth is throughout your whole system, and you want to restore a healthy balance between the yeast and the bacteria. Just killing off yeast doesn’t resolve the problem. It will always return unless the proper balance is restored, and this takes diligence.

Pain

  • It is important to get the best latch possible when you have sore nipples. Even if the cause of sore nipples is yeast, improving the latch can decrease the pain.
  • For deep breast pain, ibuprofen 400 mg every four hours may be used until definitive treatment is working.

Gentian violet (1% solution in water)

  • Can be bought from many pharmacies, including Finlandia Natural Pharmacy
  • Use once a day for four to seven days
  • Dip a clean cotton swab (Q-tip) in the gentian violet. Let the baby suck on the swab for a few seconds. The gentian violet usually spreads around the mouth quickly. If it does not, paint the inside of the mouth to cover as much of the inside of the cheeks and tongue as possible.
  • Put the baby to the breast. In this way, both the baby’s mouth and your nipple are treated.
  • If, at the end of the feeding, you have a baby with a purple mouth, and two purple nipples, there is nothing more to do. If only one nipple is purple, paint the other one with the swab and the gentian violet.
  • If pain is gone after four days, stop gentian violet.
  • If better, but not gone after four days, continue for seven days.
  • Stop after 7 days no matter what. If not better at all at four days, stop the gentian violet, but continue with the ointment as below.
  • In rare cases, gentian violet causes irritation to the baby’s mouth. Discontinue at once if this happens to your baby.

Jack Newman’s All Purpose Nipple Ointment (APNO)

  • By prescription from your midwife, from most pharmacies
  • The ointment is applied sparingly after each feeding (except the feeding when the using Gentian Violet). “Sparingly” means that the nipple and areola will shine but you won’t be able to see the ointment. Do not wash or wipe it off.
  • Use the ointment until you are pain free and then decrease frequency over a week or two until stopped.
  • If you are not having less pain after 3 or 4 days of use, or if you need to be using it for longer than two or three weeks to keep pain free, get help or advice.
  • If flaking, drying, or whiteness appears on the skin, substitute vitamin E oil or pure olive oil for APNO 1-3x/day

Grapefruit seed extract (NOT grape seed extract)

  • Can be bought at most natural food stores and pharmacies: Sweet Cherubim, Capers, Choices
  • Mix very well 5-10 drops in 30 ml (1 ounce) of water (preferably, but not necessarily, distilled). It does not need to be refrigerated.
  • Use cotton swab to apply on both nipples and areolas after feeding (except the feeding when the using Gentian Violet)
  • Let dry a few seconds, then apply APNO
  • Should be used in conjunction with oral GSE for mom: tablets, capsules, or liquid extract (see below)
  • Use until pain is gone and then wean down slowly over the period of at least a week.
  • If pain is not significantly improving after two to three days, increase the dose by 5 drops per 30 ml (ounce) of water. Can continue increasing until 25 drops per 30 ml of water.

Diaper changes

  • Rinse with each diaper change with vinegar/water solution (1T. white distilled vinegar/1C. water)
  • Do not use baby wipes, as they nurture the yeast. Use clear water for clean-up of stool, then rinse with the vinegar solution.
  • Nystatin cream or zinc oxide for diaper area
  • Sunlight is a good treatment for yeast overgrowth. Let baby sunbath naked on a diaper in the window on a sunny day.

Internal balance

MOM

  • Eliminate all sugar including fruits for at least 3-4 days. Reduce refined starches, as well as fermented and aged products. In chronic or severe cases, more dietary changes can be helpful, such as eliminating all dairy until two weeks after symptoms are gone.
  • Acidophilus 3x/day for 1-2 weeks
  • Grapefruit seed extract – 250 mg (usually 2 tablets) OR 5 drops in water, 3x/day. Oral GSE can be used before trying fluconazole, instead of fluconazole or in addition to fluconazole in resistant cases.

BABY

  • When not using Gentian Violet, treat baby with acidophilus by rolling a wet finger in acidophilus powder – break open a capsule and let baby suck on the finger right before a feeding. Use 2x /day.

External yeasts

  • Good hand washing, especially before and after touching any affected area.
  • Remember: use a clean hands or a new swab every time medication is touched.
  • Boil any bottle nipples, pacifiers, and toys as well as any breast pumps the mother may use for at least 20 minutes
  • Wash all baby clothes, bras, breast pads, breastfeeding tops, bed linens, baby blankets, etc, frequently in hot water. Dry well in hot dryer or sunlight.
  • Add 15-20 drops of GSE OR 1C vinegar to rinse water of all laundry loads
This treatment plan seems very complex, but after a few days it will seem simpler, especially when you are feeling better because of all of your efforts.REMEMBER: Continue the recommended treatments and dietary restrictions for 2 weeks after all symptoms are gone. There is a temptation to grow lax after you and your baby are feeling better, but the yeast overgrowth can come back if your system is not restored to its proper balance.

24-hour Cure

for breastfeeding babies and their mamas

During the first few weeks after birth, the mother and baby are perfecting the art of breastfeeding. Occasionally they may experience problems or setbacks that can be solved by using what is known as the 24-Hour Cure.

What is the 24-Hour Cure?

The 24-Hour Cure is the name given to a treatment advised for a number of breastfeeding problems. In essence, it involves mom and baby spending 24 hours in bed together. The forced rest and constant skin-to-skin contact has a dual purpose:

  • To nurture the MOTHER by giving her complete rest, plenty of good food and drink, and freedom from all responsibility other than feeding and fondling her baby
  • To nurture the BABY, by encouraging prolonged skin-to-skin contact with the mother and constant access to her breast


What problems can be addressed by the 24-Hour Cure?

The 24-Hour Cure can solve a number of breastfeeding problems, such as the following:

  • Doubts about whether the mother is making enough milk
  • Fatigue, lack of sleep or anxiety in the mother
  • Lack of appetite, poor nourishment or low fluid intake by the mother
  • Slow weight gain or weight loss by the baby
  • “Nipple confusion” – that is, the baby seems to prefer an artificial nipple or nipple shield to the mother’s breast
  • Plugged ducts
  • Mastitis, if fever has not lasted for more than 24 hours yet

When should I not do the 24-Hour Cure?

It is important that the mother not have sore, blistered or cracked nipples when she begins the cure. The causes for the soreness need to be addressed before starting the cure.

How to do the 24-Hour Cure:

  • Organize a full 24 hours when the mother can have help. Help is essential!
  • Mama goes to bed with the baby. They both wear as little clothing as possible under the bedcovers so the baby can get lots of warm skin-to-skin contact, which heightens the baby’s rooting reflex and interest in feeding.
  • No visitors please! Mama may read, watch television, or most importantly, doze. The extra sleep makes a big difference even though it comes in short snatches.
  • Mama gets out of bed only to go the bathroom – not to eat, answer the phone, do housework or anything else.
  • Mama is supplied with liquids; place water or juice within her reach. She should drink about two quarts of liquid during the 24 hours.
  • Tasty, nutritious meals are used to tempt mama’s appetite. A good milk supply is dependent on eating a healthy amount of calories.
  • The baby should stay in bed with mama, except when a diaper change is necessary, or when the baby is fussy (and clearly not willing to nurse) and needs to be walked or rocked.
  • Whenever the baby awakens or seems at all interested in suckling, mama offers the breast. The whole process is to get the baby to suckle as much as possible. Do NOT give the baby a bottle of either formula or breast milk, unless advised by your midwife for medical reasons such as severe weight loss.
  • There is no reason to not extend into a 48-Hour Cure if results are promising after 24-Hours!