POSTPARTUM CARE AND BREASTFEEDING
THE POSTPARTUM PERIOD
The postpartum period begins when the third stage of labor is over and ends when the reproductive organs have returned to their pre-pregnancy state. This process takes about six weeks. Provided there are no problems for her or the baby, the mother stays in the maternity unit for about 3–4 days.
The uterus: when you leave the delivery room, the top of the uterus will be at or below the level of the navel. It takes 5–6 weeks to return to its normal size. Every day throughout your stay in the maternity unit the height of the fundus of the uterus (its involution) will be checked by the doctor or the midwife.
The vagina: after birth the vagina is lax. It rarely returns to its previous shape, even once any tear or incision has healed completely.
The lochia: this is the fluid that flows from the uterus through the vagina after birth. When the placenta separates from the wall of the uterus and is delivered, it leaves behind open blood vessels, which close by themselves. This area is like an open wound, from which a certain amount of blood flows each day. At first the blood is bright red. Within a few days the colour begins to darken and it looks like a thicker fluid. From the 10th day of the postpartum period the discharge starts to decrease in amount and becomes yellowish. If the bleeding continues and increases, or if you notice a strong unpleasant smell, you should tell us, as this is a sign of a problem.
Afterpains: after birth the muscles of the uterus lose their elasticity, so they hurt as it begins to contract. These pains are rather like period pains, are called afterpains, and rarely persist beyond the third or fourth day. They are often strongest during breastfeeding.
The abdominal wall: it is entirely normal for it to have become slack during pregnancy. That is why postnatal exercises start the day after birth (unless the woman has had a cesarean section). Exercise during this period is particularly effective. It helps the muscles of the abdominal wall regain their elasticity and return to their pre-pregnancy state. The only thing that does not return completely is the stretch marks on the skin that appeared during pregnancy.
Changes in the breasts: in the first three days after birth, colostrum begins to flow from the mother's breasts. Between the third and fourth day she gradually begins to feel her breasts heavy and full. This means that the transitional milk is coming in, which is greater in quantity. Mature milk comes in at about the seventh to tenth day.
The bowel: most new mothers feel very thirsty, either because they were given medication during labor, or because of the anesthetic, or because they have lost a lot of fluid through sweat, urine and lochia. It is also quite understandable that they become constipated, because the abdominal muscles have lost their tone and so the supporting forces that help with a bowel movement are not exerted. This settles within a few days.
Temperature: the temperature after birth is slightly raised. This is normal. While you are in the maternity unit your temperature will be taken often, because a high fever can be a sign that the body is reacting to an infection.
Weight loss: women lose about 5–7 kg after birth (this corresponds to the weight of the baby, the amniotic fluid and the placenta). Many women regain the weight they lost within a few weeks, unless they manage to control their appetite, exercise often and breastfeed — breastfeeding uses up a significant number of calories.
The return of menstruation: in women who do not breastfeed, periods normally return after six to eight weeks. Women who breastfeed, by contrast, have a period after four to five months. The first period is usually heavier and lasts longer. Ovulation may occur while breastfeeding and, although the woman's fertility is not high, there is a small chance of becoming pregnant again. The return of menstruation does not affect the mother's milk and she can continue breastfeeding without any problem.
Emotional sensitivity after birth: this is an emotional reaction that appears between the third and fourth day after the birth.
A new mother may cry for no particular reason. During pregnancy, the birth and the days afterwards she has been the centre of attention of both her family and her friends. At the same time she has new responsibilities: she has to look after herself and the baby — all of which is enough to leave her emotionally charged. This emotional state does not last long and is not serious. If you do feel this way, it is good to let yourself cry. It will relieve you and make you feel better.
is a firm and attractive bust after pregnancy. Achieving it takes great care and consistent attention.
by vitamin C and by selenium, which is found in abundance in fish, cereals and liver, and is reduced if the foods containing it are cooked at high temperatures, and also if our diet is rich in fat. It is essential to remove caffeine from the diet — that is, to avoid coffee, tea and chocolate — and to reduce animal fats, red meat and high-fat dairy products. The beneficial effect of raw rather than cooked olive oil should be noted here. Obesity is directly related to maintaining the breast and preventing disease. It is vital to watch your weight gain during pregnancy and to choose a diet low in calories and rich in the vitamins found in fruit and vegetables. Great attention must also be paid to drinking enough water and fluids generally.
BREASTFEEDING
During pregnancy your body prepares to produce milk, whether or not you intend to breastfeed. The breasts gradually increase in size and weight (by about a third). The nipple becomes larger and the areola darker and bigger. After the birth and the delivery of the placenta, milk production begins; colostrum is the first milk the newborn receives. It is lemon-yellow in colour and small in quantity, but its value is unique. About three days after the birth the colostrum becomes transitional milk, and after the seventh to tenth day it becomes mature milk. This is whiter in colour, is produced in greater quantity and provides more energy. The mechanism of milk production can be affected by stress, fear, tension and tiredness, but it can also be triggered simply by hearing the baby, looking at it or even thinking about it. The more the baby feeds, the more milk will be produced. The size of the breast has nothing to do with the ability to produce milk.
THE ADVANTAGES
It provides all the nutrients the baby needs to grow and is more easily digested than commercially available milk. Breastfed newborns suffer less, or not at all, from what is known as three-month colic. Breast milk contains antibodies that protect your baby from many illnesses while strengthening its immune system. Breastfed babies are less prone to allergies. It helps prevent obesity in the child in later years. Breastfeeding helps the mother return quickly to her normal weight, because it uses up a significant number of calories. Breastfeeding releases a hormone, oxytocin, which contracts the uterus and helps it return to its normal size quickly. Babies enjoy breastfeeding, and a very special bond develops between mother and baby. Breastfeeding is the most economical way of feeding a baby. The baby is fed the best milk there is — its mother's milk. Breastfeeding is an easy option for mothers: there is always milk at the right moment and at the right temperature. In other words, no preparation or warming is needed, there are no bottles to wash and you do not have to carry anything with you when you go out.
WHEN TO START
Ideally you should start breastfeeding immediately after the birth. As that is not always possible, you can start as soon as your baby is brought to your room.
HOW OFTEN TO BREASTFEED
Feed the baby 8–12 times in 24 hours (on average every 2–3 hours). The more often you feed your baby, the sooner both you and the baby will get used to it. The more the baby feeds, too, the more milk you will have. 2. If the baby does not wake, or has been asleep for the last three hours since the previous feed, try to wake it gently and feed it. This does not apply at night, when you can take advantage of any longer sleep your baby has to rest yourself. 3. Babies tend to wake much sooner than three hours during the first weeks of life. This is completely normal; it takes a little patience on your part until their sleep pattern settles.
HOW LONG A FEED LASTS
In the first 2–3 days, when you have colostrum, feeds are short. On the first day let your baby feed for 3 minutes from each breast, on the second day 10 minutes from each breast. From the fourth day onwards a feed is 20 minutes from each breast, and stays that way. 2. During a feed your baby will stop sucking from time to time. Do not worry — it is resting. Remember that for all those months its food came ready-made, whereas now it has to make an effort. It will start feeding again by itself shortly. If you realize it has fallen asleep, wake it gently. 3. As well as milk, the baby swallows a small amount of air. If that air does not come up as a burp, it will pass into the bowel and cause colic, or it will come up on its own bringing the contents of the stomach with it — that is, the baby will be sick. That is why it is very important, when you finish feeding from each breast, to hold your baby on your shoulder for a few minutes so that it can burp.
PREPARING FOR A FEED
1. Wash your hands with soap.
2. Wash your breasts and underarms with water. Never use soap, antiseptics or alcohol to clean your breasts. They dry the skin, remove its natural oils and make it prone to cracking. 3. Sit somewhere comfortable. Have a few cushions nearby to support your legs if you are sitting on a chair. Do not lean over the baby and do not lie down.
4. Always hold the baby at the same level as your breast.
5. Choose one of the positions described below. (Whichever position you choose, the baby should be facing your breast. This matters a great deal if you are to avoid problems while feeding.)
BREASTFEEDING POSITIONS
HOW TO START A FEED — stroke the baby's lower lip with your nipple. This encourages it to open its mouth. Be a little patient, as you may need to try again. 2. As soon as the baby opens its mouth, lift your breast and give it the nipple. Let the baby take as much of the areola into its mouth as it can. This matters a great deal, because the milk ducts of the breast lie beneath the areola. That way you can be sure the baby is feeding properly and that your breast will not become sore. 3. When the baby starts to feed you may feel a little pain. After that you should feel no pain while feeding; if you do, take the baby off and start the feed again from the beginning.
HOW TO END A FEED
To stop a feed, put your little finger into the corner of the baby's mouth, between its gums, until you feel that it has stopped sucking. Then take the baby off your breast.
HOW TO TELL THAT YOUR BABY IS FEEDING WELL — the baby feeds 8–12 times in 24 hours. 2. You can hear the baby swallowing while it feeds. This is the most reliable sign that your baby is feeding, and feeding well. 3. Your breast is soft after the feed. 4. You change at least 6 nappies in 24 hours. 5. Two weeks after birth the baby is back to its birth weight. 6. The baby should gain about 150 g a week.
DOES YOUR BABY NEED SUPPLEMENTARY FEEDS?
Babies do not need water as a supplement. Breast milk is the ideal food for the first months of your baby's life.
SORE NIPPLES
Breastfeeding should be comfortable and enjoyable. Even so, some women complain of pain while feeding. This problem can be kept to a minimum if you take care, because although your nipples will be soft in the first days of breastfeeding, after 1–2 weeks they can become sore enough to hurt.
IMPORTANT: it is not normal to have blisters or very dry skin, or to feel pain both during feeds and between them.
PREVENTING SORE NIPPLES — to avoid very tender, sore nipples, make sure you are in the right position while feeding so that the baby can latch on to the nipple correctly. The baby should have stopped sucking before you take it off the breast. Put your finger between its lips and your breast so that it releases the nipple gently and does not injure it. Do not use soap, alcohol, antiseptics or special creams on your breasts. Clean your breasts with water only.
TREATING SORE NIPPLES
Limit feeding on the sore nipple. Start the feed on the nipple that is not sore. Massage your breast while feeding: this stimulates the glands and the milk comes down more quickly. Use a cotton bra and special breast pads. If your nipples become sore and the skin around them cracks, use a little lanolin as an emollient. Lanolin forms a layer and stops the skin drying out. If your breast is hard, first try to express a little milk by hand. The areola will then soften, the nipple will be stimulated and the feed will be more comfortable.
BLOCKED DUCTS
If you notice that a part of your breast is sore or that a lump has formed, a duct may have become blocked. Feed the baby frequently, every two hours. Start the feed on the affected breast. Bathe the breast in warm water for 10–15 minutes before the feed. Massage the affected area both before and during the feed.
ENGORGEMENT
In the first week after birth, when colostrum turns into mature milk, you will feel your breasts heavy and full. This feeling disappears after a few days. Engorgement occurs when your baby is not taking enough milk to reduce the amount in your breasts. In that case your breasts will feel hard, will hurt and will be very warm.
PREVENTING ENGORGEMENT
You can prevent engorgement by feeding your baby at regular intervals, about 8–12 times in 24 hours. Do not dilute the milk with water or anything else for the first 3–4 weeks, unless your pediatrician has advised you to. If you stop breastfeeding, do so gradually.
TREATING ENGORGEMENT
Place a warm, damp towel on your breast for 2–5 minutes, or have a warm bath before the feed. Once you have removed the damp towel, express a little milk by hand so that the area softens. The baby can then feed much more easily. Massage your breast gently while feeding. Apply cold compresses to your breasts after the feed so that the swelling and discomfort settle. If your baby shows a preference for one breast only, use a pump or your hand to express the milk from the other breast. If your baby cannot latch on, or if your nipples are flat, use special silicone nipple shields, which will help the baby take the breast easily. Avoid bottles, dummies and similar during a period of engorgement: they will confuse the baby and it will not want to feed from your breast.
MASTITIS
This occurs when the mother does not follow the rules of breast hygiene, when she has cracked nipples, and when she does not make sure to empty the breast each time she is engorged. The symptoms are a temperature of 39–40 °C, a fast pulse, shivering, pain in the joints and in the breast, headache, nausea and a tendency to vomit, and heaviness and heat in the breast. If you notice any of these symptoms, please tell us.
What to do: A) Continue to breastfeed at frequent intervals, starting with the affected breast. Because the infection has affected the soft tissue and not the milk, there is no need to fear that the baby will become ill. B) Bathe the affected breast in warm water, or have a warm shower before the feed. C) Make sure to express the milk whenever your breast feels heavy and full. D) Take your temperature often. If the symptoms do not settle, antibiotics are given.
HOW TO LOOK AFTER YOURSELF BETTER
A. NUTRITIONAL NEEDS:
Eat properly: follow the same nutritionally balanced diet as when you were pregnant. While breastfeeding you will need more calories. Continue taking the same vitamins as when you were pregnant. Avoid foods that are high in calories and have no nutritional value. Avoid strict diets. 3) What not to eat: indigestible foods, which cause digestive upset in your baby. Caffeine: caffeine affects the baby's nervous system, makes it irritable and means it cannot settle easily. Alcohol: an occasional glass of wine or beer while breastfeeding does no harm. Smoking: you must not smoke, and your baby must not be in a room with people who are smoking. Nicotine causes serious problems for its development. Medication: always ask your doctor before taking any medicine. Aspirin is allowed only in small doses.
B. REST
Try to sleep when your baby sleeps. Ask the rest of your family and your friends for help with the housework and the cooking.
C. YOUR SEX LIFE
Sexual intercourse is allowed after 50 days. Women go through many physical and emotional changes during pregnancy and breastfeeding. One feature of the response to these changes is that sexual desire either increases or decreases. Low estrogen levels cause vaginal dryness, so to make intercourse more comfortable it is best to use a water-soluble lubricant. A baby can make home a happier place, but it will also sap your physical energy. One of the main reasons for reduced sexual desire is the tiredness you feel. Try to rest when the baby sleeps and keep up contact and communication with your partner. During intercourse you may feel milk leaking from your breasts. This is normal, and it may happen less often if you have fed your baby beforehand. Your menstrual cycle will not return fully while you are breastfeeding. You will, however, ovulate before your period returns, so do not imagine that breastfeeding is a method of contraception.
Talk to us about the method of contraception that suits you.