Useful Information
As recently as the 1980's, women who gave birth stayed in hospital for four or five days. Today, about 70 percent of new mothers in Canada and the United States are likely to go home within one or two days.
As shorter hospital stay or an at-home birth with a midwife means new mothers need extra information on postpartum care for their infants. Here are answers to questions you may have, with information provided by Women's College Hospital in Toronto, an article published by Women's Health Matters in February 1997, and information provided by the midwives at The Midwifery Collective of Ottawa.
Can I do anything to prepare for the postpartum period?
Expectant women can prepare in a number of ways. A large collection of books is available for our clients and we are always open to any suggestions to new books we could purchase for out lending library. Midwives have a wealth of knowledge at their disposal and coming prepared with questions to your prenatal visits will help you sift through all the information. We also recommend finding a family physician, if you don't already have one, and check out community resources such as the public health department, La Leche League, and breast-feeding drop-in clinics in your area. Our office manager has a lot of information on file and would be pleased to help. Another way to prepare is to arrange for a family member, friend, or DOULA to help in the days following your birth.
It is important to check out community resources for breast-feeding help in your area, including La Leche League, Breast-feeding drop-in, local IBCLC (lacation consultants), as there may be a need for you to access these resources on the rare occasion that your midwife is unavailable for breast-feeding help. Please refer back to out prenatal source list in your packet of information given to you at your first visit.
When Can I expect to leave hospital?
Most women and their babies are ready to leave the hospital within 4 to 6 hours following normal birth. Your midwife will continue follow-up care at your home for a few more visits and then you will continue postpartum visits at the clinic.
How Can I be sure the baby is getting enough milk?
Count wet and dirty diapers. Most babies, whether breast-fed or bottle-fed, follow a similar pattern for the first few days. We have a chart available to make tracking this pattern easier. Just ask your midwife for one.
| Minimum Wet Diapers | Minimum Dirty Diapers | |
| Day 1 | 1 | 1 |
| Day 2 | 2 | 1 |
| Day 3 | 3 | 1 |
| Day 4 | 6-8 | 2 |
After day three or so, when your milk is flowing well, your baby will have 6 to 8 wet and/or dirty diapers a day until around the sixth week. After this, your baby will settle down into his or her own pattern, which may mean that they have only one bowel movement pre day or even every other day.
Breast-feeding around the clock ensures that your baby receives enough breast-milk and that your milk supply builds up quickly to meet the demand. Most breast-fed babies feed approximately every two to three hours with periods of cluster feeds. It is important during the first few days of breast-feeding that you observe your baby for "cues to feed" and that he or she is encouraged to breast-feed a minimum of 8 to 10 times during a 24hr period.
"Cues to feed" include rooting, putting hands, fists, fingers to mouth, mouth movements, wakefulness and finally crying. It is important during the first few days of breast-feeding to allow your baby to have his or her hands free from blankets etc. in order that they are able to alert you to his or her need for food.
Weight gain is a sign of adequate milk intake. Your midwife will weigh the baby at the postpartum checkup.
When should I call my midwife?
You and your baby will likely enjoy good health and a normal postpartum period. However, call your midwife or your baby's physician if your baby:- will not stop crying
- does not breast-feed 8-12 times a day
- babies may cluster feed and this is normal and count as part of the 8-12 times
- shows signs of dehydration, jaundice or infection
Dehydration: Look for fewer than normal wet or dirty diapers, dark yellow urine, a quiet baby who sleeps a lot and appears lethargic, dry lips and inside of mouth, and a yellow skin tone. Do not rely on a sunken fontanelle (small soft spot on the top front part of the baby's head) as a sign of dehydration, because the fontanelle fluctuates with feeding and even breathing.
It is not always easy to tell when a disposable diaper is really wet. If you are concerned that your baby is not urinating, line the diaper with kleenex and wait several hours. Or, since disposable diapers get heavier when wet, compare the weight of the used diaper with that of a dry diaper.
Dehydration can be serious because it depletes the body's fluids and can cause a form of shock. However, your baby will likely do well if the problem is caught early and the infant receives extra feedings or intravenous fluids.
Jaundice: About 60 percent of full-term babies develop jaundice (yellow skin or white part of the eyes) during the first week. If jaundice occurs within the first 48 hours, it may mean a blood infection or hemorrhage. More commonly, jaundice appears on day two or three and is due to the inability of the immature liver to metabolize bilirubin (the orange-yellow pigment in bile).
Jaundice usually goes away by itself, but if it becomes severe and your baby will not feed properly, your doctor will give extra fluids and place the baby under a special light.
Infection: If your baby feels hot, or has a temperature (more than 37.5 Celsius or 100 Fahrenheit under the armpits), does not feed well, is very sleepy or irritable, has a skin rash or breathes quickly (more than 60 breathes a minute), you might want to consult the doctor. Many healthy newborns occasionally have one or two of these symptoms, but if any persist for several hours or a number are present at the same time, page your midwife.
For yourself, the following signs could indicate that you are overly fatigued, running an infection or experiencing postpartum depression. Call your midwife if you:- have vaginal bleeding that is more than a heavy period
- have bleeding that soaks a pad in less than two hours
- pass a blood clot as big as a plum
- have bright red blood 10 days or more after birth
- have vaginal discharge that smells foul
- have pain that is not relieved by over-the-counter-painkillers
- feel feverish or your temperature is over 38 Celsius
- see redness, swelling, oozing or separating of your episiotomy, tear or caesarean incision
- have red, tender or lumpy areas in a breast that do not clear after nursing the baby
- feel depressed, unable to cope or are worried about your baby's or your own physical safety