PP handout

[rnchrista]

Does anyone have a PP handout they give to their clients for instructions after birth? i.e. what to watch for, when to call, importance of rest and nutrition, etc?

I know I could make one up but figured I'd save myself the time if someone doesn't mind sharing theirs

[pamamidwife]

here's mine:

Postpartum Instructions

• The largest amount of blood loss postpartum occurs within the first 24 hours of birth. With mothers lying down most of this time, it is normal to have some blood clots – anything larger than your fist is not normal. Expect to feel bleeding (often described as “gushing”, but it’s usually not as much blood as it feels) when the baby nurses (and your uterus contracts), when you move (especially when sitting or standing up).

• If you’re ever concerned about your bleeding, reach down below your navel and feel for your uterus. For the first 24 hours, it will feel like a large grapefruit. It should be hard and firm. If it is not, rub vigorously in that area until you feel it harden and contract.

• If you soak more than two pads (front and back) within a half hour, please call ASAP and immediately lie down while rubbing your uterus into a contraction.

• Your blood loss should always smell like menstrual blood. Any change in odor should be reported to us.

• If your bleeding tapers off over a few days, then starts back up bright red again it’s a sign that you are over-exerting yourself. You should take it easy for a few days (lifting no more than your baby and not doing any vigorous housecleaning or trips outside) and the bleeding should slow.

• Urinate every hour or two during these first two days. Your bladder may not feel full, but keeping it empty will encourage your uterus to stay contracted and slow bleeding.

• Ask for help. You will have family and friends asking what they can do for you – now is not the time to refuse assistance or to expect your partner to handle it all. Ask for what you need: laundry done, groceries picked up, dinners brought, etc. People ask because they want to help you – take them up on their offers and support. You will have more time to enjoy this precious time with your new baby – and heal faster.

• If at any time you have any of the following signs, please call ASAP:

oUterine tenderness that is different from aftercramping
oA rise in your temperature – anything over 100.4’ should be reported
oFlu-like symptoms (achiness, fever, chills)
oBleeding that persists in a large amount beyond the first week
oRed, warm, sore spots on legs
o Feeling extremely anxious, panicky, or depressed; accompanied by rapid heart rate, difficulty breathing, uncontrollable crying, or inability to sleep or eat.
oBaby seems disinterested in nursing longer than 3-4 hours after the first 24 hours
oBaby does not urinate within the first 24 hours
oBaby’s respirations seem labored, or unusually fast (over 60 breaths a minute)

• Babies cry for a reason. You cannot spoil a baby by holding them or paying attention to them. Their transition into the outside world is unfamiliar – first check with the basic needs (hunger, diaper, change of scenery). Sometimes baby just wants to be close to you – as he/she has been for the past nine months. This need is not a form of manipulation, but a way for the baby to secure healthy attachments to those that will care for him/her. If you feel like your baby is unusually fussy or crying a lot, please call.

• Sometimes boys have rust-colored spots in their diapers in the first 24 hours after birth. These are uric acid crystals and are completely normal. Girls may have blood spots from their mother’s hormones and are normal. If you have questions about your own baby, call.

• As your milk comes in, your baby will usually sleep longer between feedings. The bowel movement will change color, from the black/green tarry meconium to more of an orange/yellow curdy texture. If you are formula feeding, the bowel movements will be more green than yellow.

• Keep taking any supplements that you were taking prenatally. Drink plenty of water to help replace lost fluids and bring in your milk supply.

PLEASE CALL US WITH ANY QUESTIONS ABOUT YOU OR YOUR BABY!!!

[pamamidwife]

oh, I found another one that I've used before....

Postpartum Instructions

Let us know if you soak more than one pad in 20 minutes (this means a whole pad, front and back) – massage your uterus firmly to re-contract it, and if bleeding doesn’t stop, contact us at once or seek emergency care.


Check your uterus for firmness and/or tenderness several times a day, for at least 3 days.


Notice if your flow has any bad odor (it should smell like your period) – and report to us.


Take your temperature twice daily for at least three days. If your temperature goes up even a degree, please contact us.


Drink lots of water; about 2-3 quarts daily to replenish fluids lost during the birth and to help establish a good milk flow.


Continue eating the same type of diet you were on while pregnant, acknowledging that you will still need the extra calories because of nursing. Continue taking all your pregnancy vitamins and supplements.


For women who have had a child(ren) before, for the first three days after birth, they may experience afterpains while nursing. These are common contractions of the uterus while it gradually returns to its pre-pregnancy size. The contractions are most noticeable in the first three to five days, when it is vitally important for the uterus to contract to stop blood flow. To help with the pain of these contractions, try drinking chamomile tea every time you nurse. Keeping a thermos of it (hot or cold) by your bed makes it convenient. Crampbark tincture also helps. If the pain is severe, Tylenol may be taken.


If you’ve had stitches, soak them in (or use a compress of) comfrey tea three or four times a day. Report any unusual pain.


Pay special attention to your baby’s cord. While some providers recommend using alcohol or other products to clean the area, the most beneficial treatment is keeping it dry and clean. Cleaning can be easily done with water. Fold down the tops of diapers so it does not irritate the stump. In most instances, the stump will fall off within a week. Breastmilk can be used topically to help with signs of infection.


Don’t hesitate to call us if the baby seems disinterested in nursing, listless, or irritable.


Get lots of rest, sleep when the baby sleeps, eat lots of good food with plenty of iron to replenish lost blood, and ask visitors for real help – like doing your dishes or laundry. Work into activity slowly, and you won’t have any sudden breakdowns later.


Ask your friends/family to set up two weeks of meals to be brought to your home. Knowing that you will be provided with a dinner for the next fourteen days really makes your babymoon more comfortable and worry-free. When people call and ask, “Is there anything you need?”, give them a grocery list or ask them to bring food. They are offering to help, and it’s so important!


If your bleeding starts to taper off, turns brown, and then suddenly turns bright red again, this is a sign that you are doing too much. Ask for some help, rest more often, and take it easy.


Babies cry for a reason. They may be hungry, wet, or just lonely. Always respond to your baby’s cries. Babies cannot be spoiled from the giving of love and attention.

1. Warning Signs during Postpartum

Please call us at once if you experience any of the following:

1. Fever (temperature of 100.4’ or greater)

1. Burning with urination, or blood in urine

1. Inability to urinate

1. Swollen, red, painful area on the leg (especially the calf) that is hot and tender to the touch

1. Sore, reddened, hot, painful area on breast(s), along with fever and flu-like symptoms

1. Passage of blood clot larger than a lemon followed by heavy bleeding, or any bleeding heavy enough to soak a large pad in 30 minutes or less.

1. Extremely foul or fishlike odor to vaginal discharge; vaginal soreness or itching

1. Increased pain at perienal tear site, may be accompanied by foul-smelling or pus-like discharge

1. Any sudden onset of pain that is new, such as abdominal tenderness or burning near perineal stitches when urinating

1. Feeling extremely anxious, panicky, or depressed; accompanied by rapid heart rate, difficulty breathing, uncontrollable crying, or inability to sleep or eat.

Recipe for Sleep in the First Weeks after Birth

To succeed in getting enough sleep, you must take your need for sleep seriously. Many first time parents use and appreciate the following approach to obtain an adequate amount of sleep (however, it may not work as well if you have other small children):

1. Ask yourself how many hours of sleep you regularly needed before pregnancy in order to function well. Six hours? Eight hours? That is the amount of sleep you now owe yourself every day.

1. Since you cannot get this amount of sleep in one stretch because of interruptions for nursing and baby care, you will require more hours in bed to get your allotted amount of sleep.

1. Plan to stay in bed or keep going back to bed until you have slept your allotted hours. This means that, with the exception of meals and trips to the bathroom, you do not get up, shower and dress in the early morning. You can keep a mental note of approximately how much time you have slept at each stretch. You stay in your nightclothes until you have slept the set number of hours. You may have to stay in bed from 10pm until noon the next day to get eight hours of sleep! If that’s what it takes, do it. Then brush your teeth, take a shower, and dress.

1. Many parents find it easier to follow this recipe if their baby sleeps with them, or in the same room nearby.

1. As your baby grows and begins to sleep longer stretches, it will take you less time to get enough sleep.

[DoomaYula]

OMG I love the sleep one! I'm plastering it all over my house for when I birth #4, in October. Thanks Pam.

[happyartmama]

Wow, these are great. Thanks so much for sharing!!

[pamamidwife]

Originally Posted by YumaDoula

OMG I love the sleep one! I'm plastering it all over my house for when I birth #4, in October. Thanks Pam.

I have to admit that the Sleep Recipe came from Penny Simkin. I normally have the little credit on there.

[CMcC]

Here is a questioneer for things you should watch for regarding PPD and baby blues:
http://www.pfizer.com/pfizer/download/do/phq-9.pdf and http://www.wellmother.com/articles/edinburgh.htm