Postpartum – My Radiant Beginnings

Category Archives for "Postpartum"

Newborn postpartum home visit

What to expect during your first Post-Partum Home Visit (Baby)

Thank you for reading about what to expect during your first postpartum home visit for the mom! Now, it’s time to look at what that first visit looks like for the baby. During the pregnancy and after baby’s arrival, I remind my clients that I am not a pediatrician. The law does allow for midwives to care for babies for up to six weeks, but I encourage the parents to find a pediatrician and discuss how soon they should be seen. Most often, I am still the first one to see the baby by this 24-48 hour home visit window.

Lots of things happen during this visit for the baby. It is important to do a nursing check and help if there have been any difficulties with latch. If nursing is going well, then not as much time is needed there. We check baby’s vital signs including his/her heart rate, respirations, temperature, and review the chart that the parents have been using to track how baby has been doing in the time the midwife was gone. We review how many wet and dirty diapers that the baby has had, how much indirect sunlight the baby is getting (this helps to break down bilirubin levels and can help to prevent jaundice), and how baby is sleeping.

This is the ideal window to collect that first sample for the newborn screening and to perform the CCHD (Critical Congenital Heart Defect) screening. The baby is of course weighed, and we discuss how much weight loss is okay versus too much, as it is NORMAL for the baby to have dropped weight during this time. Because I do not have the equipment to perform the hearing screen, I remind the parents they will need to have this done either by their pediatrician or through another provider I refer.

As mentioned in the previous post, following baby’s checkup, he/she may be brought into the herbal bath with mom. If the baby will be in the bath, we delay applying the cord care powder to the umbilical cord until after the bath. I also use this time, if we didn’t already review it during the first herbal bath following the birth, to show the parents how easy bathing a newborn while in the tub with them can be. You’d be amazed at how overwhelming it can seem to bathe a new baby! I want everyone to feel comfortable and confident in this time! The baby is dried, diapered after applying olive oil to his/her bottom (GREAT tip for helping that tar-like meconium to slide right off!), the cord is examined and treated, and the baby is dressed and wrapped or ready for skin-to-skin with mom or dad.

Similar to my departure following birth, I like to leave mom and baby resting comfortably together in bed, well attended and nourished.

Postpartum home visit

What to expect during your first Post-Partum Home Visit (Mom)

You were able to deliver your baby at home, everything was normal and stable, and the midwife left you and baby snuggled up, resting in bed. I like to remind my clients to call me after their recovery sleep and after they’ve had some time to settle in a bit to let me know how nursing is going and to ask any questions that may have popped up in this time. Letting them call me helps to avoid me waking them with a phone call and instead allows the new parents time to adjust and do things on their schedule. If we didn’t set a time following the birth for the postpartum home visit, we typically schedule it at this time. The timing of the first home visit to check on mom and baby is anywhere from 24-48 hours following the time of birth. Of course, if there are any concerns, the midwife returns as appropriate.

While the particular timing is mostly due to the ideal time to collect a blood sample from the baby for the purpose of the first newborn screening (the test used to check for a myriad of metabolic disorders), it is also a great time to check in on mom to be sure she is remaining stable. Keep in mind that mom and dad (or perhaps another family member who was appointed for the task) have been keeping note of some vitals for the mom and baby in the time between immediate postpartum period and this first home visit. I work to make sure parents feel equipped for this and are not overwhelmed with this responsibility.

When I arrive, after washing my hands and greeting my clients and the new baby, I set out to boil another pot of herbs so that mom can take another herbal sitz bath. I didn’t used to do this routinely at this postpartum visit, yet I found all too often that when I asked if they had done any more herb baths since the birth, the answer was typically that they had not. My initial focus is on mom, addressing any questions or concerns she has.

I check her vital signs, feel her fundus (the top of her uterus), we discuss how her bleeding has been and any pain/discomfort she may be experiencing (from breasts/nipples to a sore bottom). We discuss her nutrition and her supplements since the birth. It is important to remember that a nursing mother needs more calories when breastfeeding than she did when she was pregnant! (A pregnant mom typically needs about 300 calories over what her normal was prior to pregnancy. A breastfeeding mom typically needs about 500 calories over her pre-pregnancy allowance.)

Many times it is through the discussion about supplements that a mom is reminded she should be continuing to take them. For many, it is an “out of sight, out of mind” issue. We have been encouraging moms to rest and take it easy, which typically means they are remaining in the nest of their room. This has pros and cons for sure! This protected isolation from the world can also deter some of the self-care they were so careful to instill during their pregnancy.

While discussing and addressing the various topics above, I am getting a sense of how rested mom is and a glimpse of her outlook and emotional state. I also ask directly how she is doing emotionally and whether or not she’s been able to fall asleep during her rest periods or if she’s just putting her feet up and taking it easy.

Following the mom’s assessment, we help her into her herbal sitz bath, bring her something to drink, and give her some time to herself while dad stays with the baby during his/her assessment. I have seen mothers light up with this opportunity to have some uninterrupted time in the herb bath. This is addressing her physically as well as emotionally. Sometimes, I have brought the baby to them at the conclusion of the baby’s exam and procedures, and sometimes they prefer that I don’t. The choice is yours. Those that choose to have the baby brought into the herb bath may choose to nurse the baby while in the tub, or simply hold the baby and help them to float, enjoying the warm bath.

Once mom and baby are ready to be helped out of the tub, the baby goes to dad and I help mom to the bed. During this time I demonstrate an abdominal massage and binding to help the mother feel supported and to encourage healing. The partner gets to see how they can be a part of this healing process and look forward to being in charge of providing the massage for the next couple of days.

To my former clients who are reading this and thinking things sound a bit different, you are right. Some of you are currently with me for another round and you WILL experience this. I am putting into practice new things as I grow and learn. I am blessed to have the opportunities to share this and find it providential that these changes occur and benefit the postpartum period. If you are “done done” having children, stay tuned…there is more.

The postpartum home visit is more than just a checkup. You are addressed physically as well as emotionally. I want to leave you feeling as though you matter, you are important, you are more than your birth, you are more than “just a mom”, you are (insert your name here)!

It’s a blessing to serve you!

Postpartum Sealing – A Healing Experience

I am excited! Sometimes we just need a pause. Sometimes we need momentum. Sometimes we need healing.

I feel like I received all that and more during my recent continuing education experience. I’ll spare you the rabbit trail of how I stumbled across it, but I am so grateful that I did and that the timing to be able to attend worked out so well. So, what did I do? I attended a postpartum sealing workshop in California! (May also be referred to as “bone closing”).

I wanted this for so many reasons. The shock and aftermath of my own postpartum experience three years ago forever changed me. The life it almost took has been reborn with passion and purpose to reach out to others. You are not alone!

You may feel broken or altered, but as long as you keep searching, moving one foot in front of the other by any measurable, albeit minute effort, there is hope.

There is excitement, so much excitement, but there is also still some learning and fleshing out to do before I feel truly confidant to go forth. At this time I plan to gather the things that I need and try out this method/process on a few people who have passed the traditional immediate postpartum period of 6 weeks. Why?

I genuinely want to be authentic in this healing. I don’t want to just run through the steps and seem inorganic in any way. This healing is a process and there are multiple steps, that I will share in more detail after my “practice period.”

A super-condensed look at it starts with a steam, then a hot bath followed by wrapping, massage, and abdominal wrapping. It almost does the process injustice to list it with such brevity, but I can assure you the process is warmth and it gives love and healing.

It is not only time-consuming, but also incredibly taxing on the provider; which saddens me because my original goal was to offer this option to all new mothers, not just women who delivered with me. This reinforced a lesson I’ve learned in that I have to pace and preserve myself so that I am at my best in order to offer my best. I may still be able to offer 1-2 spaces each month for this as a stand-alone service during the months I am not already booked with midwifery clients, but at this point I can’t say for sure.

Ultimately this process is done between 7-14 days following childbirth, but for many women it is healing no matter how much time has passed since her last child was born.

I’ll be sharing more in time to come but wanted to share my excitement for now and perhaps wet your appetites a bit as well!

When A Home Birth Doesn’t Go As Planned – Part 5

Welcome! You made it to the end of the series on transports and what happens when things don’t go as planned! Thank you again for joining and for sharing anything you found to be helpful with others! We’ve looked thoroughly into what happens in a transport, including some reasons why it might take place. Now let’s look at what can be expected after delivery.

Generally speaking, I stay with my clients until breastfeeding can be established with the new baby. It is important to allow family bonding and ample time for mom’s and baby’s recovery sleep after the baby has latched and is nursing.  Each woman is unique, and we discuss my next visit within the next day or two.

Often, I come up to the hospital prior to discharge to do an emotional check on mom and to allow her to process the birth. Some may choose to have me wait and come instead to their home a day or so after being discharged. The important thing to note is that the post-partum care continues beyond the birth at the hospital. I care about my mothers and their babies and I want to continue that continuity of care. If a mother chooses instead to only follow up care with her delivering OB at the hospital, she is free to choose that as well. I have only seen that happen a handful of times, mostly with individuals who utilized a birthing center or who didn’t have the rapport with their midwife that they had hoped for.

I typically see clients four times following the birth of their baby: between 24-48 hours, 4-5 days later, 10-14 days later and the final post-partum visit at 6 weeks. While these visits may be very similar in timing and structure following a hospital delivery compared to a birth completed at home, the emotional or recovery aspects would be tailored to each situation.

The After Pains

So you’ve had the baby, but you’re still experiencing contractions!?

Well, yes and no. This may be one of those areas that you weren’t warned of prior to your labor experience. What am I talking about? The “after birth” pains, or uterine contractions that follow the delivery of your baby and placenta.

More often than not, you get a break after the baby is born, but upon breastfeeding you welcome back, though not fondly, some discomfort or pain in your abdomen. These pains, that come and go, are a result of your uterus contracting in order to clamp down and continue the process of its journey to return to a smaller, pre-baby state.  While the process takes weeks to complete, the majority of women find these uncomfortable after birth pains only last up to a few days.

Does it happen to everyone?

Yes, though most first time mothers don’t notice it much, if at all. This is because your uterus was pretty toned to begin with since this was your first delivery.

Many mothers report more intense after birth cramping with each subsequent delivery. Meaning, you are more likely to notice and be uncomfortable after baby #3 than with your previous births.

Is there anything that can be done to lessen the discomfort?

Fortunately, there are things you can do to help ease your discomfort during this time.

Remember, it’s a good sign that you are noticing those sensations while breastfeeding because the nipple stimulation helps the uterus to contract. The uterus contracting helps to keep your bleeding down and to return your womb to its proper state. In addition to staying on top of the recommended pain relievers given by your healthcare professional, which may include Ibuprofen or Tylenol, you can take natural supplements. Two that I recommend are:

AfterEase

Contract Ease

Both work well, though AfterEase is an alcohol-based tincture and burns a bit when held under your tongue.  Personally, I felt this distracted me from my uterine discomfort and it made a difference in how quickly I perceived it taking effect. The benefit to these herbal supplements is that you can take them more often than you can take over-the-counter medication.

In addition to the recommendations here, taking warm herbal baths can be of comfort for this and to heal your bottom area. You could also use a heating pad set on low, or a warmed rice sock/compress for short periods of time for relief.

Home Birth: But what about newborn care?

How a midwife checks the baby’s health

So you’ve decided to have a home birth and feel confident about your prenatal care and labor choices. But what about after the baby arrives?

During the immediate postpartum period I am assessing vital signs on mom and baby regularly, helping to initiate breastfeeding and giving adequate time and support for mother/baby/family bonding. During the time of active recovery, we are following baby’s cues that he/she is interested in nursing because first and foremost, in the absence of complications or the need to intervene, this is of vital importance.

A complete newborn exam is performed in order to assess baby’s gestational age and to verify everything is within normal limits, from head to toe. Any concerns will be discussed with the parents and a plan for next steps established. In the case of an emergent concern, we would transport to the hospital; however, most situations identified during the newborn exam are truly non-emergent and may be referred to the baby’s pediatrician during normal business office hours.

Acting within the scope of my license, a midwife is able to care for the newborn within the first six weeks of birth. I do discuss with all of my clients however, that I am not a pediatrician and I recommend the baby be seen by a doctor within the first two weeks of birth, unless they elect to do so sooner or the doctor requests an earlier visit. What I provide for the pediatrician is a one-page document containing applicable pregnancy or birth events as well as any newborn procedures prior to the first visit so that they have any information they may need easily at their disposal.

Now that you have an overview, let’s take a closer look at the details of newborn care for home birth. Assuming a normal birth, baby’s AGPARS were great and baby is robust, crying and alert, the baby spends time skin to skin with mom, dad or another family member. Midwives regularly practice delayed cord clamping; many of my clients have not had the baby’s cord cut until after the placenta has delivered, ensuring baby gets his/her blood!

Vital signs are done hourly or as needed and include assessing heart rate, breathing and temperature. Typically the newborn exam is done between 1-2 hours after birth (it is at this time that baby is weighed and measured and newborn procedures are done according to law and parents’ informed choice) and includes the Ballard Exam which helps to assess overall gestational age and is comprised of neuromuscular maturity as well as physical maturity.

It is usually at the conclusion of this exam that mom and baby are helped into an herbal bath. Once out of the bath, the baby is dried, and I demonstrate the application of olive oil to the bottom (to help ease the changing/cleaning of dirty diapers), diapering, cord care, dressing and swaddling.  One last set of vital signs is taken prior to the midwife’s departure.

What’s next? You’re left alone?!?

Not to worry, during the prenatal period, as part of your care, I will have already taken the time to review what to expect and what to look for. Between 34-36 weeks I send a document about the first few days postpartum and how to care for the baby. The document includes a chart where the parents, or other elected family member or friend, write in the information requested. During the first 24 hours, vital signs are to be assessed every 4 hours. This means taking the baby’s temperature, counting respirations and heartbeat.

Does that sound scary or overwhelming? This document is reviewed at the home visit and again after the delivery prior to the midwife’s departure. I will teach you, so you can be sure of what to do! I return for a postpartum home visit between 24 – 48 hours after the birth and am on call 24/7 during those first days after the birth.

It is at the initial postpartum home visit that the first newborn screen is performed (testing for metabolic diseases) as well as the CCHD (critical congenital heart defect screening).  I check vital signs for mom and baby again at this visit as well as provide breastfeeding support. The baby is weighed again to verify he/she has not lost too much weight. We discuss the number of wet & dirty diapers, sleep & eating patterns and assess baby’s skin color for jaundice. Goldenseal is applied to the baby’s umbilical cord as needed.

There are 2 additional postpartum visits that follow; both are back at my home office and include weight and vital sign assessment. I am able to perform the second newborn screening should you choose to have me do it instead of your pediatrician around 14 days postpartum. We review the items discussed at your postpartum home visit, plus anything new that may arise!

As you can see, I do my best to help prepare you for the next tasks of caring for your baby. I want you to feel educated, supported and encouraged each step of the way.

What questions do you have about newborn care at home?

If you’ve given birth in a hospital, what was your newborn care experience like? What would you change? Comment below!

Postpartum Care: When to Call

Symptoms: Baby

If any of the following are noted, please call your midwife immediately for further instruction/information!

Respirations

  • Fewer than 30 or greater than 70 breaths per minute while resting.
  • Labored breathing with grunting, retracting of the ribs or abdomen or flaring of the nostrils.
  • Apnea: not breathing for 20 seconds or longer, especially with color changes.

Heart Rate

  • Heart rate less than 110 or greater than 160 at rest
  • Color changes associated with changes in heart rate

Color

  • Any blue or dusky color located on the face or trunk
  • Jaundice or yellow color is abnormal if it occurs in the first 24 hours and your baby should be seen immediately
  • If your baby is lethargic, feeds poorly, has excessive weight loss, temperature instability, dark urine, light colored stools or persistent jaundice

Temperature

  • Axillary temperature of less than 96.8 or greater than 99 after clothing and room temperature have been adjusted.
  • Or if baby’s temperature fluctuates a lot even when room temperature and clothing remain the same.

Elimination

  • No passage of stool or urine in the first 24 hours after birth.
  • Bloody or excessively watery stools that are a change
  • Blood or rusty color in urine esp after the third day

Other signs

  • Excessive sleepiness- sleep periods longer than 6 hrs after the first day.
  • Hyperirritability or extreme reaction to ordinary activities like diaper changes or picking him up.
  • Poor feeding, not at all interested in feeding or exhausted by it.
  • Regular projectile vomiting
  • Bile-stained vomit
  • Poor muscle tone – “Spread Eagle Positioning”
  • Taut, swollen abdomen
  • Cord Issues
    • Yellow, green or blood is noted at the base of the cord
    • There is a foul odor coming from the cord
    • There is redness or warmth around the base of the umbilical cord

Symptoms: Mom

If any of the following are noted, please call your midwife immediately for further instruction/information!

Temperature

  • Fever above 100.4 after drinking lots of fluids.

Pulse

  • Greater than 100 beats per minute while resting, occurring twice in 1-2 hours. Call your midwife immediately if accompanied by heavy bleeding.

Uterus

  • If it remains soft, does not respond to massage and heavy bleeding is occurring.

Lochia

  • Heavy bleeding, soaking a large pad completely in less than 2 hours after the first 24 hours.
  • Passage of tissue or fowl-smelling discharge.
  • Persistent passage of clots larger than a lemon.

Signs of mastitis

  • Pain lasts longer than 48 hours
  • Fever of 101 degress or higher
  • You have a hot, red, tender area on your breast
  • Difficulty nursing
  • Chills or flu-like symptoms

Infection

  • You are not able to urinate
  • You experience pain or burning with urination
  • You experience urgency
  • Your urine has a foul odor
  • Temperature of 101 degrees or greater

Other signs

  • Fainting
  • Severe headache, blurred vision, just feeling bad, hazy feeling, aura
  • Severe pain in abdomen, chest or legs
  • Shortness of breath
  • Feelings of despair, great anxiety or inability to cope