After labour and childbirth, the new mom enters a period of postpartum. This period is often referred to as the fourth trimester or the three months following birth. Postpartum can also refer to the first 12 months after birth.
Depending on the birth outcome, the woman will go through physical recovery. If you are under the care of an obstetrician and had a vaginal delivery, you can expect to stay at the hospital for at least 24 hours. If labour was a caesarean birth you can expect to stay for at least 72 hours.
For home births, the woman would remain home or if the birth was at the Toronto Birth Centre she would remain for 4-6 hours and go home and if the birth was at a hospital they may go home the same day or follow the hospital guidelines of a 24 hour stay. Midwives don’t perform caesarean births and the care of the woman would be transferred to an obstetrician and she would stay at least 72 hours in hospital.
Those under the care of an obstetrician will usually have a follow-up postpartum visit around six weeks. Those under the care of a midwife may receive in home visits the day after birth, on the third day, fifth day and 10th day and other visits in office. You are usually discharged by six weeks postpartum under both models.
For a vaginal delivery, the woman may have had tearing requiring stitches or an episiotomy which would require stitches. The new mom may experience discomfort when urinating and/or having a bowel movement. Using sitz baths and a peri bottle can help with healing and cleansing. With stitches, she may find it uncomfortable in certain positions when seated and may need the support of pillows and blankets.
For a caesarean birth, she is recovering from major surgery and may be given precautions from their care provider including no lifting or carrying anything heavier than their newborn, refraining from swimming or using baths, using stairs and certain household chores such as vacuuming. She will also need to care for any stitches or staples used and may need the support of a breastfeeding pillow or other pillows when feeding their newborn.
For both births, the woman may experience postpartum bleeding called lochia and will need to monitor the amount of bleeding and any accompanying symptoms such as fever or blood clots.
Hormones during Labour
During labour, the body produces more hormones and after labour there can be a drop in these hormones which may cause changes in mood including the baby blues. The woman may undergo an emotional adjustment during the first few days after birth. The new parent (s) may be adjusting to caring for a newborn, recovering from their labour and birth and may not be eating well and or functioning on enough sleep.
Going through this emotional adjustment can be expectant however, it is important to be aware of the differences between postpartum depression and the baby blues. The baby blues typically occur from the first few days postpartum to a few weeks and gradually goes away. Postpartum depression lasts longer than the baby blues and can be accompanying by suicidal thoughts, self-harm or harm to the baby, mood swings, less sleep and loss of energy. Being self-aware of the signs and seeking help from others such as a counsellor or trust family member or friend can help.
Skin to Skin
There are many studies about the benefits of skin to skin contact immediately after birth and boding later in the newborn’s life. Skin to skin benefits the newborn by regulating the baby’s temperature, there heart and breathing are more stable, blood sugar levels are more elevated, is less likely to cry and if the birthing person breastfeeds the newborn is more likely to latch on and latch on well. There are also benefits to the mom with skin to skin – more oxytocin is released, moods more elevated, if breastfeeding it increases milk supply, promotes bonding with the non-birthing parent and can help prevent postpartum depression.
Feeding your Baby
The Canadian Paediatric Society and Health Canada recommends for the first six months of a baby’s life to be exclusively breastfeed. When feeding at the breast isn’t possible to feed the baby expressed breast milk by spoon, cup, syringe or bottle. If breastfeeding or expressed breast milk isn’t possible using donor milk is the next recommended option. Commercial infant formula may be the most feasible alternative if the baby is not exclusively breastfed. Health Canada recommends using cow milk-based infant formula over soy based (unless the infant has galactosemia or for cultural or religious reasons). Home-made milk, cow’s milk, soy milk, almond milk and other alternatives should not be used.
However, a family decides to feed their newborn, they should be supported in their choices. For the family who chooses to breastfeed but has challenges, there is a lot of support in Toronto for them. Many hospitals offer free drop in breastfeeding clinics which are run by nurses and lactation consultants. There are also free clinics at many community centres run by the City of Toronto. Toronto has many lactation consultants who provide in home support and the city also has the Newman Clinic.
If a family has decided to supplement with formula or formula feed exclusively, they should not receive judgement, ridicule or shaming for their choice. It is important that baby gets feed rather that is by breastfeeding, expressed milk, donor milk or formula.
It is often said that raising a child requires a village of people. The first few days and weeks can be a hard adjustment for some. Some parents may feel a loss of their old life, interests and activities prior to baby. If there is a partner and they return to work, the parent at home may feel angry and upset that they can’t leave and have to stay home and care for the baby. This time can be completely overwhelming, frustrating and emotionally and physically exhausting.
During pregnancy, the couple should take time to review the changes that will occur once the baby is born. Things to review and consider include food preparation and cooking, laundry and other household chores and weekly shopping. Also, the time it takes to feed the baby, time to prepare bottles and formula, entertaining and hosting guests, sleeping and other responsibilities.
A postpartum doula is someone who is trained and educated in the postpartum period and can be hired to provide support to the family with feeding, household work (laundry, cleaning, dishes), meal prep and cooking, caring for the baby and other children. A postpartum doula also provides educate, resources and referrals, if need, to the family. Postpartum doulas may provide support during the day or overnight caring for the newborn while the parents sleep. Being supported during the postpartum period is important for families to thrive in their new roles as parents.
Spend time reviewing your postpartum period and plan during pregnancy can help. Have a list of resources for local support if they are required. Hiring a postpartum doula can provide unbiased support, care and guidance to new parents.