A midwife's guide on what to expect during baby's first week

DAY 1

MAMA: Antenatally we focus so much around giving birth to our babies that we very rarely stop to think what the healing process may be like. Expect to be sore, whether it be post Caesarean-section or vaginal birth – you have just accomplished one of the most amazing processes a human can go through, and it usually comes with some trauma. If you have had a vaginal birth with a tear or episiotomy and needed stitches, remember to take regular pain relief. Your whole body may feel achy from the sheer effort it takes to give birth. Following a C-section, you will likely be in hospital for four to five days and it is important to keep your pain well managed so you are able to care for your baby. There is a wide variety of pain medication options, so be sure to speak with your carer if you are still in pain. Your bleeding (lochia) will be heavy in the first 24 hours and you may even pass some small clots. This is very normal and you can keep pads to show your LMC if you have concerns. Your breasts will be soft and your nipples could be tender. Damage to your nipples can happen very quickly, making it much harder to feed your baby. Correct positioning and latching is paramount, so don’t be afraid to shout for help.

BABY: Birth is a tiring journey for your baby too, and after a period of alertness following the delivery, babies are often very sleepy. Skin-to-skin contact and a good breastfeed in the first hour following the birth will be invaluable to your breastfeeding journey. Baby’s stools (poo) will be black/dark green and sticky, a lot like melted licorice (sorry, licorice lovers). This first bowel motion is called meconium. Baby’s urine output will be minimal, maybe just one to two wet nappies in the first 24 hours.

TIPS:

• As tempting as it is to lay awake in bed and stare at the little miracle you have created, close your eyes and get some sleep. As I said before, babies are often sleepy in this first 24 hours and this is an opportunity to rest before your baby wants to feed frequently.
• Ice packs or frozen sanitary pads (spray witch hazel and water on a pad, put it in a plastic bag and place in the freezer) can be used to help the healing and swelling of your tender ‘lady bits’.
• Keep a plastic bottle in the bath-room to pour some soothing water over your stitches as you pass urine.
• Using some natural oil (like sweet almond) on your baby’s bottom will help when it comes to removing tarry meconium from baby’s skin.
  
  

DAY 2

MAMA: It’s not unusual for mums to feel concerned about their milk supply. Remember your baby has a belly about the size of a cherry, and although you may only see a few drops of colostrum (first milk), this provides the perfect nutrition (high in protein and calories) for your little one. Your baby needs to feed frequently and this provides feedback between your brain and breast, producing the hormone oxytocin which helps your uterus to contract and control your bleeding. This is why you may feel mild uterine cramps while your baby feeds. Your lochia will be heavy, but improved from day one. It is not unusual, even for the most regular mums, to not have a bowel motion for two to three days after birth.

BABY: Your baby will want to feed frequently. She has realised she is no longer in the safety of your womb and quickly discovers the next best thing is breastfeeding. Here she can once again feel your warmth, smell you and hear your heart beating. Each time you lift her to pop her back into the cot, she is likely to protest loudly. You put her back to the breast and she suckles a little and falls asleep. This can go on for hours. Baby’s cord will be beginning to dry and the clamp will be left in place. Her stools will be meconium and she will have one to two wet nappies. Your LMC will discuss taking a blood sample from your baby for metabolic screening known as the PKU or Guthrie test. You should also be offered a newborn hearing screen.

TIPS:

• After your baby has had a long feed at the breast, break the suction and hold your baby snuggled warm against your chest. Wait for her to fall into a deeper sleep before trying to transfer her to her own bed.
• The recommendation in New Zealand for safe sleeping is to have your baby in her own bed for each sleep. There are safe co-sleeping beds available, such as Pepi-Pods, if you want your baby to share your bed.
• Lanolin cream can be used to soothe tender nipples between each feed.
• Don’t get overwhelmed by conflicting advice, especially while in hospital. Everyone will have ideas that may or may not be useful to you. Listen and you will absorb the information that is right for you and your baby.
• Breastfeeding can be challenging, I highly recommend doing a breastfeeding workshop antenatally. If you have flat or inverted nipples, talk it through with your LMC before giving birth.
  
  
  

DAY 3

MAMA: Sleep deprivation is beginning to set in. You may have had one or two sleepless nights in labour, or may have slept poorly in anticipation of your elective surgery. This, on top of a baby feeding frequently through the night, equals minimal sleep! You may be experiencing day three blues, aka the baby blues. You may feel teary, worried, anxious or cry over a spilt cup of tea. Your body will still feel achy and uncomfortable and this is often exacerbated by lack of sleep. Your breasts may still be soft or beginning to feel heavier, fuller and warmer. Your colostrum will be changing to transitional milk; which looks thinner and yellow to creamy white, and will have increased in volume. It is not uncommon for your nipples to feel tender and sore, especially at the start of the latch as the baby draws the nipple in to the soft palate. If the pain continues through the feed, gently break the seal with your finger and get support to latch the baby deeply on to the breast. It is important to note that postpartum blues are different to postnatal depression. If you continue to feel sad, are not seeing any happy moments, have difficulty sleeping or trouble bonding with your baby, talk with your LMC, partner, GP or friends, and seek advice and support.

BABY: Your baby will continue to breastfeed frequently. She may do four to five feeds close together (cluster feeding) and then have a longer break. It is normal for a baby to feed eight to twelve times in a 24-hour period. In fact, you would want to make sure she has had at least six feeds in this time. Her stools may be transitional now and look a brownish-green colour. Her urine output should be increasing to reflect the increase in milk she is getting, which means around three to four wet nappies in 24 hours.

TIPS:

• Become a tag-team with your partner. Rest as much as you can. When your baby sleeps, you need to sleep too.
• Remember to drink plenty of water and eat well. Don’t be tempted by all the chocolates/sweets your visitors may bring, the sugar is unhelpful.
• Don’t feel you need to accept lots of visitors in the first few days. Be selective and ask for help. Meals are a great gift - especially ones you can put in the freezer. This can be a time of financial burden, however it is also time you can never get back.
• If possible, it is wonderful if your partner can get at least two weeks off work to support you and share this transition to parenthood.
• Talk through the birth with your LMC so you have a clear picture of how things unfolded.
  
  
  

DAY 4-5

MAMA: Home at last! Most mamas spend one to two days in a hospital/birthing unit after a normal birth, and four to five days following a C-section. Others may have never left the comfort of home. It is tempting, especially for all those type-A personalities out there, to be super mum. Entertaining visitors, tackling piles of washing, vacuuming ... the list goes on. But don’t do it. Rest. You and your baby need you to be on top form and the best way to do this is by resting. Your breasts may be engorged, causing discomfort and making it harder for your baby to latch. Expressing a small amount of milk by hand will help to soften the areola (area around the nipple), making it easier for baby to latch. Breastfeeding will ease the pressure and help make you feel more comfortable.

BABY: Your LMC is likely to do a full postnatal check on your baby around this time and take all the same measurements that were taken at birth. It is not uncommon for baby to weigh less at this stage, as babies may lose up to 10% of their birth weight in the first few days. If the weight loss is over 7%, a feeding plan will likely be put in place. Babies are usually back to their birth weight around two weeks of age. If your baby’s head circumference is smaller, don’t be alarmed - swelling at birth may have given a larger head measurement. Her cord will be dry and the clamp may have already been removed. The cord shrivels up and eventually falls off one to two weeks later. The amount of wet and dirty nappies should have increased and stools may now be yellow and grainy looking. If your baby has become jaundiced in the days following your birth, your LMC may want to do a blood test to check the levels of bilirubin in her blood. High levels of jaundice can be dangerous to babies and would require a referral to hospital for treatment if they become too high.

TIPS:

• Fold your baby’s nappy over and leave the cord out to allow it to dry faster and stay clean.
• Your baby’s umbilical cord will often be smelly and a little oozy but it shouldn’t look red and inflamed around the stomach. If concerned, ask your LMC to check.
• Paracetamol will assist with nipple and breast pain.
• Be kind to yourself and your partner, this is a learning curve for everyone.
• Try to do something for yourself each day. It can be small - a walk to the mailbox, a cup of tea and a magazine for 10 minutes, or a warm relaxing bath.
  
  
  

DAY 6-7

MAMA: Your breasts are beginning to master their new role. They will often feel full prior to feeding and noticeably softer afterwards. Your nipples are hopefully healing and becoming less tender, however this can take a little longer for some. Midwives will be able to support you with breastfeeding complications, however if you’re still experiencing breastfeeding challenges, enlist the support of a lactation consultant. Your lochia will have settled and will continue to decrease until it stops completely, around four to six weeks following the birth. Your stitches will begin to dissolve and should be feeling more comfortable.

BABY: Your baby will be becoming more settled but there is still a lot of guesswork when they are upset: Is it wind? Over-tiredness? Hunger or a full nappy? You will get better at reading your baby’s cues but sometimes you will just need to ‘ride it out’. She will continue to feed around eight to ten times per day. Her belly is now approximately the size of an egg and she should be producing about eight heavy wet nappies a day and soft yellow stools (the number each day varies per baby). She should be gaining around 25-35g per day. The key to getting through these first few weeks is to rest as much as possible and to ask for help. ‘Don’t sweat the small stuff’, ‘This too shall pass’ and ‘I am doing an amazing job’ should become your new mantras. Just when you have the hang of one thing, you will be given new challenges, and as the mother of two boys 18 years apart, I can certainly attest to this! Good luck on this amazing journey and remember to enjoy moments of each stage, it really does go far too quickly!

TIPS:

• The first few weeks are about survival. Eat well, drink plenty and rest as much as you can.
• Don’t worry about routines just yet, just go with the flow.
• Your baby needs lots of cuddles and time close to you, you can’t spoil a newborn by picking them up too often.
• If you’re ever struggling with breastfeeding or a tired grizzly baby, both strip off and have skin-to-skin cuddles.
• Bath time in the early evening can be a nice way to unwind and signal the end of the day for baby. This is a great task for partners and will give you that greatly needed time-out.