NEW MOTHER CARE TEACHING SHEET

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• BREAST CARE
• CESAREAN SECTION CARE
• CONSTIPATION AND HEMORRHOIDS
• DIET, DRUGS, AND FLUID INTAKE
• EMOTIONAL ADJUSTMENTS
• EXERCISE
• LACERATION OR EPISIOTOMY AND PERINEAL CARE
• REST AND ACTIVITY
• UTERUS AND LOCHIA (Bleeding)
• WHEN TO CALL FOR MEDICAL HELP

BREAST CARE

• Wear a well-fitted supportive bra for comfort if desired. 
• After nursing, wipe off baby's saliva, express colostrum or  breastmilk and rub into nipples, then air dry. 
• Check your breasts frequently for swelling, lumps, or warmth which are early signs of breast infections. Report these to your doctor.

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CESAREAN SECTION CARE

• Keep incision clean and dry—if it is in a fold of skin, lie down after your shower and expose it to air, or blow dry on low until dry.
• Observe incision daily for signs of infection: redness, discharge, edges separating. Notify your doctor immediately if you think your incision is infected.
• Activity as directed by your doctor
• Talk with your nurses, doctor, or family if you have ongoing feelings of disappointment or depression because you had a C-section.

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CONSTIPATION AND HEMORRHOIDS

• You should have a bowel movement by 2-3 days after delivery.  
• Eat a high fiber diet and drink 3-4 quarts of fluids each day. 
• Get some exercise every day. 
• Use stool softeners as directed by your doctor. 
• Tucks (witch hazel) pads may be soothing against hemorrhoids.
• Notify your doctor if you don't have a b.m. in 3-4 days.

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DIET, DRUGS, AND FLUID INTAKE

• Eat a balanced diet according to the food pyramid with 6-11 servings of grains, 3+ servings of vegetables, 2+ servings of fruits, 4 servings each of milk products and meats/dried beans. 
• Breastfeeding moms need about 500 extra calories each day.  (Diets containing less than 1800 calories per day are associated with decreased milk supply.) Be sure to continue taking prenatal vitamins if you're breastfeeding.
• Drink enough fluids to keep from being thirsty, and to keep your urine pale, not dark yellow (about 2-3 quarts or liters a day).
• If nursing, limit caffeine and any medications, including over-the-counter medicines, unless approved by your doctor. Acetaminophen (Tylenol, non-aspirin) or ibuprofen (Motrin) may be taken if needed.
• Do not drive if taking narcotic pain medicines.

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EMOTIONAL ADJUSTMENTS

Expect to be unusually emotional the first 1-2 weeks after your baby is born—especially the day your milk comes in.

Signs that you need to get help from your doctor or a counselor:

• overwhelming feelings of anxiety, depression, or inability to cope
• "baby blues" lasting more than a couple of weeks making you feel very sad, hopeless, and depressed
• excessive talking, worrying, or crying without being able to stop
• extreme loss of appetite lasting more than a couple of days
• inability to rest or sleep despite trying relaxation skills
• inability to care for your baby or worries about harming your baby

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EXERCISE

Within a day after a vaginal delivery you may begin gentle exercises for regaining your abdominal and pelvic floor muscle tone:

• Abdominal Bracing: Lie on your back with your knees bent up. Take a deep breath in through your nose. As you exhale slowly through your mouth, pull in your lower stomach muscle toward your spine.
• Pelvic Tilting: Lie on your back with your knees bent up. Tighten up your stomach muscles and roll your pelvis backwards, flattening your back against the bed. Hold this for a few seconds.
• Kegels: In any position, gently pull upward with your pelvic floor muscles (as if you were going to stop the flow of urine).
• C-section:
    
  • Huffing: Say “Ha, ha, ha…” loudly and briskly with a rapid inward pull of your stomach muscles. You may want to support your incision site with your hands.
  • You may perform pelvic tilts and kegel exercises as explained above.

Questions or concerns regarding diastasis (separation of the abdominal muscles), pelvic ring pain, incontinence issues, or regaining abdominal/pelvic floor strength may be addressed by a physical therapist. Call Summit Therapy at 332-5106 with further questions.

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LACERATION OR EPISIOTOMY AND PERINEAL CARE

• Use squirt bottle each time you use the toilet until your bleeding has stopped and perineal pain is gone .  Fill it with warm water and spray it over your bottom from front to back.  Pat dry gently from front to back to keep germs from the rectum away from your vagina, and to avoid irritating any stitches. 
• Tucks (witch hazel compresses), warm compresses, or sitz baths in a very clean tub may be used several times a day to decrease discomfort.
• Look at your stitches daily using a hand mirror, and make sure the edges are together, and there is no redness or discharge. If they are separating or you have intense, persistent pain from them, call your doctor. The stitches will dissolve by 2-3 weeks and do not need to be removed.

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REST AND ACTIVITY

Rest frequently—nap when baby naps, if possible.

Walking is fine, but avoid strenuous activity and lifting over 15 pounds until okayed by you doctor (if it hurts you aren’t ready to do it.)

Avoid tampons and sexual intercourse for 3-4 weeks, or until okayed by your doctor and only when physically comfortable to do so. (Talk with your doctor about prevention of pregnancy—there is a slight chance that you could become pregnant the first time you have intercourse after delivery.)

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UTERUS AND LOCHIA (Bleeding)

• Bleeding will be bright red and heavy for the first 12 hours, then lighten up to a discharge similar to a menstrual flow. 
• It will remain bright red for the first few days, then turn watery pinkish colored for another few days and much smaller in amount.
• By the end of the first or second week the discharge is usually brownish white--it will last up to 6 weeks.
• Flow will increase with activity, but if you notice bright red bleeding after the first few days, clots larger than a quarter, or you're soaking a pad more than every 2 hours after the 2nd day, you should lie down. Check the firmness of your uterus--it should be firm as a coconut and be shrinking by about one finger width per day. If your uterus is soft, rub it until it becomes and remains hard.  If heavy bleeding persists for more than 1-2 hours, report it to your doctor.
• Your flow should never have a foul odor—if it does you should report it to your doctor.
• Uterine cramping is normal, especially with second and more babies, or with nursing.  Ibuprofen or Tylenol will usually control the pain.

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WHEN TO CALL FOR MEDICAL HELP

Notify your doctor of the following:

• Temperature over 100.5
• Tender or painful breasts with warm red areas
• Painful area (hot, swollen, or red) in calf or thigh
• Pain or burning on urination, or inability to urinate
• Heavy bleeding (more than 1 pad soaked every 1-2 hours) or passing clots larger than a quarter
• Bad smell to lochia (vaginal bleeding)
• Vaginal discharge with pain or itching
• Increasing tenderness or pain on lower abdomen
• Intense vaginal or pelvic pain

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