Things Postpartum Nurses Wish You Knew!
Welcome to part 3 of 3 of our series on labor & delivery, NICU, and postpartum! As I mentioned in my previous posts over the last couple of weeks, I have some amazing nurse friends who gave me a few hours of their time a piece just to get you (haha, well, and me, I am also pregnant…) some helpful information about the somewhat unknown world of childbirth, unless of course you work in the healthcare industry, or you’ve had a baby before! Childbirth can be such an intimidating subject. Truthfully, I looked forward to having kids of my own someday, but then I’d think about having to go through what I’ve seen friends and my sisters do, and I’ve thought to myself, ‘I’ll just adopt…’. I’m now in a place where I WILL most definitely be having a baby before the new year, and I have to admit, after reading and taking classes, chatting with other moms, and of course, talking with my nurse friends, I feel like I CAN do this!
The one thing I still didn’t feel quite at peace with, was postpartum. Like, all these books and apps delve into fertility, then pregnancy, and a week by week update from your sesame seed sized clump o’ cells, to a pumpkin size human getting pushed out of your hoohoo (forgive my french haha). Friends will give you every single aspect of their birth story, good or bad, and from every angle. Then their husbands give you their side (not that it isn’t super helpful most of the time!). They’ll go over labor and delivery with diagrams of women’s bodies that would make Jack Dawson blush, and they give you allllll the nitty gritty info from pain management (or lack thereof) to pooping yourself during delivery and how you won’t even care (or notice?). So in L & D, I now feel well versed.
Some of my books and rabbit holes have inevitably lead me down looking at all the worst possible outcomes too. What happens if I delivered early? What diseases can be tested for, and what is left to chance? What can I do to take care of baby while I am pregnant, and what could be potentially harmful? And of course, what can go wrong during birth? The photos and information can be terrifying, but even after reading all of that information and getting clarification from a NICU nurse, the most unexplored topic is STILL postpartum.
Wait.Wait. So you’re telling me that I’m going to get 10+ months of knowledge pumped into me, and there’s a chance I’ll be so preoccupied with learning about changes in myself and baby during pregnancy, that I might overlook one teensy, tiny detail… Life. AFTER. Pregnancy. It was at this point in my life that I realized, I want to be pregnant forever. Or, maybe just gestate as long as elephants, just so I have a few extra months to now study the godawful wreckage that is post-delivery (whether that is vaginally or with a cesarean), how to breastfeed, and learning to be aware of a possible change in my mental status. On top of that, there will be a tiny dictator living with me post-delivery. He won’t feed himself. He won’t take care of himself. He can’t even bathe alone. And he’ll yell at me for no reason. So ladies, here are some tips for first time mommies, from a postpartum nurse educates tons of new mothers each year! Click on any of the links below to lead you to offsite sources with more information. It is perfectly normal to not know some of these terms. We aren’t ALL nurses and doctors. Do your research and decide what is right for your family!
Please note, names with an asterisk (*) have been changed in this dialogue to protect identities. The following statements are in no way endorsed by your specific doctor or follow your specific health needs. Always consult your doctor or healthcare professional prior to starting, stopping, or continuing any advice outlined in the following post. Take what you can, and be sure to ask questions to your healthcare provider.
Part 3: Postpartum
*Kimberly has been working as a postpartum nurse for over a year. She is a registered nurse, and enjoys long walks from the nurses station to bring new moms a refill on their water, and greeting them with a not so relaxing fundal massage. This is her list of items she wants you to know!
Fundal massage - “We know it hurts. Like you’re getting punched in the stomach, I get it, but it has to happen.” Fundal or uterine massage prevents you from hemorrhage, or heavy bleeding, and makes sure you’re not holding clots within your uterus. Many hospitals have a time requirement (such as every 4 hours) for these massages to be administered by a professional.
How to do a fundal/uterine massage: Basically you feel for the top of the uterus (usually located at the belly button or 1-2 inches below and should be midline with belly button (aligned)). Vaginal bleeding should not be heavy, there should be little to no clots. Nurses feel your uterus to make sure that it is firm, not boggy; it should have the same hardness similar to a fist. The uterus may contract when you massage it, and you may feel a gush after massaging.
Go pee often. Empty your bladder every 3-4 hours. A full bladder can displace the uterus to the side, and not allow it to contract down to size, therefore posing a risk of holding clots.
Clot sizes: Anything bigger than a ping pong ball, you are advised to contact your OB, midwife, etc. or go to the ER (this could mean you are holding an infection or hematoma, meaning blood and clots). When you urinate, always look. Check your pad. You want to keep an eye on this in the hospital and at home!
Breastfeeding - is 90% patience, 10% skill. Suck it up and get through it, or decide that you will not breastfeed, but either way baby needs to be fed. Babies are typically great feeders after birth, they will latch and suckle for 45 minutes+, but the next feedings can be a challenge. This is simply because they are sleepy. There are ways to wake your baby and to keep them awake for feeding.
Keep baby awake for feeding by:
Tickling their feet or back
Pushing lightly under their chin to encourage suckling movement of the jaw
Understand that with the warmth located close to you, hearing your heart, etc. baby will feel very relaxed and can fall asleep easily. This can make your feeding job a hassle, but DON’T GIVE UP MOMMA!
Try to get used to handling breasts. It can be awkward.
Get used to handling breast with one hand and baby with the other.
Recommend using ‘C’ or ‘U’ shape with hands to cup around areola. When moving breasts around to situate baby.
Babies tend to have a favorite breast, position, or feeding preference. What works on one side may not work on the other.
Utilize a lactation consultant, no matter how many times you’ve breastfed or had children, take the time to have someone educate you with the newest information.
It is not recommended to pump until your transition milk comes in (3-5 days after delivery). That is because if you pump right away you won’t get anything, colostrum is thick. You can attempt to hand express, or get baby to nurse.
Make a feeding plan BEFORE entering the hospital for delivery! Will you exclusively breastfeed? Allow any bottles (formula or expressed breastmilk)? Are you using strictly formula? Open to supplementing with formula? Your nurses should ask, but always make her or him aware.
We’ve all heard of the bad latches and ties (tongue tie, lip tie). If your baby is diagnosed by a doctor or pediatrician with a tie, or you have a bad, painful latch, you can hand express breastmilk and supplement spoon/syringe/cup feedings to get baby to eat.
Doctors must identify the tie. That is a diagnosis. Nurses or lactation can recommend or refer for assessment to a doctor or pediatrician, but cannot actually give the diagnosis.
Bad latch pain should go away in nipple after 13-15 suckles. You may experience uterine cramping, this is normal. If nipple pain continues, delatch baby by putting finger inside baby’s mounth instead of ripping them off your nipple (which could be painful). You can adjust until you find a comfortable position for you and baby to nurse. Nursing does not have to be uncomfortable for mom to be working!
If nipples are cracked Lanolin cream is okay (safe for baby) but colostrum, that first breast milk, is magical. Use it even if you can only hand express! If you can, store a bit in syringes in the freezer for later use. Clostrum, is chalk full of nutrients and healing properties that are safe to use for you and baby in a multitude of situations.
Baths are not a priority for baby. Feeding, temperature, blood sugar, general health is a priority. That is all.
Some studies show delaying a baby’s first bath over 24 hours is much more beneficial to baby. Waiting allows baby’s blood sugar and body temperature to stabilize, and it could play a part in breastfeeding, bonding, reducing the risk of infection, and so much more! Feel free to wipe crusties off baby, but let them be! You don’t need to dress them up immediately, as skin to skin contact is always preferred by hospitals.
After a bath baby may sleep for a long time, make sure they have eaten well before, and you will need to wake them up to feed again later. They will sleep 4-6 hours after a bath, and their tummies are not yet able to go that long without food!
If you’re calling your nurse for something, please call and ask nicely. Nurses truly love what they do, and most are naturally nurturing, and happy to assist you, but if you call the station with an attitude, you may not have a pleasant experience. Remember, they are doing their job (which doesn’t actually revolve around doting over you every second of the day (enter support person/spouse/etc.)). Be respectful and kind. It will be appreciated.
On the same note, ask for everything that you need at one time. Specify what you need from the interaction, even if it’s just water. Your nurse may have multiple patients, paperwork to complete, emergencies, etc. Don’t make the nurse walk to your room, then across the unit to get you something that was at the nurses station, where he or she got your call originally, only to go back to your room.
Spouse/Support Person/Baby Daddy PSA: Be involved, or get out of the way. Don’t be a typical 50’s husband that brings his work to the delivery and postpartum rooms. Don’t expect the nurse to do basic parenting items, like changing diapers, handing baby to mom, feeding mom while she is breastfeeding, etc. Don’t sleep the whole time; rule of thumb, if mom is awake, you should be too unless she’s given specific instruction to get some rest. Be involved. If you helped make the baby/you’re going to be the support person helping to raise baby, get a just start on parenting NOW. This is not a drill, this is the real deal!
Don’t use the excuse “I can’t do anything because she’s breastfeeding”. You can hand her baby, change diapers, put baby to sleep, feed mom, etc. If you’re not sure what to do, just ask if you can help with anything. Nurses and mom are always willing to help guide you.
If mom is on clear liquids, do not bring in food to eat in front of mom. She just went however many hours in labor without eating, and if she had a c-section, she may have to go longer. Eating your burger in front of her is just rude. If you can’t help yourself, excuse yourself to the hallway, cafeteria, or leave the hospital when family comes to visit.
Give mom some space and sleep. There is a couch for dad to sleep on, please use it and allow mom her own space. It’s absolutely okay to want to be close to mom and your new baby. It’s okay to sit close to her, to love on them both, and to be helpful, but when mom is able to sleep, give her some space, take baby or put baby in it’s own bed, and let everyone rest. Nurses cringe when they see dad overcrowding the bed, and mom is smooshed up against one side, trying to be supportive and accommodating. Don’t be that guy.
Leave your drama at home. The birthplace of your child is not a place to discuss stressful matters. If you have baby momma drama, leave it at home and pick it up later. The last thing nurses want to do is to call security to have you escorted off the unit, but if you’re a nuisance, they will not hesitate to do so.
Find a pediatrician before delivery. Most pediatricians offer a free consultation before birth, and if they don’t many insurances will cover the consult fee. Find a pediatrician you like, and have them lined up for after delivery. A pediatrician is not your OB doctor, and is a common misconception. You will have a well child visit 1-2 days after you leave the hospital that you must make an appointment for.
Just know that your nurses are not stupid about drugs. If you give a urine sample and something comes up positive on a tox screen, please be honest. Don’t claim to not do drugs if they are clearly showing up in your system.
Be honest about everything. We can take better care of you and your baby if you are open and honest with us. From recreational drug use, to pain levels, to basic knowledge, make sure you are open and honest. Your nurse is not a police officer or judge, they won’t talk down to you for lack of knowledge, and their only priority is the safety of mom and baby. They can’t do their job if you aren’t telling or asking them something just because you are embarrassed. So even when they ask if you’ve pooped, its all medically relevant, not a question designed to belittle you.
Your baby has a security tag on them. All staff monitors security to be sure no one leaves the hospital with the baby, including mom and dad.
Keep an eye out for postpartum complications:
If you experience passing clots, gushing, light headed or dizziness, let your nurse know. Keep an eye on this and go to the ER if this occurs after discharge from the hospital.
If you have a history of depression or postpartum depression (PPD), anxiety, experience changes in relationship (divorce, passing of spouse), emotional stress (loss of job, no family support), let your nurse know.
PPD can encompass a wide range, from “baby blues” to full blown psychosis. If you’re feeling down and need support, you must be self-aware of emotions. Take note if you’re not wanting to go home, you’re reluctant to care for your baby, etc. and tell your spouse/partner/family. GET HELP! There is nothing to be ashamed of!
Postpartum care, don’t make it weird.
Ask for tucks (witch hazel), ice packs, and numbing spray. These are all provided by the hospital.
Let your nurse help you the first time in the bathroom, they will show you how to layer your pads, tucks, spray, etc, then you can have privacy. Don’t be weird about it, they’ve literally seen it ALL.
Things not to bring to the hospital, despite EVERYTHING you’ve read:
Your nursing pillow(s). We have pillows and will bring you extra. Nursing pillows are a bit too bulky for the recovery beds, and you’ll just want to focus on getting the boob to mouth part right, don’t stress yourself out with a pillow that will not be accomodating if you need to change positions.
Diapers, wipes, postpartum underwear, period pads. We will supply all of these items for you, and you will soil yours.
Ask your family to leave gifts at home, it’s more for you to haul and we don’t have carts to haul your stuff, so dad is going to have to make multiple trips to the car.
Things you should bring to the hospital:
your own toiletries (toothbrush, toothpaste, hair brush, etc) but we also have basics of those.
Phone chargers for mom and dad.
Extra pillows and blankets (don’t forget stuff for dad’s bed too! Mom will be well looked after, and dad will get basics, but you’ll want extra bedding and all of dad’s toiletries).
Clothes for mom and baby to wear home.
Snacks for your spouse. The cafeteria and snack machines can be used also, but hours vary and machines may not be in every hospital. No nurse wants to deal with hangry spouses.
If you enjoyed your hospital staff and stay, feel free to:
Bring in treats: coffee, donuts, pizza, cookies/cupcakes, etc. for nurse(s).
Tell us that we are appreciated! A small gesture goes a long way!
Knowing that you appreciate them initially can make a more pleasant experience for all.
Postpartum doesn’t have to be a big secret! Help spread some knowledge to your expecting or new momma friends, especially about postpartum complications and breastfeeding. The world tends to revolve around the addition to your family, and mom (and even dad) can get neglected easily. During this time, it is especially important for moms to feel supported. She’s going through a huge wave of emotions, caring for a new baby, sleeping less, stressing more, and all around LEARNING, which can be frustrating in and of itself. Keep tabs on your new momma friends ladies, she may need a shoulder to cry on, or just someone to sip coffee with during naptime. Women have a knack for noticing when something is off, so try to check in with your friends, just to make sure they seem like they are treading water. Spouse or support persons should always check on the physical and mental health of mom. If she is not caring for herself, she cannot care for anyone else, so be sure she is taking even just a few moments for herself each day, maybe while you have bath and bonding time with baby. Protect your family’s health and well-being by caring not only for your new baby, but for your own health (mom AND dad) as well. It’s going to be hard to get any time alone for a while, and you’ll be finding a new “normal”, but celebrate your small accomplishments, don’t be afraid to say you don’t know how, or that you need help, and enjoy the slow pace that your life will take, if even just for a week or so, because the rest will truly fly by.