Nursing management

 In the first hours after delivery, hold your baby and attempt skin-to-skin contact. This helps
ensure optimal bonding and the smoothest possible transition.

 Monitor your blood pressure, heart rate, and the amount of vaginal bleeding

 Check to make sure your uterus is becoming firmer

Contractions, Bleeding, and Pain

 Once you deliver, the heavy contractions are over. But your uterus still needs to
contract to shrink back to its normal size and prevent heavy bleeding. Breastfeeding
also helps the uterus contract. These contractions may be somewhat painful but they
are important.
 As your uterus becomes firmer and smaller, you are less likely to have heavier
bleeding. Blood flow should gradually decrease during your first day. You may notice
a few smaller clots passing when your nurse presses on your uterus to check it.
 For some women, the bleeding does not slow down and may even become heavier.
This may be caused by a small piece of placenta that remains in the lining of your
uterus. Rarely a minor surgery is needed to remove it.

Care of the Vagina and Perineum

The area between your vagina and rectum is called the perineum. Even if you did not have a
tear or an episiotomy, the area may be swollen and somewhat tender.

To relieve pain or discomfort:

 Ask your nurses to apply ice packs right after you give birth. Using ice packs in the first 24 hours
after birth decreases the swelling and helps with the pain.

 Take warm baths, but wait until 24 hours after you have given birth. Also, use clean linens and
towels and make sure the bathtub is clean each time you use it.

 Take medicine like ibuprofen to relieve pain.

Some women are worried about bowel movements after delivery. You may receive stool
softeners.

Passing urine may hurt during the first day. Most often this discomfort goes away in a day or so

Caring for Your Baby

Holding and caring for your new infant is exciting. Most women feel that it makes up for the long
journey of pregnancy and the pain and discomfort of labor. Nurses and breastfeeding specialists
are available to answer questions and help you.

Keeping your baby in the room with you helps you to bond with your new family member. If the
baby must go to the nursery for health reasons, use this time and rest as much as you can.
Taking care of a newborn is a full-time job and can be tiring.

Some women feel sadness or an emotional letdown after delivery. These feelings are common
and are nothing to feel ashamed about. Talk with your health care provider, nurses, and partner.

Postpartum & Post-Delivery Care Plans for Mom

Having a baby is a life-changing event, both emotionally and physically, and proper postpartum
care is crucial to your recuperation after giving birth and to your adjustment to life as a new
parent. For the first two weeks after giving birth, allow yourself to focus on caring for yourself
and your child.

Your body needs to recover after the physical stress of pregnancy, labor, and delivery. For the
first few weeks after you give birth, give yourself time to rest and take special care of your body
as it heals from nine months of pregnancy and delivery.

1. Bathing and Sitz Baths

To prevent infections after delivery, it is preferable to take showers rather than a tub baths for
two weeks. If showers are not possible, fill the tub with three to four inches of water, and leave
the drain open and the water running. This is called a sitz bath and may be continued as long as
needed for comfort.

2. Vaginal Bleeding

Normal bleeding after delivery is similar to a heavy menstrual period and it should decrease by
the third or fourth day after birth, but can last for up to four to six weeks. You may notice an
increase in bleeding or blood clots on your first or second day at home because your activity
has increased. If you experience a heavy bleeding (soaking a pad every hour for two to three
hours) or begin cramping, it is a sign of over-activity and you must rest. If the bleeding or
cramping continue, please call our office.

Menstrual periods often resume between 5 and 12 weeks after giving birth unless you are
breastfeeding. Nursing may suppress periods for some women, but breastfeeding is not a form
of birth control since it is still possible to become pregnant while nursing.

3. Constipation and Hemorrhoids

After giving birth, it is essential to maintain normal bowel habits and avoid constipation.
Consume extra fluids and a healthy, high-fiber diet. If necessary, your physician may also
recommend a stool softener such as Colace® or Surfak®. If a laxative is needed, Colace and
Milk of Magnesia® are safe to take while nursing. If hemorrhoids are a problem, use medicated
cream or suppositories. To relieve additional discomfort from hemorrhoids try lying on your side
with your upper leg slightly bent, and take therapeutic Sitz baths.

4. Episiotomy

To sooth an episiotomy incision, take Sitz baths while you heal. Stitches should dissolve within
four to six weeks and do not have to be removed. Over-the-counter or prescription pain
medications can also provide relief, but discomfort should decrease daily. However, if any
unusual pain develops, call your physician at Kansas City ObGyn.

Cesarean Birth

A Cesarean birth is a major surgery and the recovery period is longer than it is after a vaginal
birth. Special care and attention is needed during recuperation after a C-section and it is
especially important to keep an eye on the incision as it heals. If any of the following symptoms
should occur, call our office:

 Red, hard, tender or hot area around your incision

 Separation and/or bleeding of incision
 Moderate or large amount of oozing or drainage
 Fever higher than 100º F

However, if there are no concerns with healing after a Cesarean section, a heating pad can help
with localized pain. You should wait two weeks to drive after a cesarean section and lifting
should be limited to 15 to 20 pounds for the first six weeks.
Nursing and Breast Care

Initial attempts at nursing can be painful, but tenderness and discomfort should decrease once
let-down (a tingling sensation that occurs in the breast right before and when milk comes into
the milk ducts, a sign you need to feed your baby) has occurred and should cease altogether
within a few days. However, if you have sore, cracked, or bleeding nipples, express a few drops
of breast milk on the nipples after nursing and allow to air dry. To prevent future irritation,
always keep your nipples clean, change the nursing pads when they become moist and avoid
wearing pads with plastic liners.

For a more comfortable breastfeeding experience, experiment with different nursing positions to
see what works best for you and your baby. For example, try holding your baby so that he is
lying on his side with his head resting in the bend of your arm and make sure that his mouth
covers one inch or more of your nipple and areola when sucking. For additional comfort, use
pillows to help support your arm and baby.

If you are not nursing, wear a good support bra at all times while your breasts are
engorged. You may use ice packs under the armpits and to the side of each breast during the
first couple of days of engorgement and take Tylenol® or ibuprofen for discomfort. Do not be
surprised if you have a slight elevation in temperature for a day or two while your breasts are
engorged, and you should expect milk to lbe eaking from the breasts during this period.
Read our article about breastfeeding for more information.

Exercise

You may start mild exercise after two weeks rest and recovery after giving birth, but more
strenuous exercise should be delayed for four to six weeks. Begin with easier exercises and
increase them gradually if you are comfortable and it does not cause pain. If you had a
Cesarean, do not begin an exercise program for at least six weeks after delivery and with your
physician’s permission.

Postpartum Diet

It is important to maintain a healthy and balanced diet while pregnant and you should continue
prioritizing your personal nutrition after your baby is born. Eat a wide variety of foods,
emphasizing fruits, vegetables, lean meat, and healthy proteins. Limit processed foods and
empty calories from high starch and sugary foods as much as possible.

Do not rush into dieting in an effort to lose your pregnancy weight, but if you are concerned
about reducing, cut down on high fat and high sugar foods and alcohol, but do not over-restrict
breads and cereals or fruits and vegetables. If you are nursing, you will need to consume a few
hundred additional healthy calories a day, and you should continue taking prenatal vitamins.

Sexual Intercourse and Contraception

Sexual intercourse is appropriate when it is comfortable for you, usually six weeks after giving
birth, but is preferable to wait until your vaginal discharge is clear. Vaginal tenderness may be
eased by using a water soluble cream (K-Y Jelly®), or a contraceptive foam or cream to
lubricate the area, but do not use VASELINE®.

Before intercourse is resumed, you and your partner should consider your contraceptive
options. Condoms, foam or vaginal suppositories may be used without a prescription and are
compatible with breastfeeding. Be sure to discuss other forms of birth control with your doctor at
your postpartum checkup.

Causes for Concern

After leaving the hospital, call our office if you have any of the following:
 Heavy vaginal bleeding, soaking a pad every hour for three hours
 Severe chills or fever over 100.4º F
 Frequency or burning with urination (emptying your bladder)
 A red, hard, tender area on the breast
 A red, hard, tender or hot area along the leg veins
 Shortness of breath and/or chest pain
 Any other unexplained signs or symptoms

Postpartum Medical Checkups

Your healthcare provider at Kansas City ObGyn will need to see you for your postpartum
checkup, usually five to six weeks after you give birth. This appointment provides an opportunity
to discuss any questions or concerns you have, including contraception, physical recovery, and
your emotional well-being. Call our office to schedule a doctor’s visit before leaving the hospital
or soon after going home.

Postpartum Emotional Care

Having a baby is a special time in your life, full of anticipation and joy, but it can also be a time
of great stress and anxiety as you adjust to life with a child. In the weeks and months after
giving birth, try to be especially attentive to your own emotional feelings and those of your
partner. It is perfectly normal to experience complicated and even difficult emotions after you
have a child, but be mindful if those feelings become extreme.

Postpartum Depression

After having a baby, some women may experience overwhelming feelings of frustration,
inadequacy, fatigue, and worry. These are normal emotions related to becoming a new parent
and these feelings may also be further compounded by ordinary life stresses, such as finances,
feelings of isolation, and being overwhelmed by other work or home responsibilities. If you are
experiencing difficult emotions try to be patient with yourself – take time to adjust to your new
life.

If depression persists or increases and you are experiencing thoughts and feelings that go
beyond the normal anxieties of being a new parent, or if you think your feelings are impairing
your ability to care for yourself and your family, call us immediately and we will refer you to
Kansas City area support groups or counselors that specialize in postpartum depression.

Postpartum Care for Partners

Parenthood is just as life-changing for new fathers as it is new mothers and men can experience
conflicting feelings of elation, overwhelming responsibility, depression, pride, and even jealousy
in response to becoming a dad. Allow yourself to process the complex experience of
parenthood and support your partner through her adjustment, too. Learn along with your partner
how to care for your newborn by helping with feeding, dressing, bathing, and diaper duties, and
take the time to get used to your new baby. Enjoy the new addition to your family and try not to
let the new responsibilities get in your way of sharing this special time with your family.

Pregnancy (nsd vs c-section)

Babies can enter this world in one of two ways: Pregnant women can have either a vaginal birth
or a surgical delivery by Caesarean section, but the ultimate goal of both delivery methods is to
safely give birth to a healthy baby.

In some cases, C-sections are planned for medical reasons that make a vaginal birth too risky.
A woman may know in advance that she will need a C-section and schedule it because she is
expecting twins or other multiples, or because she may have a medical condition, such as
diabetes or high blood pressure. A C-section may also be scheduled ahead of time because a
woman has an infection that she could pass along to her baby during birth, such as HIV or
genital herpes, or if she experiences problems with the placenta during her pregnancy.

A C-section may also be necessary in certain situations, such as delivering a very large baby in
a mother with a small pelvis, or if the baby is not in a heads-down position and efforts to turn the
baby into this position before birth have been unsuccessful.
Sometimes the decision by an obstetrician to perform a C-section is unplanned, and it is done
for emergency reasons because the health of the mother, the baby, or both of them is in
jeopardy. This may occur because of a problem during pregnancy or after a woman has gone
into labor, such as if labor is happening too slowly or if the baby is not getting enough oxygen.

Some C-sections are considered elective, meaning they are requested by the mother for non-
medical reasons before she goes into labor. A woman may choose to have a C-section if she
wants to plan when she delivers or if she previously had a complicated vaginal delivery.

Although C-sections are generally considered safe and, in some situations life saving, they carry
additional risks compared with a vaginal birth. They are a major surgery and involve opening up
a pregnant woman's abdomen and removing the baby from her uterus because a vaginal birth is
considered too dangerous or too difficult.

Because C-sections in first-time mothers often lead to repeat C-sections in future pregnancies,
a vaginal birth is generally the preferred method of delivery. It's the way two in three babies in
the United States are born.

In general, women say that giving birth vaginally feels like more of a natural experience, said Dr.
Allison Bryant, a maternal fetal medicine specialist at Massachusetts General Hospital in
Boston. Women may feel as if they are giving birth the way nature intended them to, she
added.

Regardless of how they decide to give birth, "women should be as informed as possible about
their childbirth options, so they can have a voice in the process, advocate for what they want
and make the most informed choice," Bryant said. Here is more information about the pros and
cons of the two birthing methods.

Pros of vaginal birth for the mother

Going through labor and having a vaginal delivery is a long process that can be physically
grueling and is hard work for the mother. But one of the benefits of having a vaginal birth is that
it has a shorter hospital stay and recovery time compared with a C-section.

Although state laws vary, the typical length of a hospital stay for a woman following a vaginal
delivery is between 24 and 48 hours. If a woman is feeling up to it, she may elect to leave the
hospital sooner than the allowable time period permitted in her state, Bryant told Live Science.

Women who undergo vaginal births avoid having major surgery and its associated risks, such
as severe bleeding, scarring, infections, reactions to anesthesia and more longer-lasting pain.
And because a mother will be less woozy from surgery, she could hold her baby and may begin
breastfeeding sooner after she delivers.

Cons of vaginal birth for the mother

During a vaginal delivery, there is a risk that the skin and tissues around the vagina can stretch
and tear while the fetus moves through the birth canal. If stretching and tearing is severe, a
woman may need stitches or this could cause weakness or injury to pelvic muscles that control
her urine and bowel function.

Some studies have found that women who have delivered vaginally are more likely to have
problems with bowel or urinary incontinence than women who have had C-sections. They may
also be more prone to leak urine when they cough, sneeze or laugh.

After a vaginal delivery, a woman may also experience lingering pain in the perineum, the area
between her vagina and anus.
Pros and cons of vaginal birth for the baby

Some advantages for a baby who is delivered vaginally is that a mother will have more early
contact with her newborn than a woman who has undergone surgery, and she can initiate
breastfeeding sooner, Bryant said.

During a vaginal delivery, muscles involved in the process are more likely to squeeze out fluid
found in a newborn's lungs, Bryant said, which is beneficial because it makes babies less likely
to suffer breathing problems at birth. Babies born vaginally also receive an early dose of good
bacteria as they travel through their mother's birth canal, which may boost their immune
systems and protect their intestinal tracts.

If a woman has had a long labor or if the baby is large and delivered vaginally, one of the risks
is that the baby may get injured during the birth process itself, resulting in a bruised scalp or a
fractured collarbone, according to the Stanford School of Medicine.

Pros of C-section for the mother

If a woman is eligible to have a vaginal delivery, then there are not a lot of advantages to having
a C-section, Bryant told Live Science.

However, if a pregnant woman knows that she will need a C-section, a surgical birth can be
scheduled in advance, making it more convenient and predictable than a vaginal birth and going
through a long labor.

Cons of C-section for the mother

A woman who has a C-section typically stays in the hospital longer, two to four days on
average, compared with a woman who has a vaginal delivery. Having a C-section also
increases a woman's risk for more physical complaints following delivery, such as pain or
infection at the site of the incision and longer-lasting soreness.

Because a woman is undergoing surgery, a C-section involves an increased risk of blood loss
and a greater risk of infection, Bryant said. The bowel or bladder can be injured during the
operation or a blood clot may form, she said.

A review study has found that women who have had a C-section are less likely to begin early
breastfeeding than women who had a vaginal birth.
The recovery period after delivering is also longer because a woman may have more pain and
discomfort in her abdomen as the skin and nerves surrounding her surgical scar need time to
heal, often at least two months.

Women are three times more likely to die during Caesarean delivery than a vaginal birth, due
mostly to blood clots, infections and complications from anesthesia, according to a French
study.
Once a woman has had her first C-section, she is more likely to have a C-section in her future
deliveries, Bryant said. She may also be at greater risk of future pregnancy complications, such
as placental abnormalities and uterine rupture, which is when the uterus tears along the scar
line from a previous C-section. The risk for placenta problems continues to increase with every
C-section a woman undergoes.

Pros and cons of C-section for the baby

Babies born by Caesarean section may be more likely to have breathing problems at birth and
even during childhood, such as asthma. They may also be at greater risk for stillbirth.

During a C-section, there is a small risk that a baby can get nicked during the surgery, Bryant
said. For reasons that remain unclear, some studies have also suggested a link between babies
delivered by C-section and a greater risk of becoming obese as children and as adults. One
possible explanation is that women who are obese or have pregnancy-related diabetes may be
more likely to have a C-section