POSTPARTUM: the first 12 weeks
Woohoo, you had a baby! Congratulations!
The next 12 weeks are going to be the biggest transitional period of your life. They are going to be filled with highs, lows and everything in between. There will be moments, even days, sometimes whole weeks where you feel like you aren’t going to get through it, or that it’s never going to get better. I will tell you what my own mom told me “this phase will end, and you’re going to miss it”. In the moment, when you hear this advice, it is infuriating...looking back, I miss it all. The days can pass so slowly, but the phases seem to fly by and it all becomes a blur. If I could give any new mom advice, it would be to write things down, good or bad, write it down because 3 years from now you are going to want to sit down, look through pictures and remember as many of those moments as you can (gosh, I’m tearing up writing this because time is such a thief). When you feel emotions, let yourself feel them and be in them; motherhood is the only job that you get no training, no manuals, no straightforward one size fits all answers- it’s learn as you go, a grow together, ever changing life long career. The goal of this post is to give you a bit of what to expect, what helped me in my personal experience, and what both of my postpartum journeys have looked like; every experience is going to be different, but I am going to try and give a general idea of what your first 12 weeks may look like.
IN HOSPITAL (the first few days):
Can you say adrenaline? You are going to think “wow, I’m exhausted”, but you won’t sleep. You will stare at your baby, there will be noise all around you, and you will try to sleep but your body will be in a total state of shock, and bliss. Whether you had a vaginal birth, c-section, tore or not, stay on top of pain management. You can alternate advil and tylenol every 6 hours and it will make a world of difference. As soon as your babe is born (if all goes as planned), they will be placed on your chest and you will be expected to breastfeed right away...it’s wild. It really does seem like your baby just knows what to do and they start sucking...initially it feels pretty easy. It is when you have done it a few times that it may start to hurt, that tongue ties are noticed, that the wrong latch is noticed or that your milk just isn’t coming in yet- it can be super painful, awkward and hard! This is all normal, and it gets better, I promise! Push to see the lactation consultant prior to heading home! They are such an amazing resource, even if you feel that all is going well- it is good to double check...it is better to get it figured out before you head home and are on your own. Also, get the prescription nipple cream (it numbs, moisturizes and heals)- the over the counter ones did diddly squat and aren't worth your money in my opinion. It took about 2 weeks the first time around and 1 week the second to feel confident and pain free feeding my new baby. In most hospitals you will be moved to the postpartum unit once you and babe get the clear from labor and delivery. Labor and delivery staff will remove your epidural if you had one, monitor your initial bleeding, complete your vital signs, do apgars and assessments on your new baby, and get you up to pee and you can often shower (as long as you didn’t hemorrhage). On the postpartum unit, you will either have a private room or shared room with a curtain separating you and another family. Ask for a private room- often your benefits cover it, and it is so worth it to have some privacy! My first baby, I had a shared room and I had to walk by the other family every time I went to the bathroom- I hemorrhaged, so it was a lot, and it was a mess- not fun to have my butt hanging out waddling by some strangers every few hours. Once you’re on the postpartum unit, you and baby will be monitored and assessed every 4 hours. The nurse will check your fundus, which should be dropping down and remaining midline (they check by pushing on/feeling your abdomen), your vitals, your pain, and your bleeding (they will press on your belly and check your pad). You will be expected to get up to the bathroom when you feel up to it, and your pee will be measured until you meet criteria (amount) to stop having to measure (pee in a hat (measuring device) in the toilet). The nurse will provide you with the famous hospital underwear (they live up to the hype- take as many as you can home), large pads that fit inside (again, take them home), and a peri bottle to use when you pee or poop. The peri bottle is used to spray your perineal area with warm water while you pee or poop to counteract the burn. The first pee and poop are always so scary postpartum, but the best thing you can do is use the peri bottle and try to relax- it gets easier and less uncomfortable every time (take a stool softener for at least a few weeks postpartum!). You are going to be sore, but like I said, stay on top of pain management whatever that may be for you. The breastfeeding journey really begins about 2-3 feeds in, and is dynamic for at least the first 2 weeks. Use pillows, get as comfortable as possible, and get as much help and advice as possible! I think something that isn’t talked about enough is the cramping that occurs when you start breastfeeding your new baby. You will already have uterine cramping and discomfort, but when you begin feeding your new baby, it will actually cause more intense contractions which can even mimic labor pain- this is another reason to stay on top of pain management, especially in the first 3 days. The cramping was much worse with my second baby than my first- it subsided in the first 24-48 hours. You have an increased blood volume of 50% going into delivery. Once the baby is delivered, this extra blood volume is no longer necessary and will be lost over the next 6-8 weeks (will be different for everyone- more or less). The bleeding after delivery will be different for everyone, but you can expect a significant amount of bleeding for the first week, and a slow taper for the following weeks. There will be clots in the beginning (~first 2 weeks), but they should remain smaller than a golf ball...it is normal for them to be more frequent and larger in the beginning, and to taper off. When you are lying or sitting, the blood will pool in your vagina and when you stand, there can be small gushes and clots- this should settle after the first 48 hours- the nurse will monitor your bleeding and let you know what is expected, and what to return to hospital for. Do not be afraid to ask a million questions while in hospital- no question is a dumb question- I can guarantee that they have seen and heard it all! If you have an uncomplicated vaginal delivery, you will be sent home after the first 24 hours...if you have a c-section or any complications, it’s generally at least 48 hours. Before being able to go home, a few things are completed on baby- expect to have the newborn metabolic screen completed (heel poke on baby), a hearing test, and a pediatrician’s assessment. Along with these procedures, the nurse will be monitoring baby’s first pees and poops, so you will be asked to write them down on a chart that is provided. You will also be provided with all of the legal documentation that must be filled out for your new baby’s existence. I think a common misconception is that the hospital staff will check your baby in the car seat- the staff cannot legally do so as they aren't trained in car seat safety, so educate yourself prior. If you are only in hospital for the 24 hours, they will not bathe your baby as there is now evidence that the vernix is beneficial in preventing bacterial infections. When the nurse comes to give you discharge instructions, make sure your partner is listening as well; there is so much information that it can be overwhelming- it is so helpful to have them absorbing the information too.Time to pull up your diaper, fasten your baby into their new seat, *slowly* make your way to your car and head home as new parents!
SUPPLIES: What do you want waiting for you at home. * You want as much prepared for you at home so that you don’t have to think about running out and grabbing anything- amazon is also your best friend in a pinch! I’ll say it again- take as much as they’ll give you from the hospital!
Pain management- advil, tylenol (have your partner fill any prescriptions needed right away)
Multivitamin with iron in it (helps you recover your hemoglobin level- make sure you take the stool softener, because iron bungs you up)
Maxi pads + hospital undies (you’ll want some good granny panties or pregnancy panties to transition to after the hospital undies)
Peri bottles (hospital provides)
Leggings, shorts, over sized tees, comfy sweaters
Nursing bras (Highly recommend the bravado ballet nursing bra)- You will live in a nursing bra day and night, so invest in comfort!
Nursing pads (the reusable ones are great in the beginning and later down the road, but when your milk comes in and is regulating, the disposable ones are much nicer to have on hand)
Easy one hand snacks- pre washed and cut fruit and veggies, granola bars, crackers, trail mix
A good water bottle- breastfeeding/postpartum bleeding = thirsty and so important to stay hydrated!
Gatorade/ electrolyte water for easy hydration
A few pre made meals, or someone to delegate to cook for you for the first week
Have a small package of the premixed formula bottles, or some formula powder just in case! It’s not something you’re going to want to have to run out and grab in the middle of the night as your baby is screaming! You may never use it, but if you need it, you want it stat
I highly recommend the Haakaa pump whether it be to catch your leakage on your opposite breast that you aren’t feeding babe on, or even just relieving pressure if your boobs are engorged. When your milk comes in, it can be uncomfortable when it is regulating- DO NOT PUMP to relieve engorgement because you will be telling your body to produce more milk, rather than regulate to what your baby needs. If you over pump and get in an engorgement cycle, it can lead to blocked ducts and mastitis...if you are pumping, pump after baby’s feeds
A swing to place them in for naps during the day- does not have to be fancy and expensive
You just went through an emotional experience that was traumatic on your body; give yourself credit and grace. Rest every chance you get, accept help, delegate tasks and advocate for yourself. You know your body best, and if anything doesn’t feel right don’t be afraid to reach out to your health care provider. We are so spoiled in this country with so many readily available, free resources; do not hesitate to use them! (LCs, OBs, healthlink, mental health resources- your healthcare provider or the community health nurse is a great resource to help access these or get more info). I will tell you that two things that are odd but normal that don’t get talked about is that your thermoregulation is going to be all over the place; night sweats, randomly being cold, or just feeling like you’re overheating, and you will stink more than usual...showers and a good deodorant are your best friends postpartum. The adrenaline will start wearing off once you are home, and emotions and exhaustion can start to rise. You are going to feel every emotion...let yourself, and talk to your people about it. The first two weeks are such a huge adjustment to your routine and sleep schedule. 90% of moms will tell you that the first two weeks were a blur and they didn’t think that they would survive...lean on your support system and sleep during the day with the baby. You will have an appointment to see the public health nurse for you and baby within the first few days of being home- if you forgot to ask any questions, or any more arise, this is the time to ask. I think it is fairly well known that your pelvic floor is weak postpartum and has been through a lot between pregnancy and delivery- what I don’t think is well known is that even walking, especially stairs in the first few days is hard on your healing body. Set up a changing station on the main floor of your house and for the first week at least, only do stairs when absolutely necessary! Do not start walking any kind of distance until at least 1 week postpartum. Do not think about any physical activity until you see your OB/midwife at your 6 week follow up appointment. The first 12 weeks are most definitely the most difficult, as it is a huge transition for you and your partner, you are healing, your emotions are absolutely wild, you have an entirely new identity, you need help (sometimes the hardest part), another life is now dependent on you for every need, you might be trying to figure out breastfeeding, everything is new, and you are not getting enough sleep. Your baby will probably get on a pretty consistent schedule during the day of feeding every 2-3 hours, needing a diaper change or two (expect a lot of diaper changes, and baby girl or boy, to pee or poop when you open their diaper- just be prepared haha!), and then sleeping until that cycle occurs again- it’s monotonous but kind of relieving how much they sleep...until night hits. It is funny that during the day, 2 hours of sleep can go by so slowly and you almost want to wake them up... and then overnight, 2 consecutive hours flies by and is so exhausting! Typically you may start getting some 4-5 hour stretches here and there by 12 weeks but your baby is new and still may want and need to feed every 3 hours consistently. Some tips and tricks to get through the nights- get a kindle (being able to read with one hand is key), have your partner help you (not only because you may need it, but because it is far less lonely), keep some snacks by your bed + water always, get a good swaddle (I recommend copper pearl), have a bassinet right by your bed so that you don’t have to move far, I don’t recommend co-sleeping but do what works for you (as long as it’s done safely) and burp your baby after every feed or they will wake up with gas pain! Personally, I would feed my baby, keep them upright on my chest after burping them and read a chapter of my book or scroll instagram just to stay awake a bit longer prior to putting them back in the bassinet- both of my girls had reflux and wouldn’t sleep if I put them back down right after a feed. Baby must always be put to sleep on their back and if their relux is bad, you can elevate the mattress with a slight wedge (under the mattress, not right under your baby). Reflux- the second hardest part of the first 3 months for some. Your baby’s guts are still developing, and they will get gas pains and most likely spit up frequently (sometimes every feed). Most babies have witching hours in the evenings, whether it be gas pain, discomfort or just being a baby, it is totally normal. Both of my girls were cranky between 7-9 pm for at least the first 3 months on and off. For us, probiotics, gripe water, a tight swaddle and lots of back pats and butt pats did help, but overall it was just time. Once our girls hit the 3-4 month mark, their tummies just stopped getting so upset, they were consistently happier and slept much better. If your baby is consistently difficult to settle, spitting up in excess with every feed and seems to be uncomfortable consistently post feeds, don’t be afraid to ask your doc...advocate for yourself and baby- you are not a bad mom for resorting to meds! Once you get through the first few nights, you are probably going to start thinking “I want to bathe my baby, it's gross and I want to see their hair clean”. You can bathe your babe in your sink, or in a baby tub (we put ours in our bath tub)- gently use a washcloth, and have a second washcloth to keep on their body to keep them warm. Babies do not control their temperature well, so it is important not to make the water too hot and to keep them warm during and right after bath (skin to skin is great!). Only bathe your baby once a week for at least the first month as their skin is already dry and flakey (totally normal)- obviously you can use a washcloth to get in their hands (make sure you unclench their fists and wash those hands; they get super gross), and under their necks where milk may drip. If you are going to bathe your baby more, just don’t use soap every time as it is super drying for their sensitive skin (get a good lotion). If your baby gets cradle cap (super common and normal) use an oil like coconut oil, let it sit for 10-15 minutes and then gently comb and wash out in bath- your babe’s hair may look greasy after for a few days but it is worth it. You are going to focus so much on your new baby’s every need, but during the postpartum period, it is so important to take care of yourself too; body and brain. You can expect to bleed for ~6 weeks, fairly heavy with small clots in the first 2 weeks and then slowly tapering off similar to a period bleeding by 6 weeks. With my second daughter I started bleeding again randomly at 8 weeks (I thought it was my period, because I guess that can happen but not usually if you are exclusively breastfeeding) and it ended up being a scab on my uterine lining that shed and caused bleeding again for a few days. Once it stopped, I haven’t started my period yet and I am at just over 10 months postpartum exclusively breastfeeding- this is different for everyone! If you’re ever concerned with anything, ask your Doctor- never be afraid to ask a stupid question and don’t depend on google! After 1-2 weeks postpartum, if you had a vaginal delivery, get some fresh air- even a 2 minute walk or a hang in your backyard can make a world of difference for your mental health. You may not feel like you want to leave your house or get out, but you do...Vit D does wonders, I promise. As far as activity, don’t push it, rest as much and long as you need and never feel guilty about it. 6 weeks (at least) can feel like such a long time to go without working out, but when you look back on that time in your life, it is but a blink. You will get your fitness back, but you can’t get those first 6 weeks back of recovery and snuggles with baby- just focus on that. I do not recommend running again until 4 months postpartum- your pelvic floor just isn’t ready prior to that. Pelvic floor is something you will become much more aware of in the postpartum period. There are so many great resources out there now as far as info and strengthening exercises (even just breathing). Pelvic floor physio sounds awkward and uncomfortable but it is so so great for you and can really make the difference in your future ability to exercise. When you first have baby, your belly is going to feel squishy, empty and you may still look pregnant- this is all normal. Your extra fluid will slowly come off, your varicose veins will settle (some disappear, some just fade significantly), your belly will start to feel more firm and you will start to feel like yourself again. Give it time, don’t compare yourself to everyone on instagram because everyone’s journey is different! I didn’t start to feel like myself again in my body until around 6-8 months postpartum. I didn’t get muscle definition back until around 8 months after both girls and it was over a year to get back to where I was prior to having them. I recommend high wasted, tight leggings or shorts and all the oversized tees (also just shirts that have easy boob access)- you’ll probably live in a bra for the first few weeks while you’re figuring out breastfeeding. As the weeks pass, your baby is going to start making cute noises, staying alert for longer periods and begin to smile. All of the hard moments wash away when you receive that first smile. After the first 12 weeks, your baby is going to hit milestone after milestone growing this beautiful little personality. It is all worth it, so worth it.
I think the main takeaways for you to absorb is that it’s going to be an adjustment. The emotions, hormones and lack of sleep are hard- talk about it, ask questions and feel it- it all passes. You will sleep again, ask for help when you’re in the thick of it and nap whenever you can. Your baby will grow out of the gassy stage, it’s normal and it’s hard- you are a mom now and you can do hard things! Your body went through a traumatic event and deserves grace- delegate things, stay on top of pain, drink lots of water, and have easy snacks and meals available. The days may pass slowly and feel exhausting, but this phase will go by the fastest when you look back on it all- let your baby sleep on your chest, watch them sleep, take a million pictures and write it all down. You’ve got this momma, and I am always here!
All my love,