Postpartum Care and Complications at a Birthing Center

We finished our five week course class but we still have extra classes we're choosing to take; breastfeeding, water birth and newborn care. This post is a combination of the fourth and fifth classes that covered postpartum care and complications.

Birth is baby's biggest transition in life, being in utero for nine months was their comfort zone and now they need to readjust to a new norm. This is obviously Mom's biggest transition in life (for her vagina anyway) so these last two classes covered postpartum care for baby and mom. The procedures and plan below is again, using a midwife and not in the care of a hospital. Hospitals have standards so unless you've done your research and know when to speak up, tell them what you want and sign a waiver, they all stick with their routine.

If I know the difference of what's performed in the hospital I'll note it in green and provide links to research further. I'm sure some hospitals have a slightly different 'standard' so I might not be exact but these hospital standards are instances the midwives and birthing assistants have experienced in Tampa hospitals. There's so many bullet points to include but I tried to only list the ones that stood out the most to me.

POSTPARTUM FOR BABY

• THE DELAY OF CUTTING THE CORD; in midwifery they wait until the cord stops pulsing, about 10 minutes, because the baby is still getting their blood supply from the placenta. When it's cut immediately baby will miss out on about 1/3 of it's own blood volume. Hospitals will cut right away unless you speak up and tell them otherwise.
• DON'T BATH BABY: baby is born with vernix, the white cream cheesy substance (sorry if you're eating this right now...) which is what protected them while in utero. Babies are coming from a very natural and sterile environment so it's normal to only (sponge) bath baby every 3-5 days. Hospitals bath right away. If you have a wrinkly baby with clumps muffin topping out... it's okay to wipe that away. This is very granola but...vernix is actually extremely good for your skin and some midwives are known to wipe some on their face and hands. 
• BABY IS BLUE, this is normal and may linger in hands and feet for the first couple weeks especially if they're cold. Unless their core, lips and face is oddly blue then something is wrong.
• ONCE BABY PLOPS OUT, they go right to mom's chest and their little lips will move (hopefully) trying to find boob within their first hour. Baby's already have the scent of amniotic fluid and your breastmilk will have the same scent, it also helps if the room is quiet and lights are dim to keep baby comfortable and able to recognize mom and dad's voices. Hospitals don't allow baby to bond enough with mom.
• DON'T OVER STIMULATE baby by passing them around to everyone else in the room. This causes baby to be exhausted, go into a deep sleep and hard to wake which prevents breastfeeding from happening quickly. 
• BREASTFEED IMMEDIATELY; this not only prevents difficulties in the following weeks but allows the uterus to contract since this causes nipple stimulation to deliver the placenta; average time to deliver is 15-20 minutes. Hospitals gently tug on the cord right after baby is born; more important info on this is under the Mom portion. 
• VITAMIN K SHOT: Necessary if your baby is born with bruising, broken clavical or you're having a boy and opting for a circumcision. This shot helps prevent blood clotting if there was complications during birth but baby will eventually produce their own vitamin K for future accidents. If you don't want this, you really have to speak up at a hospital and sign a waiver because this is standard.
• PROPHYLACTIC EYE OINTMENT: This ointment can prevent blindness caused by an STD...if mom doesn't have gonorrhea, why put eye goop on your baby's clean eyes? Again, this is standard care at hospitals and you'll have to speak up and sign a waiver. 

POSTPARTUM FOR MOM

• IF YOU TEAR and if it's small you don't need to have sutures (the vagina is insanely resilient and heals on its own very well) but if you choose to have them midwives will most definitely use lidocain if you want. Sutures are not a natural part of child birth so it's okay to use meds :) 
• IBUPROFEN, You can finally take this if you choose, this can't hurt baby via breastmilk. 
• SKIN-TO-SKIN, bond with baby. In a birthing center you're required by law to stay for at least two hours; most patients stay on average between 4-6 hours. 
• BEFORE YOU GO HOME the midwives must see you eat a meal, consume water/electrolytes, take a shower and empty your bladder. Peeing is apparently very difficult after childbirth and will all the water you're drinking to stay hydrated during labor your body will need to let go of toxins. If the bladder isn't empty the uterus can be displaced and not clamp down.
• STAY IN BED for two weeks if possible. The placenta is 1/6th the size of your baby. That's big. When the placenta detaches from your uterine wall, there's a large wound inside of you. This is why you deliver the placenta and not tug it out; mom and baby (and dad) are required (by midwives) to stay in bed for one week (preferably still skin-to-skin, baby needs dad's scent too) prior and on the second week mom is allowed to fetch your own cup of water. This is the strictest rule midwives tell us. Of course, in the first 24-48 hours you must see your Ped and Midwives but try to see both back to back. You may feel 100% but if you had a wound this size on the outside of your body no one would expect you to move but since it's on the inside no one realizes your body needs to heel. 
• BABY BLUES, this is normal for the first two weeks to have "postpartum expression" (it could just be excessive crying, I'm sure this will be me because I cry at everything) after this period it's considered PTSD.

This is a good blog post I found called "10 Decisions for Parents of Newborns"

COMPLICATIONS 

• Most transfers to hospitals are because the patient wants pain meds or they're exhausted from being labor too long (like being awake and in labor for 46 hours) so it's recommended by the midwife before serious complications can arise. To prevent exhaustion try to sleep during early labor, eat and remain hydrated (coconut water is best).  
• Baby passes Meconium (their first poo): a tiny bit is normal but if there's too much (pea soup consistency or particles) this means the baby is in distress. This can cause respiratory issues and you'll be transfer in case it turns into an emergency. 
• Midwives do not 'check' your vagina throughout labor like Drs do, after your water breaks this can introduce bacteria. 
• A real emergency is considered to be shoulder dystocia, clavicle breaking (which has never happened at Labor Love), a prolapsed cord (when the cord comes out before the baby and baby's head is pressing on their own cord causing a loss of oxygen. Very rare in and out of hospitals) 

POSTPARTUM PLANNING LIST
(a little cheat sheet from the midwives)

1. Plan to spend 7 days in bed with your baby, skin-to-skin
2. Prepare and freeze a lot of food in advance. Batches of nutritious muffins are easy to freeze and reheat for a quick breakfast or snack and perfect for individual portion size.
3. "Sleep when baby sleeps" or at least rest if you can't sleep.
4. Have a good book on hand about postpartum. Great options: After the Baby's Birth by Robin Lim, The Year After Childbirth by Sheila Kitzinger and The Pregnancy Handbook by Sylvia Brown
5. If you have other children: arrange for plenty of help caring for them, plan quiet projects that you can do in bed with your older child while baby sleeps and give them tasks so they feel like they're helping (i.e. ask them to hand you a diaper even if you can reach them). 
6. When people ask what they can do to help, give them specific tasks; go grocery shopping, pick up pictures, bring me dinner.
7. Resist the temptation to catch up with 'real life' quickly, ease into it, create an auto away message for your email.
8. Become comfortable asking for help
9. Create a portable nursing station in arms reach; be well stocked in diapers, wipes, nursing pads, pads for yourself, a trash bag, a book. 
10. If relatives want to come help after the baby is born, let them visit, not stay. Their job is to take care of you, not baby. You're still bonding with baby in this period. It is not their job to hold baby while you make dinner or do a load of laundry. 
11. Expect to be nursing all day long. It is okay and good for you both, 10-14 nursing in 24 hours if normal and acceptable. 
12. Encourage your partner to take as much time off as possible. He (and baby) can benefit from an extended period of cocooning with his newborn too!
13. Explore the idea that postpartum can be a time of expression rather than depression, let all your emotions flow. 
14. Within the first year of baby's life, there's no such thing as 'spoiling'. Baby doesn't know how to manipulate situations and their wants and needs are the same.