After the first week

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After the first week

In the first week after birth we have visited your at your home and we have been the first contact point for occurring problems. The kraamzorg has helped you along the way in taking care of  your baby. The coming weeks are all about finding a balance in this new family situation. Pregnancy and birth are physically intens. Therefore, the body needs time and rest to recover. We have transferred the medical care back to your general practitioner and the consultatiebureau. If you have an birth related question, please call us.

We will be happy to provide you with some tips and advice in support of the coming weeks:

Huisarts (G.P.)

Your general practitioner will take care of your health from now on. If you have questions or concerns about the health of yourself or your child, please contact your GP. In case of fever in the first three months after birth (> 38.0 °), contact the general practitioner immediately. When it’s only a slight fever (37.6 ° -37.9 °), check the temperature again after one hour. If you can’t reach your GP, you can call us and we will refer you to the pediatrician.

Consultatiebureau

At the consultatiebureau, doctors and nurses who specialise in care for newborns to four year olds work together. They will ollow your child in his or her growth and development. Furthermore, they provide vaccinations, information and parental advice. At the consultatiebureau you can ask all your questions about the growth and development of your baby. In the second week after birth, you will receive a home visit from the nurse. She gives advice, weighs your baby and will answer your questions. She will also give you information about the health care system of the Netherlands concerning newborns and young children. Each consultatiebureau has weekly weighing-in hours where you can weigh your baby without appointment (for example, if nursing is not optimal). You can also weigh your baby at our midwife practice as we have a digital scale for you to use. 

Bloodloss

All women lose some blood during and after delivery. For a few days after you give birth, you’ll seem to have a very heavy period. Because the amount of blood in your body rises by about 50 percent during pregnancy, your body is well prepared for this normal blood loss. Lochia is vaginal discharge during the postpartum period. (The term comes from a Greek word that means “relating to childbirth.”) It consists of blood, tissue shed from the lining of the uterus, and bacteria. For the first few days after birth, lochia contains a fair amount of blood, so it’ll be bright red and look like a heavy period. It may come out intermittently in small gushes or flow more evenly. If you’ve been lying down for a while and blood has collected in your vagina, you may see some small clots when you get up.

You should have a little less discharge each day, lightening in color. By two to four days after you’ve given birth, the lochia will be more watery and pinkish. By about ten days after the birth, you should have only a small amount of white or yellow-white discharge. At this point, the lochia is mostly white blood cells and cells from the lining of the uterus.

The lochia will taper off before it stops in another two to four weeks, though a small number of women continue to have scant lochia or intermittent spotting for a few more weeks. If you still have blood loss 6 weeks after birth, let us know. You might need an ultrasound to check if the a small piece of placental tissues is still in the uterus.

Mastitis

Mastitis is painful inflammation of your breast tissue. It’s most common during the first month of breastfeeding, but you can develop it any time – including after you wean your child. The inflamed area may be red, swollen, unusually warm, painful, or hard to the touch. Symptoms can come on gradually or suddenly, and the condition usually affects only one breast at a time. Mastitis may or may not be caused by an infection. Signs of an infection include chills, a fever of 39+ degrees or higher, and fatigue. Mastitis makes some women feel very ill. You may feel like you’ve come down with the flu.

Mastitis can be caused by engorgement, plugged milk ducts, or milk that remains in the breast after a feeding (milk stasis). These conditions can also lead to an infection, as can cracked or damaged nipples because germs can enter the breast this way.

Tips:

  • Rest. Plan to stay home in bed and rest as much as possible.
  • Nurse your baby often. Breastfeeding can be painful when you have mastitis, but it’s crucial to treat the condition and keep up your milk supply Nurse as often and as long as your baby is willing. Aim for every two hours to keep the affected breast empty
  • Use a cold compress or cold pack on your breast between feedings to relieve pain and swelling. Never apply a cold pack directly to your skin because that can cause skin damage. Wrap it in a clean cloth or towel before use
  • Apply a warm compress on the affected breast for several minutes (or take a hot shower) just before each feeding. This can stimulate your letdown reflex and make nursing more tolerable
  • Gently massage your breast from the swollen area toward the nipple, and from the nipple toward the armpit.
  • Take pain medicine. Take paracetamol with a maximum of 4 times 2 tablets of 500mg each per 24hours.
  • Eliminate pressure on your breasts. Wear loose bras or go braless. Don’t sleep on your stomach or let your baby rest on your chest.

Does the fever go up despite taking paracetamol (<38,5°) or does the fever last longer than 24hrs, your breast is red and you feel ill? Call your GP, he will prescribe antibiotics to help fight the infection. This won’t affect the baby, he might get slight stomach cramps. Keep nursing the baby to optimise the milk flow. If you stop breastfeeding while having mastitis, this will make it worse.

Vitamin K & D

All baby will receive vitamin K directly after birth. This is the amount of vitamin K he needs for the first week and helps the blood to coagulate. Three months after birth baby’s can make enough vitamin K themselves. Until then it’s advised to supplement the baby daily by giving him vitamin K drops. You can buy it at a pharmacy or drugstore.

Vitamin D is also advised to supplement after the first week for strong bones and teeth. Babies from the first week after birth to four year of age should be given a daily supplement containing 10mcg of vitamin D. Babies fed infant formula (more than 500cc per day) should be given only half the normal dose of vitamin D supplement, because infant formula is fortified with vitamin D.

Contraception

Having another baby is probably the last thing on your mind as a new mum. But you could become fertile again before you know it. Your periods will return any time from about six weeks to three months after your baby’s birth if you are formula-feeding or combining breast and formula feeds. Your periods may not start again until you cut down breastfeeds or stop breastfeeding altogether. You could still be fertile before you realise it, though. So using contraception will give you peace of mind. You are fertile two weeks before you have your period. So even if you’re not ready to have intercourse just yet, you will need to start using contraception from three weeks to four weeks after your baby’s birth. During the lactating period, condoms, the “mini-pil” Cerazette and the IUD (intra uterine device) are possible as the normal birth control pill influences you milk supply. Do you wish to have an IUD? Make an appointment at Echo Amsterdam where certified midwife will fit it for you.

Exercise after birth

The most important exercises in the first few days after birth are your pelvic floor exercises. Start doing them as soon as you can. Strengthening your pelvic floor will help to protect you against having accidental urine leaks. Try to build your pelvic floor exercises into your daily life, continuing the exercises you did while you were pregnant. It’ll benefit you in the long term, and through any further pregnancies. If you struggled to remember your exercises during pregnancy, try not to worry, as it’s never too late to start.

Pelvic floor exercises will help your perineum and vagina to heal more quickly. That’s because the exercises improve circulation to the area, helping to reduce swelling and bruising. If you have stitches, exercising your pelvic floor won’t put any strain on them. In the first few days or weeks, it’s normal to feel as if nothing is happening when you do your pelvic floor exercises. Keep going, as the feeling in your pelvic floor will return and it will be working even if you can’t feel it. In the meantime, your perineum or pelvic floor may feel uncomfortable, swollen or very heavy.

Would you like to return to your sports you did before birth? Build up your exercises slowly and listen to your body. There are different postnatal classes you can join, please check the internet.

Six-week checkup

You are welcome to make a six-week postnatal check up at the practice. You may still be dealing with some pregnancy- or childbirth-related aches and pains, and you may have some questions about how your body has changed. You may also have questions about your labour and delivery and about postpartum issues like breastfeeding, birth control, exercise, sex, and work. At this consultation we will answer your questions and look back on your pregnancy and birth and any other issues you’d like to discuss.