AWHONN - Your Guide to Postpartum and Newborn Care Sample

your guide to Postpartum & Newborn Care

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EDUCATIONAL VIDEOS

BREATHING EXERCISES

STICKERBOOK

They say a picture is worth a thousand words. That’s why we added several educational videos to enhance your learning experience as you read this book. All video content is medically accurate and up to date with the latest medical standards.

Stress reduction and relaxation are very important throughout your pregnancy and childbirth journey. Use breathing exercises in our app to help reach calm and focus.

Embellish your special moments with Stickerbook. Whether announcing the gender of your baby or just capturing a sweet moment, our beautiful hand-drawn stickers are a great addition to your photos.

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FIND Look for the blue Scan + Play icons throughout this book.

SCAN Use the Baby360 Scan + Play app to scan the blue icons.

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Table of Contents

Part 2: Caring for Your Newborn Newborn Appearance . . . . . . . 19 Newborn Screenings. . . . . . . . 20 Dried Blood Spot Screen. . . . . . . 20 Hearing Screening. . . . . . . . . . .20 Pulse Oximetry Screening for HeartDefect.. . . . . . . . . . . . .20 Jaundice. . . . . . . . . . . . . . . .20 Circumcision.. . . . . . . . . . . . 21 BabyCare..............22 UmbilicalCord. . . . . . . . . . . . 22 Removing Mucus. . . . . . . . . . . 22 NailCare............... 22 DiaperRash..............22 Diapering. . . . . . . . . . . . . . . 23 DiaperChanges.. . . . . . . . . . . 23 BathingBaby.. . . . . . . . . . . . 24 BabyBehavior. . . . . . . . . . . .25 Fussing or Crying. . . . . . . . . . . 25 Overstimulation. . . . . . . . . . . .26 Colic. . . . . . . . . . . . . . . . . . 26 Swaddling. . . . . . . . . . . . . .27 SafeSleep..............28 PacifierandSIDS. . . . . . . . . . . 29 Rooming-In/Room Sharing . . . . . . 29 CarSeats..............30 Look Before You Lock. . . . . . . . . 31 Shaken Baby Syndrome. . . . . . . 32 Baby’sHealth. . . . . . . . . . . . 33 Taking Baby’s Temperature. . . . . . 33 Immunizations. . . . . . . . . . . . . 33 Late-Preterm Infant . . . . . . . . .34 Part 3: Breastfeeding Breastfeeding Benefits . . . . . . . . 35 Exclusive Breastfeeding. . . . . . . . 35 Do I Need to Supplement withFormula?.. . . . . . . . . . . . . 35 MakingMilk...............36 IfYouFeelSleepy. . . . . . . . . . . 36 Getting Ready to Breastfeed . . . . .36 Getting in Position. . . . . . . . . . . 37 Laid Back Position and Baby-LedLatch. . . . . . . . . . . . . 37 Latch-on. . . . . . . . . . . . . . . .37 Newborn Feeding Patterns. . . . . . . . .38 Cluster Feeding. . . . . . . . . . . . 39 How Often Will My Baby Eat?. . . . .39 Common Concerns. . . . . . . . . 40 Burping. . . . . . . . . . . . . . . . 40

SleepyBaby.. . . . . . . . . . . . .40 GrowthSpurts. . . . . . . . . . . . 40 Engorgement.. . . . . . . . . . . . 40 Ductal Narrowing. . . . . . . . . . . 40 Mastitis.................41 SoreNipples.. . . . . . . . . . . . .41 Alcohol. . . . . . . . . . . . . . . . .41 Smoking and Vaping. . . . . . . . . 41 Marijuana (Cannabis). . . . . . . . . 41 Medications and Drugs. . . . . . . . 41 Expressing Breast Milk. . . . . . . 42 Hand Expression. . . . . . . . . . . .42 BreastPumps.. . . . . . . . . . . . 43 Human Milk Storage Guidelines . . . 43 Baby's Daily Feeding Log. . . . . . . 44 GoingHome.. . . . . . . . . . . .45 Glossary. . . . . . . . . . . . . . .46 Baby’s Warning Signs . . . . . . . . 47 Post-Birth Warning Signs . . . . . 48 Videos in This Book UterusChanges.. . . . . . . . . . . . 5 Hemorrhoids. . . . . . . . . . . . . . .6 Post-Birth Warning Signs. . . . . . . . 7 Postpartum Perineal Care. . . . . . . . 9 Cesarean Birth Care. . . . . . . . . . . 10 RestandSleep.. . . . . . . . . . . . 10 Postpartum Emotional Changes. . . . 14 Edinburgh Postnatal DepressionTest. . . . . . . . . . . . . 15 Skin-to-Skin. . . . . . . . . . . . . . .18 Newborn Medical Procedures. . . . . 20 Jaundice.................20 Umbilical Cord Care. . . . . . . . . . . 22 Diapering101.. . . . . . . . . . . . . 23 Bathing Your Baby. . . . . . . . . . . 24 BabyBehavior.. . . . . . . . . . . . .25 Swaddling Your Baby. . . . . . . . . . 27 SafeSleep................28 Installing an Infant Car Seat . . . . . . 30 Shaken Baby Syndrome. . . . . . . . 32 Taking Your Baby's Temperature. . . .33 Milk Production. . . . . . . . . . . . .36 FeedingCues.. . . . . . . . . . . . .36 Breastfeeding Latch. . . . . . . . . . 37 Burping Your Baby. . . . . . . . . . . 40 Hand Expression. . . . . . . . . . . . 42 FeedingLog.............. 44

Part 1: Caring for Yourself Physical Changes. . . . . . . . . . . 5 Uterus. . . . . . . . . . . . . . . . . .5 Bladder. . . . . . . . . . . . . . . . .5 Bowels. . . . . . . . . . . . . . . . . 5 Hemorrhoids..............6 Perineum. . . . . . . . . . . . . . . .6 Vaginal Discharge . . . . . . . . . . . 6 Complications. . . . . . . . . . . . 7 Postpartum Hemorrhage. . . . . . . 7 BloodClot................7 Postpartum Preeclampsia . . . . . . . 7 ManagingPain. . . . . . . . . . . .8 Cesarean Birth Pain. . . . . . . . . . . . . . . . . . . 8 GasPains................8 PersonalCare.. . . . . . . . . . . .9 PerinealCare..............9 Cesarean Birth Incision Care . . . . . 10 Moving After Cesarean Birth. . . . . 10 RestandSleep.. . . . . . . . . . . .10 HairLoss................10 SkinChanges.. . . . . . . . . . . . 11 Baths and Showers. . . . . . . . . . 11 VaricoseVeins.. . . . . . . . . . . . .11 Menstrual Cycle. . . . . . . . . . . . 11 Sex. . . . . . . . . . . . . . . . . . . 11 Healthy Lifestyle. . . . . . . . . . . 12 WeightLoss.............. 12 Exercise. . . . . . . . . . . . . . . . 12 Food and Nutrition. . . . . . . . . . 13 Healthy Eating While Breastfeeding. . . . . . . . . . . . . 13 Emotional Changes. . . . . . . . . 14 BabyBlues...............14 Postpartum Depression andAnxiety..............14 Postpartum Obsessive- Compulsive Disorder (OCD). . . . . . 15 Postpartum Psychosis. . . . . . . . . 15 Family, Friends, and Pets . . . . . . 16 Siblings................ 16 Visitors. . . . . . . . . . . . . . . . .16 FamilyPets...............16 Spouses and Partners. . . . . . . . 17 Paternal Perinatal Depression (PPND).................17 Skin-to-Skin Contact . . . . . . . . 18 Sudden Unexpected Postnatal Collapse (SUPC). . . . . . . . . . . . 18

Your Guide to Postpartum and Newborn Care is for general reference purposes only and cannot be relied upon as a substitute for medical care. You and your baby should have regular checkups with your health care provider. You should also consult with your health care provider about any special questions or concerns.

Arlington, Texas | 800.476.2253 www.baby360.com | info@baby360.com

PART 1 CARING for yourself

The first 6 weeks after giving birth (the postpartum period) will be filled with changes and challenges. That’s why it’s important to know what to expect and how to care for yourself after you bring your baby home. Everyone’s birth experience is unique. It can take anywhere from 4-6 weeks before you feel like your new self. During this time, get as much rest as you can. Pay attention to how your body is adjusting to life after childbirth. Above all, make time for plenty of personal care and attention. Self-care will help you feel more comfortable, healthy, and confident as you adapt to life with your new baby. NOTE: All words shown in purple text are defined in the glossary on page 46.

4 Your Guide to Postpartum and Newborn Care

Physical Changes

BOWELS Your first bowel movement after the birth may not happen for 2-3 days. Many things can make bowel function sluggish during

UTERUS It will take a few weeks for your

this time. Hormones , medications, dehydration, fear of pain, and decreased physical activity can all slow things down. And when the time comes, it could be a little uncomfortable and you may feel anxious or fearful.

uterus to return to its pre-pregnancy size and weight. Over the course of your pregnancy, your uterus grows to about 11 times its usual weight. So naturally, it will take time for it to return to its regular size. Your health care provider will check your uterus regularly to make sure it’s becoming smaller. SCAN + PLAY “Afterbirth” pains are belly cramps you feel as your uterus shrinks back to its pre-pregnancy size. And they’re completely normal. They may be stronger during breastfeeding, if you had twins, or if this baby isn’t your first. Keeping your bladder empty will help with the pains. The cramps usually go away on their own by the end of the first week postpartum. If they become too uncomfortable, talk to your health care provider about taking pain relief medications.

When it’s time • Try to relax

• Take some deep breaths • Put your feet on a stool • Rest your elbows on your knees

An option may be to use a clean sanitary pad for support, holding it from the front as you support the perineum .

WHAT CAN HELP

Go when you feel the urge

Uterus

Drink 6-8 glasses of water a day

Cervix

Eat fiber-rich foods

Vagina

Pre-Pregnancy

Postpartum

Walk or do yoga stretches

BLADDER For the first few days after giving birth, try to empty your bladder every 3-4 hours. This is important because when your bladder is full, it

Take stool softeners

can push on your uterus. This pressure may prevent your uterus from shrinking. Plus, it can make you bleed more. Because your body is getting rid of the extra fluid it took on during pregnancy, it’s normal to pass large amounts of urine during your first few days. If you had a cesarean birth , you may have a catheter in your bladder that will be removed as soon as possible to decrease the risk of a bladder infection.

WARNING

Call your health care provider if you: • Have a frequent or urgent need to urinate • Have severe pain or rectal bleeding • Feel you need to take a laxative

5 Your Guide to Postpartum and Newborn Care

Safe Sleep

The CDC estimates that nearly 3,500 U.S. infants die suddenly and unexpectedly every year while they are sleeping. These sleep-related deaths include fatalities from sudden infant death syndrome (SIDS) as well as accidental suffocation, and strangulation. SIDS is the leading cause of SUID for infants under 1 year old, especially from birth to 4 months. Updated Consumer Product Safety Commission (CPSC) regulations went into effect in 2022. Products intended for infant sleep—including inclined sleepers, travel and compact bassinets, and in-bed sleepers—must now have an incline of 10 degrees or less. This change is based on conclusive evidence that flat, rigid surfaces provide a safe sleep environment for babies under 5 months old.

SCAN + PLAY

Do not place your baby in any product that does not meet this new federal safety standard. If you don’t have access to a safety-approved sleep space for your baby, you can temporarily use a box, basket, dresser drawer, or similar flat object for sleep. Line the flat space with thin, firm padding and only use it until you can move your baby into a CPSC-approved bed or other sleep product.

ALONE Your baby should sleep alone, not with other people, pillows, blankets, or stuffed animals.

BACK Your baby should always be placed on their back, not their side or stomach.

In Their CRIB Your baby should sleep in a crib, not on an adult bed, sofa, cushion, or other soft surface.

TIPS

Tips for safe sleep • Always place your baby on their back to sleep and nap. • Use a firm and flat (not inclined) sleep surface, like a mattress in a safety-approved crib, play yard, or other flat surface covered by a fitted sheet. • When your baby falls asleep in their car seat, stroller, swing, infant carrier or sling, move them to a firm, flat sleep surface as soon as possible. • Keep all soft objects (pillows, blankets, toys, bumper pads, etc.) out of the crib. • Dress your baby in a well-fitting, one-piece sleeper. • Keep your baby’s head and face uncovered during sleep. • Keep your baby warm with a wearable (not loose) blanket. • Keep the room temperature comfortable and dress your baby in one more layer than you would wear.

WHAT NOT TO DO

• Don’t smoke or allow others to smoke around your baby. • Don’t drink alcohol or use drugs around your baby. • Don’t use commercial devices or cardiorespiratory (CR) monitors unless ordered by your baby’s doctor. • Don’t use items with loose ties on or around a sleeping baby, including bibs, pacifiers, cords, and other attachments.

• Don’t use products claiming to reduce risk or prevent SIDS, including wedges, positioners, or other products designed to keep infants in a specific position. • Don’t place electrical cords, window blind cords, or baby monitor cords close to the crib.

Your Guide to Postpartum and Newborn Care

PACIFIER AND SIDS Your baby is born with the instinct to suck. Although giving them a pacifier can help satisfy this desire and sometimes calm your baby down, many experts recommend that you don’t use a pacifier until after breastfeeding is going well, usually around 3 to 4 weeks of life. Here’s why:

• When your baby sucks on your breasts, it stimulates breasts to keep making milk • Giving your baby a pacifier too soon may inadvertently decrease your milk supply • Using a pacifier may make it harder for you to recognize your baby’s feeding cues

Giving your baby a pacifier at bedtime and naptime can help lower the risk of SIDS. If your baby doesn’t like the pacifier, don’t force them to take it. If the pacifier falls out of their mouth, don’t put it back in. Never attach a pacifier to the baby’s clothing, hang it around their neck, or put any substance on it. Pacifiers should be cleaned and checked often, and replaced regularly.

ROOMING-IN/ROOM SHARING Rooming-in (sharing a room but not a bed with your baby) is good for their overall health and development. Unless there is a medical issue that requires you to be separated, most hospitals allow parents to room-in during your stay. If you had a cesarean birth, are taking narcotic pain medication, or don’t have a companion in the room with you, the nursing staff will be there to help.

The benefits of room sharing • Can lower the risk of SIDS • Helps you learn your baby’s feeding cues and feed them often • You make more milk when you breastfeed more often • You are close enough to soothe your baby when they cry • You get more rest by sleeping when the baby sleeps • Helps you learn to be more confident caring for your baby

Safe Hospital Rooming-in Guidelines: • Pull the emergency cord or push the call button any time you need help • Never leave your baby alone or unattended for any reason • Keep the crib close to your bed and far from the doorway • If you’re alone and need to use the restroom, move the crib to the restroom door and leave the door open • Never give your baby to someone you don’t know or who can’t show you their hospital identification badge • Always follow the hospital’s security procedures to keep you and your baby safe

Room sharing is so valuable the AAP encourages parents to keep doing it at home. Because it also reduces the risk of SIDS, the AAP recommends room sharing until your baby is at least 6 months old.

Your Guide to Postpartum and Newborn Care

Newborn Feeding Patterns

DAY 1: FIRST 24 HOURS | BIRTHDAY NAP

Wet Diapers per day

Dirty Diapers per day

Babies are usually awake and alert for 1-2 hours after birth. Then, they often sleep for many hours. Watch for feeding cues and offer the chance to breastfeed at least 8 times today. Gently rub your baby’s legs, feet, and back if needed to keep them awake and feeding. Babies are resting from birth, so they eat less often in the first 24 hours. You’ll want lots of supervised skin-to-skin contact on baby’s first day!

At least 1

Black stool (meconium)

DAY 2: 24 TO 48 HOURS | LEARNING DAY

Wet Diapers per day

Dirty Diapers per day

Babies usually start to show more feeding cues and eat more often on day 2. Your baby may go through a “marathon” nursing phase. This means they may feed many times close together. This is completely normal. Keep your baby with you and allow your baby to feed as often as they desire. If your baby falls asleep, you may have a little break from nursing. If you put them down, they may wake up and nurse again. Not because they are hungry, but because sucking is comforting to them.

At least 2

Black or dark green stool

DAY 3: 48 TO 72 HOURS | ALL DAY BUFFET

Wet Diapers per day

Dirty Diapers per day

Babies usually want to “cluster feed” on day 3. You’ll want to keep your baby skin-to-skin to make breastfeeding easy. Watch for feeding cues and respond to them. Your baby may continue with the cluster feedings, then start to ease off as your milk supply increases.

At least 3

Brown, green, or yellow stool

DAY 4 AND 5: 72 TO 120 HOURS | NIGHT OWL

Wet Diapers per day

Dirty Diapers per day

Your milk supply will increase and your baby will be eating more at each feeding. You should hear swallowing and even gulping by this time. You may notice your baby becomes satisfied and drifts off to sleep after feeding. It’s normal if your baby sleeps more during the day and is awake more at night. Your baby will be eating at least 8 times in 24 hours and may even eat as often as 10-12 times in 24 hours. Your baby will start to gain weight. Your baby will also be having more wet and dirty diapers.

At least 4-5

Yellow, loose, and seedy stool

It is normal for babies to pass stool every time you feed them, or even more often.

Your Guide to Postpartum and Newborn Care

SAVE YOUR LIFE:

Get Care for These POST-BIRTH Warning Signs

Most women and postpartum people who give birth recover without problems. But anyone can have a complication for up to one year after birth. Learning to recognize these POST-BIRTH warning signs and knowing what to do can save your life.

q P ain in chest q O bstructed breathing or shortness of breath q S eizures q T houghts of hurting yourself or someone else

Call 911 if you have:

q B leeding, soaking through one pad/hour, or blood clots, the size of an egg or bigger q I ncision that is not healing q R ed or swollen leg, that is painful or warm to touch q T emperature of 100.4°F or higher or 96.8°F or lower q H eadache that does not get better, even after taking medicine, or bad headache with vision changes

Call your healthcare

provider if you have: (you only need one sign) (If you can’t reach your healthcare provider, call 911 or go to an emergency room)

Tell 911 or your healthcare provider:

“I gave birth on ________________ and I am having ____________________.” (Date) (Specific warning signs)

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These post-birth warning signs can become life-threatening if you don’t receive medical care right away because: • Pain in chest, obstructed breathing or shortness of breath (trouble catching your breath) may mean you have a blood clot in your lung or a heart problem • Seizures may mean you have a condition called eclampsia • Thoughts or feelings of wanting to hurt yourself or someone else may mean you have postpartum depression • Bleeding (heavy) , soaking more than one pad in an hour or passing an egg-sized clot or bigger may mean you have an obstetric hemorrhage

• Incision that is not healing, increased redness or any pus from episiotomy, vaginal tear, or C-section site may mean an infection • Redness, swelling, warmth, or pain in the calf area of your leg may mean you have a blood clot • Temperature of 100.4°F or higher or 96.8°F or lower , bad smelling vaginal blood or discharge may mean you have an infection. • Headache (very painful), vision changes, or pain in the upper right area of your belly may mean you have high blood pressure or post birth preeclampsia

This program is supported by funding from Merck through Merck for Mothers. Merck for Mothers is known as MSD for Mothers outside the United States and Canada. AWHONN thanks Kenvue for commercial support of the translations of this handout. ©2023 Association of Women’s Health, Obstetric, and Neonatal Nurses. All rights reserved. Unlimited print copies permitted for patient education only. For all other requests to reproduce, please contact permissions@awhonn.org.

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Your Guide to Postpartum and Newborn Care

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