Postnatal care at home

Caring for you and baby at home

Looking after yourself at Home

As a new mum, it is very important that you take good care of yourself. You should make sure to have someone staying with you for the first few nights. If your partner cannot be there perhaps a close relative or a good friend could stay with you.

Rest and sleep are so important for you and your baby. Try to keep visitors to a minimum until you feel ready to entertain. People who do visit should be encouraged to stay for just a short time. Very often your partner, family member or friend will take charge of organising visitors so they should be aware of your need to sleep.

Stock up your freezer in advance of baby’s arrival with cooked meals or have family members/friends lined up to provide you with meals for the first week or so. It is important to drink plenty of fluids so have plenty of drinking water easily available. When breastfeeding you may feel thirsty so keep a drink nearby and avoid very fizzy drinks or drinks with a high caffeine content.

Recovering from the birth

Birthing a baby changes your body, and it will take time for you to recover physically from the birth. Your recovery will depend on how your pregnancy and birth went. Recovery will be quicker for some women while others may take a little longer to feel back to themselves. In general, it will take six weeks to recover from the delivery and many more months for your body to get back to its pre-pregnancy state. You should plan to have at least two weeks dedicated at home to you and your baby.

Your bleeding should settle down to a period like bleed over the first three to five days. You may pass the odd small blood clot if you have been lying down for a long time or after you breastfeed.

You should seek medical help if

If your bleeding gets heavier and you are soaking pads or passing lots of clots
The bleeding suddenly gets heavier
You feel faint dizzy or have a pounding heart

The above could mean that you are having a very heavy bleed (postpartum haemorrhage). Please visit the HSE website for more information.

Please ring the emergency and assessment unit for advice – 1800 522 687.

If you are breastfeeding, it is possible that your period may not return for at least six months. If you are breast and bottle feeding your period usually returns within two months. Please visit the HSE website for more information.

At first, you may experience some stinging when passing urine, but this should ease over the first few days. If you suddenly notice increasing pain when passing urine or severe backache, you should look for medical advice to make sure you don’t have a urinary tract infection.

You may not have a bowel motion for a few days after the birth. This is normal and nothing to worry about. However, it is important not to become constipated so drink plenty of water and eat a varied diet with fruit and vegetables. If you become constipated it will increase the pain and discomfort around your stitches.

You may have pain or discomfort in your vaginal area, particularly if you had stitches. You should try to find the most comfortable position for you when sitting down. Very often it is bruising and swelling that causes the most discomfort. Regular bathing will help. Gentle pelvic floor exercises in the early days encourage the reduction of swelling and are great for easing pain.

Contact the emergency and assessment unit immediately by phoning 1800 522 687, if you have any of the following symptoms:

heavy vaginal bleeding, particularly if there are large clots
severe pain
smelly blood, fluid or pus coming from your vagina
red, swollen or painful wound
shortness of breath, chest pain or a cough
a swelling or pain in your lower leg
a temperature, fever or chills
feeling generally unwell

Cervical Screening

The cervical smear test is a screening test, which checks to see if the cells that make up the surface of the cervix are normal. It aims to identify any abnormality which can be simply and effectively treated and therefore prevent long-term problems. You should wait until 12 weeks after giving birth before having a smear test. Cervical screening is free in Ireland with ‘CervicalCheck’. You should register with your GP or Well Woman centre to avail of this service. For further information, check the website: www.cervicalcheck.ie

Sex after birth

When to restart your sex life is a very individual decision. Physically, most women will know when their bodies are ready for sex again. . It is safe to have sex when:

Vaginal bleeding has stopped
Any wounds or tears you have from birth have healed

Emotionally, it very much depends on how you and your partner are coping with this massive life-changing event. It is important to talk to your partner to make sure you both understand each other’s needs. It is possible to become pregnant again even if your periods have not returned. Talk to your Doctor or Midwife about contraception if you want to avoid getting pregnant again.

Method of Contraception

Contraception is an individual choice. Each person has to balance the risks and the benefits, bearing in mind their own culture, medical histories and lifestyles. These may change over time and therefore you may choose to use different methods at various stages in your life.

Most contraceptives have very high success rates if they are used carefully and consistently. Full instructions on using your chosen method should be provided by your GP or family planning clinic.

Further information on the various forms of contraception can be accessed from the HSE website “What you need to know about contraception”

Care of your baby following discharge from hospital

The role of the public health nurse (PHN)

Once you have been discharged from our hospital we will pass on your details to your local PHN. The PHN will contact you and arrange to visit you and your baby at home. This visit will normally take place within 48 hours of you leaving hospital.

The PHN will arrange to carry out weight and development checks on your baby until school going age. The PHN will give you lots of information about local support groups and services. If you are under the care of our community midwifery services then your first visit with the PHN will be after the community midwife has finished caring for you and your baby – usually around seven days after the birth.

The role of the GP

If you attended your GP for ‘combined care’ during your pregnancy, you should take your baby for a health check to your GP at two and at six weeks of age.

Babies who have left hospital

Your GP or PHN (public health nurse) or community midwives are available to deal with any medical or other concerns you might have about your baby. Please use these services. The community midwife or PHN will visit you at home shortly after your discharge and will advise you about any questions or problems you may have. They will also arrange to have the baby’s weight checked. In the first two weeks after discharge if you have any concerns about your baby, such as feeding issues or issues relating to passing stool etc please ring this number 01 8171728 between the hours of 08.00 – 15.30 to arrange an appointment in our Outpatients Dept in Hampson House if appropriate.

After these hours you can call this number 01 8171700 and the baby doctor will advise you where/when to get your baby seen.

Please do not present to Outpatients without an appointment.

If your baby becomes unwell or you have urgent concerns, please contact your GP promptly or attend your nearest emergency department. Please DO NOT bring your baby to the Emergency Room in the Rotunda as Babies are not seen in the EAU. If you live in Dublin this could include one of the following:

CHI Temple St

CHI Crumlin

CHI Tallaght

Postnatal depression

Postnatal depression is common. It can happen to any mother after having a baby, but it is more common if a woman has a previous history of depression. About one in eight women suffer from postnatal depression and many women have had some depressive symptoms during pregnancy.

The suffering caused by postnatal depression is profound and frequently underestimated. Sufferers are robbed of many of the joys that are so commonly written about and portrayed by the media. Women who have always been seen as competent and responsible, leading fulfilling lives, unexpectedly find their lives shaken by this condition that can creep in gradually or strike suddenly without warning.

The negative effects of postnatal depression are often made worse by a delay in diagnosis and treatment. Many women are reluctant to admit to feeling down, as they fear they may be judged ‘bad’ or unfit to care for their baby. Many do not know what is wrong with them or that help is available.

Being a new mother means you can’t do everything you did before the birth. You need to take time to recover from the pregnancy and the birth and adjust to being a mother. Take every chance you get to rest and build up reserves of energy. Your maternity leave is there for your benefit and to benefit the relationship between you and your baby. Involve your partner/family/friends and people you trust to help with the baby and housework.

Try also to:

Have regular meals; choose nutritious foods that require little cooking. Avoid high sugar snacks and meals, as they tend to increase irritability and reduce energy.
Get some physical exercise, as it is a great stress buster and will make you feel better.
Be open about your feelings and worries with someone that you trust. This will help them understand what you need. It is not your fault if you are having a hard time. Equally it is most likely not your partner’s/loved ones fault.
Make a plan to reduce stressors and take time to relax.

Signs of postnatal depression

The signs of postnatal depression are very varied and include:

feeling irritable, moody and angry;
feeling low and unhappy, not really enjoying the baby;
feeling sad and lonely even with people around;
crying for no reason;
feeling inadequate and unable to cope;
feeling out of control and as if you are losing your mind;
feeling anxious and panicky;
worrying about things you would normally take for granted;
not sleeping well, difficulty getting to sleep and waking early;
feeling exhausted and lacking in energy; and
having difficulty in getting motivated to do anything – some days hardly able to get dressed.

It can also be a sign of postnatal depression if you are over-involved with the baby and don’t allow anyone else to help. This can lead to exhaustion and make the condition worse. A small group of women feel they cannot do anything right for the baby and will ask their partner/family member or friend to care for the baby.

Some mothers with postnatal depression will be reluctant to leave the house to meet friends or take ‘time out’. They may use excuses like “what if the baby needed me” or “I’m too tired”.

Other signs of postnatal depression include:

being over-involved in keeping the house tidy or being too exhausted to do any housework;
having poor concentration – unable to focus on what people are saying, often forgetting things and finding it difficult to make decisions;
having a disturbed appetite – some mothers forget to eat and others comfort eat or a combination of both;
lacking sexual desire – some mothers think “what did I see in them” and another time will think that their partner will meet someone else and leave them;
feeling guilty about many things, for things said and things not said; and
thinking about running away or harming themselves – “the family would be better off without me”.

Treatment

It’s good to talk – Women who have postnatal depression respond well to treatment. Women who are diagnosed and treated early recover faster than those treated later. The key to prevention and early recovery is extra support and practical help. If you feel that all is not ‘right’ acknowledge this and talk to someone you trust – a friend, your midwife, your public health nurse or your GP. A bad day is normal, a bad week or two is not.

Please speak with your GP or PHN if you are worried that you may be suffering from postnatal depression. Your GP can also make a referral to the Specialist Perinatal Mental Health Service if needed.

Sometimes, postnatal depression needs a dual approach. First, talking helps mothers develop a sense of perspective about the situation and allows them to consider what steps they can take to regain a sense of control. Second, about 30% of mothers with postnatal depression will need drug treatments. These drugs are not addictive. The length of time that mothers need to be on medication varies from six months upwards. Anti-depressants take at least two weeks to begin to work. If you stop taking medication before six months there is a bigger risk of the depression coming back.

Support from family and friends is also crucial to recovering from postnatal depression and therefore should be part of your care plan. Ask for their help and support. Local parenting groups and support groups often help by offering support and understanding. With help all postnatal depression can be overcome. You will enjoy life with your new baby and family again.

Early days at home with your baby

The old saying “sleeps like a baby” certainly does not apply to newborns. Caring for your new baby is a 24-hour-a-day seven-days-a-week job. In this section we will look at caring for your baby at home. We will also explain how important it is that your baby has a safe environment and advise you what medical checks your baby should have over the first six weeks.

Going out with your baby

Women often ask how soon is it okay to take a new baby out? The answer actually depends on how you are feeling. While babies have immature immune systems they are actually born with inherited immunity from you. If you feel like going out for a short walk in the first few days after getting home, then the baby is good to go with you. Make sure the baby is well wrapped up for the weather, and protected from the sun, and both of you can enjoy your first venture outside. It is a good idea to have someone with you for support.

What a new-born baby can do

There is one important skill that babies don’t have to learn – they are born knowing how to suck. During the first few days they learn to coordinate their sucking and their breathing. Newborn babies also automatically turn towards a nipple or teat if it is brushed against one cheek, and they will open their mouths if their upper lip is stroked.

They can also grasp things (like your finger) with either hands or feet, and they will make stepping movements if they are held upright on a flat surface. All of these, except sucking will be lost within a few months, when your baby will begin to make controlled movements instead.

Newborn babies can use all their senses. They will look at people and things, especially if they are near, and particularly at people’s faces. They will enjoy gentle touch and the sound of a soothing voice, and they will react to bright light and noise. Very soon they will also know their mother’s special smell.

Baby development

Getting your baby to lie and play on their tummy keeps them active. Tummy time helps to strengthen their head, neck and back muscles and lets them experience feeling on the front of their body. For newborn babies, you can start by lying your baby on your chest while you are lying down or in a semi-reclined position. Hold them safely facing you and encourage them to lift their head to look at you. As your baby gets older, you can place them on a firm and flat surface with their hands out at either side to support themselves. You must stay close to your baby while they’re in this position. Always place your baby on their back if they fall asleep during tummy time, to reduce the risk of cot death.

When your baby goes to sleep, they will turn their head to look at the right or left because their muscles are not yet strong enough to hold their head in the middle. Make sure that your baby does not develop a preference to look at one side more than the other; ideally they should spend equal time looking at both sides.

Don’t leave your baby in a restricted position, for example in a swing or bouncer for long periods of time as it restricts their movement and they may miss out on valuable tummy time and time to play on the floor.

Sleeping

It can be difficult to encourage a pattern of sleep in the first few weeks. Newborn babies tend to sleep for two to three hours and then wake for a feed. Newborns like to sleep during the day and are often wide-awake at night. This is normal and the baby will eventually sleep more at night. You must be patient and learn to sleep when your baby sleeps.

Background talking, music or children playing generally do not cause any problems for the baby sleeping, but a sudden loud noise will. As each week progresses the baby will stay awake for longer periods and will settle into a routine of sleeping. By three months your baby will usually wake up for a time before they are due a feed and quite a few will sleep for most of the night.

Tips to help settle baby at night:

Bath and feed your baby, change their nappy if needed and dress them in a comfortable babygro.
Do not talk out loud while settling your baby as this can encourage the baby to stay awake.
Dim the light, as a bright light will keep the baby alert.
Make sure the room is not too hot and free from draughts.
Do not pick the baby up again once they are settled because this will confuse them.

It is recommended that your baby stays in the same room as you for the first six months, but they should sleep in their own cot.

Preventing Cot Death or Sudden Infant Death (SIDS)

Cot death is another name for Sudden Infant Death Syndrome (SIDS). It is the sudden and unexpected death of a seemingly healthy baby during sleep. No cause of death can be found, even after a post-mortem examination. However, cot death does not only happen in a cot. It may happen in a pram, bed, car seat, baby seat or anywhere a baby is sleeping. A seemingly healthy baby is put down to sleep and when next checked they are found dead.

Cot death is:

sudden and unpredictable
a recognised medical disorder
one of the main causes of death in babies aged between 1 month and 1 year of age most common between 2 and 4 months of age (although it can happen to older babies)
only diagnosed when all other causes of death are ruled out
not caused by immunisations
not caused by vomiting or choking
not suffocation

Because we do not know what causes cot death, we cannot completely prevent it. But research has shown that you can take steps to significantly reduce the risk of cot death.

How to reduce the risk of cot death

Always put your baby on their back to sleep in a face up, face clear (nothing blocking their face) position.
Place your baby’s feet at the foot of the cot.
Do not smoke in the same room as your baby.
Do not share a bed with your baby.
Keep your baby’s head and shoulders above the blankets.
Do not let your baby get too hot or too cold. To check how warm your baby is, feel their tummy, which should feel warm, but not hot.
Dress your baby for bed in a nappy, vest and babygro. In hot weather, your baby needs fewer clothes.
Use light layers of blankets in an ideal room temperature of 16° – 20°C.
Duvets are not recommended for babies under one year of age.
Do not put a pillow in your baby’s cot.
Take off the dribbling bib before you put your baby down to sleep.
Do not have a ‘soother’ (also called a ‘pacifier’ or ‘dummy’) attached to the babygro by a ribbon.
Use a cot mattress that is clean, firm, flat (not elevated or tilted) that fits the cot correctly.

Please refer to the Rotunda Patient Information leaflet for further information.

Baby carriers and sling safety

Baby carriers and slings can be useful for carrying your baby and freeing up your hands. Keeping your baby close to you can help with: bonding, recognising your baby’s cues for hunger and comfort, stimulating hormones for breastfeeding.

But baby carriers and slings may also be a risk to your baby, especially younger babies. They may be linked to suffocation and sudden infant death syndrome (SIDS). Always follow safety advice if you choose to use one.

Using a baby carrier or sling safely

Not all baby carriers and slings are suitable for all babies. Make sure it is safe for your baby’s weight, age and developmental stage. Practise putting baby carriers and slings on and off before using them with your baby. Check that the buckles and straps are secure.

How to position your baby

To use a baby carrier or sling safely, follow the TICKS guidelines. This is to prevent your baby from suffocating.

T – Tight enough to hug your baby close to you

Keep your baby high up and in an upright position with their head supported. Loose fabric may cause your baby to slump down. This could restrict their breathing.

I – In view at all times

Make sure your baby’s face is not covered with fabric or your body. You should always be able to see your baby’s face by glancing down.

C – Close enough to kiss

Your baby’s head should be close to your chin. By tipping your head forward, you should be able to kiss your baby on the head or forehead.

K – Keep your baby’s chin off their chest

Do this so they can breathe normally. Make sure there is always a space of at least a finger width under your baby’s chin.

S – Supported back

In an upright carrier, your baby should be held comfortably close to you. This means their back is supported in its natural position and their tummy and chest are against you.

Please visit the HSE website for more information.

Immunising your baby

Immunisation is a safe and very effective way to protect your baby against certain diseases. These diseases can cause serious illness or even death. Immunisation works by causing the baby’s immune system to produce antibodies to fight these diseases.

Your baby should have their first immunisations when they are around eight weeks old. It is very important that your baby receives the different vaccinations when they are due. Your GP or public health nurse will give you information on the schedule of vaccinations.

For further information on the childhood immunisation programme, visit the website: www.immunisation.ie

More Support

Postnatal Hubs

Frequently Asked Questions about newborn babies

How do I know if my baby is getting enough milk?

Some babies will take to feeding without any problems while others need a little bit of encouragement. Your midwife will guide you on feeding; for most babies we recommend that you feed them when they seem to want it -‘demand feeding’. Small or jaundiced babies may require more frequent feeds.

You will recognise when your baby has had enough because they:

are happy and active
sleep well between feeds and
have wet and dirty nappies.

It is common for babies to lose a small amount of weight in the first few days; however, your baby should return to their birth weight by the time they are two weeks old. The midwife will weigh your baby before you go home from hospital. The public health nurse will also check your baby’s weight when she visits you at home. If you have any concerns about your baby’s weight always ask for advice early from your midwife or doctor.

What do I need to know about vomiting?

Young babies frequently bring up some of their feed, which is called ‘posseting’, particularly if they are trying to bring up wind – this is normal. You only need to tell your midwife or doctor if:

the vomiting is forceful or repeated effortlessly and
occurs after every feed.

My baby has loose stools, why?

Your baby will pass a sticky green-black bowel motion for the first few days. This is called meconium; following this the stools turn yellowish. Formula fed babies commonly pass firmer stools than breastfed babies. However, if you find the baby is constantly passing very runny stools tell the midwife or doctor because a baby can become dehydrated quickly.

My baby has facial spots or a rash – what should I do?

Many babies have milk spots on their nose or face, which usually disappear in a few weeks without treatment. Newborns can develop spots on their bodies as they get used to the outside world. Generally these spots appear for a short time and then disappear. Please consult your midwife, public health nurse or GP if you are concerned about spots on your baby.

What should I do if my baby has trapped wind?

Trapped wind can give rise to tummy pains and the baby will cry and will not settle after the feed. There are simple techniques that usually work to deal with wind, like holding your baby up against your chest as well as gently massaging the baby’s back. Sometimes walking up and down stairs with your baby held against your or your partner’s chest can help to shift the baby’s trapped wind.

Why is my baby crying?

Crying is baby’s natural way of communicating. While you were pregnant your baby let you know they were happy with their movement and kicking; now the baby is more vocal and there are many reasons for crying.

As you get to know your baby you will begin to understand their different cries and what each one means. Reasons for crying can include that your baby:

is hungry or thirsty;
has a wet or dirty nappy and needs a change;
has trapped wind or colic;
is either too hot or too cold;
is sick or in pain; or
is lonely and wants a cuddle and some attention.

How to soothe a crying baby

Pick your baby up and hold them close to your body.
Talk or sing to your baby and gently massage their back.
Feed your baby.
Change their nappy.
Go for a short walk with your baby.

If your baby continues to cry, ask another member of the family to take over as sometimes the baby can sense if you are under stress. It is best to seek medical advice as soon as possible if:

you think the baby is in pain;
the type of crying is unusual;
the baby is pale
the baby has a purple or red rash on its body; or
the baby feels hot.

Remember never shake your baby as this can damage the baby’s body and brain

‘Sticky eyes’ – are they a problem?

‘Sticky eyes’ are usually due to a mild eye infection. You can usually solve the problem by gently cleaning the affected eye with a piece of cotton wool dipped in cooled boiled (sterile) water. Use each piece of cotton wool just once and wipe the eyes from the inside (near the nose) to the outside. Sometimes a baby will need an antibiotic depending on the infection.