Postnatal Care

Paracetamol, Ibuprofen and Diclofenac are safe for use during breastfeeding.  Pain relief medications that contain Codeine or Oxycodone are not routinely prescribed if you are breastfeeding.  If you are prescribed these medications and you are breastfeeding you need to tell the midwife or doctor if your baby is difficult to wake, does not feed well, does not gain weight, or appears limp or floppy.

Always be aware when handling your baby that Codeine or Oxycodone can affect your alertness and can make you drowsy which can slow down your movements and reaction times. Take care when standing up from a sitting or lying down position to avoid dizziness.

If you had an epidural during your labour and birth, you will need to stay in bed for at least four to six hours after the birth. This allows the effects of the drugs used in the epidural to wear off completely.  Do NOT try to get out of bed by yourself. Even if you think your legs feel normal you may become weak when you stand up. You will be given a call bell so please call us for assistance the first time you want to get out of bed.

After the birth of your baby you will lose blood from your vagina. This bleeding is normal and is called ‘lochia’.  The lochia can be heavy for a few days but will gradually settle down and usually stops within four to six weeks after the birth. The blood loss is caused by your womb contracting as it returns to the way it was before you were pregnant.

If the bleeding gets very heavy (for example, it soaks a sanitary pad in an hour or less) or if you notice any clots or a bad smell from your lochia please tell the midwife looking after you.  This could be the start of an infection or a sign of ‘retained tissue’, which could need treatment.

You will experience breast changes in the days after the birth of your baby whether you are breastfeeding or not. You may notice your breasts become swollen, hard and sometimes sore. However, this period is short because once you have established breastfeeding your body will regulate the milk supply.

If you are not breastfeeding you can help reduce the engorgement by wearing a well-fitting bra. It will also help if you avoid stimulating your breasts so don’t put hot water directly on them while in the shower or bath.  Breast engorgement will go after a few days if your baby does not stimulate them by sucking to produce milk.

Your perineum is the area between your vagina and back passage. If your baby was born vaginally, you may have stitches that become tighter as the wound begins to heal. This can make sitting down, walking and passing urine uncomfortable. Take regular pain relief. 

Wash the perineal area daily as this will help to keep the wound clean. Remember to dry yourself well after washing. There is no need to add any disinfectant or salt to the bath water as research has found bathing in plain water is much better for the healing process. It is also important to change your sanitary towels frequently. Do not use tampons or mooncups for postnatal bleeding, it is normally safe to use these when your normal periods are back.

Even if you did not need any stitches after the birth, you may still experience discomfort and heaviness in your vaginal area. This is normal as you are likely to be bruised and swollen around the vagina.  Plenty of rest, a warm bath or shower daily, a good high in protein diet and pelvic floor exercises will all help to heal the area. 

Emptying your bladder completely after giving birth is very important. You will be asked to measure how much urine you pass when you go to the toilet for the first couple of times after birth.  This is so that we know that you are emptying your bladder completely.  You should drink at least 1.5 to 2 litres of fluid a day, or 2 to 3 litres if you are breastfeeding.

Many women worry about opening their bowels for the first time after the birth. They are scared that their stitches might burst. This will not happen and in fact the sooner you start going to the toilet the better. It may help to place your hand, which is covered with toilet paper, under the vagina to provide some gentle support. If you put this off you may become constipated.  To prevent this happening, drink plenty of water and eat high fibre foods such as fruit and vegetables. Gentle exercise will also help.  The best position to sit on the toilet is pictured below.

• Use a foot stool or raise your heels so that your knees are higher than your hips
• Lean forward, with your feet apart and your elbows on your knees
• Breathe in and let your tummy gently swell out
• Breathe out as you push down towards your back passage
• Your tummy should stay braced out and don’t allow your tummy to suck back in again
• Repeat as necessary
• Allow yourself time, do not rush
• If you put this off you may become constipated.  To prevent this happening, drink plenty of water and eat high fibre foods such as fruit and vegetables. Gentle exercise will also help.  The best position to sit on the toilet is pictured below.

If your blood group is rhesus negative you may need an injection called Anti-D. We will give you this injection within 72 hours of your baby being born. 

During your pregnancy your blood will be tested to see if you are immune to rubella (German measles). If you are not immune to rubella, you should attend your GP for the rubella vaccine.  If you were identified as not having immunity to chickenpox in pregnancy, you should also discuss vaccination with your GP after pregnancy.

The midwife caring for you will carry out a daily postnatal check. They will want to know:

• how you are feeling;
• if you are in any pain;
• if you are experiencing any difficulties with the baby;
• how much you are bleeding vaginally (lochia); 
• that you are passing urine without too much discomfort.

The midwife may also check your breasts, your stomach and, if you have stitches, your perineum. She will ask you if you have pain especially in your legs and she may check your haemoglobin (iron) level by taking a blood sample.

During this daily check the midwife will give you information and advice about taking care of yourself. She will happily answer any questions you may have.

If your baby was born by caesarean section or if you had an instrumental (vacuum or forceps) delivery then a doctor will visit you on the postnatal ward.

They will be happy to answer any questions you have about the birth of your baby. 

Sometimes, the doctor may advise you to return to the hospital for your six-week check if they think they will need to review you are doing. Otherwise you should visit your GP around this time.

It is common to feel a little low a few days after your baby is born. The ‘baby blues’ describe weepy moments you may have during this time. Feeling overcome, emotional and crying for no apparent reason is a very normal response to the massive change that has happened in your life.  You can feel overjoyed and frightened all at the one time. The tears may start for no reason.  Don’t be frightened by this, just go with it and have a good cry.  As long as every day is not a tearful one you will be fine.

Having support on ‘baby blues’ days can be invaluable.  A partner, relative or friend who will cuddle the baby while you have a bath and a cry will seem like a great support to you.

You will be asked to fill out a simple questionnaire called the ‘Edinburgh score’ before leaving the hospital. It will ask you to consider your mood and feelings at the time around the birth of your baby. This is a simple tool we use to identify mothers who are emotionally distressed. When you leave hospital, we pass on the score you received on the questionnaire to your GP and public health nurse (PHN). If you do have negative feelings, talking about them and planning a recovery programme can help prevent postnatal depression.

Once your baby is born and providing you and your baby are both well, the baby can be placed directly on your chest for skin to skin contact. Your partner can hold your baby skin to skin if you are unable to do so at the time of birth. Skin to skin contact with you can be continued or commenced on the postnatal ward.

When you arrive on the postnatal ward after your caesarean section, you will have a drip in your arm, through which you will be getting intravenous fluids. You will have a catheter which will drain urine from your bladder for the first 24 hours and you will pass urine normally within six hours of the catheter being removed. There will be a wound dressing on your abdomen over the caesarean section scar. The drip will be continued until you are able to drink enough fluids to stay hydrated and we are sure that the bleeding is not excessive.

If you had a spinal or epidural you will feel numb from the waist down for up to six hours after surgery.  After that time, feeling and sensation will gradually come back into your legs. It is important that you do not try to get out of bed on your own during this time. If you had a general anaesthetic, you may feel groggy and sleepy for the first few hours. You may have a special pump attached to the drip through which you receive pain medication.  This is known as patient controlled analgesia and the midwife will show you how to regulate the pump yourself.

During the first few hours after surgery, the midwife will be checking your observations regularly, including your temperature, pulse, blood pressure, respiratory rate and oxygen saturations, the wound dressing for signs of bleeding and your vaginal blood loss. She will encourage you to move your body a little in the bed at least every two hours so that a pressure sore will not develop. You will continue to wear white surgical stockings while in hospital and you will be encouraged to bend and move your legs to help prevent a blood clot developing in your leg.

Once you are fully awake after surgery, you will be offered sips of water. Usually you can have tea/coffee and toast about four hours after surgery. If you are feeling ok after this we can stop the intravenous fluids.  The catering staff will offer you a daily menu choice. If you would like something other than what is on the menu please ask the catering officer. Fruit or nuts can be a good snack especially when you are breastfeeding.  Drink plenty of water to prevent dehydration and constipation.

The wound must be kept clean and dry to prevent an infection it will remain dressed with a bandage for five days. The midwife will check your wound every day.  You may have dissolvable stitches, or clips or beads, which will be removed after five days. Sometimes the doctor may ask that the wound is covered for longer with a “pico” dressing which is a negative pressure dressing, or that the stitches or clips stay in for a longer period this will be discussed on an individualised basis.  Wear underwear that come up above your wound, to avoid friction on the wound site. The physiotherapist will visit you after the operation and she will advise you on postnatal exercises.

Your baby will stay at your bedside on the postnatal ward, unless your baby needs admission to the neonatal unit.  If you are breastfeeding the midwife will help you and show you different positions to hold your baby so that they will not hurt your wound.  

You will know the evening before your discharge that you will most likely be going home the following day. Ask your partner, family member or friend to bring in your clothes and the baby’s clothes and car seat for going home. We will try to have you ready for home by 11 am. We will advise you where to go for your six week postnatal check up. Try to feed your baby just before going home as this will help to keep your baby settled while you are travelling and will give you some time to get settled in at home.

It is common to feel tired after the operation, so try to get as much rest as possible at home. Don’t be afraid to accept help from family or friends with caring for your baby.

You will spend the first few days looking at your baby.  You will notice every detail – the colour and texture of their hair, the shape of their hands and feet, and the different expressions on their face. The final colour of your baby’s eyes will not be clear until they are six months old or more. You may notice that your baby’s head appears pointed. This is because while your baby is being born their skull bones overlap. If you had a vacuum delivery, you may also notice a soft round cup mark on top of the baby’s head. Overlapping or a cup-mark are both normal. Don’t worry; by the end of a week your baby’s head will regain the normal round shape.

Your baby needs a clean environment, as they have not yet developed immunity to the many germs in our environment. Always wash your hands after changing your baby’s nappy. Discourage visitors from holding your baby unless their hands are clean. Babies do not like to be handled by lots of people so ask visitors to look but not to lift your baby. Please visit the HSE website for information on RSV and HSV

During your stay in hospital, your baby will stay in the cot by your bed. Keep your baby in the cot when changing nappies or dressing them. Do not put your baby on your bed at any time, as there is a risk of the baby falling off.

The doctor’s check

While you are in hospital, the midwives and doctors will check your baby’s health and wellbeing.  Like you, your baby will have a daily check with the midwife.  She will ask you about your baby’s feeding pattern and whether they are having wet and dirty nappies. The midwife will also check the colour of your baby’s skin for a yellow discolouration called jaundice.  She will discuss your baby’s sleeping pattern with you.

The midwife will examine the umbilical cord to make sure it is clean and dry. The midwife or care assistant will show you how to bath your baby, change the nappy, care for baby’s delicate skin and how to look after the umbilical cord.

We will give you advice and support about aspects of feeding while in hospital. If you are formula feeding the midwife will show you how to sterilise bottles and how to safely make up feeds.

Before you go home, either a doctor from the paediatric team or a midwife will carry out a thorough physical examination of your baby.  They will put a probe on your baby’s hand or foot to check their oxygen levels. They will check your baby’s hips by gently bending the legs upwards and then rotating the hips outwards; this test will detect a dislocated or ‘clicky hip’. Clicky hips are a common problem that can be corrected easily while the baby is young and therefore prevent long-term damage.

The umbilical cord stump and clamp usually stay in place for about eight to 10 days after birth.  Keep the cord area clean and dry – no special cleaning is recommended.  After seven to 10 days the stump will simply fall off, leaving the ‘tummy button’ in its place.

If you notice the stump is moist, dirty with an unpleasant smell or if the area around it is red you should tell the midwife, as it could be a sign of infection.

Jaundice is very common, occurring in as many as 60% of all newborns and is called ‘physiological jaundice’. The baby’s skin and whites of their eyes take on a yellow tinge due to excess levels of bilirubin. This type of jaundice is visible within the first few days of life and usually disappears within 10 days without any treatment. A baby with jaundice may be sleepier and we will encourage you to make sure that your baby is waking up regularly for their feeds.

If the jaundice levels are rising and the midwife is concerned, she may use a skin probe (bilimeter) on the baby’s forehead and chest to test the skin level of jaundice. If the level is high, a paediatric doctor will review the baby.

The doctor may take a small blood sample from your baby to be tested in the laboratory. If your baby needs treatment for jaundice, we will use phototherapy. Phototherapy (light treatment) is the process of using light to eliminate bilirubin from the blood, which can then be excreted through the urine. We will also encourage you to feed your baby regularly as increasing the amount of fluid will help to resolve the problem.

Breast milk jaundice is another common form, usually occurring four to seven days after birth and can last for three to six weeks. This is not harmful to your baby.

Signs of significant jaundice include when:

• baby’s skin takes on a yellow colour beginning on the face and then moving down to the chest and body;
• baby is tired and sleeps most of the time;
• baby is slow to feed and does not feed well;
• baby’s nappies are dry; and
• baby appears to have a fever and appears sick or off-form.

If these signs are present it is important that you get medical advice and treatment immediately.

Sometimes jaundice can be a sign of a serious problem, for example, if jaundice appears within 24 hours of birth. It can also occur in a baby that is premature or it could be a sign of infection or when the baby’s body is unable to process and remove bilirubin.

This test is also known as the ‘heel-prick test’. It identifies babies who may have rare but serious inherited conditions, which are treatable if detected early in life. Early treatment can improve their health and prevent severe disability and even death. 

When your baby is due to have the heel prick test, you will be given information and asked to sign the newborn screening card to confirm that you have received information about the programme, that the information about your baby is correct and that you consent to the test being done.

Screening your baby for these conditions is strongly recommended. The test is done between 72 and 120 hours after your baby is born, so it may be done by a midwife or else by the public health nurse. The midwife will prick your baby’s heel using a special device to collect some drops of blood onto a special card, which is then sent away for testing. Occasionally a second blood sample from your baby’s heel will be required. If the test results show that your baby does not have any of the conditions, you will not be contacted.

All babies born in the Rotunda are offered newborn hearing screening before they are discharged. This will screen for congenital nerve deafness. The test takes place at the bedside for well babies and in the neonatal unit for babies admitted there for more than 48 hours. The test takes just a few minutes. A failed test in either or both ears does not necessarily mean your baby has a serious hearing loss, but may be due to the ear canals being full of fluid following birth. If your baby fails three tests they will be referred for a more advanced specialist hearing assessment.

If you are discharged home before the screening test an outpatient appointment will be arranged for your baby to have the test. For the small number of babies who have nerve deafness, early detection means they can be fitted with hearing aids as early as three months. This reduces the long-term speech and social interaction difficulties that come from not having hearing in the normal range. Without newborn hearing screening most of these babies would not be detected until close to three years of age. If your baby passes the test but there is a strong family history of nerve deafness or you have concerns regarding your baby’s ability to hear you will be offered specialist screening around nine months of age.

The skin on a newborn baby is delicate and needs to be treated with care. It is not recommended to bath babies for the first 24 hours after they are born. This allows the baby’s natural oils to soak into the skin. 

If your baby’s hair is bloodstained following the birth, you can use warm wet cotton wool to gently loosen and remove the blood. The midwife or care assistant will show you how to hold and support your baby as you wash them. You need to get everything together before you start. This is because the baby can get cold very quickly so it is very important to organise yourself before you take off your baby’s clothes.  A baby does not need a bath every day, two to three times a week is enough to keep baby fresh in the first few weeks. On the days that you do not bath your baby you can ‘top and tail’ by washing your baby’s face, the folds under the neck and arms and bottom.

Most newborn babies will cry with great gusto during their first few baths. This does not mean that your baby is distressed, it is just something new and very soon your baby will learn to love bath time.

• Collect clean bath towel, clothes, nappy, cotton wool or wipes and place them beside the bath.
• Close any windows near you to prevent a draught.
• Put the cold water into the bath first, then the warm water. Fill the bath just high enough to cover the baby’s tummy. Four inches (10 cms) is usually enough for a newborn.  Spread the hot water around the bath evenly with your hand. 
• Check the temperature of the water with your elbow – it should feel nice and warm but not too hot.
• Undress your baby and with both hands gently lower the baby into the bath.
• While washing the baby with one hand support their back and head with the other hand.
• Make sure you use both hands to lift your baby out of the bath. Lay the baby flat on the towel and cover and dry all the skin folds gently. 

Do’s and don’ts when bathing your baby:

• do choose a quiet time when you are not too tired;
• don’t be tempted to answer the phone;
• don’t ever leave your baby alone even for a second;
• don’t leave an older brother or sister to watch over your baby in a bath;
• don’t add any bath products to the water for the first month; and
• don’t bath your baby directly after a feed, as they could get sick.

How long you stay in hospital will depend on the type of delivery you had or if you or your baby had any complications following birth. We recommend that you stay in hospital for at least 24 hours unless you are going home under the care of the community midwifery team (DOMINO and ETH). If you are breastfeeding for the first time and are not living within the community midwives’ area, we recommend that you stay in hospital for 48 hours. While in hospital, try to get as much rest as possible.

The ETH service is provided by the community midwives who, if all is well, offer women and babies the opportunity to be discharged from hospital within the first 24 hours following birth.

A midwife from the team will then visit you at home for up to a week to provide care, advice and support. The ETH team operates in the local catchment area of the hospital – the north side of Dublin.

The midwives visit the postnatal wards every morning to arrange for suitable women and babies to go home. If you are not within the catchment area for the ETH service then your public health nurse (PHN) will visit you within two days of leaving hospital. You can also avail of postnatal support in any of our Postnatal Hubs.

Leaving hospital with your new baby is one of the most exciting and scary parts of the whole pregnancy, birth and baby journey. You will remember your first night at home with your baby forever.

If you are taking your baby home by car you must have an appropriate car seat. It is very dangerous and also illegal to travel without a properly fitted car seat.

You should buy your car seat well before your baby is due to be born. You should become very familiar with the seat and know how to fit it correctly and safely into a car. Babies up to 13 kgs (29 lbs) must be strapped into the seat, which must face the rear of the car – not the front. Never put a rear facing baby seat into the front passenger seat of the car where an airbag is fitted. If the airbag was ever activated, even in a small accident, the airbag could severely injure or even kill your baby. For further information on car safety, please check the website: www.rsa.ie