Emotional Changes | Nutritional Guidelines | Breast Care and Bottle Feeding
Breast Care and Breastfeeding | Reasons To Call Your Doctor Or Midwife | Exercise

Feelings

Along with the physical changes your body goes through following a delivery you may experience many emotional changes and feelings. The first day or two after delivery you may feel exhausted and overwhelmed. It is important to get plenty of rest. You may also feel blue at times. If you are unable to care for yourself or your baby because you feel depressed, talk to your nurse, doctor or midwife who may be able to offer advice and treatment.

Sexuality

Reestablishing sexual relations with your partner may take time. Most doctors and midwives recommend no intercourse for four to six weeks, until vaginal bleeding has stopped and your episiotomy or Cesarean incision has healed. In the early weeks at home, kissing, cuddling, hugging and massage can be wonderful alternatives to intercourse.

When you resume relations, your physical comfort may be improved with the use of water soluble lubricants, such as K-Y jelly™, and by varied positions.
Your feelings about having sex may change after giving birth. You may have either an increased desire for sex or you may feel unattractive and undesirable. You may also feel "too tired" or have a fear of being hurt. These reactions are all normal. Good communication, patience and understanding between you and your partner will help you overcome these concerns.

You also should discuss family planning with your partner and doctor or midwife. Remember, breastfeeding does not provide birth control and you can become pregnant even before you resume your menstrual period.

Coping

When you first go home, accept offers from friends and family to help with everyday activities such as meal preparation, shopping, cleaning and baby-sitting. Take naps during the day when you feel tired, especially when your baby is sleeping.

Each day, try to find the time to get out of the house, even if only for a short time. Seek the companionship of other new mothers. If you are breastfeeding, you will get support from other breastfeeding mothers at a La Leche League meeting.

Limit visitors and phone calls to specific hours that suit your schedule. This gives you and your baby more time to spend getting to know one another. Your close friends and family will understand your need for privacy and rest.

Following a pregnancy you need a well-balanced diet to help your body recover from delivery and prevent fatigue. And while you may be anxious to lose the extra weight that you gained during pregnancy, this is not the time to "crash" diet. Talk to your doctor or midwife about a diet if you have concerns about your weight when you have your postpartum check-up — which is usually four to six weeks after delivery. You also might want to join our MOTHERWELL™ Maternity Fitness Program to help you regain your pre-pregnancy shape.

The following tips will help you practice sensible and healthy eating habits:

• Plan all meals ahead of time.
• Select a variety of foods.
• Choose low-calorie, nutritious snacks.
• Choose lean meats, fish, or chicken.
• Choose fresh fruits and vegetables.
• Limit use of butter or margarine, as well as heavy cream.
• Broil foods rather than frying.
• Avoid "junk" food.
• Do not skip breakfast.
• Drink eight to ten glasses of water a day.

Nutrition Notes For Breastfeeding Mothers

• Get an extra 300 calories more per day to keep up your energy.
• Drink at least eight cups of fluids each day to help you make enough milk for your baby. Try drinking one to two cups of water, juice or milk with each feeding.
• Check with your doctor before taking any drugs or medicines.

Some common foods in your diet that occationally may bother your baby include:

• broccoli.
• cabbage.
• cauliflower.
• chocolate.
• onions.
• beans.
• orange juice.
• tomatoes.
• Dairy products, especially if there is a family history of cow's milk allergy.

You do not need to avoid these foods unless you are sure that they bother your baby. Enjoy all foods in moderation.

Food Safety Precautions

What you eat can make you sick if the food has bacteria contamination. One type of bacteria, listeria, is especially harmful to a pregnant woman. Listeria during pregnancy can result in miscarriage, premature delivery and stillbirth. Reduce your risk of infection by following these food safety precautions:

• Avoid soft cheeses such as feta, Brie, Camembert, blue-veined cheeses and any unpasteurized milk or milk products.
• Reheat all leftovers until steaming hot, especially hotdogs, luncheon meats or deli meats. Throw away any left overs that have been unrefrigerated for two hours.
• Do not eat refrigerated pate' or meat spreads unless they come from a can.
• Cook all perishable items in refrigerator as soon as possible. When in doubt throw it out!.

If you have eaten a contaminated product and develop flu-like symptoms within the next two months, call your doctor. Symptoms of listeriosis may include chills and fever, muscle aches, diarrhea and nausea.

You can expect to have some degree of breast fullness, called engorgement, to develop from the second to fifth day after your delivery. This is because your body's natural response after delivery is to produce breastmilk. Until your body discontinues the production of this milk, you may choose the following comfort measures:

• Wear a supportive bra day and night for the next week.
• Avoid letting water run on your breasts for a long time in the shower.
• Apply cool compresses to your breasts for 15 - 20 minutes every three to four hours. (never apply ice directly to the skin).
• Take Tylenol™ every three to four hours for discomfort.

It is not unusual to have a slightly elevated temperature at this time, but notify your doctor or midwife if you:

• Develop a fever over 101 degrees F or feel the discomfort is getting worse.
• Have a sore, hot, reddened area on your breast.
• Have continuous breast pain with flu-like symptoms. .

Continue to drink fluids and eat a well-balanced diet.

Engorgement

Engorgement is swelling of the breasts and filling of the milk ducts that may occur between the second to fifth day after delivery. Prevent engorgement by nursing frequently in the first days. Apply cool compresses to your breasts for 5-10 minutes following nursing to soothe pain and relieve swelling. Full breasts may be too firm for baby to latch. Express milk by doing the following:

• Use moist heat to get milk to flow: shower, tub bath, soak breasts in a basin or use compresses.
• Circular massage beginning at chest wall, working toward nipple.
• Lean forward and shake shoulders to encourage let-down.
• Squeeze out a few drops of milk or use breast pump.
• Nursing relieves the fullness. Continue breastfeeding through engorgment.
• If you use a breast pump to express milk only remove enough milk to make yourself feel comfortable.

Nipples Need Extra Care during nursing

Wash hands before feeding your baby.
Wash breasts with clear water only, Soap may be drying.
Allow breastmilk to dry on nipples after nursing.

Preventing Sore Nipples

Change nursing pads after each feeding and when they become wet.
Avoid bra pads with plastic liners because they hold in moisture and cause chapping.
Change baby's position for nursing occasionally.
Make certain the baby latches-on to nipple and at least one-half inch of breast tissue.
If baby is not latched-on well, remove baby from breast and stimulate the baby's rooting reflex by tickling your baby's top lip until he opens his mouth wide, then quickly pull him onto your breast until baby latches-on.
Hold baby in close so tip of nose is touching your breast.

Treatment Of Sore Nipples

Use expressed milk to heal sore nipples. Express a small amount of milk after you finish nursing and gently rub it onto to the nipple allowing it to air dry.

Apply purified lanolin (if not allergic to wool) to nipples after feeding to keep the nipples moist.
Begin nursing on the more comfortable side first.
Breast shells worn inside the bra can help with comfort if clothing causes too much pressure.
Use warm salt water soaks (8 oz of warm water and 1/4 teaspoon of salt) for 10-15 minutes between feedings. Comfort gel pads can be soothing. They are available at Susquehanna Health Pharmacy.

• Temperature fo 101 degrees F or higher.
• Too much vaginal bleeding (soaking a pad in less than one hour).
• Burning or urgency with urination.
• Vaginal discharge with a bad odor.
• Breast pain with redness, fever and/or chills and overall achiness.
• Shortness of breath, sharp abdominal pain or pain in your leg.
• Redness, increased pain or separation of your cesarean incision or episiotomy.
• Depression, feeling very sad and hopeless, crying without being able to stop, loss of appetite, inability to sleep or inability to care for yourself or your baby.

If you have a medical emergency go to your nearest emergency department.

After delivery, your doctor or midwife will advise you on when to begin a gradual exercise program. The following exercises are designed to slowly increase your activity. Do not do too much physical exercise too quickly because rest is a very important part of recovery. Within four to six weeks, you may choose to join a regular exercise class such as the MotherwellT Maternity Fitness Program held at The Birthplace. Check with your doctor or midwife before beginning an exercise program.

Exercises

The exercises listed here are a starting point to help you recover your strength. You may usually begin foot exercises and pelvic tilting immediately.

Foot Exercises

These two exercises will help to increase blood flow in your legs as well as reduce muscle cramps.

Starting Position: You may either sit or lie down. In either position, your legs may be relaxed over a pillow, or your feet can be elevated.

Action: Foot-bending and foot-stretching: Bend your ankle as far as you can, pulling your toes up towards you, thus stretching your calf muscles; then push the ball of your foot downward. Repeat this several times.

Ankle Rotating: Make large, slow circles with each foot, first in a clock-wise, then in a counterclockwise direction. Repeat several times.

Pelvic Tilting

This exercise helps to improve posture, to prevent and relieve backache and to strengthen your abdominal muscles.

Position: Lie on your back with your knees bent.

Action: Rock your pelvis back flattening your lower back on the floor.
Hold this position for three seconds and then relax. Keep breathing normally throughout. Repeat five times initially, then gradually increase the number of repetitions.
Place one hand under the arch of your back to see if you have the tilt in correct position. You should be able to feel your back pressing down on your hand.

Progression: Raise your hips so that your knees and hips form a straight line. Gradually increase repetitions from five to twenty.

Checking For Separation Of Abdominal Muscles

The abdominal area around the navel is an especially weak area. Stretching and straining of the abdominal muscles is not uncommon during pregnancy. If there is a large separation in these muscles after delivery, it needs to be supported by doing abdominal exercises to encourage them to close.

Position: Lie on your back with your knees bent. Place the fingers of one hand directly below your navel.

Action: Lift your head until your neck is about eight inches from the bed. With your fingers, feel the width of the separation. If you can fit three or more fingers across this space, you will need to do the following exercises to close the separated abdominal muscles.

Exercises For Repairing Separated Abdominal Muscles

Position: Lie on your back with your knees bent. Cross your hands over your abdomen so that you can pull your muscles together as you lift your head.

Action: Take a deep breath. As you exhale, slowly lift your head and pull your abdominal muscles together with your hands. If possible, do five sets of ten head lifts each day. Within a week or two, the separation will close. You may then perform the curl-up exercises illustrated in this booklet that are a progression of this exercise.

Caution: You should avoid exercises that rotate or bend your trunk to one side, as well as those that twist your hips. These movements tend to pull other abdominal muscles, causing the separation to increase.

Abdominal Wall Tightening

Position: Lie on your back or side with your knees bent. Place your hands on the abdominal area below your ribs.

Action: Inhale through your nose, feeling the nostrils widen slightly.
(Breathing though the nose warms and filters the air.) Keep your ribs as still as you can, letting your abdominal wall expand upward. Then, lips slightly parted, blow the air out through your mouth slowly but forcibly, pulling in your abdominal muscles all the way until you feel that your completely emptied you lungs. Repeat five times initially, then gradually increase the number of repetitions.

Progression: Other positions that you can try include sitting and standing. Avoid taking too many deep breaths in succession — you may get dizzy.

Leg Sliding

Position: Lie on your back, knees bent, pelvis tilted backward, and spine flattened. Keep breathing normally throughout.

Action: Hold the position of corrected pelvic tilt and slowly slide your heels away from your body until your legs straighten. If your abdominals are unable to keep your back flat, draw your knees back up again, one at a time, to the point where your spine begins to arch. Work in this range until your abdominals maintain a flattened back with your legs outstretched. Repeat five times initially, then gradually increase the number of repetitions.

Straight Curl-Ups

Position: Lie on your back with knees bent.

Action: Bring your chin onto your chest. With arms extended, reach towards your knees while exhaling, bringing your neck up to about eight inches from the floor. Slowly return to the starting position. Repeat 10 times, gradually working up to 20 repetitions.

Progression: Arms can be folded across your chest, then clasped behind your head.

Diagonal Curl-Ups

Position: Lie on your back with knees bent.

Action: Bring your chin onto your chest. While you breathe out, reach your right arm towards your left knee. Slowly return to the starting position. Repeat this movement to your right knee. Continue alternating up to 10 repetitions, gradually increasing to 20 curl-ups.