Narayana Health Care

THE MOMENT A CHILD IS BORN, A MOTHER IS BORN

 POSTNATAL DISCHARGE INSTRUCTIONS

BREASTFEEDING

Breast fullness and tenderness, or engorgement, is a normal process that usually begins approximately 48 hours after delivery.

Listed below are some comfort measures that you can take:

1. Feed your baby frequently using both breasts
2. If the breasts feel engorged, apply warm, moist towels to your breasts.
3. Be sure the baby takes the whole nipple and areolar areas into his/her mouth.
4. Be sure to break the suction of the baby’s mouth on your nipple with your little finger before pulling the baby off your breast.
5. Burp each time post feed
6. If you are using contact nipple shields, you must pump at least 6 times a day/ 15 minutes on each breast.
7. If any queries, seek follow-up with a lactation consultant and your pediatrician

Different positions recommended for breastfeeding are as follows

VAGINAL BLEEDING

0 – 4 Days	Bright Red Heavy like a period Small/medium clots
5 – 8 Days	Red / Pink Loss Bleeding Heavier when active Small Clots
9-14 Days	Pink / Brown Minimal Loss No Clots
3-4 Weeks	White / Cream Blood changes to discharge No clots

PERINEAL CARE

You may or may not have stitches from an episiotomy.

Listed below are steps you can take to prevent infection and to increase your comfort after a vaginal delivery.

1. Cleanse the perineal area from front to back each time you urinate or have a bowel movement.
2. Apply a clean pad for every change.
3. Apply the medication to your suture area as ordered by your doctor.
4. Enjoy a warm sitz bath several times a day
5. Avoid rubbing or applying on suture area

BOWEL AND BLADDER FUNCTION

1. You may urinate more than usual on the second and third days after birth.
2. Drink a lot of fluids at least 6-8 glasses of fluid/day
3. Diet to include fiber-rich foods
4. Take stool softeners, if prescribed by a doctor

POSTNATAL EXERCISES:

Postnatal exercises are one of the best ways to strengthen the pelvic floor and rejuvenate

Should be carried out with doctors order

Top 5 Postnatal Core Exercises

Key isometric core exercises, supported by research and can be implemented almost immediately after childbirth

	Abdominal Bracing – Lying flat on your back, brace your abdominals by contracting your entire stomach as hard as possible. Hold for 5-10 seconds and relax.
	Pelvic Tilts – Lying flat on your back, knees bent to 90 degrees, heels flat on the floor. Brace your abdominals (like above) and tilt your pelvis in a posterior direction by pressing your lower back into the floor. Hold for 5-10 seconds.
	Bird Dog – Begin on all fours. Brace your abdominals, and keep your back and pelvis still. Reach one arm out in front of you, and the opposite leg out directly behind you. Return to the start and repeat on the other side to complete one rep. Do 5-10 reps per side.
	RKC Plank – Start in a normal plank position with your hips elevated slightly more than normal. Brace your abdominals, clench your hands together and squeeze your glutes all hard as you can. Hold this for 5-10 seconds.
	Side Plank – Start laying on your side with your elbow under your shoulder. Your head, trunk, hips, knees and feet should be in a straight line. Brace your core and lift your hips off of the floor. Hold for 10-20 seconds, then switch.

NUTRITIONAL NEEDS

All mothers have increased nutritional needs after delivery, especially if they are breastfeeding.

1. Eat a well-balanced diet. No dieting or junk food.
2. Eat foods rich in fiber-rich, nutritious.
3. Continue to take vitamins and iron tablets as ordered.

OTHER NEEDS

1. Rest/sleep when the baby sleeps.
2. No heavy lifting for 4 weeks.
3. Cesarean Mothers: NO lifting for 6 weeks.
4. Pelvic rest- No sexual intercourse for 4-6 weeks is suggested or driving for 2 weeks.
5. Mothers can resume work in 4-6 weeks after follow-up.

ALARMING SIGNS O WATCH FOR

IN MOTHER

• Heavy bleeding soaks a pad in less than 5 minutes
• Severe abdominal pain or unexplained pain in the chest or legs, disorientation, visual disturbance
• Severe headache
• Breathing difficulty
• Fever, chills, or vomiting
• Inability to urinate easily or leaking
• Feeling depressed or extreme negative emotions

IN NEWBORN

• The cord doesn’t fall off in two weeks, drainage present or the naval and the surrounding area become swollen or red
• The child develops a fever or appears unwell. Feels hot or dry mouth
• Has a sharp, high cry for no reason or is unusually fussy
• Doesn’t eat in his/her usually way
• Unusual breathing (slower, faster, and noisier)
• Vomiting (not just spitting up) especially if it is green or projectile
• Refusal of food several times in a row
• Excessive crying or Listlessness
• Loose, runny stools if there is mucus, blood, or a foul odor
• Unusual rash

Dr. Rujul Jhaveri, Consultant – Obstetrics & Gynaecology, SRCC Children’s Hospital, Mumbai