The First 72 Hours Postpartum

When you’re expecting, it’s common to focus on labor as the “end result.” Giving birth is the goal you’ve been looking forward to for 40-odd weeks. First-time mothers wonder what it will feel like, how long it will take, what interventions—if any—will be necessary. On the other hand, veteran moms know what labor feels like, but with that knowledge comes excitement, expectation, perhaps a little dread. (After all, every birth is different.) Will a VBAC be possible? Will labor go as quickly as last time? How soon should I get the epidural?

It makes perfect sense. You have to climb the mountain before you can enjoy the view. The work comes first.

Just the Beginning

The moment after birth (and the hours and days after that) is the real deal—intense, profound, raw…and important! A baby on the outside presents a whole new set of challenges, joys and experiences. Pregnancy discomforts and labor pains seem minimal compared to the vibrant, vulnerable open wound that is your new parent heart, with worry like wildfire and a love so big you can barely stand it.

The transition from nonparent to parent is one of the most significant of all human experiences, creating a vast divide between life before and life after. A new mother is a new person. That alone is a lot to cope with.

Jack Maypole, MD, Boston-based pediatrician, director of the Comprehensive Care Program at Boston Medical Center, says, “I believe the first days of an infant’s life and the postpartum period are, in essence, a super-concentrated consolidation of what parenthood holds in store: exhilaration, sleep deprivation, exhaustion, love, awe, tenderness and cascades of ever-shifting emotions.”

Couple that with the physical and hormonal changes for both mom and baby, and there’s a lot to consider. The good news is: As we look at the big picture, it seems that nature is on our side. In a way, pregnancy and birth are merely training protecting the beauty and sacredness of exercises that prepare us for the big show that is parenting.

Armed with the knowledge of what those earliest hours of motherhood will be like, you’ll be ready to take on anything. (First bowel movements and hemorrhoids included, but grab the stool softener just to be safe.)

The Golden Hour

During the first hour of a baby’s life, many biological and neurological wirings and firings take place, guided by an intricate combination of instinct, hormones and common sense. The placenta is delivered, the newborn quiets to the sound of mom’s coo, and often, breastfeeding is initiated.

This inaugural hour, dubbed “the golden hour,” is a crucial time for the new family members. “No matter how the labor and birth went—whether it was straightforward, short, long, emotionally trying, complicated, joyful, done in water or on land—when the golden hour is respected, it can be a magical time,” says Janine Stiles, CPM, of Mandala Midwifery Care in Minneapolis. “As a home birth midwife, during the first hour, I take seriously the balance between safety for both the birthing parent and baby and this precious time.”

The golden hour is not reserved for home birth parents alone. Fortunately, today nearly every hospital and birth center supports the practice of “stopping time” to allow mother and child to properly meet in one full hour of near-uninterrupted skin-on-skin contact. Though medical attention to a mother or baby in distress would be a first priority, all other interventions and procedures can wait or be done with the infant in the mother’s arms by health care providers.

Benefits of the Golden Hour

• Bonding between mother and child.
• Hormonal release for mom, which aids in the delivery of the placenta, production of milk and establishment of joyful, loving feelings.
• Temperature regulation for the baby adapting to life outside the womb.
• Heart and respiratory system regulation as the baby mimics mom’s patterns.
• Better breastfeeding success.

Parents who are separated from their baby shortly after birth for medical reasons are encouraged to take their own golden hour as soon as they are able, even if it’s days after delivery. In fact, quiet, alert periods of skin-on-skin contact with either parent throughout the first month are beneficial for the same bonding reasons as that initial hour.

Many hospitals and ob/gyns are allowing for a golden hour of sorts after C-sections, too. “Gentle cesarean” is a real thing, and it’s getting better all the time. James Betoni, DO, a maternal-fetal medicine physician in Boise, Idaho, describes the gentle approach for non-emergent cesareans as including immediate skin-to-skin for baby and mom, using of a clear drape so mom can witness the birth, inviting dad to cut the cord, and allowing dad and baby to stay with mom in the recovery room as long as the baby is stable.

Pokes, Prods and Procedures

In a home birth or birth center, the parents are more likely to be asked whether they want each postbirth procedure. In the hospital, most are considered routine and might be performed without official parental consent. However, it is usually no problem to opt out or delay, should you decide to do so.

Possible Postnatal Newborn Procedures

• Antibiotic ointment in the eyes, to protect against transmission of any STDs from the mother and certain unwanted bacteria found in the vagina and rectum.
• Vitamin K injection, to address potential bleeding issues.
• Blood tests.
• Hearing test.
• Weighing and measuring of baby.
• The hepatitis B vaccination might be offered in the hospital, but not without consent and a liability waiver.
• Circumcision will not be performed without parental consent, but should be researched and discussed in advance.

As for the mother, she will deliver the placenta anywhere from 5-30 minutes after giving birth. Some new moms forget about this part because they’re busy gazing at their beautiful newborns, but that adorable distraction isn’t a bad thing. It can hurt a little as contractions propel the process, but thankfully it’s nowhere near as intense as pushing out an infant.

If any sutures are needed to repair an episiotomy or tears, they are administered within the first hour or two.

Involution, or shrinking and contracting of the uterus, will occur over the next few days and can at times be painful. Breathe through these mini contractions just as you did during labor.

Helpful Versus Disruptive

During the first 72 hours, every new parent has direct access to a team of experts, whether she birthed at home, in a birth center or in a hospital. Take advantage of this valuable resource while it’s at your fingertips, remembering to voice all sorts of questions in between eating and sleeping.

Even if you feel confident breastfeeding, ask the lactation consultant to show you different holds and the proper latch. Ask her about baby weight loss after birth, thrush and diet and how to know whether baby is getting enough. (Answer: If she is content, pooping and peeing, she’s getting her fill.)

After discharge, these professionals will continue to take your calls. Never again—barring an emergency—are health providers going to be so readily available to you.

“Do consider your child’s primary care provider or office as a resource. That is a big part of my job as a pediatrician— hearing parents’ concerns, helping them work through problems and reducing stress,” assures Maypole.

As for the scores of neighbors, relatives and friends who want to stop by, hold the baby and tell you what you’re doing wrong, kindly delay their visits and unsolicited advice. “No visitors—unless they are coming to help you,” advises Liz Pickett, CM, LM, MS in Kingston, New York. “You may feel like you have to entertain those who stop by because they are guests. This can get tiring very quickly! Limit visitors to helpful people who make you feel good and value your postpartum care and well-being.”

On that note, when people ask if there’s anything they can do, say “yes,” and give specific instructions and requests. They are asking because they truly want to be involved, and you need the support, whether it’s in the form of an extra hour of sleep, a warm meal in your belly, a new appreciation for clean sheets or just a less distracted mind. Ask for and accept real help, and protect your “birth bubble” by politely shooing away those who expect to be entertained in the days postpartum.

Input and Output

After things calm down a bit and both mom and baby are clean, dry and resting from the marathon that is birth, life will become a round-the-clock game of feeding, pooping and sleeping. That’s it. Simple enough, right?

For the first few days, your baby’s diapers will be streaked with a thick, tarry substance called meconium. This is the first bowel movement of a newborn infant. It will slowly move from almost black to light brown to seedy yellowish-green in breastfed infants, or brown and slightly more solid in formula-fed babies.

In terms of what’s in your diaper? (Sorry, but it’s true.) Mom will experience vaginal bleeding mixed with lochia, which is the vaginal discharge after giving birth, containing blood, mucus, and uterine tissue. Lochia discharge typically continues for four to six weeks postpartum after childbirth. (Note that it is advised new moms use pads only during postpartum recovery and avoid tampons. Your health care provider will give you the all-clear for these products at your six-week checkup, pending everything has healed well. To expedite the process, try taking a warm water sitz bath once a day and using witch hazel pads for extra relief.)

In terms of eating, colostrum is the breastfed baby’s first food, and although they will suck for a long time, babies only take small drops of this rich, oily starter milk. It is often called “liquid gold” because it provides baby’s first immunizations from mom’s anti-bodies, as well as gut-balancing bacteria.

During day one, baby will be sleepy, and you will likely have to wake her to feed regularly. Though you might be wired and anxious, try to rest on this day because day two brings more alertness in newborns and possible cluster feeding.

Cluster feeding is an infant’s way of stimulating milk production and refers to what will feel like a “feeding frenzy” to any nursing mother—nearly nonstop sucking for a few hours at a time. Try lanolin creams and ointments for sore, chapped or cracked nipples. Also get that good advice on latching from the lactation consultant to avoid these discomforts from the start.

Your little one should be at the breast as much as possible. This stimulates milk production, strengthens baby’s sucking reflex, and helps mom’s uterus contract and slowly return to prepregnancy size.

If you’re exclusively breastfeeding, avoid artificial nipples such as pacifiers, nipple shields and bottles for at least the first week. They may lead to difficulties if initiated too early.

If you’re not planning to breastfeed, ask your nurse, midwife or lactation counselor about comfort measures for breast engorgement. Even though you’ve made up your mind not to nurse, your body still needs to be clued in. Until it is, it will produce milk—quite a bit of it—somewhere between days three and five of baby’s life.

“Milk Day” is a hugely emotional day for the mother, whether she’s intending to breastfeed or not. Some hormones are off-the-charts high, some are crashing, engorgement is common as the body figures out the right supply, and sleep deprivation is beginning to take a toll. For this reason, day three or four is the perfect time for a first visit from your postpartum doula or best friend.

Home Alone

Where you choose to deliver affects some aspects of the postbirth experience: environment, of course, and time of discharge. Typically, a family will be discharged from a birth center 6-12 hours after a vaginal birth. A normal vaginal birth in a hospital ordinarily means a two-night stay before heading home, depending on what time of day the baby arrived. If a baby is born via C-section, the stay is generally three to five days.

Of course, a home birth requires no discharge, and the family is instantly tucked in to their own environment, with the midwives leaving about four hours after birth and visiting frequently throughout the first week.

Some parents refer to the first night home alone with baby as “that which we shall never speak of again.” Expect it to feel like a grenade went off in your life—for at least three months. You will forget to brush your teeth, forget to bathe and possibly even forget your name. You’ll be stunned by how much laundry a new baby creates. (You will be drowning in it.) Hours will seem eternal and days will fly by and bleed into one another. But through it all, you will shine as parents, and your baby will thrive.